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Spitz CN, Pitta IJR, Andrade L, de Carvalho LB, de Carvalho DMT, Schmidt FDR, Siquara de Sousa AC, Mendonça SM, Sarno EN, Sales AM, Pinheiro RO, Jardim MR. Case report: Myelitis and ganglionitis, an atypical presentation of Hansen's disease. Front Med (Lausanne) 2024; 11:1400423. [PMID: 38835799 PMCID: PMC11149418 DOI: 10.3389/fmed.2024.1400423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/22/2024] [Indexed: 06/06/2024] Open
Abstract
Hansen's disease, or leprosy, is a disease characterized by dermatological and neurological disorders. A neural form also exists, in which peripheral neuropathy occurs in the absence of skin lesions. However, cases of leprosy that involve the central nervous system and proximal nerves are rare in the literature. We describe the case of an oligosymptomatic patient diagnosed with the neural form of leprosy with involvement of peripheral nerves, dorsal root ganglion, and cervical spinal cord in an atypical presentation of the disease. Through complementary examinations and nerve biopsies, the bacillus was identified, and treatment was subsequently initiated. This case highlights the importance of investigating the suspicion of leprosy, even in cases with atypical manifestations, as early diagnosis and treatment can reduce neurological damage and deformities.
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Affiliation(s)
- Clarissa Neves Spitz
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Izabela Jardim R Pitta
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Neurology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Ligia Andrade
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Larissa Bittencourt de Carvalho
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | - Ana Caroline Siquara de Sousa
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Euzenir Nunes Sarno
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna Maria Sales
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberta Olmo Pinheiro
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- National Institute of Science and Technology on Neuroimmunomodulation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Rodrigues Jardim
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Leprosy, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Rio de Janeiro, Brazil
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Benlamkadam S, Errahmany A, Raymond K, Chraa M, Kissani N. Hansen's Disease: A Practical Update on a Neglected Globally Significant Infection. Cureus 2024; 16:e57374. [PMID: 38694670 PMCID: PMC11061821 DOI: 10.7759/cureus.57374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Leprosy is a great mimicker. It is caused by Mycobacterium leprae and Mycobacterium lepromatosis, together termed the M. leprae complex. Leprosy can result in systemic manifestations; however, the neurocutaneous syndrome is the most classic. There is a gap in recognizing the condition leading to misdiagnosis and delays in treatment. Leprosy remains an important cause of aesthetic and functional impairment. In this paper, we provide a practical review of leprosy touching on pathophysiology, clinical manifestation, classification, diagnostic approach and management of the condition in a way that can translate into clinical practice and help physicians better identify and manage potential cases of leprosy.
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Affiliation(s)
| | - Amina Errahmany
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Klevor Raymond
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Mohamed Chraa
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Najib Kissani
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
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Pitta IJR, Angst DBM, Pinheiro RO, Vieira JSDS, Spitz CN, Andrade LR, Carvalho LB, Hacker MA, Sarno EN, Jardim MR. Cytokines profile in pure neural leprosy. Front Immunol 2023; 14:1272471. [PMID: 38116016 PMCID: PMC10728593 DOI: 10.3389/fimmu.2023.1272471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction Pure Neural Leprosy (PNL) is a form of this long time known disease that affects only the peripheral nervous system. Since it is a rare form of the disease, its pathophisiology is still poorly understood. Objective Describe the cytokines profile in patients with PNL. Methods 30 Patients diagnosed with PNL in the Souza Araujo Outpatient Clinic and with cytokines evaluated were selected. They were evaluated by neurologists and diagnosed after a nerve biopsy. Serum levels of IL-1 β, IL-6, IL-10, IL-17, TNF, CCL-2/MCP-1, IFN-ϒ, CXCL-10/IP-10 and TGF-β were evaluates at the moment of the diagnosis. Results Neural thickening was a common clinical finding in this groups of patients. Small and medium sensitive fibers signs and symptoms were present in 92% of the patients and motor involvement in 53%. 43% of patients presented neuropathic pain and no one had neuritis TGF-beta, IL-17, CCl-2 and IP-10. CCL-2 levels were associated with demyelinating patters and IP-10 and IL-1o were associated with axonal patterns at NCS. Discussion PNL patients' cytokine profile appears to be different of other clinical forms of leprosy, with the presence of cytokines described in both tuberculoid and lepromatous leprosy. High levels of CCl-2 may be related to the presence of silent neuritis as well as the presence of IL-10. PNL is unique a form of leprosy, therefore, understanding its immunological profiles essential to better understand the disease itself.
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Affiliation(s)
- Izabela Jardim R. Pitta
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Department of Neurology, Antonio Pedro University Hospital/Fluminense Federal University, Niteroi, Brazil
| | | | | | | | - Clarissa Neves Spitz
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ligia Rocha Andrade
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Larissa Bittencourt Carvalho
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Marcia Rodrigues Jardim
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
- Post-Graduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Neurology, Pedro Ernesto University Hospital/Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
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Barbosa CC, Bezerra GSN, Xavier AT, de Albuquerque MDFPM, do Bonfim CV, de Medeiros ZM, de Souza WV. Systematic Review of Survival Analysis in Leprosy Studies-Including the Following Outcomes: Relapse, Impairment of Nerve Function, Reactions and Physical Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12155. [PMID: 36231457 PMCID: PMC9566694 DOI: 10.3390/ijerph191912155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
Leprosy is a public health problem in South American, African and Oceanian countries. National programs need to be evaluated, and the survival analysis model can aid in the construction of new indicators. The aim of this study was to assess the period of time until the outcomes of interest for patients with or exposed to leprosy by means of survival analysis surveys. This review researched articles using the databases of PubMed, Science Direct, Scopus, Scielo and BVS published in English and Portuguese. Twenty-eight articles from Brazil, India, Bangladesh, the Philippines and Indonesia were included. The Kaplan-Meier method, which derives the log-rank test, and Cox's proportional hazards regression, which obtains the hazard ratio, were applied. The mean follow-up until the following outcomes were: (I) leprosy (2.3 years) in the population who were exposed to it, (II) relapse (5.9 years), (III) clinical manifestations before, during and after treatment-nerve function impairment (5.2 years), leprosy reactions (4.9 years) and physical disability (8.3 years) in the population of patients with leprosy. Therefore, the use of survival analysis will enable the evaluation of national leprosy programs and assist in the decision-making process to face public health problems.
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Affiliation(s)
- Celivane Cavalcanti Barbosa
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | - Amanda Tavares Xavier
- Postgraduate Health Sciences, University of Pernambuco, Recife 50100-130, Brazil
- Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | - Cristine Vieira do Bonfim
- Postgraduate Program in Public Health, Federal University of Pernambuco, Recife 50670-901, Brazil
- Social Research Division, Joaquim Nabuco Foundation, Ministry of Education, Recife 52171-010, Brazil
| | - Zulma Maria de Medeiros
- Postgraduate Health Sciences, University of Pernambuco, Recife 50100-130, Brazil
- Department of Parasitology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | - Wayner Vieira de Souza
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
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