1
|
Sharath S, Sinha S, Sardana K, Ahuja A. Sequential occurrence of upgrading and downgrading type 1 leprosy reactions: A case report. Trop Doct 2024; 54:185-188. [PMID: 38356319 DOI: 10.1177/00494755241229754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Savitha Sharath
- Senior Resident, Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Surabhi Sinha
- Assistant Professor, Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College, New Delhi, India
| | - Kabir Sardana
- Director Professor and Head of the Department, Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arvind Ahuja
- Director Professor and Head of the Department, Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| |
Collapse
|
2
|
Benlamkadam S, Errahmany A, Raymond K, Chraa M, Kissani N. Hansen's Disease: A Practical Update on a Neglected Globally Significant Infection. Cureus 2024; 16:e57374. [PMID: 38694670 PMCID: PMC11061821 DOI: 10.7759/cureus.57374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Leprosy is a great mimicker. It is caused by Mycobacterium leprae and Mycobacterium lepromatosis, together termed the M. leprae complex. Leprosy can result in systemic manifestations; however, the neurocutaneous syndrome is the most classic. There is a gap in recognizing the condition leading to misdiagnosis and delays in treatment. Leprosy remains an important cause of aesthetic and functional impairment. In this paper, we provide a practical review of leprosy touching on pathophysiology, clinical manifestation, classification, diagnostic approach and management of the condition in a way that can translate into clinical practice and help physicians better identify and manage potential cases of leprosy.
Collapse
Affiliation(s)
| | - Amina Errahmany
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Klevor Raymond
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Mohamed Chraa
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Najib Kissani
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| |
Collapse
|
3
|
Serrano-Coll H, Wan EL, Restrepo-Rivera L, Cardona-Castro N. Leprosy reactions: Unraveling immunological mechanisms underlying tissue damage in leprosy patients. Pathog Dis 2024; 82:ftae013. [PMID: 38806255 PMCID: PMC11180982 DOI: 10.1093/femspd/ftae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/21/2024] [Accepted: 05/27/2024] [Indexed: 05/30/2024] Open
Abstract
Leprosy is a chronic granulomatous infectious and disabling disease caused by two mycobacteria, Mycobacterium leprae and Mycobacterium lepromatosis. Acute inflammatory responses, known as leprosy reactions, are significant contributors to disabilities. Three types of leprosy reactions have been identified based on excessive cytokine release (e.g. type 1) or the accumulation of immune complexes in tissues inducing multiorgan damage (e.g. types 2 and 3). The type of leprosy reaction has implications on treatment and management strategies, yet are not well understood by health workers caring for leprosy patients. We attempt to describe the immunologic mechanisms behind the different leprosy reactions and the rationale for tailoring clinical treatment and management to the particular type of leprosy reaction based on the underlying immunologic situation.
Collapse
Affiliation(s)
- Héctor Serrano-Coll
- Instituto Colombiano de Medicina Tropical-Universidad CES, Medellín 055450, Colombia
| | - Eric L Wan
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington DC 200072, United States
| | - Lina Restrepo-Rivera
- Instituto Colombiano de Medicina Tropical-Universidad CES, Medellín 055450, Colombia
| | - Nora Cardona-Castro
- Instituto Colombiano de Medicina Tropical-Universidad CES, Medellín 055450, Colombia
| |
Collapse
|
4
|
Hsu CH, Yang CS, Yen CY. Type 1 lepra reaction induced by a COVID-19 vaccine. J Eur Acad Dermatol Venereol 2023; 37:e266-e268. [PMID: 36377290 DOI: 10.1111/jdv.18735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Chung-Hao Hsu
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chi-Shun Yang
- Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Yang Yen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
5
|
