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Xie CB, Stryjewska BM, McNiff J, Shiferaw B. Erythema nodosum leprosum after allergen immunotherapy as initial presentation of lepromatous leprosy treated with novel multidrug regimen. JAAD Case Rep 2023; 41:77-80. [PMID: 37916038 PMCID: PMC10615896 DOI: 10.1016/j.jdcr.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Affiliation(s)
- Catherine B. Xie
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, St. Mary’s Hospital, Waterbury, Connecticut
| | | | - Jennifer McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Bethel Shiferaw
- Department of Infectious Disease, St. Mary’s Hospital, Waterbury, Connecticut
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2
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Tanabe MB, Group AR, Rincon L, Stryjewska BM, Sarria JC. Persistent Infection Versus Type 2 Immunological Reaction in Lepromatous Leprosy. J Investig Med High Impact Case Rep 2021; 8:2324709620927884. [PMID: 32462938 PMCID: PMC7273538 DOI: 10.1177/2324709620927884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The distinction between persistent infection and immunologic reactions in leprosy
is often difficult but critically important since their management is different.
We present the case of a 51-year-old Vietnamese female who presented in 2015
with areas of erythema and skin infiltration on face and chest, as well as edema
on her hands and feet. Skin biopsy was consistent with lepromatous leprosy. She
was treated with rifampin, clarithromycin, and levofloxacin for 2 years. Her
lower extremity edema was attributed to type 2 immunological reaction for which
she was started on prednisone and methotrexate, but she was lost to follow-up
for 19 months. She presented with new skin lesions and pain on her extremities.
New biopsies revealed an intense neutrophilic infiltrate in the dermis and
acid-fast bacilli focally within cutaneous nerve twigs. As compared with the
initial biopsy, the inflammatory infiltrates were diminished and the bacilli had
a degenerating appearance. These findings were consistent with type 2
immunological reaction. The patient was treated with thalidomide with
improvement in the appearance of the skin lesions. A follow-up biopsy showed
lack of neutrophilic infiltrates and decreased number of bacilli. This case
illustrates the importance of differentiating between persistent infection and
immunologic reactions in leprosy. Clinicians should be aware of these
complications. A high index of suspicion and accurate interpretation of skin
biopsy results are essential for appropriate diagnosis.
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Affiliation(s)
- Melinda B. Tanabe
- University of Texas Medical Branch,
Galveston, TX, USA
- Melinda B. Tanabe, MD, Department of
Infectious Diseases, University of Texas Medical Branch, 301 University Blvd,
Route 0435, Galveston, TX 77555, USA.
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3
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Gioe OA, Drapcho C, Stryjewska BM, Nesheiwat JP, Murphy C. Extensor plaques with associated arthritis and neuropathy. JAAD Case Rep 2020; 6:603-605. [PMID: 32685648 PMCID: PMC7355211 DOI: 10.1016/j.jdcr.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Olivia A. Gioe
- Department of Dermatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
- Correspondence to: Olivia Gioe, MD, 1542 Tulane Avenue, Suite 639, New Orleans, LA 70112.
| | - Colleen Drapcho
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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4
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Maymone MBC, Venkatesh S, Laughter M, Abdat R, Hugh J, Dacso MM, Rao PN, Stryjewska BM, Dunnick CA, Dellavalle RP. Leprosy: Treatment and management of complications. J Am Acad Dermatol 2020; 83:17-30. [PMID: 32244016 DOI: 10.1016/j.jaad.2019.10.138] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/25/2023]
Abstract
In the second article in this continuing medical education series, we review the treatment of leprosy, its immunologic reactions, and important concepts, including disease relapse and drug resistance. A fundamental understanding of the treatment options and management of neuropathic sequelae are essential to reduce disease burden and improve patients' quality of life.
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Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Samantha Venkatesh
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Melissa Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Rana Abdat
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Mara M Dacso
- National Hansen's (Leprosy) Disease Program, Baton Rouge, Louisiana; University of Texas Southwestern Medical Center, Dallas, Texas
| | - P Narasimha Rao
- Special Interest Group on Leprosy, Indian Association of Dermatologists, Venereologists and Leprologists, Delhi, India
| | | | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado.
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Maymone MBC, Laughter M, Venkatesh S, Dacso MM, Rao PN, Stryjewska BM, Hugh J, Dellavalle RP, Dunnick CA. Leprosy: Clinical aspects and diagnostic techniques. J Am Acad Dermatol 2020; 83:1-14. [PMID: 32229279 DOI: 10.1016/j.jaad.2019.12.080] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/26/2019] [Accepted: 12/11/2019] [Indexed: 01/27/2023]
Abstract
Leprosy, also known as Hansen's disease, is a curable infectious disease that remains endemic in >140 countries around the world. Despite being declared "eliminated" as a global public health problem by the World Health Organization in the year 2000, approximately 200,000 new cases were reported worldwide in 2017. Widespread migration may bring leprosy to nonendemic areas, such as North America. In addition, there are areas in the United States where autochthonous (person-to-person) transmission of leprosy is being reported among Americans without a history of foreign exposure. In the first article in this continuing medical education series, we review leprosy epidemiology, transmission, classification, clinical features, and diagnostic challenges.
