1
|
Chen X, Di L, Qian M, Shen D, Feng X, Zhang X. Neurological features of Hansen disease: a retrospective, multicenter cohort study. Sci Rep 2024; 14:10374. [PMID: 38710787 PMCID: PMC11074337 DOI: 10.1038/s41598-024-60457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
To elucidate the neurological features of Hansen disease. The medical records of patients with confirmed Hansen disease transferred from the neurology department were reviewed, and all medical and neurological manifestations of Hansen disease were assessed. Eleven patients with confirmed Hansen disease, 10 with newly detected Hansen disease and 1 with relapsed Hansen disease, who visited neurology departments were enrolled. The newly detected patients with Hansen disease were classified as having lepromatous leprosy (LL, n = 1), borderline lepromatous leprosy (BL, n = 2), borderline leprosy (BB, n = 2), borderline tuberculoid leprosy (BT, n = 1), tuberculoid leprosy (TT, n = 2), or pure neural leprosy (PNL, n = 2). All of the patients with confirmed Hansen were diagnosed with peripheral neuropathy (100.00%, 11/11). The symptoms and signs presented were mainly limb numbness (100.00%, 11/11), sensory and motor dysfunction (100.00%, 11/11), decreased muscle strength (90.90%, 10/11), and skin lesions (81.81%, 9/11). Nerve morphological features in nerve ultrasonography (US) included peripheral nerve asymmetry and segmental thickening (100.00%, 9/9). For neuro-electrophysiology feature, the frequency of no response of sensory nerves was significantly higher than those of motor nerves [(51.21% 42/82) vs (24.70%, 21/85)(P = 0.0183*)] by electrodiagnostic (EDX) studies. Nerve histological features in nerve biopsy analysis included demyelination (100.00%, 5/5) and axonal damage (60.00%, 3/5). In addition to confirmed diagnoses by acid-fast bacteria (AFB) staining (54.54%, 6/11) and skin pathology analysis (100.00%, 8/8), serology and molecular technology were positive in 36.36% (4/11) and 100.00% (11/11) of confirmed patients of Hansen disease, respectively. It is not uncommon for patients of Hansen disease to visit neurology departments due to peripheral neuropathy. The main pathological features of affected nerves are demyelination and axonal damage. The combination of nerve US, EDX studies, nerve biopsy, and serological and molecular tests can improve the diagnosis of Hansen disease.
Collapse
Affiliation(s)
- Xiaohua Chen
- Leprosy Department, Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
- Beijing Key Laboratory for Research On Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China.
| | - Li Di
- Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Qian
- Department of Neurology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC), Beijing, China
| | - Xinhong Feng
- Department of Neurology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xiqing Zhang
- Department of Neurology, Beijing Junyi Traditional Chinese Medicine Hospital, Beijing, China
| |
Collapse
|
2
|
Moreira RJDO, Bezerra JM, Santos FS, Pascoal LM, dos Santos LH, Santos M. Clinical-epidemiological characteristics and temporal trend of new cases of grade 2 disability leprosy in the state of Maranhão, Brazil, 2011- 2020. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2023; 32:e2022435. [PMID: 37729263 PMCID: PMC10510615 DOI: 10.1590/s2237-96222023000200026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/21/2023] [Indexed: 09/22/2023] Open
Abstract
MAIN RESULTS Out of 2,147 grade 2 disability leprosy cases, the majority were male, of mixed race/skin color, multibacillary and borderline. The São Luís regional health unit showed a falling trend. IMPLICATIONS FOR SERVICES The results can guide strategies for the leprosy control program in the state, aiming at new approaches towards early diagnosis, treatment and prevention of disabilities. PERSPECTIVES Further studies are needed, such as spatial distribution of cases and detection rates of leprosy in children under 15 years of age, in order to gain a better understanding of the epidemiological profile of leprosy in Maranhão. OBJECTIVE to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020. METHODS this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression. RESULTS of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9). CONCLUSION incidence trend was stable in the state of Maranhão and falling in São Luís.
