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PubMed1993

Cross-sectional assessment of ELISA reactivity in leprosy patients, contacts, and normal population using the semisynthetic antigen natural disaccharide octyl bovine serum albumin (ND-O-BSA) in Cebu, The Philippines.

An indirect enzyme-linked immunosorbent assay (ELISA) using natural disaccharide octyl bovine serum albumin (ND-O-BSA) as antigen was used in testing leprosy patients, contacts and a normal population in Cebu, The Philippines, from 1985 to 1989. A total of 1413 persons were studied. The results suggested that ELISA reactivity and the bacterial index (BI) correlate in a general way. In multibacillary (MB) leprosy, positivity ranges from 54.2% to 92.3% among patients with a BI of < 2+ to > 4+ on the Ridley scale, with an overall average of 84.5%. Paucibacillary (PB) leprosy patients have a low degree of reactivity, with only 15.0% ELISA positive. The test is more efficient in detecting MB than PB leprosy. The contacts of MB leprosy showed 6.5% positivity; contacts of PB leprosy, 7.0% positivity. The normal population showed 1.7% positive ELISA or 17 per thousand population, which is very much less than that of the household contacts. However, because the normal population is a much larger population than the household contact population in a community, more new leprosy cases would emanate from it. Leprosy workers are concerned about the transmission of the disease to household contacts. However, for the reason stated above, we should be more concerned with the silent spread of the disease to the normal population in the community.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Multibacillary leprosy: lesions with macrophages positive for S100 protein and dendritic cells positive for Factor 13a.

In the defense against Mycobacterium leprae, macrophages play an essential part in the mechanism of bacterial lysis but require the presence of cytokines such as interleukin 2 and gamma interferon from lymphocytes in order to effectively kill the organisms in any number. While there have been many studies of the lymphocytes in lesions of leprosy, less attention has been given to the immunohistochemical characterization of the macrophage populations. In this study, the cutaneous lesions of 69 patients with leprosy (42 lepromatous, 5 mid-borderline, and 22 tuberculoid) were evaluated by immunohistochemistry for the expression of S100 protein, CD1a, CD68, muramidase, HLA-DR, and Factor 13a. The macrophages from lesions of polar, subpolar, and borderline lepromatous leprosy patients expressed S100 protein intensely and constantly. In contrast, the lesions of polar and subpolar tuberculoid leprosy had very few cells that were immunoreactive for S100 protein ('S100+') in the granulomas in the dermis. The macrophages in all lesions were reactive for CD68 and muramidase. In paraffin sections, macrophages of lepromatous lesions failed to stain for HLA-DR, whereas in tuberculoid lesions, they were strongly positive for HLA-DR. Three patients with histoid leprosy (relapse lesions) had lesions that were strongly positive for Factor 13a and were negative for S100 protein ('S100-'). Given the possible chemotactic and migration inhibition effects of the calcium-binding proteins of the S100 family, these data suggest a possibly important role for S100 protein in the accumulation of macrophages in lepromatous leprosy, and also reveal infection of Factor 13a + dermal dendritic cells in histoid leprosy.

Antigens, CD↗
PubMed1994

Protective effect of BCG against leprosy and its subtypes: a case-control study in southern Vietnam.

A case-control study was conducted to assess the protective effect of intradermal BCG against leprosy and its subtypes in southern Vietnam. A total of 177 cases were selected with a distribution by subtypes as follows: 38 TT, 23 BT, 51 BB, 36 BL, 22 LL, and 7 indeterminate. Two controls were matched with a case for age, sex, ethnic group, socioeconomic status, and district area. The odds ratio assessing the protective effect of BCG varied from 0.44 (0.19-1.03) in the BB subtype to 3.00 (0.24-37.5) in indeterminate leprosy; whereas its overall value was 0.71 (0.45-1.10) for leprosy per se. When all borderline leprosy types were pooled, the protective effect of BCG was found significant with an odds ratio of 0.48 (0.27-0.84). In the polar forms of leprosy, TT and LL, the odds ratio was > 1 with large confidence intervals. It is possible that BCG induces a shift in the immune response to a higher level of cell-mediated immunity. When BCG vaccination is given after primary infection with Mycobacterium leprae, this shift could be the cause of an increase in the risk of the occurrence of milder and transient forms of the disease. In TT forms BCG might reinforce the preexisting subclinical immunopathological reactions, and in stable LL forms BCG might be unable to induce any protective form of immunity. These results confirm the important variability in the protection offered by BCG with respect to the different types of leprosy, and may have important implications for the design and the interpretation of vaccine trials that should take into account the respective proportions of leprosy forms observed in the study region.

