The present study included total of 182 clinically suspected cases of leprosy. A major problem in the management of leprosy patients is the occurrence of reactions. Repeated episodes tend to occur later in treatment than the type i reaction, usually after several years. Pathogenesis and pathology of leprosy international. Type 2 reaction or erythema nodosum leprosum enl is a type iii immunological reaction. In this retrospective study, we included 64 patients diagnosed during a 3year period as lepra reaction based on clinico. A clinico histopathological study of reactions in leprosy is a bonafide work done by me at the department of dermatology, govt. A manual of diseases of the nervous system 1892 14784056745. Histopathology and slit skin smears led to diagnosis of lepromatous leprosy in type ii lepra reaction.
Type 2 lepra reaction, also known as erythema nodosum leprosum enl, is an immune complex mediated hypersensitivity reaction gell and coombs type iii hypersensitivity which occurs in patients with polar lepromatous or borderline lepromatous leprosy and follows initiation of leprosy treatment in majority. Enl or type 2 reaction is a serious, difficult to manage immunological complication of borderline lepromatous bl and lepromatous leprosy ll. Conclusions histology revealing dermal or intragranuloma oedema on a background of leprosy granuloma favours the diagnosis of lepra reaction. Evaluation of leprosy cases in correlation of histopathology. Abundant acidfast bacilli afb were visible on fites. New insights in the pathogenesis of type 1 and type 2 lepra. All sss positive patients had more than 5 skin lesions, except for one patient with bt leprosy in type 1 lepra reaction who had less than 5 lesions. The disease ranges from a singular patch or single nerve thickening. We analyzed skin histopathology in 64 cases of lepra reaction. Lepra reactions remain a major persistent problem in leprosy.
Type i lepra reaction, driven by delayed hypersensitivity to m. Table 1 figure 4 had lepra reaction during fdt four cases had t1r and one had t2r. A rare form of lepra reaction is lucio phenomenon, which manifests as tender nodules with ulceration, bulla formation, and necrotic areas 711. Biomarkers, erythema nodosum leprosum, leprosy, type 1 lepra reaction, type 2 lepra reaction, toll like receptor, nerve damage how to cite this article. Histopathological features in leprosy, postkalaazar dermal. Type i reaction in leprosy a histopathological analysis. Histopathology of skin lesions of leprosy before and after. It usually occurs later during the course of treatment and in longstanding untreated patients 2. Type ii lepra reaction, called enl, occurs in lepromatous or borderline spectra, where cellmediated immunity is weak and bacillary load is usually high. These reactions are the consequences of the dynamic nature of the immune response to mycobacterium leprae m. New observations on the polar spectrum of human leprosy 1. Out of the 50 patients, 4 were of type 1 reaction and 46 of type 2 reaction from which recurrence was more commonly seen with type 2 reactions. Clinical diagnosis of leprosy international textbook of. Analytical study of histopathological and haematological.
In its usual presentation, it is a chronic disease whose slow clinical progression is often punctuated by hypersensitivity reactions lepra reactions. We report a 23 years old male patient presented with fever for two weeks with no visible skin lesion suggestive of leprosy and with no history of either completion or concurrent anti leprosy drug treatment was eventually turned out to. Histopathology of the lepromatous skin biopsy sciencedirect. Type 2 lepra reaction is a type 3 coomb and gell hypersensitivity reaction usually seen in lepromatous and borderline lepromatous patients.
Clinical diagnosis of leprosy international textbook of leprosy. Erythema nodosum leprosum and lepra reaction a matter of great interest and significance is the relationship of erythema nodosum leprosum to the other manifestations of the hypersensitive state included in the comprehensive term lepra reaction. Leprosy is classified as a tropical neglected disease by the world health organization who. Introduction leprosy, which is caused by the mycobacterium leprae see chapter 5. Leprosy type 1 reactions and erythema nodosum leprosum. Clinical and histopathological features in lepra reaction. Blood samples and skin biopsy was subjected to histopathology, immunofluorescence assay, immunohistochemical staining, quantitative rtpcr reverse transcriptasepolymerase chain reaction and flow cytometry. Twenty of the 23 sss positive patients had more than. Request pdf type i reaction in leprosy a histopathological analysis even though type 1 lepra reaction tir is a commonly encountered clinical problem, its histology has not yet been clearly. Lepra reactions are not always diagnosable under the microscope. Guidelines for the diagnosis, management and prevention of. Evaluation of leprosy cases in correlation of histopathology and demonstration of lepra bacilli. In type 1 lepra reaction, the biopsy will show invasion of the epidermis by the granulomatous infiltrate figure 2 a and edema in the superficial.