Pinheiro RO, Rosa PS, Spencer JS, Soares CT. Editorial: Leprosy reactions: New knowledge on pathophysiology, diagnosis, treatment and prevention. Front Med (Lausanne) 2022; 9:1072274. [DOI: 10.3389/fmed.2022.1072274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
|
6
|
Pitta IJR, Hacker MA, Vital RT, Andrade LR, Spitz CN, Sales AM, Antunes SLG, Sarno EN, Jardim MR. Leprosy Reactions and Neuropathic Pain in Pure Neural Leprosy in a Reference Center in Rio de Janeiro - Brazil. Front Med (Lausanne) 2022; 9:865485. [PMID: 35402428 PMCID: PMC8992651 DOI: 10.3389/fmed.2022.865485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Leprosy reactions are complications that can occur before, during, or after multidrug therapy (MDT) and are considered a major cause of nerve damage. Neuritis is an inflammatory process that causes nerve function impairment associated with pain and tenderness along the nerve. Neuritis can be found in both type 1 and type 2 reactions and may also be the sole manifestation of a leprosy reaction. The objective of this study is to describe the incidence of leprosy reactions and its association with neuropathic pain in pure neural leprosy (PNL) patients. Methods We selected 52 patients diagnosed with PNL and 67 patients with other clinical forms of leprosy. During the MDT the patients visited the clinic monthly to take their supervised dose. The patients were instructed to return immediately if any new neurological deficit or skin lesions occurred during or after the MDT. Results Of the PNL patients, 23.1% had a leprosy reaction during or after the MDT, while this was 59.7% for patients with the other clinical forms of leprosy. There was an association between having PNL and not having any reaction during and after the MDT, as well as having PNL and having neuritis after the MDT.There was also an association between having previous neuritis and having neuropathic pain in the other clinical forms of leprosy group, although this association was not present in the PNL group. Discussion Our data suggest that PNL is a different form of the disease, which is immunologically more stable. In addition, PNL patients have more neuritis than the classical leprosy skin reactions. In PNL there was no association between acute neuritis and neuropathic pain, suggesting that these patients may have had silent neuritis. Understanding and identifying neuritis is essential to reduce disability and the impact on public health.
Collapse
Affiliation(s)
- Izabela Jardim Rodrigues Pitta
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Neurology, Antonio Pedro University Hospital/ Fluminense Federal University, Niteroi, Brazil
| | | | - Robson Teixeira Vital
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Department of Neurology, Pedro Ernesto University Hospital/ Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ligia Rocha Andrade
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Clarissa Neves Spitz
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna Maria Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Marcia Rodrigues Jardim
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Neurology, Pedro Ernesto University Hospital/ Rio de Janeiro State University, Rio de Janeiro, Brazil
| |
Collapse
|
7
|
Kurizky PS, Motta JDOCD, Bezerra NVF, Sousa MCDS, Corazza D, Borges TKDS, Gomes CM. Dramatic secukinumab-mediated improvements in refractory leprosy-related neuritis via the modulation of T helper 1 (Th1) and T helper 17 (Th17) immune pathways. Rev Soc Bras Med Trop 2021; 54:e03362021. [PMID: 34932761 PMCID: PMC8687500 DOI: 10.1590/0037-8682-0336-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
A 39-year-old woman was diagnosed with relapsed multibacillary leprosy and refractory neuritis. Here, we describe an evident loss of therapeutic effectiveness after the third pulse of corticosteroids, which may be attributed to tachyphylaxis and the posterior modulation of interferon- γ (IFN-γ), tumor necrosis factor- α (TNF-α,) interleukin-17A (IL-17A), and IL-12/23p40 after the induction phase of secukinumab. In this case, plasma cytokine analysis showed that secukinumab induced a reduction in IL-17 concomitant with impressive clinical improvements in the patient's neural function. Interestingly, secukinumab induced reductions in cytokines related to Th1 responses and earlier stages of the Th17 response, including IL-23/12.
