1/296. syphilis in an hiv infected patient misdiagnosed as leprosy. A 42-year-old man with uveitis and a widespread cutaneous eruption, histopathologically characterized by dermal granulomatous infiltrates with perineurial invasion, was incorrectly diagnosed and treated as having borderline leprosy. Further studies demonstrated secondary syphilis and human immunodeficiency virus (hiv) infection. Standard penicillin therapy resolved his cutaneous and ocular lesions. Reports on clinical and pathological findings of active syphilis in hiv infected patients are scarce but this case and isolated previous case reports suggest that granulomatous infiltrates might be a common feature in secondary syphilis with short evolution in hiv infected patients. ( info) |
2/296. classification of leprosy from the clinical point of view. While, according to some, classification of leprosy is primarily clinical, there should be no objection to the application of the advances made in the last decade in understanding the immunological and histopathological aspects of the disease, provided thereby the clinical classification can be made with more accuracy. Unlike most other diseases, the bulk of the process of attempts at diagnosis and classification of this disease is still in the hands of para-medical personnel in the field, and hence it is important that at the same time, an easily understood, uniformly accepted clinical classification should be recommended for field workers. While tuberculoid and lepromatous leprosy of the polar types can be diagnosed with accuracy even under field conditions, confusion generally arises with reference to the diagnosis or indeterminate maculoanaesthetic and borderline forms, and to identify some reacting lesions. Certain terminologies in vogue add further to the confusion. Reacting lesions are confused with active lesions. The importance of recognition of varieties of reacting lesions is stressed since the therapeutic management in such cases is entirely different. It is suggested that the early forms of leprosy characterised by paucity of cardinal features of the disease should be separated from the more established types and grouped under the term indeterminate leprosy. The diagnostic points to be taken into consideration in these lesions are discussed. The importance of investigating thoroughly before classifying patients who report rarely with neuritic symptoms without any evidence of skin lesion is stressed. ( info) |
3/296. Transformation from lepromatous to borderline leprosy under clofazimine therapy. patients of lepromatous leprosy who have evolved from the borderline type of disease are known to revert to the borderline state through a reactionary phenomenon under anti-leprosy chemotherapy with dapsone. We present here the case report of a reversal from a reactional lepromatous disease to the borderline type under clofazimine. ( info) |
4/296. Reactive episodes in borderline lepromatous leprosy--a case report. A thirtyseven years old Hindu male of borderline lepromatous leprosy with reactions in the form of silvery white scales all over the body with scarring at places and greasy crusted lesion on the cheek further developed pustular reaction, after giving dapsone for a week, is reported. ( info) |
5/296. Reverse flow instep island flap. The retrogradely perfused medial plantar artery flap was used in a leprosy patient with a plantar ulcer over the heads of the second and third metatarsals. The flap is based on the anastomosis of the medial plantar artery with the branch of the first plantar metatarsal artery, which supplies the medial side of the great toe. This design provides reconstruction with like local tissues while not distorting the weight-bearing pattern of the foot. ( info) |
| The aim of this study was to develop a scale for identifying disability among people in the rural areas of developing countries. The studies were carried out in the Green Pastures Hospital and the leprosy field programme of the Western Region of nepal. With the help of staff experienced in working with people with disability, a 68-question questionnaire was made, based on the International classification of Impairments, Activities and Participation (ICIDH-2). A survey was carried out of 269 people affected by leprosy who had impairments, as well as a sample of those who were unimpaired. The survey results were used to develop the questionnaire into a scale, using standard scale development methods. This included checking of criterion validity, discrimination and reliability and stability using weighted kappa statistics. Of the 68 questions, 38 were included in the second draft of the instrument. Eight questions were added to identify difficulty in relationships, about the use of aids and about occupation and employment. The sum score of the scale against the expert score gave a Spearman correlation coefficient of 0.72. Intra- and inter-interviewer reliability coefficients were 0.77 (95% CI 0.73-0.81) and 0.61 (95% CI 0.56-0.67), respectively. The stability test gave an overall kappa of 0.76 (95% CI 0.70-0.82). Four questions with particularly poor results were omitted from the final draft of the instrument. An interview-based instrument was developed for identifying limitations in activities of daily living (disability) in people living in a rural setting in a developing country--the Green Pastures Activity Scale (GPAS). The scale performed well during validity and reliability testing. It consists of 34 activity questions, five relationship questions, and three questions on the use of aids, occupation and employment. ( info) |
| The problems of women patients as revealed by a case study of a woman patient and a questionnaire study of 100 leprosy patients (47 men and 53 women) are presented. These include, besides general ones like ignorance of facts about the disease, specific ones like lack of privacy during clinical examination, indifference towards women's feelings and difficulties in communicating with male workers. A greater sensibility towards the sentiments and problems of women patients, on the part of the health service is required to amend the situation. Recruiting more women workers might help in this regard. ( info) |
8/296. Hansen's disease--an enigma. Hansen's disease is an ancient condition that continues to remain endemic in several countries and also in parts of the united states. It has a varied clinical presentation that requires a high index of suspicion for diagnosis. The immune response of the patient is closely related to the presentation of the disease and is being used for immunotherapy and the development of a vaccine. The therapy regimen usually used is as recommended by the world health organization but several different regimens are undergoing trials to aid in decreasing the duration of therapy. ( info) |
9/296. Reddening of the upper central incisors associated with periapical granuloma in lepromatous leprosy. Four years after starting treatment for lepromatous leprosy in england a male Pakistani aged 26 was found to have red discoloration of the upper central incisor teeth. A radiograph suggested periapical abscess on the right with haziness in a corresponding area on the left. Right apicectomy was performed with removal of a solid mass attached to the apex, sections revealing a lepromatous infiltrate with acid-fast fragments of mycobacterium leprae in the cytoplasm of foamy macrophages. Clinical and archaeological evidence for the frequent involvement of these teeth in lepromatous leprosy is reviewed. The upper incisor area is relatively cool, a factor which may be of critical importance for the lodgement and multiplication of this bacillus, as it is in other body sites in lepromatous leprosy. ( info) |
| clofazimine-induced crystal-storing histiocytosis is a rare but well-recognized condition in the literature. Besides the common reddish discoloration of the skin, clofazimine produces gastrointestinal disturbances-sometimes severe abdominal pain, prompting exploratory laparotomy, because pathologic and radiologic findings can produce diagnostic difficulties if the pathologic changes caused by clofazimine are not recognized. The authors report such a case in a leprosy patient to emphasize the importance of history taking, the radiologic abnormalities of the small intestine, and the pathologic findings in small intestine and lymph node biopsies. clofazimine crystals are red in the frozen section and exhibit bright-red birefringence. However, they are clear in routinely processed histologic sections because they dissolve in alcohol and organic solvents. They also appear as clear crystal spaces during electron microscopic study, but some osmiophilic bodies can be observed. histiocytosis caused by clofazimine crystals produces infiltrative lesions in radiologic studies mimicking malignant lymphoma or other infiltrative disorders. Associated plasmacytosis in the histologic sections can simulate lymphoplasmacytic lymphoma or multiple myeloma with crystal-storing histiocytosis. With the knowledge of this rare condition caused by clofazimine, appropriate management to avoid an unnecessary laparotomy is possible. ( info) |