Collapse
Affiliation(s)
| | - Janaína Miranda Bezerra
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde e Tecnologia, Imperatriz, MA, Brazil
| | - Floriacy Stabnow Santos
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde e Tecnologia, Imperatriz, MA, Brazil
| | - Lívia Maia Pascoal
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde e Tecnologia, Imperatriz, MA, Brazil
| | | | - Marcelino Santos
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde e Tecnologia, Imperatriz, MA, Brazil
| |
Collapse
|
3
|
Spekker O, Tihanyi B, Kis L, Madai Á, Pálfi G, Csuvár-Andrási R, Wicker E, Szalontai C, Samu L, Koncz I, Marcsik A, Molnár E. Leprosy: The age-old companion of humans - Re-evaluation and comparative analysis of Avar-period cases with Hansen's disease from the Danube-Tisza Interfluve, Hungary. Tuberculosis (Edinb) 2023; 142:102393. [PMID: 37684080 DOI: 10.1016/j.tube.2023.102393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
In recent years, our knowledge of leprosy in the past has substantially been enriched. Nonetheless, much still remains to be discovered, especially in regions and periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of eight Avar-period leprosy cases from the Danube-Tisza Interfluve (Hungary). In every case, to reconstruct the biological consequences of leprosy, the detected bony changes were linked with palaeopathological and modern medical information. To reconstruct the social consequences of being affected by leprosy, conceptualisation of the examined individuals' treatment in death was conducted. In every case, the disease resulted in deformation and disfigurement of the involved anatomical areas (rhinomaxillary region, feet, and/or hands) with difficulties in conducting certain physical activities. These would have been disadvantageous for the examined individuals and limited or changed their possibilities to participate in social situations. The most severe cases would have required continuous support from others to survive. Our findings indicate that, despite their very visible disease and associated debility, the examined communities did not segregate leprosy sufferers but provided and cared for them, and maintained a strong enough social network that made their survival possible even after becoming incapable of self-sufficiency.
Collapse
Affiliation(s)
- Olga Spekker
- Ancient and Modern Human Genomics Competence Centre, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary; Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Balázs Tihanyi
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Luca Kis
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Ágota Madai
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Anthropology, Hungarian Natural History Museum, Ludovika tér 2-6, H-1083, Budapest, Hungary.
| | - György Pálfi
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | | | - Erika Wicker
- Kecskeméti Katona József Museum, Bethlen körút 1, H-6000, Kecskemét, Hungary.
| | - Csaba Szalontai
- National Institute of Archaeology, Hungarian National Museum, Múzeum körút 14-16, H-1088, Budapest, Hungary.
| | - Levente Samu
- Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - István Koncz
- Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - Antónia Marcsik
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - Erika Molnár
- Department of Biological Anthropology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| |
Collapse
|
4
|
Seok SH, Yoon MS, Kim DH. Lupus Vulgaris Mimicking Tinea Corporis. Ann Dermatol 2023; 35:S132-S134. [PMID: 37853886 PMCID: PMC10608390 DOI: 10.5021/ad.21.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 10/20/2023] Open
Affiliation(s)
- Seung Hui Seok
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Moon Soo Yoon
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Dong Hyun Kim
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
| |
Collapse
|
5
|
Quintarelli L, Magnaterra E, Maglie R, Corrà A, Ruffo di Calabria V, Aimo C, Mariotti EB, Verdelli A, Maio V, Antiga E, Caproni M. Lepromatous leprosy presenting with erythema nodosum leprosum mimicking Bechet's disease. Travel Med Infect Dis 2022; 52:102521. [PMID: 36528249 DOI: 10.1016/j.tmaid.2022.102521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Affiliation(s)
- L Quintarelli
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
| | - E Magnaterra
- Department of Health Sciences, Section Dermatology, University of Florence, Italy.
