Necrotic erythema nodosum reaction associated with histological alterations of Lucio’s phenomenon

Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio’s phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.     

Lucio phenomenon mimicking antiphospholipid syndrome: The occurrence of antiphospholipid antibodies in a leprosy patient

Lucio phenomenon is an atypical reaction of leprosy, characterized by vasculitic lesions that can mimic antiphospholipid syndrome (APS) clinically. Distinguishing the two can be difficult as antiphospholipid autoantibodies may be present in patients with leprosy. We report on a 32‐year‐old female patient presenting with a sudden onset of fever, hemorrhagic bullae, and skin necrosis on her lower legs. She was treated for APS due to the presence of antiphospholipid antibodies but had an inadequate response. A skin biopsy revealed thrombotic vasculopathy and necrotizing vasculitis associated with aggregation of foam cells in the perivascular area and subcutis, with acid‐fast bacilli in the histiocytes and blood vessel walls. Direct immunofluorescence showed IgM, C3, and fibrinogen deposition in the superficial and deep dermal blood vessels. The pathology confirmed the diagnosis of Lucio phenomenon, and appropriate therapy was given. It is essential to evaluate the patient comprehensively, including clinical, serological, and pathological aspects, to obtain the correct diagnosis.     

江苏省2011－2015年麻风误诊情况分析

目的：：了解低发病率状态下江苏省2011－2015年麻风误诊情况。方法：对全省2011－2015年被误诊的新发麻风病例进行分析。结果：误诊与麻风发病年龄、麻风型别、畸残情况、查菌情况、流动人口有统计学关联。结论：新发麻风患者人数少、临床症状不典型及医生警惕性、业务水平不高，是导致麻风误诊的主要因素。     

浙江省麻风可疑症状监测系统实施效果评价

目的:评价浙江省麻风可疑症状监测系统的实施效果。方法:比较可疑症状监测系统实施前后病例早期发现情况、新发麻风病例畸残率和麻风病例误诊率。结果:监测系统运行后,新发现病人的平均延迟期从36.64个月缩短至17.89个月;II级畸残率从23.15%降至12.12%;误诊率从79.27%降至25.76%。结论:建立麻风可疑症状监测系统有利于麻风病例的早期发现和降低II级畸残率。     

麻风畸残患者实施自我护理3年效果

目的：探讨麻风畸残患者自我护理效果。方法：989例麻风残疾患者进行自我护理训练，发放自我护理手册和图解，提供必要的自我护理包，并定期随访3年。结果：患者红眼、眼痛、手皲裂、手溃疡、足皲裂、足溃疡等麻风继发性畸残分别较治疗前下降了78．95％、89．02％、91．86％、90．90％、93．85％和38．67％。且有87．06％的患者形成了自我护理行为。说明自我护理可被患者接受．而且效果肯定。结论：自我护理是预防和治疗麻风继发性畸残的重要手段。专业医务人员对患者的健康教育技巧、患者家属和乡村医生日常督导以及适宜的康复器材供应是治疗的关键．同时应开展小外科和矫形手术治疗以解决患者严重的兔眼和足底溃疡问题。     

Prevalence of Disability and Associated Factors among Registered Leprosy Patients in All Africa Tb and Leprosy Rehabilitation and Training Centre (ALERT), Addis Ababa,Ethiopia

Background

Delay in leprosy diagnosis and treatment causes disabilities due to nerve damage, immunological reactions and bacillary infiltration. Leprosy disability leads not only to physical dysfunction and activity limitation but also disrupts social interaction of affected individuals by creating stigma and discrimination. This study was aimed at assessing leprosy disability status in patients registered at All African TB and Leprosy Rehabilitation and Training Centre.

Methods

Medical records of leprosy patients registered from September 11, 2010 to September 10, 2013 G.C were reviewed. Prevalence of disability calculated, bivariate and multiple logistic regressions were used to determine crude and adjusted odds ratios with 95% confidence interval.

Results

The overall prevalence of disability was found to be 65.9% from all categories of patients (40.2% Grade I and 25.7% Grade II). The Prevalence among the new category was 62.8% (39.1% Grade 1 and 23.7% Grade 2). Those ageed above 30 years, with duration of symptoms 6–12 months and above 24 months, with sensory loss, nerve damage and reversal reaction were more likely to develop disability.

Conclusion

In this study the prevalence of disability, both Grade I and II, is very high. Disability was associated with age, duration of symptom, sensory loss, signs of nerve damage and reversal reaction. These risk factors indicate the existence of delay in diagnosis and treatment of leprosy cases. Therefore, the national leprosy control program should investigate leprosy case detection and diagnosis system in the country and work on improving early case detection and prevention of disability.     

Induction and treatment of anergy in murine leprosy

Leprosy is a disease consisting of a spectrum of clinical, bacteriological, histopathological and immunological manifestations. Tuberculoid leprosy is frequently recognized as the benign polar form of the disease, while lepromatous leprosy is regarded as the malignant form. The different forms of leprosy depend on the genetic and immunological characteristics of the patient and on the characteristics of the leprosy bacillus. The malignant manifestations of lepromatous leprosy result from the mycobacterial‐specific anergy that develops in this form of the disease. Using murine leprosy as a model of anergy in this study, we first induced the development of anergy to Mycobacterium lepraemurium (MLM) in mice and then attempted to reverse it by the administration of dialysable leucocyte extracts (DLE) prepared from healthy (HLT), BCG‐inoculated and MLM‐inoculated mice. Mice inoculated with either MLM or BCG developed a robust cell‐mediated immune response (CMI) that was temporary in the MLM‐inoculated group and long‐lasting in the BCG‐inoculated group. DLE were prepared from the spleens of MLM‐ and BCG‐inoculated mice at the peak of CMI. Independent MLM intradermally‐inoculated groups were treated every other day with HLT‐DLE, BCG‐DLE or MLM‐DLE, and the effect was documented for 98 days. DLE administered at a dose of 1.0 U (1 × 10⁶ splenocytes) did not affect the evolution of leprosy, while DLE given at a dose of 0.1 U showed beneficial effects regardless of the DLE source. The dose but not the specificity of DLE was the determining factor for reversing anergy.