Adolescent↗
PubMed2005

Leprosy and mortality in the Medieval Danish village of Tirup.

Leprosy was a well-recognized and dreaded disease in Denmark in the Middle Ages (AD 1000-1536). A large fraction of the population was affected by leprosy in the 13th century. This paper analyzes the correlation between signs of leprosy and risk of dying in the small Danish village of Tirup (AD 1150-1350). Seven different dichotomous osteological lesions indicative of leprosy are analyzed, and it is possible to score at least one of these conditions on 135 skeletons of adult or adolescent people (aged 14 or more). Scores were transformed to a statistic, lambda, indicating the likelihood that the person to whom the skeleton belonged suffered from leprosy. The analyses indicate that the prevalence of leprosy among adult people in Tirup was 26% (95% confidence interval, 17-35%). The lambda statistic indicates that people who died with signs of leprosy did not differ in the distribution of age at death from those who did not have such signs. Skeletons showing dental enamel hypoplasia were less likely to come from skeletons with high lambda-values. The association between lambda and dental enamel hypoplasia indicates a relationship between stress in early childhood (ages 1-6 years) and subsequent development of signs of leprosy.

Bone and Bones↗
PubMed2006

Outside St. Jørgen: leprosy in the medieval Danish city of Odense.

Leprosy was a common and dreaded disease in the Danish Middle Ages (AD 1050-1536). Starting in the second half of the 13th century, leprosaria were established in many Danish towns and cities. In the city of Odense (on the island of Funen, Denmark), the cemetery of the leprosarium was totally excavated, and four nonleprosarium medieval and early modern cemeteries have been partly excavated. This paper explores the frequency of leprosy in the nonleprosarium cemeteries in Odense, and looks for evidence of selective exclusion from the ordinary population. The analyses are based on 733 skeletons from four cemeteries in Odense: the Gray Friars monastery, St. Albani parish church, St. Knuds cathedral, and Black Friars monastery. Seven lesions are scored and, based on known epidemiological properties (i.e., specificity and sensitivity) of these lesions, scores were transformed to statistics characterizing an individual's risk of having suffered from leprosy. This statistical approach remains of primary theoretical value, pending confirmation by independent research groups at other sites. Prevalence of the skeletal manifestation of leprosy at death varied between 0-17% among the different cemeteries in Odense. The highest prevalence was seen in cemeteries with many burials before AD 1400. It is estimated that before AD 1400, between 14-17% of those buried in the nonleprosarium cemeteries suffered from leprosy. In all nonleprosarium cemeteries, there was evidence for selective exclusion of people with facial leprosy lesions. For a short period just up to AD 1300, the cemetery of the Odense leprosarium had, on average, more than 20 yearly burials. The establishment of the leprosarium was followed within a relatively short period by a dramatic decline in the number of sufferers of leprosy in the nonleprosarium cemeteries. The number of yearly burials in the leprosarium cemetery also declined rapidly during the 14th century. The present analyses do not permit conclusions about the reasons for this decline in leprosy prevalence.

Bone and Bones↗
PubMed1998

Bone island and leprosy.

OBJECTIVE: To determine the incidence of bone islands in leprosy patients. DESIGN: X-rays of feet and hands of patients with Hansen's disease (leprosy) were reviewed retrospectively. A second group of related age- and sex-matched patients who did not have Hansen's disease was used for control purposes. Controls had undergone hand and foot X-rays during diagnosis of other pathologies. The patients with Hansen's disease were compared with the control groups, and were also analyzed as subgroups with different types of leprosy. The results were subjected to statistical analysis. PATIENTS: Ninety patients with Hansen's disease were randomly selected for this study. Patients who had had ulcers on hands or feet were excluded from the study. RESULTS AND CONCLUSIONS: Bone islands were demonstrated in 20 patients with Hansen's disease; no bone islands were observed in the controls. This was statistically significant (P < 0.01). Bone islands were only seen in patients with lepromatous leprosy and borderline types but were not demonstrated in patients with tuberculoid leprosy. There was also a statistically significant relationship for a disease duration of 15 years or more. The cause of this raised incidence of enostosis in leprosy patients is not clear, but there may be a genetic predisposition in patients with leprosy, or it may be a side effect of leprosy, especially the lepromatous form.

Adult↗
PubMed1984

Childhood leprosy and social response in south India.