Collapse
Affiliation(s)
- Patrícia Shu Kurizky
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Brasília, DF, Brasil.,Universidade de Brasília, Faculdade de Medicina, Hospital Universitário de Brasília, Brasília, DF, Brasil
| | | | | | | | - Danilo Corazza
- Universidade de Brasília, Núcleo de Medicina Tropical, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil
| | - Taiana Karla Dos Santos Borges
- Universidade de Brasília, Núcleo de Medicina Tropical, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil
| | - Ciro Martins Gomes
- Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, Brasília, DF, Brasil.,Universidade de Brasília, Faculdade de Medicina, Hospital Universitário de Brasília, Brasília, DF, Brasil.,Universidade de Brasília, Núcleo de Medicina Tropical, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil
| |
Collapse
|
8
|
Autophagy-Associated IL-15 Production Is Involved in the Pathogenesis of Leprosy Type 1 Reaction. Cells 2021; 10:cells10092215. [PMID: 34571865 PMCID: PMC8468917 DOI: 10.3390/cells10092215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 01/18/2023] Open
Abstract
Leprosy reactional episodes are acute inflammatory events that may occur during the clinical course of the disease. Type 1 reaction (T1R) is associated with an increase in neural damage, and the understanding of the molecular pathways related to T1R onset is pivotal for the development of strategies that may effectively control the reaction. Interferon-gamma (IFN-γ) is a key cytokine associated with T1R onset and is also associated with autophagy induction. Here, we evaluated the modulation of the autophagy pathway in Mycobacterium leprae-stimulated cells in the presence or absence of IFN-γ. We observed that IFN-γ treatment promoted autophagy activation and increased the expression of genes related to the formation of phagosomes, autophagy regulation and function, or lysosomal pathways in M. leprae-stimulated cells. IFN-γ increased interleukin (IL)-15 secretion in M. leprae-stimulated THP-1 cells in a process associated with autophagy activation. We also observed higher IL15 gene expression in multibacillary (MB) patients who later developed T1R during clinical follow-up when compared to MB patients who did not develop the episode. By overlapping gene expression patterns, we observed 13 common elements shared between T1R skin lesion cells and THP-1 cells stimulated with both M. leprae and IFN-γ. Among these genes, the autophagy regulator Translocated Promoter Region, Nuclear Basket Protein (TPR) was significantly increased in T1R cells when compared with non-reactional MB cells. Overall, our results indicate that IFN-γ may induce a TPR-mediated autophagy transcriptional program in M. leprae-stimulated cells similar to that observed in skin cells during T1R by a pathway that involves IL-15 production, suggesting the involvement of this cytokine in the pathogenesis of T1R.
Collapse
|
9
|
Clinical prediction rules for the diagnosis of neuritis in leprosy. BMC Infect Dis 2021; 21:858. [PMID: 34425777 PMCID: PMC8381570 DOI: 10.1186/s12879-021-06545-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 08/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Diagnosing neuritis in leprosy patients with neuropathic pain or chronic neuropathy remains challenging since no specific laboratory or neurophysiological marker is available.
Methods In a cross-sectional study developed at a leprosy outpatient clinic in Rio de Janeiro, RJ, Brazil, 54 individuals complaining of neural pain (single or multiple sites) were classified into two groups (“neuropathic pain” or “neuritis”) by a neurological specialist in leprosy based on anamnesis together with clinical and electrophysiological examinations. A neurologist, blind to the pain diagnoses, interviewed and examined the participants using a standardized form that included clinical predictors, pain features, and neurological symptoms. The association between the clinical predictors and pain classifications was evaluated via the Pearson Chi-Square or Fisher’s exact test (p < 0.05). Results Six clinical algorithms were generated to evaluate sensitivity and specificity, with 95% confidence intervals, for clinical predictors statistically associated with neuritis. The most conclusive clinical algorithm was: pain onset at any time during the previous 90 days, or in association with the initiation of neurological symptoms during the prior 30-day period, necessarily associated with the worsening of pain upon movement and nerve palpation, with 94% of specificity and 35% of sensitivity. Conclusion This algorithm could help physicians confirm neuritis in leprosy patients with neural pain, particularly in primary health care units with no access to neurologists or electrophysiological tests.
