Cases reported "Leprosy"

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1/53. Sporotrichoid presentations in leprosy.

    Two adult patients of leprosy, one woman and one man, presented with a clinical picture simulating sporotrichosis. The skin and regional nerve trunk was affected in one, and in the other the disease was confined to the nerve. Both had features of an upgrading reaction following anti-leprosy therapy; this was seen as erosion and scarring of the plaque, and acute onset of abscesses along the easily palpable and thickened nerve that ruptured through the skin. The diagnosis was supported by histopathology. In the light of other infections that give rise to a sporotrichoid pattern of infection it is concluded that leprosy should also be included in this category so that early diagnosis and use of corticosteroids can be implemented quickly to prevent nerve destruction.
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2/53. Neural leprosy--a case report.

    Neural leprosy is rare. This is a report of a 63-year-old Indian man who had long standing multiple peripheral neuropathy. The slit skin smear for acid-fast bacilli of mycobacterium leprae was positive. The skin and nerve biopsies were normal. He was treated with rifampicin, dapsone and clofazimine.
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3/53. leprosy: a close mimic in a rheumatology clinic.

    Cutaneous and neurological manifestations of leprosy are readily diagnosed. However, physicians sometimes fail to recognize that leprosy may present with a rheumatic symptoms. A plethora of rheumatic manifestations are associated with leprosy, particularly with lepra reactions. A diligent examination for skin lesions/nerve involvement may uncover the diagnosis of leprosy in a patient referred for a rheumatological disorder. To highlight the fact that leprosy can mimic several rheumatological disorders, we have discussed a few representative cases seen over the past two years at our rheumatology clinic in a teaching hospital. In all these cases, a diagnosis of leprosy was made when the patient was referred for a rheumatic complaint.
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4/53. PCR-restriction fragment length polymorphism analysis (PRA) of mycobacterium leprae from human lepromas and from a natural case of an armadillo of Corrientes, argentina.

    polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis (PRA) which relies on the amplification of a 439-bp portion of the hsp65 gene present in all mycobacteria, followed by two distinct digestions (with BstEII and HaeIII) of the PCR product, offers a rapid and easy alternative that allows identification of the species without the need for specialized equipment. Wild leprosy in the nine-banded armadillo (Dasypus novemcinctus) is characterized by the presence of multiple bacilli in internal organs such as lymph nodes, spleen and liver, as well as in nerves and skin. We could observe this in 9 out of 132 animals captured in Corrientes, argentina, an area endemic for leprosy in humans. mycobacterium leprae were recognized in those naturally infected animals through different techniques. Three samples of extracted dna of the mycobacteria present in the spleen, liver and popliteal lymph node of a naturally infected animal during the Experimental Program in Armadillo (PEA) and three samples of human lepromas were processed by PRA. The patterns of the six samples analyzed were identical and were characteristic of M. leprae. These studies, made for the first time in argentina, corroborate the initial discoveries in south america made by our investigative group on the detection of armadillos naturally infected with the Hansen bacillus.
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5/53. Ultrastructure of keloid: an unusual incident involving lepromatous leprosy.

    A patient with lepromatous leprosy developed keloids on the dorsum of both arms in response to ulcerations due to acute erythema nodosum leprosum reactions. Electron microscopic examination of the keloidal dermis showed a morphology indicative of increased production of normal collagen fibrils. The greatest cellular changes from normal were in fibroblasts which were enlarged due to increased amounts of rough endoplasmic reticulum and extensive Golgi complexes. Nuclear folds were also evident in these fibroblasts. Some cells, considered to be fibroblasts, were filled with cytoplasmic filaments and contained bizarre shaped nuclei. mast cells, blood vessels and nerve processes were also present.
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6/53. leprosy: otolaryngologist's perspective.

