Frequent testicular involvement in multibacillary leprosy

Immune Regulation in the Testis and Epididymis

Immune regulation within the male reproductive tract is necessary for the protection of the spermatogenic cells from a detrimental immune response. This is done by the production of immunomodulatory factors, sequestration of the spermatogenic cells behind the blood-testis barrier (BTB) and blood-epididymal barrier (BEB), and controlled presentation of germ cell antigens. At the same time, bacteria and viruses can take advantage of this unique environment, inducing inflammation and infecting the male reproductive tract, resulting in histological damage, germ cell loss, and potentially leading to infertility. An antimicrobial response is important to counter this affliction that if not properly controlled can lead to germ cell autoimmunity or provide a haven for pathogens. Therefore, the immunomodulatory environment within the testis and epididymis is intrinsically important to maintain this property.

Highly catalytic sulfur-doped and bimetal-coordinated CoFe(CN)5NO nanoparticles coupled with PER/HCR amplification cascades for sensitive electrochemical aptamer luteinizing hormone assay

Sensitive monitoring of luteinizing hormone (LH), a glycoprotein that regulates the synthesis of regulatory steroid hormones, can facilitate the diagnosis of various reproductive diseases. In this work, a new and highly catalytic Sulfur-doped and bimetal-coordinated CoFe(CN)5NO (denoted as S-CoFe(CN)5NO) nanoparticles are synthesized. Such material is further used to construct high performance sensing interface and coupled with primer exchange reaction (PER) and hybridization chain reaction (HCR) amplification cascades for sensitive electrochemical aptamer-based LH assay. Target LH molecules bind aptamer sequences in DNA duplex probes to liberate ssDNA strands, which initiate subsequent PER/HCR amplification cascades for the capture of many ferrocene (Fc)-tagged DNAs on sensing interface. S-CoFe(CN)5NO subsequently leads to catalytic oxidation of these Fc tags for yielding substantially magnified currents for realizing ultrasensitive assay of LH with the detection limit of 0.69 pM in range from 5 pM to 10 nM. Owing to the high specificity of aptamer, such sensor has high selectivity and can achieve low levels of LH assay in diluted serum samples. With the successful demonstration for detecting trace LH, such sensor can be easily extended as a universal aptamer-based electrochemical sensing method for monitoring various target analytes in the biomedical and biological fields.

Hypogonadism and associated factors among male Leprosy patients

BACKGROUND

Leprosy affects various organs in addition to skin, eyes, and peripheral nerves. Testicular involvement in leprosy patients is common and causes disturbance in endocrine function of the testis and results in hypogonadism. Hypogonadism is frequently undiagnosed and underreported.

OBJECTIVE

This study aimed to assess hypogonadism and associated factors among leprosy patients at Alert Comprehensive Specialized Hospital, Ethiopia.

METHODS

A cross-sectional study design was used in which consecutive 146 male leprosy patients aged between 18 to 65 years attending outpatient follow-up at leprosy outpatient clinic were included. Data was gathered both from patient charts and through patients' interviews. Androgen deficiency symptoms were assessed by androgen deficiency in the aging male questionnaire, and 5ml of blood samples were taken from study participants and serum total testosterone, LH, and FSH were analyzed by Electrochemiluminescence method. Statistical correlation was assessed by Spearman correlation. A multivariable binary logistic regression model was used to identify the independent factors associated with hypogonadism and P-value <0.05 was used to declare statistical significance.

RESULTS

The prevalence of hypogonadism was 39 (26.7%). Out of this, 34 (87.2%) had primary hypogonadism, whereas 5 (12.8%) had secondary hypogonadism. Total testosterone was inversely correlated with Body mass index (r = -0.37, p = 0.002), Luteinizing hormone (r = -0.43, p <0.001), and Follicular stimulating hormone (r = -0.42, p< 0.001). However, Total testosterone was not significantly correlated with age (r = -0.019, p = 0.81). BMI [AOR = 1.32, 95%CI (1.16-1.51)] and grade-II disability [AOR = 3.80, 95%CI (1.23-11.64)] were identified as independent risk factors for hypogonadism.

