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Harikrishna GV, Ca J, Doddapaneni S, Bhat N, Bhanu P. A Case of Borderline Tuberculoid Leprosy With Type One Lepra Reaction. Cureus 2023; 15:e38081. [PMID: 37252606 PMCID: PMC10212743 DOI: 10.7759/cureus.38081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. The variants that can be identified include tuberculoid (TT), borderline tuberculoid (BT), mid-borderline (BB), borderline lepromatous (BL), and lepromatous forms (LL). Type one lepra reactions are delayed hypersensitivity reactions that are often observed in borderline variants due to an unstable immunological response. They can exacerbate skin lesions and neuritis, leading to a higher risk of disabilities and deformities. Early detection and management would play a major role in limiting morbidity. Here, we present a case of a 46-year-old male diagnosed with borderline tuberculoid leprosy on multidrug therapy who developed features suggestive of type one lepra reaction. Early recognition of this entity helps in mitigating the risk of permanent nerve damage, disability, deformity, and morbidity.
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Affiliation(s)
| | - Jayashankar Ca
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Sravya Doddapaneni
- Dermatology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Nuthan Bhat
- Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
| | - Prakash Bhanu
- Dermatology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
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Tulip A. Jhaveri, Samantha Williams, Sandeep Kancharla, Ithiel James Frame, Allison Cruse, Svenja J. Albrecht, Barbara M. Stryjewska, Risa M. Webb. Closing the Brief Case: Delayed Diagnosis of Cutaneous Mycobacterial Infection in Rural Mississippi. J Clin Microbiol; 60:e00308-22. [PMID: 36541842 DOI: 10.1128/jcm.00308-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Tulip A. Jhaveri, Samantha Williams, Sandeep Kancharla, Ithiel James Frame, Allison Cruse, Svenja J. Albrecht, Barbara M. Stryjewska, Risa M. Webb. The Brief Case: Delayed Diagnosis of Cutaneous Mycobacterial Infection in Rural Mississippi. J Clin Microbiol; 60:e00307-22. [PMID: 36541843 DOI: 10.1128/jcm.00307-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Oliveira JAP, Gandini M, Sales JS, Fujimori SK, Barbosa MGM, Frutuoso VS, Moraes MO, Sarno EN, Pessolani MCV, Pinheiro RO. Mycobacterium leprae induces a tolerogenic profile in monocyte-derived dendritic cells via TLR2 induction of IDO. J Leukoc Biol 2020; 110:167-176. [PMID: 33040382 PMCID: PMC8359402 DOI: 10.1002/jlb.4a0320-188r] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/03/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
The enzyme IDO‐1 is involved in the first stage of tryptophan catabolism and has been described in both microbicidal and tolerogenic microenvironments. Previous data from our group have shown that IDO‐1 is differentially regulated in the distinctive clinical forms of leprosy. The present study aims to investigate the mechanisms associated with IDO‐1 expression and activity in human monocyte‐derived dendritic cells (mDCs) after stimulation with irradiated Mycobacterium leprae and its fractions. M. leprae and its fractions induced the expression and activity of IDO‐1 in human mDCs. Among the stimuli studied, irradiated M. leprae and its membrane fraction (MLMA) induced the production of proinflammatory cytokines TNF and IL‐6 whereas irradiated M. leprae and its cytosol fraction (MLSA) induced an increase in IL‐10. We investigated if TLR2 activation was necessary for IDO‐1 induction in mDCs. We observed that in cultures treated with a neutralizing anti‐TLR2 antibody, there was a decrease in IDO‐1 activity and expression induced by M. leprae and MLMA. The same effect was observed when we used a MyD88 inhibitor. Our data demonstrate that coculture of mDCs with autologous lymphocytes induced an increase in regulatory T (Treg) cell frequency in MLSA‐stimulated cultures, showing that M. leprae constituents may play opposite roles that may possibly be related to the dubious effect of IDO‐1 in the different clinical forms of disease. Our data show that M. leprae and its fractions are able to differentially modulate the activity and functionality of IDO‐1 in mDCs by a pathway that involves TLR2, suggesting that this enzyme may play an important role in leprosy immunopathogenesis.