    A patient with hemi-facial erythematous swelling as a result of borderline leprosy and reversal reaction is reported. This uncommon presentation of the disease poses initial diagnostic difficulties to the otolaryngologist. The otolaryngologist must be familiar with otolaryngologic manifestations of leprosy, since early diagnosis and treatment reduces the risk of transmission of the disease and may avoid permanent nerve damage.
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7/53. Reversal reaction to Hansen's disease.

    A 25-year-old man with a history of mid-borderline (BB) Hansen's disease developing a reversal reaction after starting dapsone and rifampin therapy is presented. His clinical features included erythematous, edematous plaques and peripheral neuropathy. Reversal reactions are caused immunologically by enhanced cell-mediated (Th-1) immunity to mycobacterium leprae, resulting in inflammation of infected tissues, such as skin and nerves. Acute neuritis can lead to permanent nerve damage and necessitate prompt treatment with prednisone and/or clofazamine.
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8/53. The allocation of leprosy patients into paucibacillary and multibacillary groups for multidrug therapy, taking into account the number of body areas affected by skin, or skin and nerve lesions.

    In nepal, the setting up and maintaining of reliable services for slit-skin smears has proven difficult. A clinical classification system for leprosy has therefore been developed to assist in the allocation of patients to either paucibacillary or multibacillary groups for the purpose of multiple drug therapy (MDT), using 9 body areas: head (1), arms (2), legs (2), trunk (4). patients with more than two areas of the body affected are grouped as multibacillary (MB) and those with only one or two areas affected are paucibacillary (PB). Using a computer simulation model and the data of 53 patients registered at Green Pastures Hospital (GPH) in Pokhara and 703 field patients from the Western Region, different clinical classification systems were evaluated with regard to their sensitivity, specificity, and predictive value for MB or PB classification, as compared with the histological classification for the GPH cases and the bacteriological classification for the field patients. The sensitivity and specificity of the body area system in present use were 93% and 39%, respectively. The low specificity is due to MB overclassification. The sensitivity of the WHO classification system without skin smear facilities is 73% (the difference with the body area system is significant: p < 0.05, McNemar's test). Our histology findings confirm previous publications indicating that, while some borderline-tuberculoid (BT) patients may outwardly have a 'PB appearance' and be skin-smear negative, their nerve biopsy and sometimes skin biopsy may show a 'MB' picture. This is the first publication discussing a 'body area system' for the purpose described, including diagrams of the areas used. In nepal it has proved easy to use and teach and its use may be justified in other control programmes which implement MDT, particularly if slit-skin smear services are unreliable or nonexistent.
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9/53. tangier disease--a diagnostic challenge in countries endemic for leprosy.

    A case of tangier disease (TD) is reported from india. The patient had presented with indolent mononeuritis multiplex and trophic ulcers of 16 years duration mimicking Hansen's disease. He received antileprosy treatment for one and a half years. Nerve conduction studies revealed features of demyelinating neuropathy. Biopsies of the sural nerve and skin showed striking vacuolation of schwann cells and myelin sheaths, and foamy vacuolated fibroblasts, respectively, and no evidence of Hansen's disease. Low levels of apolipoprotein A1 (ApoA1) and cholesterol in the serum and undetectable levels of high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol in the blood confirmed the diagnosis of TD. This is the first reported case of TD from a tropical country-india. An attempt to establish a correct diagnosis should be made by demonstrating the histopathological and lipoprotein abnormality to avoid long term medications that are chosen empirically and are unnecessary. The importance of recognising this disease in a country where Hansen's disease is highly endemic cannot be overemphasised.
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10/53. ulnar nerve abscess and relapse in a patient with indeterminate leprosy 1 year after completion of multidrug therapy.

    The introduction of multidrug therapy has efficiently controlled leprosy in developing countries. However, Mycobacterium laprae may survive and cause relapse despite adequate treatment with antileprosy drugs. Relapse may be characterized by a combination of new signs or symptoms and presence of acid-fast bacilli on skin or nerve biopsy samples. We report a case of a child in whom ulnar abscess developed 12 months after successful completion of multidrug therapy with clinical and histopathological evidence of relapse.
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