CONCLUSION

Nearly one-fourth of male leprosy patients had hypogonadism. Overweight and grade-II disability were independent risk factors for hypogonadism.

Dermoscopic features of nails in Leprosy patients in a tertiary referral hospital in West Java, Indonesia

INTRODUCTION

Leprosy is a chronic granulomatous infectious disease, mainly affecting the skin and peripheral nerves, caused by the obligate intracellular bacteria Mycobacterium leprae. The disease has been discussed in several review articles in recent research, but as far as we know, only a few have addressed the effects of leprosy on nails, especially those who examine the dermoscopic features of nails in leprosy patients.

PURPOSES

We aimed to document nail changes in leprosy patients and identify any particular findings through dermoscopic examination.

METHOD

This was an observational study conducted in the Dermatology and Venereology Clinic of Hasan Sadikin Hospital, West Java, Indonesia, from March 2023 through May 2023. All patients have established cases of leprosy, and the diagnosis is based on clinical and bacteriological examinations. Recruitment was done through total sampling. Dermoscopic examination of all fingernails and toenails was performed at 10x magnification using a handheld dermatoscope (Heine DELTA 20 T Dermatoscope) in polarized mode without the linkage fluid to document the dermoscopic features.

RESULT

Of a total of 19 patients, 15 had nail changes due to leprosy. Out of 15 patients, 13 patients were male. Patients below 25 years old had more nail changes. Most of the patients had a duration of disease greater than two years. Both fingers and toes were involved in nine patients. In this study, the most common dermoscopic feature found was the longitudinal ridge. Other dermoscopic features found in this study were transverse lines, onycholysis, longitudinal melanonychia, leukonychia, subungual hemorrhage, subungual hyperkeratosis, anonychia, and onychorrexis.

CONCLUSION

Nail changes are found in leprosy patients and have a wide variety of clinical appearances. A dermoscopy should be performed to assess nail changes in leprosy.

Evaluation of Clinical, Hormonal and Ultrasound Parameters of Male Reproductive System in Leprosy: A Cross-Sectional Study

Background and Objectives

Testicular involvement in leprosy is neglected as it is insidious and silent, although it can have an impact on quality of life. Our study aimed at evaluating and estimating the frequency of the hormonal, radiological and clinical parameters in these patients.

Materials and Methods

A cross-sectional study was conducted including 31 male leprosy patients attending our OPD. After detailed clinical assessment, patients were subjected to ultrasonological with Doppler examination of the scrotum and hormonal evaluation by ELISA technique for serum follicle-stimulating hormone (FSH), luteinising hormone (LH) and total testosterone.

Results

Thirty-one patients were included with ages ranging from 19 to 54 with a mean of 34 years. Decreased libido (19.3%) was significantly observed in the abnormal FSH (P < 0.01) and testosterone (P < 0.01) groups. The majority of the clinical findings such as erectile dysfunction, infertility and altered pubic hair pattern were seen in the lepromatous spectrum. Six (19.6%) patients had increased LH and FSH. Twenty-three (74%) had testicular atrophy (<12 ml) as assessed by USG. There was a significant association between the bilateral decreased testicular volumes (TVs) and FSH (P = 0.016 on the left and P < 0.01 on the right). Four of 31 patients had altered testicular echo texture of which two belong to the BL spectrum. The increase in the resistive index (RI) corresponded significantly to the decreased TV (P < 0.01) albeit on the left side only.

Conclusion

A sizeable proportion (74%) of the study sample had testicular atrophy. The significant association between increased RI and testicular atrophy, especially in patients with infertility, emphasises the ancillary role of Doppler indices in methodical diagnosis. Risk factors noted in the study include increased bacillary index, delayed initiation of treatment and recurrent ENL. Early detection, early initiation of MDT and specific therapies such as testosterone replacement can help improve the quality of life.

