A clinical study of eye complications in leprosy

A study was conducted to find out the incidence of ocular complications in leprosy. The ocular lesions were found in 6.6% of lepromatous leprosy and 1.6% in nonlepromatous leprosy. Out of 150 patients with eye lesions 74% were males and 80% belonged to lepromatous leprosy. The age group in all the patients varied from 3rd to 6th decade. Mean duration of leprosy ln lepromatous leprosy was 6.2 years. The important eye complication observed were lagophthalmos (8.1%), corneal ulcers (10%) and iridocyclitis (24%). The loss of eye-brows (76%) was found to be most frequent in this study followed by corneal lesion (62%). It is concluded that examination of eyes are essential in all types of leprosy.     

A study of ocular complications in leprosy

A total of 380 leprosy patients were studied in four different leprosy hospitals. The involvement of eye was found in 18.95% of cases in which 10.97% in lepromatous leprosy and 8.16% in non-lepromatous leprosy cases. In total cases studied 52.63% were of lepromatous leprosy and 47.37% of non lepromatous leprosy cases. Among them 11.05% were males and 18.95% were females. In 72 cases of ocular involvement, males constituted 80.56% and females 19.44% of cases. Maximum cases (52.78%) of ocular involvement were in leprosy patient with 5 to 10 years of duration. Blindness among the total leprosy patients studied was 1.84% which was mainly due to corneal opacity following exposure keratitis and ulceration, iridocyclitis and its complications.     

Leprotic keratopathy in India

Corneal affections cause severe ocular morbidity in leprosy. Poor nutrition and low socio-economic status make the eyes prone to repeated secondary infections which makes the pattern of corneal disease in this country different from that reported in western literature. A study of 250 patients shows that leprotic keratopathy has 4 different patterns. Primary leprous keratitis was seen in 56.5% of cases, while secondary leprous keratitis (groups B, C & D) constituted 57.7%. In the latter group the ocular morbidity could be prevented by controlling infection and prevention of concomitant diseases. Cases of lepromatous leprosy showed a consistently higher incidence of different types of corneal involvement than tuberculoid cases.     

Uveal changes in leprosy

A total of 424 leprosy patients were screened for uveal involvement. Uveal changes were found in 11.2% of these patients. Uveal involvement was more common in patients with greater duration of the disease and in patients on irregular Dapsone therapy. Of the patients with uveal involvement 82% were lepromatous, 16% were borderline and 2% were of tuberculoid leprosy. Uveal changes in form of active iridocyclitis (21.3%), healed iridocyclitis (58.5%), iris atrophy (10.6%), iris pearls (7.4%), small irregular pupil (46.7%), pupil refractory to dilatation (56.3%) were seen. Posterior segment involvement was rare. Lepromatous and borderline leprosy patients with no clinical evidence of uveal involvement had decreased power of accommodation as compared to normal subjects.     

麻风性葡萄膜病的调查研究

目的：了解麻风性葡萄膜病的特点和患病情况。方法：选择江苏泰兴市存活的麻风治愈者及现症患者1045例，由培训的眼科医生检查，资料输入计算机统计分析。结果：麻风杆菌的直接损害、Ⅱ型麻风反应和继发性角膜病引起的葡萄膜病占7．85％，现症(25％)、多菌型(24．47％)和病期长(38．93％)的病人患病率明显增高。损害以肉芽肿虹膜睫状体炎为特征，睫状充血占14．73％，瞳孔形状不规则(48．06％)、光反应消失(45．74％)、虹膜后粘连(35．66％)和小瞳孔(28．68％)比较常见，其次为瞳孔闭锁(19．38％)、虹膜前粘连(17．83％)、虹膜萎缩(17．05％)、色素脱落(15．5％)和膜闭(14．73％)o慢性虹膜睫状体炎并发白内障占81．54％，视力减退占60％，眼盲为40．24％，可治盲为52．73％。结论：麻风性葡萄膜病可因麻风杆菌直接侵犯，也可由Ⅱ型麻风反应引起。好发于现症、多菌型及病期长的病人。损害以肉芽肿虹膜睫状体炎为特征，多数并发白内障并导致视力损害。     