| | - R Maglie
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - A Corrà
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - V Ruffo di Calabria
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - C Aimo
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - E B Mariotti
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - A Verdelli
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
| | - V Maio
- Department of Health Sciences, University of Florence, Florence, Italy
| | - E Antiga
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - M Caproni
- Department of Health Sciences, University of Florence, Florence, Italy
| |
Collapse
|
6
|
Shen YL, Kong WM, Yu MW, Wu LM, Fei LJ. Suspicious symptom monitoring for leprosy: an optimal practice for early detection under a low endemic situation in Zhejiang Province, China. Int J Dermatol 2022; 61:1532-1539. [PMID: 35913701 DOI: 10.1111/ijd.16366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/11/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Leprosy is a chronic infectious disease that causes disabilities and deformities. Early detection is a major strategy for leprosy control. This study reported a new practice of suspicious symptom monitoring for early detection of leprosy. METHODS A descriptive and comparative analysis between a non-strategy group of pre-implementation of suspicious symptom monitoring in 2005-2011 and a strategy group of strategy implementation in 2012-2018 was conducted through indicators of the number of times of misdiagnoses, delayed period, proportion of early detected cases, and proportion of disabilities. RESULT Compared with the non-strategy group in 2005-2011, the median number of times of misdiagnoses was decreased from two times to zero times (z = 4.387, P < 0.001), and the median delayed period of newly detected cases were shortened from 24 months to 13 months (z = 2.381, P < 0.001), the proportion of early detected cases was increased from 43.7% to 75.2% (χ2 = 29.464, P < 0.001), the proportion of grade 2 disabilities was decreased from 28.6% in the highest year of 2005 to 4.0% in the lowest year of 2014, and the average proportion of disabilities was decreased from 33.5% to 17.6% (χ2 = 9.421, P = 0.002) in the strategy group in 2012-2018, respectively. CONCLUSION Suspicious symptom monitoring promoted early detection of cases by reducing the number of times misdiagnosis of leprosy patients, shortening the delayed period, increasing the proportion of early detection, and decreasing the proportion of disabilities. It is an important and recommendable public health strategy for leprosy prevention and control in a low epidemic condition.
Collapse
Affiliation(s)
- Yun-Liang Shen
- Zhejiang Provincial Institute of Dermatology, Huzhou City, Zhejiang Province, P. R. China
| | - Wen-Ming Kong
- Zhejiang Provincial Institute of Dermatology, Huzhou City, Zhejiang Province, P. R. China
| | - Mei-Wen Yu
- National Center for Leprosy Control, Chinese Center for Disease Control and Prevention, Hospital for Skin Diseases (Institute of Dermatology), Chinese Academy of Medical Science & Peking Medical University, Nanjing, Jiangsu, P. R. China
| | - Li-Mei Wu
- Zhejiang Provincial Institute of Dermatology, Huzhou City, Zhejiang Province, P. R. China
| | - Li-Juan Fei
- Zhejiang Provincial Institute of Dermatology, Huzhou City, Zhejiang Province, P. R. China
| |
Collapse
|
7
|
Santana MADO, da Costa WVT, Celestino IC, dos Santos DF, Dornelas BDC, Pavelka MM, Luppi ADM, Goulart IMB. Fever of Unknown Origin, Wasting Syndrome and Bone Marrow Involvement: A Leprosy Case Report. Front Immunol 2022; 13:916319. [PMID: 35874693 PMCID: PMC9300819 DOI: 10.3389/fimmu.2022.916319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/03/2022] [Indexed: 12/04/2022] Open
Abstract
Mycobacterium leprae, the etiologic agent of leprosy, is an acid-fast-staining and slow-growing bacilli that infect macrophages and Schwann cells individually or through forming globi. The clinical presentation of leprosy is broad and depends on the host immune response. We report a case of a 42-year-old Brazilian man presenting with fever of unknown origin (FUO), anemia, wasting syndrome, and neuropathy. The diagnosis of lepromatous leprosy was made after an extensive investigation revealed the presence of M. leprae in the bone marrow. Bone marrow involvement in leprosy is rare and some authors believe the presence of M. leprae in the bone marrow can act as a reservoir of the disease facilitating future relapses. It is important to investigate bone marrow involvement in leprosy, especially when the patient presents with cytopenias and positive epidemiologic history.
