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Sharma A, Narang T, Takkar A, Padhi BK, Dogra S. Nerve function impairment and quality of life in patients with leprosy: a prospective, observational study. Int J Dermatol 2024. [PMID: 38872509 DOI: 10.1111/ijd.17323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND There is a limited number of studies assessing the alterations in nerve function impairment (NFI) in leprosy over an extended period of time. To the best of our knowledge, no published study has evaluated neurological state longitudinally during treatment utilizing a combination of clinical, functional (activity limitation), electrophysiological, and patient-reported quality of life (QOL) outcomes. METHODS This prospective, observational study included leprosy patients of all spectra. Over 1 year of treatment, cutaneous and neurological examinations were done in addition to a nerve conduction study (NCS) and sympathetic skin response (SSR) assessment. QOL and activity limitation assessments using the World Health Organization Quality of Life brief version (WHOQOL-BREF) and Screening of Activity Limitation and Safety Awareness scale (SALSA), respectively, were also performed. RESULTS Out of 63 leprosy patients, loss of sensation was noted in 43 (68.2%) at baseline. At the completion of treatment, proportionate change revealed no change in 18 (28.5%), restored function in 9 (14.2%), improved status in 34 (53.9%), and deteriorated NFI in only 2 (3.1%) cases. The association between NCS-SSR abnormalities was significant for a longer duration of disease at presentation (P = 0.04), in multibacillary cases [OR 9.12 (95% CI, 1.22-67.93)], in those in reaction [OR 3.56 (95% CI, 0.62-20.36)] and in those aged over 40 [OR 1.93 (95% CI, 0.28-13.41)]. There was an improvement in WHOQOL-BREF and SALSA scores at release from treatment (P = 0.005 and P = 0.01, respectively). CONCLUSION The majority of leprosy patients on treatment show improvement in NFI at the completion of therapy. However, change is influenced by critical factors such as bacillary load, disease duration, age, and the presence of reaction(s).
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Affiliation(s)
- Apoorva Sharma
- Department of Dermatology, Venereology and Leprology, 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
| | - Aastha Takkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, 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
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Spitz CN, Pitta IJR, Andrade L, de Carvalho LB, de Carvalho DMT, Schmidt FDR, Siquara de Sousa AC, Mendonça SM, Sarno EN, Sales AM, Pinheiro RO, Jardim MR. Case report: Myelitis and ganglionitis, an atypical presentation of Hansen's disease. Front Med (Lausanne) 2024; 11:1400423. [PMID: 38835799 PMCID: PMC11149418 DOI: 10.3389/fmed.2024.1400423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/22/2024] [Indexed: 06/06/2024] Open
Abstract
Hansen's disease, or leprosy, is a disease characterized by dermatological and neurological disorders. A neural form also exists, in which peripheral neuropathy occurs in the absence of skin lesions. However, cases of leprosy that involve the central nervous system and proximal nerves are rare in the literature. We describe the case of an oligosymptomatic patient diagnosed with the neural form of leprosy with involvement of peripheral nerves, dorsal root ganglion, and cervical spinal cord in an atypical presentation of the disease. Through complementary examinations and nerve biopsies, the bacillus was identified, and treatment was subsequently initiated. This case highlights the importance of investigating the suspicion of leprosy, even in cases with atypical manifestations, as early diagnosis and treatment can reduce neurological damage and deformities.
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Affiliation(s)
- Clarissa Neves Spitz
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Izabela Jardim R Pitta
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Neurology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Ligia Andrade
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Larissa Bittencourt de Carvalho
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | - Ana Caroline Siquara de Sousa
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Euzenir Nunes Sarno
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna Maria Sales
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology on Neuroimmunomodulation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Rodrigues Jardim
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Benlamkadam S, Raymond K, Chraa M, Kissani N. Neurologic Complications of Leprosy: A Case Series. Cureus 2024; 16:e59884. [PMID: 38854261 PMCID: PMC11159591 DOI: 10.7759/cureus.59884] [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: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Leprosy, caused by the Mycobacterium leprae complex, manifests as a chronic infection. Its hallmark presentation involves the neurocutaneous syndrome, characterized by peripheral nerve involvement and dermatologic lesions. Neurological complications significantly contribute to disability in leprosy patients. Peripheral neuropathy may manifest acutely or chronically, in either axonal or demyelinating forms, and can present as mononeuropathy, mononeuropathy multiplex, or polyneuropathy. The diverse clinical presentations emphasize the importance of considering leprosy in the differential diagnosis of peripheral neuropathy, enabling appropriate investigative approaches. Skin and nerve biopsies, slit skin smears, and nerve conduction studies serve as crucial diagnostic tools for identifying peripheral nerve involvement in leprosy. In this paper, we present three cases of leprosy with peripheral nerve involvement, discussing their clinical spectrum, diagnostic approach, and management.