Collapse
|
10
|
Chandan N, Ashack KA, Hill C. Ulcers and edema in a patient with leprosy. Int J Dermatol 2020; 59:1073-1075. [DOI: 10.1111/ijd.14845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Neha Chandan
- Department of Dermatology University of Illinois at Chicago Chicago IL USA
| | - Kurt A. Ashack
- Department of Dermatology University of Illinois at Chicago Chicago IL USA
| | - Carlotta Hill
- Department of Dermatology University of Illinois at Chicago Chicago IL USA
| |
Collapse
|
11
|
Is there an antagonistic pleiotropic effect of a LRRK2 mutation on leprosy and Parkinson's disease? Proc Natl Acad Sci U S A 2020; 117:10122-10123. [PMID: 32345713 DOI: 10.1073/pnas.2000533117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
12
|
Mi Z, Liu H, Zhang F. Advances in the Immunology and Genetics of Leprosy. Front Immunol 2020; 11:567. [PMID: 32373110 PMCID: PMC7176874 DOI: 10.3389/fimmu.2020.00567] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/12/2020] [Indexed: 12/21/2022] Open
Abstract
Leprosy, a disease caused by the intracellular parasite Mycobacterium leprae or Mycobacterium lepromatosis, has affected humans for more than 4,000 years and is a stigmatized disease even now. Since clinical manifestations of leprosy patients present as an immune-related spectrum, leprosy is regarded as an ideal model for studying the interaction between host immune response and infection; in fact, the landscape of leprosy immune responses has been extensively investigated. Meanwhile, leprosy is to some extent a genetic disease because the genetic factors of hosts have long been considered major contributors to this disease. Many immune-related genes have been discovered to be associated with leprosy. However, immunological and genetic findings have rarely been studied and discussed together, and as a result, the effects of gene variants on leprosy immune responses and the molecular mechanisms of leprosy pathogenesis are largely unknown. In this context, we summarized advances in both the immunology and genetics of leprosy and discussed the perspective of the combination of immunological and genetic approaches in studying the molecular mechanism of leprosy pathogenesis. In our opinion, the integrating of immunological and genetic approaches in the future may be promising to elucidate the molecular mechanism of leprosy onset and how leprosy develops into different types of leprosy.
Collapse
Affiliation(s)
- Zihao Mi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
13
|
Maymone MBC, Venkatesh S, Laughter M, Abdat R, Hugh J, Dacso MM, Rao PN, Stryjewska BM, Dunnick CA, Dellavalle RP. Leprosy: Treatment and management of complications. J Am Acad Dermatol 2020; 83:17-30. [PMID: 32244016 DOI: 10.1016/j.jaad.2019.10.138] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/25/2023]
Abstract
In the second article in this continuing medical education series, we review the treatment of leprosy, its immunologic reactions, and important concepts, including disease relapse and drug resistance. A fundamental understanding of the treatment options and management of neuropathic sequelae are essential to reduce disease burden and improve patients' quality of life.
Collapse
Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Samantha Venkatesh
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Melissa Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Rana Abdat
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Mara M Dacso
- National Hansen's (Leprosy) Disease Program, Baton Rouge, Louisiana; University of Texas Southwestern Medical Center, Dallas, Texas
| | - P Narasimha Rao
- Special Interest Group on Leprosy, Indian Association of Dermatologists, Venereologists and Leprologists, Delhi, India
| | | | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado.
| |
Collapse
|
14
|
Ahmadi Rastegar D, Dzamko N. Leucine Rich Repeat Kinase 2 and Innate Immunity. Front Neurosci 2020; 14:193. [PMID: 32210756 PMCID: PMC7077357 DOI: 10.3389/fnins.2020.00193] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
For more than a decade, researchers have sought to uncover the biological function of the enigmatic leucine rich repeat kinase 2 (LRRK2) enzyme, a large multi-domain protein with dual GTPase and kinase activities. Originally identified as a familial Parkinson's disease (PD) risk gene, variations in LRRK2 are also associated with risk of idiopathic PD, inflammatory bowel disease and susceptibility to bacterial infections. LRRK2 is highly expressed in peripheral immune cells and the potential of LRRK2 to regulate immune and inflammatory pathways has emerged as common link across LRRK2-implicated diseases. This review outlines the current genetic and biochemical evidence linking LRRK2 to the regulation of innate immune inflammatory pathways, including the toll-like receptor and inflammasome pathways. Evidence suggests a complex interplay between genetic risk and protective alleles acts to modulate immune outcomes in a manner dependent on the particular pathogen and cell type invaded.