Collapse
Affiliation(s)
- Marcela Araujo de Oliveira Santana
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
- *Correspondence: Marcela Araujo de Oliveira Santana,
| | | | - Isadora Costa Celestino
- Post-Graduation Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | - Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | - Bruno de Carvalho Dornelas
- Post-Graduation Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
- Pathology Department, Clinical Hospital, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Andrea De Martino Luppi
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
- Post-Graduation Program in Health Science, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics’ Hospital, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil
| |
Collapse
|
8
|
Leprosy: A Review of Epidemiology, Clinical Diagnosis, and Management. J Trop Med 2022; 2022:8652062. [PMID: 35832335 PMCID: PMC9273393 DOI: 10.1155/2022/8652062] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 01/03/2023] Open
Abstract
Leprosy is a neglected infectious disease caused by acid-fast bacillus Mycobacterium leprae. It primarily affects the skin and then progresses to a secondary stage, causing peripheral neuropathy with potential long-term disability along with stigma. Leprosy patients account for a significant proportion of the global disease burden. Previous efforts to improve diagnostic and therapeutic techniques have focused on leprosy in adults, whereas childhood leprosy has been relatively neglected. This review aims to update the diagnostic and therapeutic recommendations for adult and childhood leprosy. This review summarizes the clinical, bacteriological, and immunological approaches used in the diagnosis of leprosy. As strategies for the diagnosis and management of leprosy continue to develop better and more advanced knowledge, control and prevention of leprosy are crucial.
Collapse
|
9
|
Chen H, Zhang G, Zhang P, Long H. Case of borderline leprosy presenting with urticaria-like eruptions and limbs swelling: A lesson to be learned for dermatologists. J Dermatol 2022; 49:e409-e410. [PMID: 35665532 DOI: 10.1111/1346-8138.16483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Huan Chen
- Department of Leprosy Prevention and Control, Hunan Provincial Centre for Disease Control and Prevention, Changsha, China
| | - Guiying Zhang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Peng Zhang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hai Long
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW The aim of this article is to review the most recent evidences concerning mycobacterial skin infections, limiting the period of literature research to 2020--2021. RECENT FINDINGS Mycobacterial skin infections include a heterogeneous group of cutaneous diseases.Cutaneous tuberculosis is usually the result of hematogenous dissemination or spread from underlying foci and it must be distinguished from tuberculids, resulting from the immunological reaction to Mycobacterium tuberculosis antigens. Leprosy prevalence was drastically reduced after introduction of multidrug therapy in the 1980 s, but cases are still reported due to underdiagnosis, and animal and environmental reservoirs. Recent advances concentrate in the diagnostic field. Specific guidelines for the treatment of nontuberculous mycobacteria skin infections are missing and surgical procedures may be required. Prognosis is better as compared to nontuberculous mycobacteria lung disease. Rapid laboratory-confirmed diagnosis of Buruli ulcer may be achieved by the IS2404 PCR. Among new drugs, telacebec is promising in terms of potency, shorter duration and tolerability in animal studies. A clinical trial in humans is planned. SUMMARY Mycobacterial cutaneous lesions are nonpathognomonic and clinical suspicion must be confirmed by culture or molecular detection. Long-course multidrug treatment is required based on susceptibility tests. Surgical intervention may also be required. Rehabilitation and psychosocial support reduce long-term physical and mental consequences mostly in Buruli ulcer and leprosy.
Collapse
|
11
|
Periche Fernández JD, Pou-Soarez V, Arenas R, Juárez-Duran ER, Luna-Rojas SL, Xicohtencatl-Cortes J, Martínez-Chavarría LC, Martínez-Hernández F, Hernández-Castro R. Mycobacterium leprae and Mycobacterium lepromatosis infection. A report of six multibacillary cases of leprosy in Dominican Republic. Jpn J Infect Dis 2022; 75:427-430. [PMID: 35354704 DOI: 10.7883/yoken.jjid.2021.709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The causative agents of leprosy are Mycobacterium leprae and Mycobacterium lepromatosis. M. lepromatosis was found in 2008 to cause diffuse lepromatous leprosy in Mexican patients. The objective of this work was to identify M. leprae and M. lepromatosis in paraffin-embedded skin samples from Caribbean leprosy patients. A total of 6 skin samples were obtained from the Dominican Republic. All cases presented the multibacillary form; 5 cases were nodular lepromatous leprosy, and 1 case was borderline lepromatous leprosy. All patients received multidrug therapy. Molecular identification was achieved using the M. leprae-specific repetitive element (RLEP) for M. leprae and the hemN gene for M. lepromatosis. Mycobacterium leprae was identified in two lepromatous leprosy cases and 1 borderline lepromatous leprosy case; M. lepromatosis was found in 1 nodular lepromatous leprosy case. Both Mycobacterium species were present in two nodular lepromatous leprosy cases. This is the first report of M. lepromatosis in the Dominican Republic.