Erythema nodosum leprosum: A rare cause of testicular nodules

Erythema nodosum leprosum (ENL), characterized by erythematous subcutaneous nodules with multiorgan involvement and systemic manifestations such as neuritis, arthritis, and orchitis, affects approximately 50 % of patients with lepromatous leprosy (LL). It has also been associated with testicular atrophy and adult-onset hypogonadism, but testicular nodules have rarely been reported. We present the case of a 35-year-old male patient with biopsy confirmed LL who completed multidrug therapy and presented for follow-up with a complaint of testicular tenderness. His disease course had been complicated by ENL and polyneuritis. At the time, physical examination revealed a palpable tender nodule in the left testicle. Testicular ultrasound and magnetic resonance imaging showed bilateral intratesticular masses, of which the differential diagnosis included malignancy and inflammatory or postinfectious granulomatous process. Laboratory workup, testicular malignancy markers, and hormone levels were within normal limits. In view of the patient's underlying condition and after Urology evaluation, a diagnosis of granulomatous process was favored. The patient completed a prednisone taper followed by a 3-day prednisone pulse and weekly methotrexate, with sequential testicular ultrasounds to monitor response. After a year of close follow-up and slow tapering of methotrexate, the patient achieved complete resolution of the left intratesticular mass and decrease in size of the contralateral mass, evidenced by both physical examination and imaging. This case highlights the importance of a high index of suspicion in patients with LL and ENL who present with testicular nodules, as awareness of testicular involvement in this population is imperative to avoid life altering procedures such as orchiectomy.

Changes in plasma levels of endocrine hormones in lepromatous leprosy patients

Background

Leprosy affects various endocrine glands and causes disorders in internal organs in addition to the skin and peripheral nerves. These disorders are often silent and remain undiagnosed or underreported. In particular, patterns of hormone changes during leprosy, especially in lepromatous leprosy (LL) patients, are often associated with dysregulation of different endocrine and sex hormones. The aim of this study was to assess changes in four endocrine hormones - namely cortisol, dehydroepiandrosterone (DHEA), growth hormone (GH), and leptin - among LL patients compared with apparently healthy controls.

Method

In total, 80 plasma samples were systematically retrieved from a biorepository at the Armauer Hansen Research Institute (AHRI), based on quality, adequacy of sample volume, and appropriateness of linked clinical and sociodemographic data. Forty of the samples were obtained from LL patients (cases) and the remaining 40 from apparently healthy controls. Enzyme-linked immunosorbant assay (ELISA) was used to quantify levels of DHEA, cortisol, GH, and leptin hormones in the plasma samples. Data were analyzed using non-parametric statistics and the Mann-Whitney U-test (GraphPad Prism version 7.01). A p-value < 0.05 was considered statistically significant.

Results

Plasma levels of cortisol concentration were significantly higher in LL cases (median = 111.4 ng/ml, range = 20.54-525.7) compared with healthy controls (median = 51.98 ng/ml, range = 3.805-328.4) (p = 0.003). Levels of GH and leptin were significantly lower in LL cases compared with healthy controls (median values for GH = 1.01 µIU/ml, range = 0.4625-86.82 and 2 µIU/ml, range = 0.5838-63.36, respectively (p = 0.022); median values for leptin = 891 pg/ml, range = 728.4-21816 and 5147 pg/ml, range = 730.4-52747, respectively (p < 0.0001)). There was an apparent reduction in the plasma levels of DHEA among LL cases compared with healthy controls (p = 0.297), although this difference was not statistically significant.

Conclusion

Alterations in levels of endocrine hormones seen in LL patients reflect clinical and immunological conditions during lepromatous leprosy. However, large-scale studies are warranted to determine how leprosy causes such alterations in hormones and the interplay between endocrine hormones and the immune system during leprosy disease.