128例麻风患者眼病与视力调查分析

目的：了解当前麻风患者的眼病患病情况及其视力下降原因。方法：检查128例住院麻风病人眼病及其视力。结果：100例患者（78．13％），189只眼（73．83％）有眼病，主要眼病为兔眼（45．70％），角膜病变（34．77％），角膜感觉障碍（32．42％），陈旧性虹睫炎（26．56％），白内障（23．44％），下睑外翻（17．19％）等，8l例患者（63．28％），144只眼（56．25％）有视力下降，引起视力下降的主要原因依次为白内障（38．19％），角膜病变（25．69％），虹睫炎（19．44％）。结论：随着麻风病人年龄增长，白内障在其视力下降中作用突出，要加强防治，对其他眼疾，也要训练病人进行自我护理，防止眼病加重及视力下降。     

Erythema nodosum leprosum: reactional leprosy

The different clinical forms of leprosy are mainly related to the variety of immunological responses to the infection. Thus, lepromatous leprosy occurs in patients with a poor cell-mediated immunity to Mycobacterium leprae, whereas tuberculoid leprosy is associated with a high resistance to leprosy bacillus. Intermediate forms, including borderline tuberculoid leprosy, borderline lepromatous leprosy, and borderline leprosy, are a continuous and unstable spectrum of the disease. Leprosy reactions are rare and not well-known states that interrupt the usual chronic course and clinical stability of patients with leprosy. They are expressions of immunological perturbations. Attending to the clinical and histopathological manifestations, leprosy reactions may be separated in 2 or 3 different variants: reverse reaction (type I), erythema nodosum leprosum (type II), erythema polymorphous (type II) and Lucio's phenomenon, mainly considered a type II reaction, but sometimes designated type III. Type I leprosy reaction, also named "upgrading reaction," occurs in borderline leprosy states and is associated with a shift toward the tuberculoid pole. Type II reaction usually occurs in lepromatous leprosy, and there are 3 different clinical variants, including erythema nudosum leprosum, erythema polymorphous-like reaction, and Lucio's phenomenon.     

联合化疗中麻风反应的临床特征及糖皮质激素治疗的效果分析

目的了解麻风联合化疗时麻风反应的发生情况,评价糖皮质激素对麻风反应的治疗效果。方法对本市1986-2005年采用联合化疗方案治疗后达到临床治愈的新发及复发麻风病人的临床资料进行回顾性分析。结果 63例进行联合化疗的麻风患者,有37例曾经发生72例次麻风反应,23例发生Ⅰ型麻风反应34例次,15例发生Ⅱ型麻风反应31例次,7例发生混合型麻风反应7例次;且73.53%麻风反应发生在联合化疗1年内,Ⅱ型麻风反应均出现在联合化疗1年后,但是混合型麻风反应出现时间不一。麻风反应以皮肤和周围神经症状为主要表现,其中Ⅰ型、Ⅱ型和混合型麻风反应发生时有皮肤症状者分别占64.71%,100%和100%,有神经受累者分别占100%,61.29%和42.86%。治愈24例次,显效19例次,好转21例次,无效0例次,恶化8例次,有效率为59.72%。糖皮质激素治疗后25例次(34.72%)出现胃部不适,16例次出现满月脸多血质,7例次出现骨质疏松症样疼痛,但是均未影响治疗。结论麻风联合化疗患者麻风反应高发,神经受累相对较多,激素治疗麻风反应有一定的效果,但治疗方案仍有改进的空间。     

Observations on reactions of leprosy in the field

In order to assess the incidence of reaction in leprosy, it would be necessary to examine the data from a field control unit. In this study, it was found, at a fully monitored control unit, that Type I reaction occurred in 3.9% of borderline cases and Type II in 23.7% of LL and BL cases. Even so, the load of reaction is not high since reaction of Type I and Type II together are seen only in 3.7% of all types of cases. A majority of them are of mild or moderate degree and could be treated as out-patients. Of the borderline cases, the BB type showed maximum rate of reaction. The BL type can present with both Type I and Type II reactions with a total incidence of 12.8%. While the BT type constituted 74% of total cases, reaction of Type I occurred in 3.1% of cases. Reaction also occurred in 0.8% of RFT cases.     