Collapse
Affiliation(s)
| | - Víctor Pou-Soarez
- Dominican Dermatological Institute and Skin Surgery Dr. Huberto Bogaert, Dominican Republic
| | - Roberto Arenas
- Mycology Service, General Hospital Dr. Manuel Gea González, Mexico
| | | | | | | | | | | | | |
Collapse
|
12
|
Bharucha J, Saito-Tom L. Postpartum sepsis-like illness and rash associated with Hansen’s disease. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Hansen’s disease (HD) often manifests during pregnancy and the postpartum. Patients with HD may experience reactions that mimic other conditions making diagnosis challenging.
Case presentation
We present a case of a patient from Chuuk, a state of the Federated States of Micronesia with a sepsis-like illness and worsening painful rash immediately postpartum. Antepartum, the patient noted a pruritic rash on her legs. Four hours after delivery, the patient became febrile and later developed systemic inflammatory response syndrome (SIRS). The rash rapidly spread to other areas of her body and became painful and edematous. Eight weeks after delivery, a skin biopsy revealed tuberculoid granulomatous dermatitis consistent with HD.
Conclusions
HD and its associated reactions are easily misdiagnosed. Performing a skin biopsy of unusual skin lesions or common skin lesions with severe illness in a pregnant patient can expedite diagnosis of rare conditions such as HD. Early initiation of treatment for HD and its reactions are critical to prevent serious nerve damage and permanent disability.
Collapse
Affiliation(s)
- Jinai Bharucha
- Department of Obstetrics, Gynecology, & Women’s Health , John A. Burns School of Medicine, University of Hawai’i , Honolulu , HI , USA
| | - Lynne Saito-Tom
- Department of Obstetrics, Gynecology, & Women’s Health , John A. Burns School of Medicine, University of Hawai’i , Honolulu , HI , USA
| |
Collapse
|
13
|
Jariyakulwong N, Julanon N, Saengboonmee C. Lepromatous leprosy with a suspected 30-year incubation period: A case report of a practically eradicated area. J Taibah Univ Med Sci 2022; 17:602-605. [PMID: 35983441 PMCID: PMC9356350 DOI: 10.1016/j.jtumed.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives Methods Results Conclusions
Collapse
|
14
|
Mi Z, Wang Z, Xue X, Liu T, Wang C, Sun L, Yu G, Zhang Y, Shi P, Sun Y, Yang Y, Ma S, Wang Z, Yu Y, Liu J, Liu H, Zhang F. The immune-suppressive landscape in lepromatous leprosy revealed by single-cell RNA sequencing. Cell Discov 2022; 8:2. [PMID: 35013182 PMCID: PMC8748782 DOI: 10.1038/s41421-021-00353-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022] Open
Abstract
Lepromatous leprosy (L-LEP), caused by the massive proliferation of Mycobacterium leprae primarily in macrophages, is an ideal disease model for investigating the molecular mechanism of intracellular bacteria evading or modulating host immune response. Here, we performed single-cell RNA sequencing of both skin biopsies and peripheral blood mononuclear cells (PBMCs) of L-LEP patients and healthy controls. In L-LEP lesions, we revealed remarkable upregulation of APOE expression that showed a negative correlation with the major histocompatibility complex II gene HLA-DQB2 and MIF, which encodes a pro-inflammatory and anti-microbial cytokine, in the subset of macrophages exhibiting a high expression level of LIPA. The exhaustion of CD8+ T cells featured by the high expression of TIGIT and LAG3 in L-LEP lesions was demonstrated. Moreover, remarkable enhancement of inhibitory immune receptors mediated crosstalk between skin immune cells was observed in L-LEP lesions. For PBMCs, a high expression level of APOE in the HLA-DRhighFBP1high monocyte subset and the expansion of regulatory T cells were found to be associated with L-LEP. These findings revealed the primary suppressive landscape in the L-LEP patients, providing potential targets for the intervention of intracellular bacteria caused persistent infections.