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Affiliation(s)
- Jéssica A P Oliveira
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mariana Gandini
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jorgenilce S Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sérgio K Fujimori
- Laboratory for Development and Analytical Validation, Oswaldo Cruz Foundation, Farmanguinhos, Rio de Janeiro, Brazil
| | - Mayara G M Barbosa
- Cascalho-Platt Laboratory, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Valber S Frutuoso
- Immunopharmacology Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Milton O Moraes
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Euzenir N Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Maria C V Pessolani
- Laboratory of Cellular Microbiology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Roberta O Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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de Mattos Barbosa MG, de Andrade Silva BJ, Assis TQ, da Silva Prata RB, Ferreira H, Andrade PR, da Paixão de Oliveira JA, Sperandio da Silva GM, da Costa Nery JA, Sarno EN, Pinheiro RO. Autophagy Impairment Is Associated With Increased Inflammasome Activation and Reversal Reaction Development in Multibacillary Leprosy. Front Immunol 2018; 9:1223. [PMID: 29915584 PMCID: PMC5994478 DOI: 10.3389/fimmu.2018.01223] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 05/15/2018] [Indexed: 12/15/2022] Open
Abstract
Leprosy reactions are responsible for incapacities in leprosy and represent the major cause of permanent neuropathy. The identification of biomarkers able to identify patients more prone to develop reaction could contribute to adequate clinical management and the prevention of disability. Reversal reaction may occur in unstable borderline patients and also in lepromatous patients. To identify biomarker signature profiles related with the reversal reaction onset, multibacillary patients were recruited and classified accordingly the occurrence or not of reversal reaction during or after multidrugtherapy. Analysis of skin lesion cells at diagnosis of multibacillary leprosy demonstrated that in the group that developed reaction (T1R) in the future there was a downregulation of autophagy associated with the overexpression of TLR2 and MLST8. The autophagy impairment in T1R group was associated with increased expression of NLRP3, caspase-1 (p10) and IL-1β production. In addition, analysis of IL-1β production in serum from multibacillary patients demonstrated that patients who developed reversal reaction have significantly increased concentrations of IL-1β at diagnosis, suggesting that the pattern of innate immune responses could predict the reactional episode outcome. In vitro analysis demonstrated that the blockade of autophagy with 3-methyladenine (3-MA) in Mycobacterium leprae-stimulated human primary monocytes increased the assembly of NLRP3 specks assembly, and it was associated with an increase of IL-1β and IL-6 production. Together, our data suggest an important role for autophagy in multibacillary leprosy patients to avoid exacerbated inflammasome activation and the onset of reversal reaction.
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Affiliation(s)
| | | | - Tayná Quintella Assis
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Helen Ferreira
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | | | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Turner D, McGuinness SL, McGuiness S, Leder K. Leprosy: diagnosis and management in a developed setting. Intern Med J 2015; 45:109-12. [PMID: 25582940 DOI: 10.1111/imj.12638] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
Abstract
Leprosy remains an important global health concern, but little has been published about its diagnosis and management in developed settings. It has been postulated that delay in diagnosis is common in developed settings. We reviewed all the cases of leprosy seen at a major tertiary referral centre between 1999 and 2013 and demonstrated that delay in diagnosis is common, especially when patients present with symptoms of leprosy reactions rather than classical symptoms, such as hypo-pigmented hypo-aesthetic skin lesions and neuropathy.