Mast cells in leprosy and leprosy reaction

BACKGROUND: Mast cells can be visualized in routine, acid-fast-staining, paraffin tissue section as metachromatic staining cells, and can be activated to release inflammatory mediators which play a role in the cell-mediated immune response. METHODS: Skin biopsy tissues were taken from the most active skin lesion of each leprosy patient at the time of diagnosis (nonreactional group) and at the time of reaction (reactional group) during the years 1994-1997 in the leprosy clinic at the Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. Mast cells were identified by metachromatic staining (purple) in Fite's stain sections and reported as the average number of cells per high power field in three compartments: at the center and periphery of the granuloma and in the interstitium. The data were analyzed in three groups: nonreactional group, type I, and type II leprosy reactions. The mast cell count of each group and each compartment of the section, expressed as the mean +/- standard error, was compared. RESULTS: A total of 95 persons were included in the study, but 108 tissue sections were obtained due to nine cases having more than one section. Of these patients, 63 cases (66.32%) had no reaction, 19 cases (20%) had type I reaction, and 13 cases had type II reaction. There was no difference in age and sex among these groups. The mast cell count in the interstitium was higher than that within the granuloma, both at the center and at the periphery, in every type, and the count in this area reduced significantly in leprosy reactions, both type I and type II, compared with the nonreactional group. CONCLUSIONS: The change in the average mast cell number in nonreactional leprosy and leprosy reactions may indicate the important role of mast cells in dynamic changes in the cell-mediated immune response in leprosy and leprosy reactions.     

麻风联合化疗中发生麻风反应43例临床分析

目的:了解联合化疗(MDT)中发生麻风反应患者的临床特征及相关因素,为麻风防治工作提供依据.方法:收集2006-2020年在全国麻风病防治管理信息系统(LEPMIS)中登记并终审通过的山东省所有完成MDT且在此期间发生麻风反应的患者的相关信息,应用SPSS 23.0软件进行一般描述性统计分析和非参数Spearman秩相...     

Clinical manifestations of iridocyclitis in leprosy

Iridocyclitis--an inflammation of the iris and ciliary body occurs in lepromatous spectrum of leprosy of long duration. It is usually bilateral, has a very chronic course with acute exacerbations which are suppressed with the help of corticosteroids and other antiinflammatory drugs--Mydriatic to keep the Pupil dilated and also an antibiotic to take care of secondary infection which may be present. It is a major cause of blindness, due to its secondary damaging effects on the various ocular tissues. Medical and Paramedical Workers attending these patients must be made aware of the chronicity of the iridocyclitis so that regular referrals for examination of the eyes including slit lamp examination could be done and the activity of the disease and its complications detected early and treated. This chronic variety of iridocyclitis often gets less medical attention because of its insidious onset and minimal clinical signs in early stages, except by slit lamp examination. 57 patients suffering from iridocyclitis attending the ophthalmic department of S.L.R. & T.C. Karigiri were followed up carefully over a period of 2 1/2 years to study the clinical manifestations of iridocyclitis, it's complications and management.     

Eye lesions in leprosy

Out of 742 out-patients screened for ocular disease, 177 (24%) had eye lesions due to leprosy. These were more in the lepromatous spectrum of the disease and showed increasing trend with age of patient and duration of the disease. Madarosis was the commonest lesion (76%). The serious and sight threatening lesions like lagophthalmos, corneal anaesthesia, corneal opacities and ulcers, iritis and complicated cataracts constituted 8.22% of the lesions. Blindness due to corneal opacity and complicated cataract developed in 6 patients, constituting 3.4% of eye lesions with a prevalence rate of 0.8% among all the leprosy patients. Although the blinding lesions occurred in a very small percentage of patients, most of these are preventable through early recognition and institution of appropriate treatment. The simple techniques of examination to detect potentially sight threatening lesions should be taught to all leprosy workers to prevent blindness among leprosy patients.     