Collapse
Affiliation(s)
- Zihao Mi
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Zhenzhen Wang
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Xiaotong Xue
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Tingting Liu
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Chuan Wang
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Lele Sun
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Gongqi Yu
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Yuan Zhang
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Peidian Shi
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Yonghu Sun
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Yongliang Yang
- grid.460018.b0000 0004 1769 9639Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong China
| | - Shanshan Ma
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Zhe Wang
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Yueqian Yu
- grid.410587.fShandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong China
| | - Jianjun Liu
- grid.418377.e0000 0004 0620 715XHuman Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - 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, Shandong, 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, Shandong, China.
| |
Collapse
|
15
|
Semyonova VG, Levicheva YY, Shelepova TN, Nabieva AR, Nikonorov AA, Smolyannikova VA, Kubanov AA. A clinical case of borderline leprosy. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background. Described a rare case of leprosy, borderline form in the active stage.
Aim. To present a clinical case of the development of leprosy with atypical manifestations in a patient outside a region endemic for leprosy.
Case report. A 67-year-old patient from 2018 to 2020 received treatment for allergic dermatitis, pyoderma, no effect was observed; in 2020 he was examined for sarcoidosis, the diagnosis was not confirmed. In the Leprosy Research Institute, an examination was carried out, including a bacterioscopic examination of skin scarificates, a pathomorphological examination of skin biopsies, and molecular genetic methods.
Results. Based on complaints, anamnesis, examination data and physical examination, the results of clinical and laboratory examination, the diagnosis was made: leprosy, borderline form (ICD-10 A30.3), active stage.
Conclusion. The presented observation indicates that the variety of clinical manifestations of leprosy and the lack of alertness in relation to this disease, about the difficulty in establishing the correct clinical diagnosis in the patient, given the lack of history of data on contact with patients with leprosy.
Collapse
|
16
|
Chen X, Zha S, Shui TJ. Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study. PLoS Negl Trop Dis 2021; 15:e0009913. [PMID: 34813585 PMCID: PMC8610243 DOI: 10.1371/journal.pntd.0009913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/14/2021] [Indexed: 12/31/2022] Open
Abstract
Background Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis. Methodology/Principal findings In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010–2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms. Conclusions Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early. Early diagnosis is key in leprosy control; however, the diagnosis of leprosy is still challenging. In this study, we reviewed the common and rare symptoms of leprosy. Numbness, erythema, painless nor pruritic skin lesions, eyebrow hair loss, and tubercles were common symptoms of leprosy. Despite low proportions, formic sensation, pain, pruritus, finger contracture, muscle atrophy, and motor dysfunction were also reported by leprosy patients. As initial symptoms at symptom onset and only symptoms at diagnosis, nerve symptoms were associated with a greater degree of physical disability and a longer diagnosis interval than skin and skin and nerve symptoms. Understanding the presenting symptoms in detail would improve the level of leprosy awareness in the community. Increasing awareness of nerve symptoms, focusing on individuals with nerve symptoms at neurology outpatient visits, and holding focused training for medical staff specializing in neurology would enhance the capacity of the health system to recognize leprosy early.
