The histamine test is very useful in the diagnosis of indeterminate leprosy in fairskinned individuals. The histopathology of such a lesion maybe only that ofa nonspecific, chronic dermatitis with scattered round cell infiltrates ofthe dermis. Lesions of lepromatous leprosy will show numerous organisms which are easy to identify. Clinicohistopathological correlation of skin biopsies in leprosy. In our experience with the prognosis of indeterminate leprosy, three out of four indeterminate cases heal on their own and the rest become determinate and enter the clinical spectrum of leprosy.
Treatment with six oncemonthly doses of rom has been used to treat borderline tuberculoid leprosy in a woman with armadillo exposure. Histopathology of the skin with clinicopathological correlation. The histopathological analysis was done at the lepra society blue peter research. A skin biopsy may show characteristic histopathology, with granulomas mixed inflammatory cell infiltrate in the deeper layers of the skin, the dermis and involvement of the nerves. In borderline leprosy, skin lesions are numerous but remain asymmetrical. The most common clinical manifestation of the disease was a hypopigmented macule. Some points to consider when making a diagnosis of leprosy are the following.
However, when the clinical suspicion is doubtful and the histology is inconclusive, the. It also depends on factors such as nature and depth of biopsy, the acidfaststained sections examined, and the interobserver variation in both clinical and histopathological examinations. To study histopathology of leprosy cases and identify histological types in. Leprosy is a chronic infectious disease caused by mycobacterium leprae, which primarily affects the skin and peripheral nerves. Cases of indeterminate leprosy are also difficult to diagnose due to the nonspecific histology of the lesions. Indeterminate colitis journal of clinical pathology. The tuberculoid type of leprosy is essen tially a localized disease involving a single nerve trunk or a small area in the skin. Leprae, though this may not have any clinical evidence. Ppt leprosy powerpoint presentation free to download. Pdf indeterminate leprosy and lepromatous index case. Of the 19 ssl cases examined histopathologically, 15 99% showed features of borderline tuberculoid, 1 5% borderline lepromatous and 3 16% had indeterminate type of leprosy. These manifestations of leprosy are due to the immunologic response of the host to the bacilli. We report the case of three patients diagnosed with indeterminate leprosy in the same family.
In either there is a close interrelation between the clinical features, histology, bacteriology, immunology and prog nosis. The term indeterminate leprosy is used when the biopsy sample is taken from a lesion that is so early in the course of the disease that the cellular response does not reveal the type of leprosy. This suggests that some of the reported differences in the prevalence and proportion of indeterminate leprosy in different. Least concordance was present in borderline lepromatous leprosy 55. Indeterminate leprosy definition of indeterminate leprosy.
Pathogenesis and pathology of leprosy international. Borderline tuberculoid leprosy was the most frequent morphologic type, seen in 56. Histopathological features in leprosy, postkalaazar dermal leishmaniasis, and cutaneous leishmaniasis avninder singh 1, v ramesh 2 1 department of pathology, indian council of medical research, safdarjung hospital campus, new delhi, india 2 department of dermatology, vmm. Histopathology examination should be regarded as the gold standard in the diagnosis of a skin. Skin biopsies were carried out on 20 patients in canton, china, presenting with hypopigmented macules provisionally diagnosed as indeterminate leprosy. Ppt leprosy powerpoint presentation free to download id. Histopathology and demonstration of lepra bacilli is a vital tool to supplement clinical examination and diagnosis for correct classification and therefore treatment of patients. It may cause no discomfort at all, or may induce varying degrees of pain, deformity and disfigure ment. Modified fite faraco stain positivity was ob still prevalent in the region of study, lepromatous leprosy being the commonest.
Lepromatous leprosy underneath a normal epidermis and grenz zone, there are sheets or clusters of macrophages figure 1. An illdefined, normoanesthetic, hypopigmented to erythematous patch situated on the face or the outer aspect of arms and legs may often be the presenting feature of indeterminate leprosy. A study of histopathology of clinically normal appearing skin. Clinicopathological correlation with the skin biopsy findings was seen in 14 out of 27 cases 51. The lesions have been classified as tubercu loid, borderline tuberculoid, borderline, borderline lepromatous and lepromatous leprosy. Skin biopsies from 20 patients with indeterminate leprosy were studied histopathologically. The disease is clinically characterized by one or more of the three cardinal signs. Given that the occurrence of indeterminate leprosy is socially associated with stigmatization and ostracism, early definitive diagnosis, or reliable exclusion of a suspected diagnosis of leprosy, is particularly important and poses a dermatological challenge figure 2. Brazil remains as the country with the second largest number of cases in the world. The basis for this diversity has been recognized to be the differing capability of individuals to develop a cellular immune response to m. Indeterminate colitis ic originally referred to those 1015% of cases of inflammatory bowel disease ibd in which there was difficulty distinguishing between ulcerative colitis uc and crohns disease cd in the colectomy specimen. Report of the round table on borderline and indeterminate.