Soluble interleukin-2 receptors: levels in leprosy, and during and after type 1 (lepra) and type 2 (ENL) reactions.

Twenty-five patients with Type 1 (lepra) and Type 2 (ENL) reactions, were assayed for SIL-2R in serum--before and after treatment for their acute condition--and the results were compared with 10 normal healthy adults and 20 patients of leprosy per se. Classification of each subject into different leprosy groups, and into various types and subtypes of reactions, was done according to standard criteria, prior to inclusion into the study. Detailed statistical evaluation of the data revealed significantly higher levels of SIL-2R in all leprosy patients, as compared to normal controls, with higher levels in the multibacillary groups as compared to the paucibacillary group. SIL-2Rs appeared higher in Type 1 upgrading reaction than in other forms of reaction, though this was not statistically significant. There was no significant change in levels following treatment and clinical remission.     

Mycobacterium leprae infection and serum lactoferrin levels

Serum lactoferrin level, using competitive enzyme linked immunosorbent assay (ELISA) method, was estimated in 298 leprosy patients admitted into the hospital and attending the out-patient department of the Schieffelin Leprosy Research and Training Center. Serum from an equal number of non-leprosy individuals served as control. Mean (SD) of serum lactoferrin in non-leprosy individuals was 0.277 (0-092) microg/ml while in leprosy patients it was 0.494 (0.394) microg/ml, the difference being significant (P=0.0001). Serum lactoferrin levels were not significantly associated with type 2 reactions (P=0.613). Serum lactoferrin was significantly associated with age (P = 0.006), duration of the disease (P=0.0001), DDS monotherapy (P =0.007), deformity (P= 0.005), average bacterial index (BI) (P=0.01) and smear positivity (P=0.0001), orbicularis oculi weakness (P= 0.001), lagophthalmos (P = 0.002), corneal opacity (P = 0.001) and cataract (P=0.004) in simple regression analysis. All these variables, with the exception of smear positivity (P=0.019), lost their significance (P>0.05) when analysed using multiple regression. Serum lactoferrin showed poor association with type 1 (P = 0.286) and type II reactions (P = 0.613) and iridocyclitis (P = 0.207). We conclude that serum lactoferrin is strongly and inversely associated with increasing BI but does not show significant association with type 2 reactions.     

A study of leprosy reactions in a tertiary hospital in Delhi

A retrospective study of 531 leprosy patients was undertaken to study the profile of reactions in the post Multi-Drug-Therapy period in a tertiary hospital in Delhi. BT was the most common group. The prevalence of reactions was found to be 8.09% for the Type 1 and 4.70% for the Type 2 reactions for a male:female ratio of 2.2. The Type 1 reaction was most frequently observed in the BB group followed by BL, BT and LL groups respectively. More than half of the patients had reactions at the time of presentation. In only 39.8% of the patients did reaction follow Multi-Drug-Therapy. In 4.5% of the patients with Type 1 reactions (T1R), concomitant infections were noted. The most common presentation of T1R was cutaneous lesions (74.41%) followed by cutaneous lesions and neuritis (53.6%), neuritis alone (12.1%), and only edema of hands and feet (7.31%) respectively. The Type 2 reactions (T2R) presented chiefly as papulo-nodular (92%) lesions followed by pustulonecrotic (8%) lesions. Associated neuritis was found in 40% and periosteitis and iritis in 8% and 4%, respectively. In 8.6% of the patients with T2R, precipitating factors could be observed. The prevalence of deformities in patients with reaction was 25%, and was more common in females. Deformities were observed in 23.25% of the T1R patients and 28% of the T2R patients.     

Assessment of testicular volume in bacilliferous leprosy: correlation with clinical parameters

Testicular involvement in leprosy was studied in 30 multi-bacillary (BL/LL) patients. Ten (33.3%) gave past history of type II reactions, of whom nine (30%) gave history of testicular pain and/or swelling. Decreased libido was a common complaint (63.3%). Gynaecomastia was noted in 3 patients (10%) and altered hair pattern in 11 patients (36.7%). Testicular sensation was impaired in 10 (33.3%) patients. Testicular volume was assessed objectively using the Prader orchidometer and found to be reduced in nine (30%) patients. Reduction in testicular volume correlated with longer duration of disease and a past history of type II reaction.     