Collapse
Affiliation(s)
| | - Nicolas Dzamko
- Brain and Mind Centre, Central Clinical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
15
|
Gomes LT, Morato-Conceição YT, Gambati AVM, Maciel-Pereira CM, Fontes CJF. Diagnostic value of neutrophil-to-lymphocyte ratio in patients with leprosy reactions. Heliyon 2020; 6:e03369. [PMID: 32083213 PMCID: PMC7021565 DOI: 10.1016/j.heliyon.2020.e03369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/29/2019] [Accepted: 02/03/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Leprosy reactions, classified as type 1 and type 2 reactions, are acute clinical conditions of exacerbation of localized or systemic inflammatory response inpatients with leprosy. No laboratory biomarker is available to predict the emergence of these reactions. Neutrophil-to-lymphocyte ratio (NLR) is an accurate biomarker for diagnosis and prognosis of various inflammatory and neoplastic diseases. OBJECTIVE This study aimed to investigate the accuracy of the NLR in the diagnosis of leprosy reactions. MATERIALS AND METHODS NLR was calculated for all patients and a receiver operating characteristic curve (ROC) were generated to identify the NLR cut-off point. RESULTS A total of 123 patients with leprosy were included, 98 with leprosy reactions of which 56 (45.5%) had type 1 and 42 (34.1%) with type 2. Mean NLR was higher among patients with reactions than among those without. It was also statistically higher among patients with type 2 reactions than in those with type 1 reactions. Receiver operating characteristic curves were generated to identify the NLR cut-off point. The area under the ROC curve was 0.794 for diagnosis of any leprosy reaction and 0.796 for the diagnosis of type 2 reaction. The NLR cut-off points for diagnosis of any leprosy reaction and for type 2 reaction were 2.75 (sensitivity 61.0%, specificity 92.0%, accuracy 77.0%) and 2.95 (sensitivity 81.0%, specificity 74.0%, accuracy 78.0%), respectively. CONCLUSION These results suggest that NLR could be a potential biomarker for diagnosis of leprosy reaction and useful for discriminating patients with type 2 reactions from those with type 1 leprosy reactions.
Collapse
Affiliation(s)
- Luciano Teixeira Gomes
- Júlio Müller University Hospital, Department of Infectious Diseases, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Yvelise Terezinha Morato-Conceição
- Júlio Müller University Hospital, Department of Infectious Diseases, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | | | | | - Cor Jesus Fernandes Fontes
- Júlio Müller University Hospital, Department of Infectious Diseases, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- Faculty of Biomedical Sciences of Cacoal, Cacoal, Rondonia, Brazil
| |
Collapse
|
16
|
Pino L, de Souza MDGC, Lupi O, Bouskela E. Tuberculoid leprosy: An in vivo microvascular evaluation of cutaneous lesions. PLoS One 2020; 15:e0227654. [PMID: 31929590 PMCID: PMC6957169 DOI: 10.1371/journal.pone.0227654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/22/2019] [Indexed: 12/02/2022] Open
Abstract
Tuberculoid leprosy (TT) is characterized by cutaneous lesions called plaques. Although microvascular ultrastructure of TT patients’ skin is well-documented, little is known about functional aspects of their microcirculation. We aimed, for the first time, to evaluate, in vivo, the microcirculation of TT cutaneous lesions. Seven TT patients, males, under treatment were included in the study. The spectral analysis of frequency components of flowmotion (endothelial, sympathetic, myogenic, cardiac and respiratory) was performed using laser Doppler flowmetry (LDF). Endothelial dependent and independent vasodilatations were assessed by LDF associated to acetylcholine (ACh) and sodium nitroprusside (SNP) iontophoresis, respectively. Vessel density (VD), perfused vessel density (PVD), proportion of perfused vessels (PPV%), microvascular flow index (MFI) and flow heterogeneity index (FHI), reflecting tissue perfusion and oxygenation, were evaluated through sidestream dark field (SDF) imaging. All microvascular analysis were performed in TT lesions and in healthy skin in the contralateral limb of the same patient, used as control skin. VD, PVD and PPV% and MFI were significantly lower in the cutaneous lesion compared to contralateral healthy skin. The contribution of different frequency components of flowmotion, endothelial dependent and independent vasodilatations and FHI were not statistically different between control skin and cutaneous lesion. Our results suggest that TT cutaneous lesions have a significant impairment of tissue perfusion, which may aggravate peripheral nerve degeneration caused by Mycobacterium leprae infection.