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Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Melissa Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Samantha Venkatesh
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Mara M Dacso
- National Hansen's (Leprosy) Disease Program, Baton Rouge, Louisiana; University of Texas Southwestern Medical Center, Dallas, Texas
| | - P Narasimha Rao
- Special Interest Group on Leprosy, Indian Association of Dermatologists, Venereologists and Leprologists, Hyderabad, India
| | | | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado.
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Jansen NK, Durso TA, Bandino JP, Stryjewska BM, Lindholm DA. Case report: Hansen's disease in an active duty soldier presenting with type 1 reversal reaction. MSMR 2019; 26:2-6. [PMID: 31860322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Leprosy, or Hansen's disease (HD), is caused by the bacterium Mycobacterium leprae and is a significant cause of morbidity worldwide. Clinical manifestations range from isolated skin rash to severe peripheral neuropathy. Treatment involves a prolonged course of multiple antimicrobials. Although rare in the U.S., with only 168 new cases reported in 2016, HD remains a prevalent disease throughout the world, with 214,783 new cases worldwide that same year.1 It remains clinically relevant for service members born in and deployed to endemic regions. This report describes a case of HD diagnosed in an active duty soldier born and raised in Micronesia, a highly endemic region.
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McCormick CD, Lea J, Stryjewska BM, Thompson A, Fairley JK. Trends of leprosy and multibacillary infection in the state of Georgia since the early 1900s. PLoS Negl Trop Dis 2019; 13:e0007713. [PMID: 31603913 PMCID: PMC6808490 DOI: 10.1371/journal.pntd.0007713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 10/23/2019] [Accepted: 08/15/2019] [Indexed: 11/18/2022] Open
Abstract
Few investigations to date have analyzed the epidemiology of Hansen’s disease (leprosy) in the United States, and in particular, if birth location is related to multibacillary versus paucibacillary leprosy. We collected data on 123 patients diagnosed with leprosy in Georgia from the National Hansen’s Disease Program from 1923—January 2018. A logistic regression model was built to examine the relationship between country of origin (U.S.-born or immigrant) and the type of leprosy. While the model showed no significant relationship between country of origin and type of leprosy, being Asian or Pacific Islander was associated with a higher odds of multibacillary disease (aOR = 5.71; 95% CI: 1.25–26.29). Furthermore, since the early 1900s, we found an increasing trend of leprosy reports in Georgia among both domestic born and immigrant residents, despite the overall decrease in cases in the United States during the same time period. More research is therefore necessary to further evaluate risk for multibacillary leprosy in certain populations and to create targeted interventions and prevention strategies. Leprosy is often believed to not be an issue in many countries. However, the disease is still very much a problem globally, and in the past several decades has been on the rise in the United States. Frequently the disease is misdiagnosed several times before appropriately treated. Although newly diagnosed cases in the United States only remain around 160 every year, there is limited investigation of leprosy in the United States. As the concern over transmission from armadillos continues to rise, coupled with the increase in connectedness of the global population, it is important to be able to identify populations at higher risk for the more infectious form of leprosy, multibacillary leprosy, for targeted interventions. The researchers sought to investigate which populations are at higher risk for this more infectious form, while also describing the history of cases in the state of Georgia. By adding to the body of literature on leprosy in the United States, it is the hope that more research will be produced that provides a better understanding of the disease trends within the country, while also enabling more targeted interventions.
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Affiliation(s)
- Carter D. McCormick
- Hubert Department of Global Health, Emory University Rollins School of Public Health Atlanta, GA, United States of America
- * E-mail:
| | - Jacqueline Lea
- National Hansen’s Disease Programs, Baton Rouge, LA, United States of America
| | | | - Ashton Thompson
- Georgia Department of Public Health, Atlanta, GA, United States of America
| | - Jessica K. Fairley
- Hubert Department of Global Health, Emory University Rollins School of Public Health Atlanta, GA, United States of America
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Williams DL, Araujo S, Stryjewska BM, Scollard D. Dapsone Resistance in Leprosy Patients Originally from American Samoa, United States, 2010-2012. Emerg Infect Dis 2019; 24:1584-1585. [PMID: 30016255 PMCID: PMC6056125 DOI: 10.3201/eid2408.180033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Skin biopsies from US leprosy patients were tested for mutations associated with drug resistance. Dapsone resistance was found in 4 of 6 biopsies from American Samoa patients. No resistance was observed in patients from other origins. The high rate of dapsone resistance in patients from American Samoa warrants further investigation.
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Virk A, Pritt B, Patel R, Uhl JR, Bezalel SA, Gibson LE, Stryjewska BM, Peters MS. Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerg Infect Dis 2018; 23:1864-1866. [PMID: 29048278 PMCID: PMC5652441 DOI: 10.3201/eid2311.171104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report Mycobacterium lepromatosis infection in a US-born person with an extensive international travel history. Clinical symptoms, histopathology, and management are similar to those of infections caused by M. leprae. Clinicians should consider this pathogen in the diagnosis of patients with symptoms of leprosy who have traveled to endemic areas.