Leprosy Scenario at a Tertiary Level Hospital in Delhi: A 5-year Retrospective Study

Background:

Leprosy has been officially eliminated from India since December, 2005; still, there are districts and blocks reporting high prevalence indicating ongoing transmission. The present study aimed at determining the current clinical profile of leprosy from a tertiary level hospital in Delhi.

Materials and Methods:

A retrospective, record-based study was carried out on patients diagnosed and registered in the leprosy clinic of a tertiary level teaching hospital in East district of Delhi (April 2007 to March 2012). Data regarding demographic details, clinical features, treatment started and complications was analyzed.

Results:

A total of 849 patients were registered over a 5-year period, with M: F ratio of 2.3:1. 9.3% were children (≤14 years). 54.3% patients were immigrants from adjoining states. Multibacillary leprosy was the most common clinical type (86.9%). Borderline tuberculoid leprosy was the most frequent morphologic type, seen in 56.3% followed by borderline-borderline (1.5%), borderline lepromatous (24.9%), lepromatous leprosy (8.1%), pure neuritic (8.1%), histoid and indeterminate leprosy (0.5% each). 37.4% patients presented in reaction (Type I in 30.4% cases and Type II in 7% cases). WHO grade II deformities were diagnosed in 37.9% with claw hand being the most common paralytic deformity (23.3% cases).

Conclusion:

Our study offers insight into the current status of the disease in an area of otherwise low prevalence. It is seen that despite statistical elimination, multibacillary disease, leprosy reactions and deformities are commonly seen as presenting manifestations, in contrast to national projected trends. Delhi''s unique demography with a high degree of migrant workers, presenting to our center (near border location) could be a possible contributing factor towards these aberrations. It highlights the need for continuation of targeted leprosy control activities and active case detection.     

Circulating cytokine profiles in leprosy patients

BACKGROUND: Leprosy is a chronic infectious disease caused by Mycobacterium leprae which is an obligate intracellular pathogen. It is characterised by a broad spectrum of clinical forms dictated by the patient's immune response to the organism. The tuberculoid pole has good cell mediated immunity to M. leprae, with few lesions and bacilli while the lepromatous pole has poor immunity coupled with extensive involvement and greater bacillary load. METHODS: We studied serum levels of interferon gamma and interleukin 6 in 100 patients of untreated leprosy, compared them with 30 age and sex matched normal healthy controls and co-related them with different parts of the spectrum and reactional episodes. The purpose of this study was to delineate the role of cytokines and their clinical implications in the leprosy spectrum and during reactional episodes. RESULTS: We observed that mean cytokine levels were significantly higher in the patient group as compared to the controls. In the non reactional patient group, pure neuritic leprosy patients showed highest levels of INFgamma which were directly proportional to the extent of nerve involvement. Lepromatous leprosy patients had the highest levels of IL6. Bacteriological index demonstrated a negative and positive corelation with INFgamma and IL 6 levels respectively. Type I and Type II reactional patients had higher levels of INFgamma and IL 6 respectively as compared to nonreactional patients. CONCLUSIONS: Our results suggest that pure neuritic leprosy and borderline tuberculoid patients in type I reaction are at greatest risk for nerve and tissue damage. Thus cytokines have the potential to play a significant role in classification, prognosis and treatment of leprosy.     

Effect of clofazimine on eye in multibacillary leprosy

Seventy-six patients of multibacillary leprosy received clofazimine as part of multidrug therapy (MDT) for periods ranging between 6 and 24 months. Complete ocular examination including slit lamp microscopy and examination of tears was carried out in all these patients. Reddish brown conjunctival and corneal pigmentation was seen in 46% and 53% of the patients respectively. Clofazimine crystals in tears were found in 32% of the patients. Apart from this no other eye changes or symptoms attributable to clofazimine were observed.