Collapse
Affiliation(s)
- Xiaohua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Shun Zha
- Yunnan Center for Disease Control and Prevention, Yunnan, China
| | - Tie-Jun Shui
- Yunnan Center for Disease Control and Prevention, Yunnan, China
- * E-mail:
| |
Collapse
|
17
|
Leal-Calvo T, Avanzi C, Mendes MA, Benjak A, Busso P, Pinheiro RO, Sarno EN, Cole ST, Moraes MO. A new paradigm for leprosy diagnosis based on host gene expression. PLoS Pathog 2021; 17:e1009972. [PMID: 34695167 PMCID: PMC8568100 DOI: 10.1371/journal.ppat.1009972] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/04/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
Transcriptional profiling is a powerful tool to investigate and detect human diseases. In this study, we used bulk RNA-sequencing (RNA-Seq) to compare the transcriptomes in skin lesions of leprosy patients or controls affected by other dermal conditions such as granuloma annulare, a confounder for paucibacillary leprosy. We identified five genes capable of accurately distinguishing multibacillary and paucibacillary leprosy from other skin conditions. Indoleamine 2,3-dioxygenase 1 (IDO1) expression alone was highly discriminatory, followed by TLR10, BLK, CD38, and SLAMF7, whereas the HS3ST2 and CD40LG mRNA separated multi- and paucibacillary leprosy. Finally, from the main differentially expressed genes (DEG) and enriched pathways, we conclude that paucibacillary disease is characterized by epithelioid transformation and granuloma formation, with an exacerbated cellular immune response, while multibacillary leprosy features epithelial-mesenchymal transition with phagocytic and lipid biogenesis patterns in the skin. These findings will help catalyze the development of better diagnostic tools and potential host-based therapeutic interventions. Finally, our data may help elucidate host-pathogen interplay driving disease clinical manifestations.
Collapse
Affiliation(s)
- Thyago Leal-Calvo
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Charlotte Avanzi
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mayara Abud Mendes
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrej Benjak
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Philippe Busso
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Roberta Olmo Pinheiro
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Euzenir Nunes Sarno
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stewart Thomas Cole
- Global Health Institute, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institut Pasteur, Paris, France
| | - Milton Ozório Moraes
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
18
|
Torun S, Karaman I. Leprosy suspect presenting at a chest clinic. Trop Doct 2021; 51:655-658. [PMID: 34134563 DOI: 10.1177/00494755211019603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Leprosy is an ancient ailment, also known as Hansen's disease. It primarily involves the superficial peripheral nerves, skin, upper respiratory tract mucosa, eyes, bones and testicles, but not the lungs. Although leprosy patients are not included in the study area of pulmonology, here we present an undiagnosed leprosy patient with a history of smoking, who was referred owing to upper respiratory tract symptoms and bilateral pleural effusions. From this undiagnosed case, we would like to draw specific attention of pulmonologists, since a patient with leprosy can present in this way due to hypoalbuminemia resulting from a systemic inflammatory state, which may then progress to sepsis. Collaboration of different specialists may be required to clinch extra-neurological and extra-cutaneous features of leprosy.
Collapse
Affiliation(s)
- Serife Torun
- Department of Pulmonary Diseases, Baskent University Faculty of Medicine, Konya, Turkey
| | - Irem Karaman
- Intern/Medical Student, Bahcesehir University School of Medicine, Istanbul, Turkey
| |
Collapse
|
19
|
Gautam S, Sharma D, Goel A, Patil SA, Bisht D. Insights into Mycobacterium leprae Proteomics and Biomarkers-An Overview. Proteomes 2021; 9:7. [PMID: 33573064 PMCID: PMC7931084 DOI: 10.3390/proteomes9010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 02/07/2023] Open
Abstract
Although leprosy is curable, the identification of biomarkers for the early diagnosis of leprosy would play a pivotal role in reducing transmission and the overall prevalence of the disease. Leprosy-specific biomarkers for diagnosis, particularly for the paucibacillary disease, are not well defined. Therefore, the identification of new biomarkers for leprosy is one of the prime themes of leprosy research. Studying Mycobacterium leprae, the causative agent of leprosy, at the proteomic level may facilitate the identification, quantification, and characterization of proteins that could be potential diagnostics or targets for drugs and can help in better understanding the pathogenesis. This review aims to shed light on the knowledge gained to understand leprosy or its pathogen employing proteomics and its role in diagnosis.