This paper reports a field study of childhood leprosy in the state of Karnataka, India, as encountered through a private, secular leprosy hospital and its rural outpatient program serving some 60 villages. Symptoms of leprosy among children are subtle, ambiguous and not readily distinguishable from those of relatively innocuous skin ailments with which villagers of the region commonly lump them. In addition, severe stigma attaches to the disease. As a result, diagnosis tends to be resisted, rendering effective treatment difficult. The research focused on the hospital's comprehensive program of diagnosis, treatment, education and rehabilitation, and the responses of people of it. Three categories of response to diagnosis and treatment, as defined by the hospital program, were investigated: regular acceptors, irregular acceptors and refusers. Contrary to expectation, those who accept treatment irregularly and hence ineffectively, express greater awareness of the cause, symptoms and treatment of the disease than either those who accept regular treatment or those who refuse treatment. Despite frequent verbal denials of belief in, or fear of, contagion, people's behavior regarding leprosy and its victims indicates that such beliefs are indeed harbored. The effectiveness of the program is assessed with reference to its policies and procedures as they affect the rural population. Especially effective is the policy of not confronting people with diagnoses of leprosy in problematic childhood cases, but of asserting instead that leprosy can be averted if treatment is accepted. Resistance generated by the fear and stigma of leprosy is thus mitigated by presenting its childhood symptoms as pre-leprous rather than as early leprosy. The research concludes that the program has achieved notable success in each of its aspects and is therefore worthy of emulation elsewhere.

Adolescent↗
PubMed1989

Culture and 'compliance' among leprosy patients in Pakistan.

In Pakistan approx. 30% of the 18,000 known leprosy patients have dropped out of their treatment programs. To investigate reasons for such widespread noncompliance, 128 diagnosed leprosy patients--59 outpatients and 69 inpatients--were interviewed in Karachi. More than half of the 'noncompliant' outpatients denied having the disease. Denial was found to be an understandable coping mechanism in view of the severe stigma associated with leprosy. The presence of close-knit extended families, in which joint decision-making was the norm and in which such a dread diagnosis could spell the end of job and marriage prospects for even distant relatives, contributed to the likelihood of denial. In such a setting, the very term 'noncompliant' appeared to be an oversimplification since it covered so many different types of culturally-constrained behavior. In addition, many of the patients who initially seemed most 'compliant' by virtue of being long-term hospital inpatients in fact owed their hospitalization to the fact that they had been markedly noncompliant in the past. Thus the usual view that adherence to a biomedical treatment regimen constitutes 'compliance' and that nonadherence to such a regimen constitutes 'noncompliance' proved inadequate for understanding the health behavior of these Third World leprosy victims. The study also showed that many patients had initially consulted traditional healers, inadequately-trained physicians, and/or untrained medical practitioners for treatment of their symptoms, which resulted in lengthy delays before they were correctly diagnosed. Further, even after the diagnosis was made and appropriate medications were prescribed by trained personnel, most patients were not told what had caused their leprosy and how the drug regimen worked to combat it: when questioned, only 4% of the 128 respondents attributed the disease to infectious organisms. In addition, patients were usually not warned in advance of the possibility of undesirable side effects from their leprosy medications, which led to further 'compliance' problems. The findings of this study emphasize the need for better training of physicians and other health care providers in early diagnosis of leprosy and better health education of diagnosed patients. To be truly effective, the treatment of leprosy must include counseling of extended families and education of the public at large as well as enhanced communication with the patients themselves.

Adolescent↗
PubMed2005

Effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of leprosy: a population-based case-control study in Yavatmal District, India.

OBJECTIVE: To estimate the effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of leprosy. Study design. Population-based case-control study. METHODS: The study was carried out in Yavatmal District, Maharashtra, India. It included 364 cases of leprosy (diagnosed by the World Health Organization's criteria), born since 1962, that were detected during a leprosy survey conducted by the Government of Maharashtra in 2,175,514 people. Each case was pair-matched with one neighbourhood control for age, sex and socio-economic status. Exclusion criteria for controls included past or current history of tuberculosis or leprosy. BCG vaccination status was assessed by examination for the presence of a BCG scar, immunization records if available and information from subjects/parents of children. Subjects who were uncertain about BCG vaccination were not included. RESULTS: A significant protective association between BCG and leprosy was observed [odds ratio=0.46, 95% confidence intervals (CI) 0.34-0.61]. Overall vaccine effectiveness (VE) was 54% (95% CI 39-66). BCG effectiveness against multibacillary, paucibacillary and single skin lesion leprosy was 68% (95% CI 26-86), 57% (95% CI 29-74) and 48% (95% CI 22-65), respectively. Analysis of linear trend revealed a significant linear association between the protective effect of BCG and the type of leprosy. The BCG vaccine was more effective in those aged < or =20 years compared with those aged >20 years (VE 61%, 95% CI), among females compared with males (VE 60%, 95% CI), in lower socio-economic strata compared with upper and middle strata (VE 57%, 95% CI), and in subjects who had a BCG scar size < or =5 mm compared with those with a BCG scar size >5 mm (VE 61%, 95% CI). However, these differences were not statistically significant, as reflected by the overlapping 95% CIs. The overall prevented fraction was 35% (95% CI 22-46). CONCLUSION: The current study identified a beneficial role of BCG vaccination in the prevention of leprosy in the study population.