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Labuda SM, Schieffelin JS, Shaffer JG, Stryjewska BM. Hansen's Disease and Rheumatoid Arthritis Crossover of Clinical Symptoms: A Case Series of 18 Patients in the United States. Am J Trop Med Hyg 2017; 97:1726-1730. [PMID: 29141716 DOI: 10.4269/ajtmh.17-0197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hansen's Disease (HD) is a rare, chronic granulomatous infection of the skin and peripheral nerves caused by the noncultivable organism Mycobacterium leprae. Arthritis is the third most common symptom of HD. Subjects with both confirmed HD on skin biopsy and chronic arthritis were identified at the National Hansen's Disease Program (NHDP). We conducted a series of medical chart reviews and extracted and logged personally deidentified data into a database and carried out descriptive analyses. Eighteen of 261 subjects presented to the NDHP with both HD and chronic arthritis between 2001 and 2015. Among these, 16 were male, 16 were white, and 15 were residents of Louisiana. The median age at diagnosis of HD was 67 years. Ten of these subjects were diagnosed with borderline lepromatous leprosy, seven were diagnosed with lepromatous, and one was diagnosed with borderline tuberculoid leprosy. Patients were symptomatic with arthritis for a median of 5.3 years before HD diagnosis. Sixty-two percent of patients (11) were diagnosed with rheumatoid arthritis (RA) before HD diagnosis, and 10 of which were seronegative RA. Hands, feet, wrists, and elbows were most commonly reported as affected joints. Over half of the patients (61%) had completed HD multidrug therapy at the time of review, and 73% of these subjects had persistent joint pain requiring steroids or methotrexate for symptomatic control. Chronic arthritis in HD patients is present in a series of US-acquired cases of HD. Arthritis did not resolve with successful treatment of HD in most cases.
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Affiliation(s)
- Sarah M Labuda
- Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Jeffrey G Shaffer
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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12
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Affiliation(s)
- Skylar Souyoul
- Department of Dermatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Katharine Saussy
- Louisiana State University School of Medicine, New Orleans, Louisiana
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Sotiriou MC, Stryjewska BM, Hill C. Two Cases of Leprosy in Siblings Caused by Mycobacterium lepromatosis and Review of the Literature. Am J Trop Med Hyg 2016; 95:522-7. [PMID: 27402522 DOI: 10.4269/ajtmh.16-0076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/17/2016] [Indexed: 11/07/2022] Open
Abstract
We describe two leprosy cases in Mexican siblings caused by a new species Mycobacterium lepromatosis This is likely the first report of family clustering of this infection. The patients showed severe prolonged leprosy reactions after antimicrobial treatment, raising a challenge for clinical management. The current status of M. lepromatosis infection is reviewed.
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Affiliation(s)
- Michael C Sotiriou
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois.
| | | | - Carlotta Hill
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois
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Marcos LA, Dobbs T, Walker S, Waller W, Stryjewska BM. Indigenous Cases of Leprosy (Hansen's Disease) in Southern Mississippi. J Miss State Med Assoc 2015; 56:188-191. [PMID: 26434167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hansen's disease or leprosy is a chronic infection of the skin and peripheral nerves caused by Mycobacterium leprae. In the U.S., leprosy is mainly reported in immigrants, but indigenous leprosy cases have been also reported in this country, especially in semitropical southern states (i.e., Texas, Louisiana). The objective of this series of cases is to describe indigenous leprosy cases reported in southern Mississippi (MS) during the period 2012-2014. Information was collected from medical records at Hattiesburg Clinic and the MS Department of Health. Four cases were reported during the period of study (3 Caucasian males, 1 African-American woman). Non of visited endemic leprosy country. The age ranged from 60 to 83 years (median: 75.5 years). Of the four cases, three presented with a slowly progressive erythematous rash disseminated mainly on the thorax and abdomen, with a lesser degree on the extremities. The time between onset of rash until the diagnosis ranged from 5 to 16 months (median: 7 months). Only one case had direct contact with armadillos (blood exposure). Non of these patients had a history of immunosuppression. The most common symptoms were neuropathic pain (n=2), generalized pruritus (n=2) and loss of sensation in extremities (n=2). One case had severe peripheral neuropathy with muscle weakness, atrophy in left arm, and wasting on left hand. Skin biopsies showed diffuse granulomatous infiltrate with foamy histiocytes along with acid fast bacilli by Fite stain. By Ridley-Jopling classification system, three cases were diagnosis as lepromatous leprosy, and one, borderline lepromatous. Treatment included clofazimine, dapsone and rifampin that was offered free of charge by the National Hansen's Diseases Program, Baton Rouge, L.A. One patient did not tolerate therapy. In conclusion, a slowly progressive disseminated erythematous skin rash on the trunk should raise suspicion for leprosy in the elderly population in south MS.
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