Collapse
Affiliation(s)
- Sakshi Gautam
- Department of Biochemistry, National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Tajganj, Agra 282004, India; (S.G.); (D.S.); (S.A.P.)
- Department of Biotechnology, GLA University, NH-2, Mathura-Delhi Road, Mathura 281406, India;
| | - Devesh Sharma
- Department of Biochemistry, National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Tajganj, Agra 282004, India; (S.G.); (D.S.); (S.A.P.)
| | - Anjana Goel
- Department of Biotechnology, GLA University, NH-2, Mathura-Delhi Road, Mathura 281406, India;
| | - Shripad A. Patil
- Department of Biochemistry, National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Tajganj, Agra 282004, India; (S.G.); (D.S.); (S.A.P.)
| | - Deepa Bisht
- Department of Biochemistry, National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Tajganj, Agra 282004, India; (S.G.); (D.S.); (S.A.P.)
| |
Collapse
|
20
|
Zhang QP, Li G, Li C, Lin ZX, Chen P. Epidemiological situation of leprosy in a province in China: a long time to diagnosis and a high rate of deformity. BMC Public Health 2020; 20:1790. [PMID: 33238966 PMCID: PMC7690005 DOI: 10.1186/s12889-020-09933-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This epidemiological study aimed to analyse both the distribution and characteristics of leprosy in an endemic province in Northwest China. METHODS The medical records of leprosy patients in the province of Shaanxi, China, from 1998 to 2018 were collected from the Chinese Leprosy Management Information System (LEPMIS). Epidemiological variables were analysed in this study. RESULTS A total of 477 new cases were diagnosed between 1998 and 2018 in this region. The average annual detection rate was 0.070/100,000 population, and the average annual prevalence was 0.305/100,000 population. The mean age of the newly diagnosed patients was 46.7 years, and the ratio of males to females was 2.5:1. There were 399 cases (83.6%) of multibacillary (MB) leprosy. One hundred forty-eight patients (31.0%) had grade 2 disability. The mean diagnosis time for new cases was 62.0 months. CONCLUSION This epidemiological study showed that the characteristics of newly diagnosed leprosy cases in our province were a long time to diagnosis and a high rate of deformity, indicating the need for actions focusing on early diagnosis and treatment and strengthening the detection of leprosy in low-prevalence areas.
Collapse
Affiliation(s)
- Qing-Ping Zhang
- Shaanxi Provincial Institute for Endemic Disease Control, Xi'an, 710003, China
| | - Ge Li
- Shaanxi Provincial Institute for Endemic Disease Control, Xi'an, 710003, China
- Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Chao Li
- Department of Orthopedics, Xijing Hospital, the Fourth Military Medical University, West Road 169, Xi'an, Changle, 710032, Shaanxi Province, China.
| | - Zhao-Xing Lin
- Shaanxi Provincial Institute for Endemic Disease Control, Xi'an, 710003, China
| | - Ping Chen
- Shaanxi Provincial Institute for Endemic Disease Control, Xi'an, 710003, China
| |
Collapse
|
21
|
Kumar S, Mehta H, Aggarwal D, Chatterjee D, Narang T, Dogra S. Leprosy pseudoimbricata: an unusual presentation of steroid-modified borderline lepromatous leprosy. Int J Dermatol 2020; 59:e124-e125. [PMID: 31957882 DOI: 10.1111/ijd.14783] [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: 11/26/2019] [Revised: 12/02/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sheetanshu Kumar
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Aggarwal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
22
|
Karadag AS. Commentary: Great imitators in dermatology: II. Clin Dermatol 2019; 38:137-139. [PMID: 32513394 DOI: 10.1016/j.clindermatol.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ayse Serap Karadag
- Department of Dermatology and Venereology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| |
Collapse
|
23
|
Affiliation(s)
- Ayşe Serap Karadağ
- Department of Dermatology and Veneorology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - WenChieh Chen
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
| |
Collapse
|
24
|
Thangaraju P. Comment to the contribution, "Leprosy: A great imitator". Clin Dermatol 2019; 37:380-381. [PMID: 31345327 DOI: 10.1016/j.clindermatol.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|