Ocular complications observed in leprosy patients in Romania

Ocular leprosy

Ocular involvement in leprosy is estimated to be 70-75%, about 10-50% of leprosy patients suffer from severe ocular symptoms, and blindness occurs in about 5% of patients. The disease leads to many ophthalmologic symptoms and signs in the range of the eyeball itself, as well as of the bulb adnexa, ie, eyebrows, eyelids with eyelashes, and lacrimal drainage system. Especially dangerous are complications of lagophthalmos and corneal hypoanesthesia, neurotrophic or infectious keratitis, and iridocyclitis and cataract formation, which may lead to significant decrease of visual acuity or even blindness. Multidrug treatment rapidly interrupts transmission of Mycobacterium leprae by infectious patients, but even after being completed, it does not guarantee the withholding of ocular complications.

The prevalence of ocular complications in leprosy patients seen in the United Kingdom over a period of 21 years

OBJECTIVE

The objective of this study was to determine the prevalence of ocular complications and blindness among leprosy patients presenting in the United Kingdom.

METHODS

Observational prospective study.

RESULTS

A total of 126 consecutive leprosy patients attending their ophthalmic visit were examined, out of which 18 patients were blind in one eye (14.3%) and five patients were blind in both the eyes (4.0%). Visual acuity of ≥ 6/18 was present in 96 patients (76.2%). A total of 65 patients (51.6%) had an ocular complication and 28 patients (22.2%) had a sight-threatening leprosy complication (lagophthalmos, severe corneal, or iris disease). The most common ocular complications were impaired lid closure (24 patients, 19%), impaired corneal sensation (20 patients, 15.9%), cataract (20 patients, 15.9%), mild corneal opacity (17 patients, 13.5%), and iris atrophy (17 patients, 13.5%). Impaired corneal sensation was associated with vision <6/18 (P<0.001, OR 13.5, 95% CI 5.14-35.44) and vision <3/60 (P=0.01 OR 6.42, 95% CI 2.15-19.15). Impaired lid closure was significantly associated with increasing age (P=0.029, OR 1.039, 95% CI 1.0-1.08) and vision <3/60 (P=0.03, OR 6.06, 95% CI 1.81-20.24).

CONCLUSION

There is a significant rate of ocular complications and blindness seen in leprosy patients in the United Kingdom, and over one in five had a potentially sight-threatening ocular complication. Health professionals and all leprosy patients, including those cured of the disease, need to be aware that new eye symptoms and signs require prompt ophthalmology review to prevent avoidable blindness, due to the life-long risk of sight-threatening ocular complications.

Initial diagnosis of leprosy in patients treated by an ophthalmologist and confirmation by conventional analysis and polymerase chain reaction

PURPOSE

To report the initial diagnosis of leprosy in patients seeking treatment from an ophthalmologist in a tertiary eye care center, its confirmation by histopathologic and polymerase chain reaction analysis, and review of literature.

DESIGN

Noncomparative retrospective case series.

PARTICIPANTS

Patients with no known history of leprosy who were selected based on either a clinical suspicion or a histopathologic diagnosis and were found to have ocular or periocular lesions suggestive of leprosy.

METHODS

Review of clinical records of patients with no known history of leprosy seen by an ophthalmologist at a tertiary eye care referral center.

MAIN OUTCOME MEASURES

Patient demographics, presenting symptoms and signs, diagnostic studies, complications, and treatment.

RESULTS

Among the 6 patients (5 women and 1 man; average age, 55 years), only 2 were found to have leprosy from clinical examination alone. Histopathologic characteristics or demonstration of acid-fast bacilli, suggestive of leprosy, were found in 5 patients. Definite confirmation of leprosy was made by polymerase chain reaction performed on formalin-fixed, paraffin-embedded tissues of 4 patients having suspected leprosy based on clinicohistopathologic examination results.

CONCLUSIONS

The diagnosis of leprosy relies on the clinical symptom complex, epidemiologic factors, and demonstration of acid-fast bacilli in the tissue sample. Considering that the global leprosy population is 12 million, a patient with leprosy may be found anywhere. The ophthalmologist may be the first one to encounter such patient, in which case suspicion and detection of ocular findings may lead to early treatment of the infection. Polymerase chain reaction may be a new tool in the definite diagnosis of leprosy when suspicion of the diseases is raised by clinicohistopathologic studies.

Detection of Mycobacterium leprae in Ocular Tissues by Histopathology and Real-Time Polymerase Chain Reaction

AIM

To report detection of leprosy in ocular tissue by histopathology and its confirmation by genetic analysis.

METHODS

Excised tissue from a clinically-suspected ocular leprosy patient was processed and analyzed histopathologically. The DNA from the paraffin-embedded tissue was extracted, an 85 A-C intergenic region of Mycobacterium leprae was amplified using specific primers and analyzed by conventional as well as real-time polymerase chain reaction (RT-PCR).

RESULTS

With periodic acid-Schiff-hematoxylin (PAS-H) staining the specimen showed presence of a thin fibrinous layer of inflammatory cells. The majority of the tissue was fibrovascular with extensive infiltration by histiocytes having reticulated cytoplasm. Modified PAS-H and acid-fast staining (AFS) showed the presence of several acid-fast organisms within the cytoplasm of histiocytes and mast cells. Conventional PCR showed a 250-bp DNA from excised conjunctival tissue, which was in agreement with the positive controls for M. leprae. Through RT-PCR, it was calculated that the suspected tissue had 44.68 pg of M. leprae DNA, which is 8937.06 genome copies of M. leprae.

CONCLUSIONS

Presence of inflammatory cells and AFS bacilli in tissue presented a typical picture of leprosy. M. leprae DNA can be detected using RT-PCR in ocular tissues when acid-fast bacteria are seen in histopathological sections. And when the diagnosis of leprosy is inconclusive and acid-fast bacteria are seen, RT-PCR for M. leprae DNA could be used as a rapid confirmatory test to identify the presence of M. leprae and, therefore, the diagnosis of leprosy.