In tuberculoid and borderline tuberculoid leprosy, epithelioid noncaseating granulomas predominate, and acidfast bacilli afb are absent or only rarely present. Pathological features of leprosy immunopathological spectrum of leprosy mycobacterium leprae elicits a uniquely broad spectrum of clinical and pathological features from susceptible individuals. In the postelimination era, renewed interest in leprosy has developed owing to the reemergence of. In the 1980s, the prevalence of leprosy around the world was approximately 12 million cases, while in the early 2000s, it declined to around 800,000 cases. Leprosy is a chronic infection caused by mycobacterium leprae, an obligate intracellular, grampositive organism. A retrospective analysis of histopathology of 64 cases of lepra. Clinical and histopathological study of lepra reactions from a tertiary care center in south india background. Type i lepra reaction as the presenting sign of histoid.
The lepromin skin test is used to determine what type of leprosy a person has. It involves the injection of a standardized extract of the inactivated leprosy bacillus mycobacterium leprae or hansens bacillus under the skin. The major advantages of histopathology are speed, low cost and the ability to provide a presumptive identification of the infecting fungus as well as demonstrating the tissue reaction. Adhe v, dongre a, khopkar u indian j dermatol, 572. New insights in the pathogenesis of type 1 and type 2. The majority of patients with enl go on to develop several episodes over many years, as multiple acute episodes or chronic enl. Reactions in leprosy are acute inflammatory episodes occurring in an otherwise chronic course of the infection. Leprosy can be considered 2 connected diseases that primarily affect superficial tissues, especially the skin and peripheral nerves. The age of the patients varied from 7 years to 82 years with peak incidence 26. Special stain in histopathology linkedin slideshare. Type 2 lepra reaction as a cause of pyrexia of unknown origin. There is considerable tissue resist ance, and the disease is largely selflimited.
A study on histological features of lepra reactions in patients. There are two main types of leprosy reactions depending on the immunological mechanism, i. Histopathology of the lepromatous skin biopsy cesare massone, mda. Lepromatous leprosy numerous lesions plaques, macules, papules and nodules early symptoms include nasal stuffiness, discharge and bleeding, and swelling of the legs and ankles. Antigenantibody complexes are formed during the treatment in. In this retrospective study, we included 64 patients diagnosed during a 3year period as lepra. Manoharansolemnly, declare that dissertation titled, a clinico histopathological study of reactions in leprosy is a bonafide work done by me at the department of dermatology, govt. Lepra reactions are the histopathological response to the bacterial antigen and a least understood phenomenon since several centuries of. A retrospective analysis of histopathology of 64 cases of. Half of the cases of mb and few cases of bt also showed f.
Comparison between histopathologic features of leprosy in. Histoid leprosy with type 1 reaction semantic scholar. In the english literature, there are only few reports of. Histopathology of skin lesions of type 2 lepra reaction erythema nodosum leprosum, enl shows dermal edema, neutrophilic infiltration and vasculitis on a background of macrophage granuloma.
Histopathology remains one of the major tools of diagnosis in mycology20 table 3. The histopathology of lepromatous skin varies according to the cellmediated immunity of the host against mycobacterium leprae. Hansens disease clinically atypical presentation with. Type ii lepra reaction usually present with skin lesions. He gradually developed bluishblack hyperpigmentation conforming precisely to lesions of lepra reaction b. Type 1 lepra reaction in histoid leprosy singh 2015. Comparison of two systems of classification of leprosy. Clinical features and histopathology of leprosy and type 1 and type 2 reactions do not always match, though they are generally accepted as important for arriving at a diagnosis. Wide variations in clinical presentation of leprosy in reaction, make histopathology an important tool for supporting clinical diagnosis. Used for classifying leprosy on the basis of immune response cmi suppressed in ll but tt pt. Lepromatous leprosy underneath a normal epidermis and grenz zone, there are sheets or clusters of macrophages figure 1. Correlation of dermoscopic and histopathologic patterns in. Leprosy clinical diagnosis should be considered whenever skin lesions and sensory loss occur.