In most cases, 5% to 10% of the dermis was occupied by the infiltrate. Six patients had granulomas in the normal skin, six others showed a histological pattern consistent with indeterminate leprosy in the biopsies taken from normal skin. Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology reference and guide. The important difference between ll and bl leprosy histology is that in bl, the lymphocytes are more prominent and there is a tendency for some activation of macrophages to form poorly to moderately defined granulomas.
Thus, indeterminate lesions may heal spontaneously or progress to either lepromators or tuberculoid forms. Their histological appearances and relationship to nerve involvement. The lesions are usually plaques rather than macules and exhibit satellite lesions. Leprosy histopathology is characterized by granulomatous infiltrate with only few exceptions indeterminate leprosy and some particular forms. Borderline leprosy an overview sciencedirect topics. Conference addis ababa, ethiopia, on february 2728, 2010. Review articles indeterminate leprosy this represents the early phase of leprosy. For single paucibacillary lesions usually indeterminate leprosy one dose of rom rifampin 600 mg, ofloxacin 400 mg, minocycline 100 mg. Pdf significance of histopathology in leprosy patients with 15. Correlation of skin and nerve histopathology in leprosy 123 table 5. A large proportion of children 49% had single skin lesion ssl.
Sensation may be normal or impaired, while hair growth and. The main clinical types correlate with a specific histopathologic pattern. At this early disease stage, leprosy is not contagious and permanent nerve. Histopathology of the lepromatous skin biopsy sciencedirect. Pdf leprosy is a chronic infectious disease caused by m. Pathogenesis and pathology of leprosy international textbook of. Media in category histopathology of leprosy the following 31 files are in this category, out of 31 total. Leprosy is a chronic infection caused by mycobacterium leprae, an obligate intracellular, grampositive organism. In addition, four 1% biopsies were classified as indeterminate on histology, meaning that although there was evidence of. Only those who underwent a pretreatment biopsy from our institution were included in the study. Hansen disease histopathology showed a superficial and. It presents as a single or multiple asymmetrical, illdefined macules and may be difficult to diagnose.
However, ic is increasingly used when a definitive diagnosis of uc or cd cannot be made at colonoscopy, in colonic biopsies or at colectomy. Multiple drug therapy has revolutionised the treatment of leprosy and many patients are now cured within six months to two years, depending on their bacterial load. It may be limited to a small hypo pigmen,ted patch in the skin or it may be a generalized systemi c disease. Histopathology of the lepromatous skin biopsy clinics in.
Clinicohistological correlation in hansens disease. Indeterminate leprosy, british journal of dermatology 10. Leprosy can involve nerves without any skin changes. For those individuals unable to resist infection withm. From cairo to havana, from madrid to india and on to caracas, arguments and feelings. A clinical diagnosis of tuberculoid leprosy tt was made in 15 patients, borderline tuberculoid bt leprosy in 6 patients, and indeterminate il leprosy in 6 patients.
Leprosy or hansens disease is a chronic, progressive bacterial infection that can cause disfigurement and disability if left untreated. Leprosy an overview of clinical features, diagnosis, and. Study on the histopathology of leprosy skin lesions 143. Clinical diagnosis of leprosy international textbook of. Tuberculoid leprosy was not seen in any, indicating less likelihood of selfhealing. Reactions socalled reactions in leprosy are clinically apparent, immunologically mediated inflammatory conditions occurring during the course of the disease in about 50% of patients. Indeterminate leprosy, international journal of dermatology.
In this cohort 43% of patients had borderline tuberculoid leprosy. It is caused by the slowgrowing organism mycobacterium leprae, which is an obligate intracellular parasite. Leprosy should be included in the differential diagnosis for annular plaques, particularly those not. Liu tzechun, yen lizung, ye ganyun, and dung gujing 2.