Adult↗
PubMed2004

Relative lack of clinical disease among household contacts of tuberculosis patients compared to leprosy households.

The incidence of clinical tuberculosis and clinical leprosy among household members of tuberculosis and leprosy patients in Sri Lanka was studied. The study period was approximately 20 years (January 1981 to December 2001) and the total number of patients and contacts were 325 and 968 for tuberculosis and 726 and 3066 for leprosy, respectively. While none of the tuberculosis patient households had more than 1 patient nor any contacts who developed clinical disease during the observation period, 20% (148/726) of the leprosy patients had more than 1 patient in the family and 0.9% (13/1403) of their contacts who were followed-up developed clinical leprosy during the observation period. Although the tuberculosis patient household contacts did not develop clinical disease, in 79% (88/112) of contacts who were tested by Western blot analysis, there was serologic evidence of Mycobacterium tuberculosis infection. These data show that in populations of comparable socio-economic, environmental and geographic locations, tuberculosis and leprosy show very different transmission patterns. In general, in tuberculosis household contacts, in spite of exposure, infection did not proceed to clinical disease. In contrast, a significant number of leprosy household contacts developed clinical leprosy. These findings have implications in the design and implementation of control programmes for these two diseases.

Adolescent↗
PubMed2000

Do nerve growth factor-related mechanisms contribute to loss of cutaneous nociception in leprosy?

While sensory loss in leprosy skin is the consequence of invasion by M. leprae of Schwann cells related to unmyelinated fibres, early loss of cutaneous pain sensation, even in the presence of nerve fibres and inflammation, is a hallmark of leprosy, and requires explanation. In normal skin, nerve growth factor (NGF) is produced by basal keratinocytes, and acts via its high affinity receptor (trk A) on nociceptor nerve fibres to increase their sensitivity, particularly in inflammation. We have therefore studied NGF- and trk A-like immunoreactivity in affected skin and mirror-site clinically-unaffected skin from patients with leprosy, and compared these with non-leprosy, control skin, following quantitative sensory testing at each site. Sensory tests were within normal limits in clinically-unaffected leprosy skin, but markedly abnormal in affected skin. Sub-epidermal PGP 9.5- and trk A- positive nerve fibres were reduced only in affected leprosy skin, with fewer fibres contacting keratinocytes. However, NGF-immunoreactivity in basal keratinocytes, and intra-epidermal PGP 9.5-positive nerve fibres, were reduced in both sites compared to non-leprosy controls, as were nerve fibres positive for the sensory neurone specific sodium channel SNS/PN3, which is regulated by NGF, and may mediate inflammation-induced hypersensitivity. Keratinocyte trk A expression (which mediates an autocrine role for NGF) was increased in clinically affected and unaffected skin, suggesting a compensatory mechanism secondary to reduced NGF secretion at both sites. We conclude that decreased NGF- and SNS/PN3-immunoreactivity, and loss of intra-epidermal innervation, may be found without sensory loss on quantitative testing in clinically-unaffected skin in leprosy; this appears to be a sub-clinical change, and may explain the lack of cutaneous pain with inflammation. Sensory loss occurred with reduced sub-epidermal nerve fibres in affected skin, but these still showed trk A-staining, suggesting NGF treatment may restore pain sensation.

Adult↗
PubMed2003

Chromosome 6q25 is linked to susceptibility to leprosy in a Vietnamese population.