Lepra type ii reaction is also called erythema nodosum leprosum enl. A retrospective study of the severe and uncommon variants of. Rheumatic manifestations can be the initial presentation of type ii lepra reaction. Type i lepra reaction as the presenting sign of histoid leprosy. Clinical and histopathological study of lepra reactions from. It is not recommended as a primary mode of diagnosis. Wakade case report 170 thrombocytopenia induced by intermittent therapy with rifampicin a case report r. All the patients with type ii lepra reaction responded to capsule thalidomide clinically and all the skin lesions resolved in 714 days. The basis for this diversity has been recognized to be the differing capability of individuals to develop a cellular immune response to m. The type 1 reaction is characterized by edema in the upper. Treatment of leprosy and leprosy reactions springerlink. Clinical types, histopathology, immunology teodoro carrada bravo abstract leprosy is a chronic granulomatous infection of the skin and peripherial nerves, caused by mycobacterium leprae.
Leprosy is a chronic infection caused by the acidfast, rodshaped bacillus mycobacterium leprae. Histopathological features in leprosy, postkalaazar. The main clinical types correlate with a specific histopathologic pattern. Most cases occur in india, brazil, and indonesia, and are caused by mycobacterium leprae. Lepra reaction with lucio phenomenon mimicking cutaneous. A retrospective analysis of histopathology of 64 cases of lepra reactions. Type 1 and type 2 erythema nodosum leprosumenl reactions are. Clinical and histopathological study of lepra reactions. In this study we included 50 patients diagnosed during a 1year period as lepra reactions based on clinichistopathological corelation. Aug 24, 2018 leprosy is a chronic infection caused by the acidfast, rodshaped bacillus mycobacterium leprae. Pathogenesis and pathology of leprosy international textbook of.
Rheumatic manifestations thus can be the initial presentation of type ii lepra reaction even before starting multi drug. Comparison between histopathologic features of leprosy in reaction lesions in hiv coinfected and noncoinfected patients. To make detailed observations on histopathologic features of type 1. Casereport lepra reaction with lucio phenomenon mimicking cutaneous vasculitis durgaprasannamisra,1 jyotiranjanparida,1 abhrachandrachowdhury,1 krushnachandrapani,2 nirajkumari,2 narendrakrishnani,2 andvikasagarwal1. Media in category histopathology of leprosy the following 31 files are in this category, out of 31 total. Both had lepra reaction from the time of diagnosis. The reactional states of leprosy are distinctive, tissue destructive, in. Casereport lepra reaction with lucio phenomenon mimicking cutaneous vasculitis durgaprasannamisra,1 jyotiranjanparida,1 abhrachandrachowdhury,1 krushnachandrapani,2. Histopathology revealed enhanced basal layer pigmentation, giant cells and few granulomas with brownish refractile gran. Tuberculoid leprosy has hypopigmented center and raised erythematous border lepromatous leprosy has macules, papules and plaques, but firm nodules may also be seen in the face borderline leprosy has hypopigmented macules.
It affects those with borderline lepromatous or lepromatous leprosy and is a humoral antibodyantigen reaction to immune complexes. Randomized control trial to evaluate the clinical and. Leonard woocl memorial laboratory culion leper colony, philippine islands in1roduclion manifestations of lepra reaction in cases of tuberculoid leprosy or in individual tuberculoid lesions have not been described as such. Frequently, erythema nodosum in leprosy coincides with or heralds acute or progressive lepra reaction. Lepra reaction occurs as a result of broken balance between m. Fig 8 histopathological appearances of leprosy reactions. Initially, a mycobacterial infection causes a wide array of cellular immune responses. Type 1 lepra reaction lesion on histopathology h and e stain at 40. To make detailed observations on histopathologic features of type 1 and type 2 lepra reaction erythema nodosum leprosum, enl.
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