This unusual occurrence is called pure neural leprosy. Histopathology of the skin with clinicopathological correlation. Correlation of skin and nerve histopathology in leprosy 123 table 5. Leprosy or hansens disease is a chronic, progressive bacterial infection that can cause disfigurement and disability if left untreated. In either there is a close interrelation between the clinical features, histology, bacteriology, immunology and prog nosis. In this case, lack of clinical suspicion and unfa miliarity with the histology of indeterminate leprosy delayed diagnosis and. In tuberculoid and borderline tuberculoid leprosy, epithelioid noncaseating granulomas predominate, and acidfast bacilli afb are absent or only rarely present. Tuberculoid leprosy was not seen in any, indicating less likelihood of selfhealing. In most cases 510% of the dermis was occupied by infiltrate composed mainly of histiocytes and lymphocytes, found chiefly around sweat glands and in arrector pili muscles. The clinical spectrum of the disease has its direct correlate on histopathology, reflecting the different grades of cellmediated immune response.
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. 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. Pathogenesis and pathology of leprosy international. However, ic is increasingly used when a definitive diagnosis of uc or cd cannot be made at colonoscopy, in colonic biopsies or at colectomy. The basis for this diversity has been recognized to be the differing capability of individuals to develop a cellular immune response to m.
Leprosy histopathology is characterized by granulomatous infiltrate with only few exceptions indeterminate leprosy and some particular forms. Borderline tuberculoid leprosy was the most frequent morphologic type, seen in 56. Study on the histopathology of leprosy skin lesions 143. In most cases, 5% to 10% of the dermis was occupied by the infiltrate. Leprosy can involve nerves without any skin changes.
This suggests that some of the reported differences in the prevalence and proportion of indeterminate leprosy in different. This type of skin sampling is quick, requires little tr aining and sutures for closure are not required. An active search led to the discovery of the index case. Lepromatous leprosy underneath a normal epidermis and grenz zone, there are sheets or clusters of macrophages figure 1. The lesions are usually plaques rather than macules and exhibit satellite lesions.
Reactions socalled reactions in leprosy are clinically apparent, immunologically mediated inflammatory conditions occurring during the course of the disease in about 50% of patients. Apr 27, 2012 leprosy histopathology is characterized by granulomatous infiltrate with only few exceptions indeterminate leprosy and some particular forms. The indeterminate form of leprosy the most common initial symptom in. Sensation may be normal or impaired, while hair growth and. A study of histopathology of clinically normal appearing skin. Hansen disease histopathology showed a superficial and. The study of indeterminate leprosy has been mentioned in research publications which can be found using our bioinformatics tool below. Pdf leprosy is a chronic infectious disease caused by m. 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.
To study histopathology of leprosy cases and identify histological types in. The histopathology of such a lesion maybe only that ofa nonspecific, chronic dermatitis with scattered round cell infiltrates ofthe dermis. However, when the clinical suspicion is doubtful and the histology is inconclusive, the. Media in category histopathology of leprosy the following 31 files are in this category, out of 31 total. 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. Leprosy, reaction, antibiotics, hladr, granuloma, histology, immunohistology. 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 histopathological analysis was done at the lepra society blue peter research. Leprosy is a disease that has spectral presentation. They are usually meant for superficial lesions where the pathology is confined to epidermis and is not of use in leprosy. Indeterminate leprosy, international journal of dermatology. Only those who underwent a pretreatment biopsy from our institution were included in the study.
Report of the round table on borderline and indeterminate. A large proportion of children 49% had single skin lesion ssl. It is generally agreed that it is an unstable form of leprosy. Least concordance was present in borderline lepromatous leprosy 55. In borderline leprosy, skin lesions are numerous but remain asymmetrical. Comparing the clinical and histological diagnosis of leprosy and. Thepresence ofacidfast bacilli or an infiltrate selectively in a nerve bundle in the. Histopathology and demonstration of lepra bacilli is a vital tool to supplement clinical examination and diagnosis for correct classification and therefore treatment of patients. Leprosy has very characteristic clinical features but the diagnosis must be confirmed because of the need for prolonged treatment with antibiotics.
Modified fite faraco stain positivity was ob still prevalent in the region of study, lepromatous leprosy being the commonest. Indeterminate colitis journal of clinical pathology. Some points to consider when making a diagnosis of leprosy are the following. In borderline lepromatous and lepromatous leprosy, the infiltrate is composed of macrophages with a. Pdf clinico histopathological correlation in leprosy researchgate. 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. Histopathology of the lepromatous skin biopsy sciencedirect. The tuberculoid type of leprosy is essen tially a localized disease involving a single nerve trunk or a small area in the skin. Clinical diagnosis of leprosy international textbook of leprosy.
Pdf significance of histopathology in leprosy patients with 15. 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. Borderline leprosy an overview sciencedirect topics. It presents as a single or multiple asymmetrical, illdefined macules and may be difficult to diagnose. The lesions have been classified as tubercu loid, borderline tuberculoid, borderline, borderline lepromatous and lepromatous leprosy. 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. Histopathology of the lepromatous skin biopsy clinics in. From cairo to havana, from madrid to india and on to caracas, arguments and feelings.