Collapse
Affiliation(s)
- Livia Pino
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria das Graças Coelho de Souza
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Omar Lupi
- Departamento de Dermatologia, Universidade Federal do Estado do Rio de Janeiro (UniRio), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliete Bouskela
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
17
|
Differential Expression of IFN- γ, IL-10, TLR1, and TLR2 and Their Potential Effects on Downgrading Leprosy Reaction and Erythema Nodosum Leprosum. J Immunol Res 2019; 2019:3405103. [PMID: 31781675 PMCID: PMC6875386 DOI: 10.1155/2019/3405103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/16/2019] [Indexed: 01/30/2023] Open
Abstract
Leprosy reactions are acute immunological events that occur during the evolution of chronic infectious disease causing neural damage and disabilities. A study using blood samples of 17 leprosy reaction patients and 17 reaction-free was carried out by means of associations between antigens, receptors, and expression of cytokines, using path analysis providing new insights into the immunological mechanisms involved in triggering leprosy reactions. Toll-like receptors (TLR) such as TLR1 and TLR2, presented balanced expression in the reaction-free multibacillary (MB) group (TLR1: 1.01 ± 0.23, TLR2: 1.22 ± 0.18; p = 0.267). On the other hand, downgrading type 1 reaction (T1R) (TLR1: 1.24 ± 0.17, TLR2: 2.88 ± 0.37; p = 0.002) and erythema nodosum leprosum (ENL) (TLR1: 1.93 ± 0.17, TLR2: 2.81 ± 0.15; p = 0.004) revealed an unbalance in relation to the expression of these receptors. When the path analysis was approached, it was noted that interleukin 10 (IL-10) expression showed a dependence relation with phenolic glycolipid I (PGL-I) in downgrading T1R (direct effect = 0.503 > residual effect = 0.364), whereas in ENL, such relationship occurred with lipoarabinomannan (LAM) (direct effect = 0.778 > residual effect = 0.280). On the contrary, in the reaction-free leprosy group, interferon-gamma (IFN-γ) levels were dependent on the association between TLR2 and TLR1 (0.8735). The high TLR2 expression associated with IL-10 levels, in the leprosy reaction groups, may be hypothetically related to the formation of TLR2/2 homodimers and/or TLR2/6 heterodimers linked to evasion mechanisms in downgrading reactions and pathophysiology of ENL.