Leprosy, a chronic infectious disease caused by Mycobacterium leprae, affects an estimated 700,000 persons each year. Clinically, leprosy can be categorized as paucibacillary or multibacillary disease. These clinical forms develop in persons that are intrinsically susceptible to leprosy per se, that is, leprosy independent of its specific clinical manifestation. We report here on a genome-wide search for loci controlling susceptibility to leprosy per se in a panel of 86 families including 205 siblings affected with leprosy from Southern Vietnam. Using model-free linkage analysis, we found significant evidence for a susceptibility gene on chromosome region 6q25 (maximum likelihood binomial (MLB) lod score 4.31; P = 5 x 10(-6)). We confirmed this by family-based association analysis in an independent panel of 208 Vietnamese leprosy simplex families. Of seven microsatellite markers underlying the linkage peak, alleles of two markers (D6S1035 and D6S305) showed strong evidence for association with leprosy (P = 6.7 x 10(-4) and P = 5.9 x 10(-5), respectively).

Alleles↗
PubMed2005

Protective role of vitamin E on the oxidative stress in Hansen's disease (Leprosy) patients.

BACKGROUND: A constellation of reactive oxygen species (ROS) capable of damaging cellular constituents generated in excess during the chronic, inflammatory, neurodegenerative disease process of leprosy. The consequences of this leads to enhanced oxidative stress and lower antioxidant status. Enzymatic antioxidants provide first line defense against ROS. We have measured the levels of oxidative stress indices like lipid peroxidation (LPO), protein carbonyls together with enzymatic antioxidants in the blood samples of control and leprosy patients. Nutritional rehabilitation by way of exogenous supplementation of functionally efficient antioxidants like vitamin E reactivates the enzymatic antioxidant system and guards against the insult caused by ROS during the pathogenesis of the disease and antileprosy chemotherapy. DESIGN: Untreated leprosy patients were selected on the basis of clinical examination and skin smear. All diagnosed untreated leprosy patients received multi drug therapy (MDT) consisting of rifampicin, dapsone and clofazimine as recommended by World Health Organization. A small number of untreated cases were selected for co-supplementation of vitamin E along with MDT. Oxidative stress indices, enzymatic and nonenzymatic antioxidant status were assayed in untreated, MDT treated and those supplemented vitamin E along with MDT. STATISTICAL METHODS: We have compared the significance in the mean+/-s.d. values of the oxidative stress indices and the levels of antioxidants using one way analysis of variance (ANOVA) between control, untreated, MDT treated and those supplemented vitamin E with MDT and the results were significant at P < 0.05. Statistical analysis of the results suggests that oral administration of vitamin E lowers oxidative stress and augments antioxidant status in affected individuals. RESULTS: Enhanced oxidative stress as evidenced by increased LPO and protein carbonyl in leprosy cases lowers the antioxidant status. Treatment with MDT has a limited impact on increased oxidative stress and decreased antioxidant status. Coadministration of vitamin E along with MDT decreases oxidative stress and activate the antioxidant status. DISCUSSION: The excess production of ROS as seen in leprosy cases could lead to degeneration of tissues and derangement of internal organs. The possible reason for the decreased antioxidant status in leprosy cases may be increased production of ROS, deranged liver function, and the free radical producing ability of drugs used in MDT of leprosy. Intervention with antioxidant supplementation like vitamin E prevents oxidative stress mediated through ROS and activates the net antioxidant status during the chronic course of the disease and antileprosy chemotherapy.

Adult↗
PubMed2000

Mycobacterium leprae--millennium resistant! Leprosy control on the threshold of a new era.

Over the past decades, the conditions of leprosy control implementation have changed dramatically. Introduction of multidrug therapy, together with the global effort of the World Health Organization to eliminate leprosy as a public health problem, had a tremendous impact on leprosy control, particularly by decreasing the registered prevalence of the disease. At the beginning of the new millennium, leprosy control programmes face several new challenges. These relate not only to changes in the prevalence of the disease, but also to changes in the context of leprosy control, such as those created by health sector reforms and other disease control programmes. This review discusses current knowledge on the epidemiology of Mycobacterium leprae and some important aspects of leprosy control. It is argued that our understanding is still insufficient and that, so far, no consistent evidence exists that the transmission of leprosy has been substantially reduced. Sustainable leprosy control, rather than elimination, should be our goal for the foreseeable future, which also includes care for patients on treatment and for those released from treatment. This, however, requires new strategies.

Communicable Disease Control↗
PubMed2002

Inoculation (tattoo) leprosy: a report of 31 cases.