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Affiliation(s)
- D Turner
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Dupnik KM, Bair TB, Maia AO, Amorim FM, Costa MR, Keesen TSL, Valverde JG, Queiroz MDCAP, Medeiros LL, de Lucena NL, Wilson ME, Nobre ML, Johnson WD, Jeronimo SMB. Transcriptional changes that characterize the immune reactions of leprosy. J Infect Dis 2015; 211:1658-76. [PMID: 25398459 PMCID: PMC4425823 DOI: 10.1093/infdis/jiu612] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/04/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Leprosy morbidity is increased by 2 pathologic immune reactions, reversal reaction (RR) and erythema nodosum leprosum (ENL). METHODS To discover host factors related to immune reactions, global transcriptional profiles of peripheral blood mononuclear cells were compared between 11 RR, 11 ENL, and 19 matched control patients, with confirmation by quantitative polymerase chain reaction. Encoded proteins were investigated in skin biopsy specimens by means of immunohistochemistry. RESULTS There were 275 genes differentially expressed in RR and 517 differentially expressed in ENL on the microarray. Pathway analysis showed immunity-related pathways represented in RR and ENL transcriptional profiles, with the "complement and coagulation" pathway common to both. Interferon γ was identified as a significant upstream regulator of the expression changes for RR and ENL. Immunohistochemical staining of skin lesions showed increased C1q in both RR and ENL. CONCLUSIONS These data suggest a previously underrecognized role for complement in the pathogenesis of both RR and ENL, and we propose new hypotheses for reaction pathogenesis.
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Affiliation(s)
- Kathryn M. Dupnik
- Division of Infectious Diseases and Center for Global Health, Weill Cornell Medical College, New York, New York
| | | | | | | | | | | | | | | | | | | | - Mary E. Wilson
- Departments of Internal Medicine and Microbiology, University of Iowa and the VA Medical Center, Iowa City
| | - Mauricio L. Nobre
- Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte
- Hospital Giselda Trigueiro, Natal
- Post-graduate Program in Tropical Medicine, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro
- National Institute of Science and Technology of Tropical Diseases, Salvador, Bahia, Brazil
| | - Warren D. Johnson
- Division of Infectious Diseases and Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Selma M. B. Jeronimo
- Department of Biochemistry
- Institute of Tropical Medicine of Rio Grande do Norte, Universidade Federal do Rio Grande do Norte
- National Institute of Science and Technology of Tropical Diseases, Salvador, Bahia, Brazil
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de Oliveira AL, Amadeu TP, de França Gomes AC, Menezes VM, da Costa Nery JA, Pinheiro RO, Sarno EN. Role of CD8(+) T cells in triggering reversal reaction in HIV/leprosy patients. Immunology 2013; 140:47-60. [PMID: 23566249 DOI: 10.1111/imm.12108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 04/01/2013] [Accepted: 04/03/2013] [Indexed: 11/29/2022] Open
Abstract
It has been reported that the initiation of highly active anti-retroviral therapy (HAART) is associated with the development of reversal reaction (RR) in co-infected HIV/leprosy patients. Nevertheless, the impact of HIV and HAART on the cellular immune response to Mycobacterium leprae (ML) remains unknown. In the present study, we observed that ex vivo peripheral blood mononuclear cells (PBMCs) of both RR and RR/HIV patients presented increased percentages of activated CD4(+) T cells when compared with the healthy individuals (HC) group. The frequency of CD8(+) CD38(+) cells increased in the PBMCs of RR/HIV patients but not in RR patients when compared with the HC group. Both RR and RR/HIV skin lesion cells presented similar percentages of activated CD4(+) cells, but the numbers of activated CD8(+) cells were higher in RR/HIV in comparison to the RR group. The frequency of interferon-γ-producing cells was high in response to ML regardless of HIV co-infection. In ML-stimulated cells, there was an increase in central memory CD4(+) T-cell frequencies in the RR and RR/HIV groups, but an increase in central memory CD8(+) T-cell frequency was only observed in the RR/HIV group. ML increased granzyme B(+) effector memory CD8(+) T-cell frequencies in the RR/HIV PBMCs, but not in the HC and RR groups. Our data suggest that the increased expression of effector memory CD8(+) T cells, together with greater perforin/granzyme B production, could be an additional mechanism leading to the advent of RR in co-infected patients. Moreoever, this increased expression may explain the severity of RR occurring in these patients.
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