Collapse
|
18
|
Sardana K, Mathachan SR, Agrawal D, Lavania M, Ahuja M. Late reversal reaction with resistantMycobacterium leprae: an emerging paradigm. Trop Doct 2019; 50:77-81. [DOI: 10.1177/0049475519884421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kabir Sardana
- Professor, Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Sinu Rose Mathachan
- Postgraduate student, Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Diksha Agrawal
- Postgraduate student, Department of Dermatology, Venereology and Leprosy, Dr. Ram Manohar Lohia and Post Graduate Institute of Medical Education and Research, New Delhi, India
| | - Mallika Lavania
- Research scientist, Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, Delhi, India
| | - Madhvi Ahuja
- Research scientist, Stanley Browne Laboratory, The Leprosy Mission Community Hospital, Nand Nagari, Delhi, India
| |
Collapse
|
19
|
Alemu Belachew W, Naafs B. Position statement:LEPROSY: Diagnosis, treatment and follow‐up. J Eur Acad Dermatol Venereol 2019; 33:1205-1213. [DOI: 10.1111/jdv.15569] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Affiliation(s)
- W. Alemu Belachew
- Department of Dermatovenereology Ayder Referral Hospital Mekelle University Mekelle, Tigray Ethiopia
| | - B. Naafs
- Department of Dermatovenereology Ayder Referral Hospital Mekelle University Mekelle, Tigray Ethiopia
- Regional Dermatology Training Centre (RDTC) Moshi Tanzania
- Instituto Lauro de Souza Lima (ILSL) Bauru SP Brazil
- Foundation Global Dermatology Munnekeburen the Netherlands
| |
Collapse
|
20
|
Sardana K, Sinha S, Agrawal D, Malhotra P, Lavania M, Ahuja M. Multidrug resistance as a cause of steroid-nonresponsive downgrading type I reaction in Hansen's disease. Int J Mycobacteriol 2019; 8:305-308. [DOI: 10.4103/ijmy.ijmy_121_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
21
|
de Macedo CS, de Carvalho FM, Amaral JJ, de Mendonça Ochs S, Assis EF, Sarno EN, Bozza PT, Pessolani MCV. Leprosy and its reactional episodes: Serum levels and possible roles of omega-3 and omega-6-derived lipid mediators. Cytokine 2018; 112:87-94. [DOI: 10.1016/j.cyto.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 01/27/2023]
|
22
|
Saleem MD, Oussedik E, Picardo M, Schoch JJ. Acquired disorders with hypopigmentation: A clinical approach to diagnosis and treatment. J Am Acad Dermatol 2018; 80:1233-1250.e10. [PMID: 30236514 DOI: 10.1016/j.jaad.2018.07.070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
Acquired hypopigmented skin changes are commonly encountered by dermatologists. Although hypopigmentation is often asymptomatic and benign, occasional serious and disabling conditions present with cutaneous hypopigmentation. A thorough history and physical examination, centered on disease distribution and morphologic findings, can aid in delineating the causes of acquired hypopigmented disorders. The second article in this 2-part continuing medical education series focuses on conditions with a hypopigmented phenotype. Early diagnosis and appropriate management of these disorders can improve a patient's quality of life, halt disease progression, and prevent irreversible disability.
Collapse
Affiliation(s)
- Mohammed D Saleem
- Department of Internal Medicine, University of Florida College of Medicine and University of Florida Health, Gainesville, Florida.
| | | | - Mauro Picardo
- Department of Dermatology and Pediatric Dermatology, Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida, Gainesville, Florida; Department of Pediatrics, University of Florida, Gainesville, Florida
| |
Collapse
|
23
|
Carmo RLML, Cintra ML, Velho PENF, Macedo LT. Subclinical leprosy manifesting as a reversal reaction after LHRH agonist administration. IDCases 2018; 12:32-33. [PMID: 29942743 PMCID: PMC6010934 DOI: 10.1016/j.idcr.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- R L M L Carmo
- Oncology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Brazil
| | - Maria Letícia Cintra
- Department of Pathology, Faculty of Medical Sciences, State University of Campinas, Brazil
| | | | - Lígia Traldi Macedo
- Oncology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Brazil
| |
Collapse
|
24
|
