Summaryobjectives To compare a new scoring system for multibacillary (MB) leprosy relapses, which combines time factor, risk factors and clinical presentation at relapse, to WHO criteria. results The new scoring system that combines time factor, risk factors and clinical presentation at relapse had a higher sensitivity in MFP-confirmed relapses than the WHO-criteria (95% vs. 65%, P < 0.01). The sensitivity of the scoring system was also significantly higher than the WHO criteria in the 57 cases of MB-relapses diagnosed in Karachi (72% vs. 54%, P < 0.05).conclusions This new simple scoring system for diagnosing MB-relapses in leprosy should be further validated in a prospective study to confirm its superior sensitivity and to evaluate the specificity of these criteria by using MFP-confirmation for patients presenting with signs of activity after treatment.
Objective: To determine the occurrence and characteristics of lepra reactions, in patients at a leprosy hospital, in Pakistan. Methods: A retrospective study was conducted on patients admitted at Marie Adelaide Leprosy Centre (from January 1, 2013 to December 31, 2015) for management of lepra reactions. The data was used after approval from MALC management. Results: Lepra reactions, an immunological complication of leprosy can occur before, during or after treatment. The study included 130 cases. Mean age at onset of the first episode was 39 years. Male-female ratio was 2.7:1. Borderline lepromatous was the most common classification (58%). 58% cases had the first episode of a type 1 reaction and 42% had type 2. 44% presented with a reaction at diagnosis. 38% had it during and 18%, after discharge from treatment. Type 1 was frequent at diagnosis and during treatment. Type 2 was common after discharge.Risk factors associated with recurrence were skin lesions, fever, lymphadenopathy and type of reaction. Inflamed plaques were most common in type 1 and crops of erythematous nodules in type 2. Ulnar was the most common enlarged nerve (80%). Conclusion: It is important that health care providers are aware of the clinical manifestations of lepra reactions, to diagnose them early; thus preventing deformity and disability. Keywords: Leprosy, Lepra reactions, Type 1 (reversal reactions), Erythema Nodosum Leprosum (ENL), Peripheral Neuropathy, Neuritis. Continuous...
Abstract Objective: To determine the occurrence and characteristics of the two types of lepra reactions, in new leprosy cases at initial diagnosis, in a Pakistani population. Methods: This retrospective descriptive study was done at MALC Karachi .All new leprosy cases who were registered at MALC during a two-and-a-half year period were enrolled. Their medical records were checked and selected all cases who had presented with a lepra reaction, at initial diagnosis. A total of 50 such cases were identified. Data was then collected from their medical histories, physical examination records and laboratory investigation reports. Results: Out of the total 50 cases in this study, 2 (4%) were children and 48 (96%) were adults. Male-female ratio was 4.6:1. 30 (60%) cases presented with a type 1 reaction and 20 (40%) with type 2. 30 (60%) cases were classified as borderline lepromatous (BL). Among these 17 (57%) had a type 2 reaction. Inflamed plaques were the main feature, in 27 (90%) cases of type 1. Crops of painful, erythematous nodules were seen in 19/20; 95% cases of type 2. Ulnar nerves were the most commonly enlarged nerves, in those with type 1 (73%) and common peroneal in type 2 (65%). Conclusion: Lepra reactions can be a presenting feature in a significant number of new leprosy cases, at initial diagnosis. Early recognition and management of these reactions can help prevent disease transmission, lifelong deformities and disabilities. Keywords: Leprosy, Lepra reactions, type 1 (reversal) reaction, type 2 erythema nodosum leprosum (ENL) reaction.
Background Mycobacterium leprae (slow‐growing bacteria) is the etiological agent for leprosy infection, which is a chronic granulomatous disease. Symptoms initiate with the loss of sensation in the affected areas, which can lead to severe injuries, cuts and burns. IRAK2 (interleukin‐1 receptor‐associated kinases 2) is reported to function in the regulation of the NFκB pathway. The frequency of the IRAK2 polymorphism (rs708035) was unknown in the Pakistani population. Therefore, the study was designed to identify the role of the rs708035 SNP (single nucleotide polymorphism) in susceptibility to leprosy. Methodology The case–control study was designed, and participants were selected by Ridley–Jopling Classification. Blood samples from healthy individuals and patients were collected after ethical approval. Genomic DNA was extracted for the amplification of selected polymorphisms by tetra‐primer amplification refractory mutation system polymerase chain reaction. The desired products were observed via agarose gel (2.5%) electrophoresis followed by data analysis using bioinformatics tools (SNP Stats and SHEsis) and statistical tests (odds ratio, OR, and chi square). Results The study revealed that the mutant genotype (TT) was found to be frequent among cases (22.80%) in comparison with the controls (1.66%). The SNP rs708035 was significantly associated with the progression of leprosy (χ2 = 17.62, p < 0.0001). The targeted SNP significantly increases the risk of leprosy 2.3 times (OR = 2.3119, 95% CI 1.2729–4.1989, p < 0.01). The genetic model also confirms the significant association of the A/T genotype with leprosy in the over‐dominant model (OR = 2.83, 95% CI 1.16–6.89, p < 0.001). Conclusions The study revealed a significant association of the targeted SNP with leprosy and provided baseline data regarding the association of rs708035. The current research could be utilized for the preparation of biomarkers by considering a larger sample size. Highlights The patients suffering from leprosy faced various comorbidities, including hypertension and diabetes. The study reports for the first time a significant association of interleukin 1 receptor associated kinases 2 (IRAK2) single nucleotide polymorphism (SNP) rs708035 among the Pakistani population (Karachi). The current study provides baseline data to develop diagnostic biomarkers for early detection of leprosy.
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