In addition, four 1% biopsies were classified as indeterminate on histology, meaning that although there was evidence of. 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. Polymerase chain reaction pcr studies may prove useful in confirming the diagnosis of leprosy. 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 typical example of indeterminate leprosy is the simple macular type of the cairo conference of 1938. In this cohort 43% of patients had borderline tuberculoid leprosy. In all forms of leprosy, at least one peripheral nerve is attacked by m. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology. 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. The histology of the earliest skin lesion of leprosy is chronic. 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. Histopathological features in leprosy, postkalaazar.
Treatment with six oncemonthly doses of rom has been used to treat borderline tuberculoid leprosy in a woman with armadillo exposure. Skin biopsies from 20 patients with indeterminate leprosy were studied histopathologically. Leprosy leprosy hansen s disease a chronic infectious disease caused by the bacterium mycobacterium leprae it is mainly a granulomatous disease affecting. These are characteristic findings in indeterminate leprosy.
The histamine test is very useful in the diagnosis of indeterminate leprosy in fairskinned individuals. 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. Ppt leprosy powerpoint presentation free to download. The correlation was highest in borderline tuberculoid 63. Mycobacterium leprae, lepromatous leprosy, tuberculoid leprosy. Conference addis ababa, ethiopia, on february 2728, 2010 leprosy. A free powerpoint ppt presentation displayed as a flash slide show on id. Nerve involvement in borderline leprosy is manifested as thickening or tenderness of local nerves, but the skin lesions retain sensation. Cases of tuberculoid, indeterminate and erythema nodosum leprosum may prove difficult as the organisms may be scarce. Indeterminate leprosy definition of indeterminate leprosy. Clinical diagnosis of leprosy international textbook of. Disease bioinformatics research of indeterminate leprosy has been linked to leprosy, leprosy, lepromatous, tuberculoid leprosy, leprosy, paucibacillary, leprosy, multibacillary. It is caused by the slowgrowing organism mycobacterium leprae, which is an obligate intracellular parasite. Histological classification and the immunological spectrum.
The most common clinical manifestation of the disease was a hypopigmented macule. Indeterminate leprosy, british journal of dermatology 10. Pdf indeterminate leprosy and lepromatous index case. A manual of diseases of the nervous system 1892 14784056745. Brazil remains as the country with the second largest number of cases in the world.
At this early disease stage, leprosy is not contagious and permanent nerve. Jul 31, 20 dermatopathology reference describes indeterminate leprosy histopathology including histologic features and provides links to additional medical references. The clinical informations described simply an annular lesion, and histopathology disclosed a. A comparative evaluation of skin and nerve histopathology in.
It may be limited to a small hypo pigmen,ted patch in the skin or it may be a generalized systemi c disease. 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. In tuberculoid tt, borderline tuberculoid bt, and border. The clinical and histological manifestations of leprosy are known to be closely correlated with the immunological state of the patient, which determines prognosis and constitutes the natural basis for the classification of this disease. Cases of indeterminate leprosy are also difficult to diagnose due to the nonspecific histology of the lesions. These manifestations of leprosy are due to the immunologic response of the host to the bacilli. Leprosy is a chronic infection caused by mycobacterium leprae, an obligate intracellular, grampositive organism.
Leprosy should be included in the differential diagnosis for annular plaques, particularly those not. Good concordance was observed in indeterminate leprosytype 100% followed by borderline tuberculoid leprosy 69. Skin biopsies were carried out on 20 patients in canton, china, presenting with hypopigmented macules provisionally diagnosed as indeterminate leprosy. 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. 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. Leprosy, ridleyjopling classification, histopathology anuja sharma, rajesh kumar sharma, k c goswsami, subash bardwaj introduction leprosy, also known as hansen s disease, is a chronic, infectious disease that primarily affects the skin and the peripheral nerves 1. It is from this form that the other types of leprosy develop, depending on the host immunity.
Conference addis ababa, ethiopia, on february 2728, 2010. Liu tzechun, yen lizung, ye ganyun, and dung gujing 2. Ppt leprosy powerpoint presentation free to download id. Leprae, though this may not have any clinical evidence. Their histological appearances and relationship to nerve involvement.
Clinicopathological correlation with the skin biopsy findings was seen in 14 out of 27 cases 51. Pathological features of leprosy immunopathological spectrum of leprosy mycobacterium leprae elicits a uniquely broad spectrum of clinical and pathological features from susceptible individuals. The main clinical types correlate with a specific histopathologic pattern. The histopathology of lepromatous skin varies according to the cellmediated immunity of the host against mycobacterium leprae. Leprosy an overview of clinical features, diagnosis, and. Thus, indeterminate lesions may heal spontaneously or progress to either lepromators or tuberculoid forms. Histopathology of skin lesions of leprosy before and after. Pathogenesis and pathology of leprosy international textbook of. Leprosy is a chronic infectious disease caused by mycobacterium leprae, which primarily affects the skin and peripheral nerves. For those individuals unable to resist infection withm. Pdf patients with 15 skin lesions are clinically categorized as paucibacillary for treatment purposes. 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. For single paucibacillary lesions usually indeterminate leprosy one dose of rom rifampin 600 mg, ofloxacin 400 mg, minocycline 100 mg.202 1320 1111 1153 51 238 1475 700 385 856 760 290 508 483 929 534 1350 430 379 892 714 335 16 891 618 722 976 680 703 815 110 1185 781 410 924 437 1131 384 305 230 532 984 1188