Vieira AP, Trindade MAB, de Paula FJ, Sakai-Valente NY, Duarte AJDS, Lemos FBC, Benard G. Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a paradoxical manifestation associated with deficiency of antigen-specific regulatory T-cells? BMC Infect Dis 2017; 17:305. [PMID: 28438129 PMCID: PMC5404339 DOI: 10.1186/s12879-017-2406-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/13/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Due to its chronic subclinical course and large spectrum of manifestations, leprosy often represents a diagnostic challenge. Even with proper anti-mycobacteria treatment, leprosy follow up remains challenging: almost half of leprosy patients may develop reaction episodes. Leprosy is an infrequent complication of solid organ transplant recipients. This case report illustrates the challenges in diagnosing and managing leprosy and its reactional states in a transplant recipient. CASE PRESENTATION A 53-year-old man presented 34 months after a successful renal transplantation a borderline-tuberculoid leprosy with signs of mild type 1 upgrading reaction (T1R). Cutaneous manifestations were atypical, and diagnosis was only made when granulomatous neuritis was found in a cutaneous biopsy. He was successfully treated with the WHO recommended multidrug therapy (MDT: rifampicin, dapsone and clofazimine). However he developed a severe T1R immediately after completion of the MDT but no signs of allograft rejection. T1R results from flare-ups of the host T-helper-1 cell-mediated immune response against Mycobacterium leprae antigens in patients with immunologically unstable, borderline forms of leprosy and has been considered an inflammatory syndrome in many aspects similar to the immune reconstitution inflammatory syndromes (IRS). The T1R was successfully treated by increasing the prednisone dose without modifying the other immunosuppressive drugs used for preventing allograft rejection. Immunological study revealed that the patient had a profound depletion of both in situ and circulating regulatory T-cells and lack of expansion of the Tregs upon M. leprae stimulation compared to T1R leprosy patients without iatrogenic immunosuppression. CONCLUSIONS Our case report highlights that leprosy, especially in the transplant setting, requires a high degree of clinical suspicion and the contribution of histopathology. It also suggests that the development of upgrading inflammatory syndromes such as T1R can occur despite the sustained immunosuppressors regimen for preventing graft rejection. Our hypothesis is that the well-known deleterious effects of these immunosuppressors on pathogen-induced regulatory T-cells contributed to the immunedysregulation and development T1R.
Collapse
Affiliation(s)
- Ana Paula Vieira
- Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Flávio Jota de Paula
- Renal Transplantation Service, Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Neusa Yurico Sakai-Valente
- Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Gil Benard
- Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of São Paulo, São Paulo, Brazil. .,Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
25
|
Nogueira MRS, Latini ACP, Nogueira MES. The involvement of endothelial mediators in leprosy. Mem Inst Oswaldo Cruz 2016; 111:635-641. [PMID: 27706378 PMCID: PMC5066329 DOI: 10.1590/0074-02760160122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 07/15/2016] [Indexed: 01/04/2023] Open
Abstract
Leprosy is a chronic infectious disease that requires better understanding since it
continues to be a significant health problem in many parts of the world. Leprosy
reactions are acute inflammatory episodes regarded as the central etiology of nerve
damage in the disease. The activation of endothelium is a relevant phenomenon to be
investigated in leprosy reactions. The present study evaluated the expression of
endothelial factors in skin lesions and serum samples of leprosy patients.
Immunohistochemical analysis of skin samples and serum measurements of VCAM-1, VEGF,
tissue factor and thrombomodulin were performed in 77 leprosy patients and 12
controls. We observed significant increase of VCAM-1 circulating levels in
non-reactional leprosy (p = 0.0009). The immunostaining of VEGF and tissue factor was
higher in endothelium of non-reactional leprosy (p = 0.02 for both) than healthy
controls. Patients with type 1 reaction presented increased thrombomodulin serum
levels, compared with non-reactional leprosy (p = 0.02). In type 2 reaction, no
significant modifications were observed for the endothelial factors investigated. The
anti-inflammatory and antimicrobial activities of the endotfhelial factors may play
key-roles in the pathogenesis of leprosy and should be enrolled in studies focusing
on alternative targets to improve the management of leprosy and its reactions.
Collapse
Affiliation(s)
- Maria Renata Sales Nogueira
- Instituto Lauro de Souza Lima, Divisão de Pesquisa e Ensino, Secretaria de Estado da Saúde, Bauru, SP, Brasil
| | - Ana Carla Pereira Latini
- Instituto Lauro de Souza Lima, Divisão de Pesquisa e Ensino, Secretaria de Estado da Saúde, Bauru, SP, Brasil
| | | |
Collapse
|
26
|
Grzybowski A, Virmond M. Leprosy: Between biblical descriptions to advances in immunology and diagnostic techniques. Clin Dermatol 2016; 34:1-2. [DOI: 10.1016/j.clindermatol.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|