Thirty-one female patients with leprosy lesions starting over tattoo marks observed over a period of 16 years are reported. All the patients belonged to the Chhattisgarh State, which is highly endemic for leprosy. Most of the patients were in the third decade of life. All of them had ornamental tattooing done by roadside tattoo artists, who used unsterile needles for tattooing a large gathering one after another with the same needles. In all of them, the first lesion of leprosy started over a tattoo mark. Twenty-five cases had only single lesion of leprosy exclusively confined to tattoo marks. The duration between tattooing and appearance of first lesion in most of the cases varied from 10 to 20 years. Paucibacillary leprosy was the commonest type observed in 29 cases, while two had multibacillary leprosy. The diagnosis was confirmed by histopathology in all cases. The present report supports the hypothesis of transmission of leprosy in these cases through tattooing. To the best of our knowledge, such a large collection of leprosy cases subsequent to tattooing has not been reported so far.

Adult↗
PubMedDate not supplied

The genetics of leprosy.

Population and family distributions of leprosy in the Bogia Subprovince of Papua New Guinea have been examined for evidence of inherited susceptibility to the disease. Evidence for multigenic inheritance of leprosy severity is provided by the restriction of pleiotropy with red-cell enzyme 6PGD phenotypes to a single clinical form of leprosy and by the superior fit of pedigree data to a multifactorial, rather than single-gene model, of inheritance. Discrimination of the multifactorial model as superior to the single-gene model in testing the mode of inheritance of quasi-continuous multiple threshold traits was possible by extending the models to incorporate information on assortative mating for leprosy. Leprosy epidemiological patterns simulated blood genetic marker gene frequency distributions of 13 polymorphic loci in their dependence on linguistic and distance effects. In an analysis of leprosy prevalence rates in 25 languages, leprosy rates corresponded more closely with linguistic similarity than with geographic proximity, suggesting the importance of ancestral genetic relationships between groups as a determinant of similarity in between-group leprosy susceptibility.

Blood Group Antigens↗
PubMed1980

HLA segregation of tuberculoid leprosy: confirmation of the DR2 marker.

Families with multiple cases of leprosy were tested for HLA (histocompatibility leukocyte antigen)-linked control of susceptibility to tuberculoid leprosy and association with HLA-DR2. Thirty-one non-HLA genetic markers were also examined for indications of non-HLA-linked genetic factors that might control susceptibility to tuberculoid leprosy. A significant (P = 0.002) preferential inheritance of HLA-DR2 by siblings affected with tuberculoid leprosy, but not by healthy siblings nor by siblings affected with lepromatous leprosy, was observed. In addition, combined family data showed a significant (P less than 0.0025) excess of identical HLA haplotypes inherited from healthy parents by siblings affected with tuberculoid leprosy. Segregation on non-HLA polymorphisms did not deviate significantly from what would have occured randomly. These data are compatible with a recessive inheritance of HLA-linked susceptibility to tuberculoid leprosy. The preferential segregation of DR2 observed in children with tuberculoid leprosy (P less than 0.001 for the combined data from India) indicates that the HLA-linked susceptibility gene is either DR2 or in linkage disequilibrium with it.

Epitopes↗
PubMed2006

Arthritis as presenting manifestation of pure neuritic leprosy--a rheumatologist's dilemma.

OBJECTIVES: Leprosy classically presents with cutaneous and neurological manifestations. In diagnosed cases of leprosy, rheumatological involvement varies from 1% to 70%. A primary articular presentation without cutaneous manifestations is not yet known. Herein, we present our experience of five cases of leprosy that presented with predominant articular involvement in the absence of cutaneous manifestations. METHODS: The study was conducted in the Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences located in the state of Uttar Pradesh, one of the nine endemic states in India. Case records of patients with a definite diagnosis of leprosy were screened for the presenting manifestations, pattern of articular involvement, tenosynovitis, neurological signs and symptoms. Reports of nerve conduction study (NCS), nerve and synovial biopsy and other diagnostic tests were retrieved from laboratory records. Available radiographs were examined for evidence of juxta-articular osteopenia and erosions. RESULTS: Case records of 11,740 patients were screened, of which 28 had a diagnosis of leprosy. Twenty patients had presented with rheumatological complaints primarily. Five of the patients who presented with inflammatory arthritis with/without tenosynovitis (n = 4) and tenosynovitis alone (n = 1) had pure neuritic leprosy. All of these patients had thickened peripheral nerves and abnormal NCS. Sural nerve biopsy confirmed the diagnosis of leprosy in all these cases. CONCLUSION: A combination of tenosynovitis and thickened nerves in association with symmetric polyarthritis should raise a suspicion of leprosy even in the absence of cutaneous features.

Adult↗