Comparing the clinical and histological diagnosis of leprosy and. Jul 31, 20 dermatopathology reference describes indeterminate leprosy histopathology including histologic features and provides links to additional medical references. An active search led to the discovery of the index case. A free powerpoint ppt presentation displayed as a flash slide show on id. A typical example of indeterminate leprosy is the simple macular type of the cairo conference of 1938. Sep 04, 2012 leprosy, also known as hansens disease, is a chronic infectious disease caused by mycobacterium leprae, a microorganism that has a predilection for the skin and nerves the disease is clinically characterized by one or more of the three cardinal signs. A study of histopathology of clinically normal appearing. It is from this form that the other types of leprosy develop, depending on the host immunity. Nerve involvement in borderline leprosy is manifested as thickening or tenderness of local nerves, but the skin lesions retain sensation. In tuberculoid tt, borderline tuberculoid bt, and border. Apr 27, 2012 leprosy histopathology is characterized by granulomatous infiltrate with only few exceptions indeterminate leprosy and some particular forms. Pathological features of leprosy immunopathological spectrum of leprosy mycobacterium leprae elicits a uniquely broad spectrum of clinical and pathological features from susceptible individuals. Disease bioinformatics research of indeterminate leprosy has been linked to leprosy, leprosy, lepromatous, tuberculoid leprosy, leprosy, paucibacillary, leprosy, multibacillary. Polymerase chain reaction pcr studies may prove useful in confirming the diagnosis of leprosy.
Leprosy, reaction, antibiotics, hladr, granuloma, histology, immunohistology. In borderline lepromatous and lepromatous leprosy, the infiltrate is composed of macrophages with a. This unusual occurrence is called pure neural leprosy. A manual of diseases of the nervous system 1892 14784056745. Pdf clinico histopathological correlation in leprosy researchgate. These are characteristic findings in indeterminate leprosy. Original research article histopathological study of. Histopathological features in leprosy, postkalaazar. The clinical informations described simply an annular lesion, and histopathology disclosed a. The indeterminate form of leprosy the most common initial symptom in. This type of skin sampling is quick, requires little tr aining and sutures for closure are not required. Thepresence ofacidfast bacilli or an infiltrate selectively in a nerve bundle in the. Pdf patients with 15 skin lesions are clinically categorized as paucibacillary for treatment purposes. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology.
Leprosy is a disease that has spectral presentation. In all forms of leprosy, at least one peripheral nerve is attacked by m. Good concordance was observed in indeterminate leprosytype 100% followed by borderline tuberculoid leprosy 69. Leprosy, also known as hansens disease, is a chronic infectious disease caused by mycobacterium leprae, a microorganism that has a predilection for the skin and nerves. Mycobacterium leprae, lepromatous leprosy, tuberculoid leprosy. Indeterminate leprosy indeterminate leprosy browne, stanley g. Histopathology of skin lesions of leprosy before and after. Histological classification and the immunological spectrum. The histology of the earliest skin lesion of leprosy is chronic. The correlation was highest in borderline tuberculoid 63. Conference addis ababa, ethiopia, on february 2728, 2010 leprosy. The study of indeterminate leprosy has been mentioned in research publications which can be found using our bioinformatics tool below.
The histopathology of lepromatous skin varies according to the cellmediated immunity of the host against mycobacterium leprae. Belonging to this type are most of those cases where leprosy is mild and heals spontaneously in a short time, and also those in which the simple macule is a prelude to the development journal. They are usually meant for superficial lesions where the pathology is confined to epidermis and is not of use in leprosy. In tuberculoid tt, borderline tuberculoid bt, and borderline borderline leprosy bb the infiltrated margins are diagnostic.
In this case, lack of clinical suspicion and unfa miliarity with the histology of indeterminate leprosy delayed diagnosis and. A comparative evaluation of skin and nerve histopathology in. It is generally agreed that it is an unstable form of leprosy. In tuberculoid and borderline tuberculoid leprosy, epithelioid noncaseating granulomas predominate, and acidfast bacilli afb are absent or only rarely present. The clinical spectrum of the disease has its direct correlate on histopathology, reflecting the different grades of cellmediated immune response. We report a 43yearold woman in whom the diagnosis of leprosy was challenging, especially, because the biopsy was sent without any clinical suspicion and italy is a nonendemic area. Cases of tuberculoid, indeterminate and erythema nodosum leprosum may prove difficult as the organisms may be scarce. Clinical diagnosis of leprosy international textbook of leprosy. Leprosy leprosy hansen s disease a chronic infectious disease caused by the bacterium mycobacterium leprae it is mainly a granulomatous disease affecting. Leprosy has very characteristic clinical features but the diagnosis must be confirmed because of the need for prolonged treatment with antibiotics.
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