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Affiliation(s)
| | - 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
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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.
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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
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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.
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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
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Pitta IJR, Angst DBM, Pinheiro RO, Vieira JSDS, Spitz CN, Andrade LR, Carvalho LB, Hacker MA, Sarno EN, Jardim MR. Cytokines profile in pure neural leprosy. Front Immunol 2023; 14:1272471. [PMID: 38116016 PMCID: PMC10728593 DOI: 10.3389/fimmu.2023.1272471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Pure Neural Leprosy (PNL) is a form of this long time known disease that affects only the peripheral nervous system. Since it is a rare form of the disease, its pathophisiology is still poorly understood. Objective Describe the cytokines profile in patients with PNL. Methods 30 Patients diagnosed with PNL in the Souza Araujo Outpatient Clinic and with cytokines evaluated were selected. They were evaluated by neurologists and diagnosed after a nerve biopsy. Serum levels of IL-1 β, IL-6, IL-10, IL-17, TNF, CCL-2/MCP-1, IFN-ϒ, CXCL-10/IP-10 and TGF-β were evaluates at the moment of the diagnosis. Results Neural thickening was a common clinical finding in this groups of patients. Small and medium sensitive fibers signs and symptoms were present in 92% of the patients and motor involvement in 53%. 43% of patients presented neuropathic pain and no one had neuritis TGF-beta, IL-17, CCl-2 and IP-10. CCL-2 levels were associated with demyelinating patters and IP-10 and IL-1o were associated with axonal patterns at NCS. Discussion PNL patients' cytokine profile appears to be different of other clinical forms of leprosy, with the presence of cytokines described in both tuberculoid and lepromatous leprosy. High levels of CCl-2 may be related to the presence of silent neuritis as well as the presence of IL-10. PNL is unique a form of leprosy, therefore, understanding its immunological profiles essential to better understand the disease itself.
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Affiliation(s)
- Izabela Jardim R. Pitta
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Department of Neurology, Antonio Pedro University Hospital/Fluminense Federal University, Niteroi, 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, Rio de Janeiro, Brazil
- Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, 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, Rio de Janeiro, Brazil
- Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Larissa Bittencourt Carvalho
- 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, Rio de Janeiro, Brazil
- Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, 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, Rio de Janeiro, Brazil
- Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
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Barbosa CC, Bezerra GSN, Xavier AT, de Albuquerque MDFPM, do Bonfim CV, de Medeiros ZM, de Souza WV. Systematic Review of Survival Analysis in Leprosy Studies-Including the Following Outcomes: Relapse, Impairment of Nerve Function, Reactions and Physical Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12155. [PMID: 36231457 PMCID: PMC9566694 DOI: 10.3390/ijerph191912155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Leprosy is a public health problem in South American, African and Oceanian countries. National programs need to be evaluated, and the survival analysis model can aid in the construction of new indicators. The aim of this study was to assess the period of time until the outcomes of interest for patients with or exposed to leprosy by means of survival analysis surveys. This review researched articles using the databases of PubMed, Science Direct, Scopus, Scielo and BVS published in English and Portuguese. Twenty-eight articles from Brazil, India, Bangladesh, the Philippines and Indonesia were included. The Kaplan-Meier method, which derives the log-rank test, and Cox's proportional hazards regression, which obtains the hazard ratio, were applied. The mean follow-up until the following outcomes were: (I) leprosy (2.3 years) in the population who were exposed to it, (II) relapse (5.9 years), (III) clinical manifestations before, during and after treatment-nerve function impairment (5.2 years), leprosy reactions (4.9 years) and physical disability (8.3 years) in the population of patients with leprosy. Therefore, the use of survival analysis will enable the evaluation of national leprosy programs and assist in the decision-making process to face public health problems.
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Affiliation(s)
- Celivane Cavalcanti Barbosa
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | - Amanda Tavares Xavier
- Postgraduate Health Sciences, University of Pernambuco, Recife 50100-130, Brazil
- Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | - Cristine Vieira do Bonfim
- Postgraduate Program in Public Health, Federal University of Pernambuco, Recife 50670-901, Brazil
- Social Research Division, Joaquim Nabuco Foundation, Ministry of Education, Recife 52171-010, Brazil
| | - Zulma Maria de Medeiros
- Postgraduate Health Sciences, University of Pernambuco, Recife 50100-130, Brazil
- Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | - Wayner Vieira de Souza
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
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