Inoculable leprosy

Ghorpade, Ashok

doi:10.1111/j.1365-4632.2009.04140.x

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…Although the exact mode is uncertain, leprosy is believed to spread mostly through the respiratory route. The findings observed and referenced here, along with previous reports of leprosy occurring after and at the sites of tattooing, trauma, and vaccination, suggest that skin could be a portal for both the exit and entry of the bacillus and contribute to its transmission. Untreated multibacillary cases have been aptly labeled as “mobile factories of lepra bacilli” as they offer safe houses for mycobacterial multiplication and dissemination.…”

Section: Discussionsupporting

confidence: 76%

Histoid leprosy with mycobacterial keratinous bullets after possible transepidermal elimination of bacilli

Ghorpade¹

2013

Int J Dermatology

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A 68-year-old Indian woman presented with multiple, asymptomatic skin lesions over the trunk and limbs of four months' duration. There was no history of previous skin lesions or oral or topical treatment. There was hypoesthesia in the distal extremities (glove and stocking area), and the bilateral ulnar and lateral popliteal nerves were thickened and non-tender. Cutaneous examination showed shiny, circumscribed, skin-colored, and/or erythematous nodules, papules, and plaques on the breasts, abdomen, and back, and both arms, legs, and buttocks (Fig. 1). The subject's family members did not have any skin problems. Routine hematology and liver and kidney function tests were normal; blood venereal disease research laboratory (VDRL) test and enzyme-linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) 1 and 2 were negative. Systemic examination was normal. Slit smear examination from routine sites, including five papulonodular lesions and both ear lobes, was highly positive, with a bacterial index of 6 + (>1000 bacilli per oil immersion field) and a morphological index of 85%. A skin biopsy from a histoid nodule on the back showed a thin epidermis, a clear subepidermal grenz zone, and dermal granulomas of tightly packed, spindle-shaped histiocytes in bundles and whorls with foamy macrophages without the classical pseudo-capsule (Fig. 2). Ziehl-Neelsen staining of a section in this biopsy showed abundant lepra bacilli in the dermis. Equivalent staining of a section from a shiny nodule on the abdomen additionally revealed mild acanthosis with numerous, mostly solid-staining acid-fast bacilli arranged primarily in clumps inside the epidermis at various levels (a) (b) Figure 1 (a) Shiny, skin-colored and erythematous nodules and papules on the breasts and abdomen of a 68-year-old woman. (b) Close-up of the shiny, skin-colored and erythematous nodules and plaques on the abdomen, arising abruptly on normal skin

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Section: Discussionsupporting

confidence: 76%

Histoid leprosy with mycobacterial keratinous bullets after possible transepidermal elimination of bacilli

Ghorpade¹

2013

Int J Dermatology

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“…There have also been scant reports of leprosy lesions developing at the site of vaccination and injury . However, it is not easy to pinpoint the mode of acquisition of infection in this particular case, as the period between entry of the organism (through vaccination scar as well as tattooing) and development of leprosy lesion can vary from a few years to a few decades . The author has earlier reported inoculation indeterminate and tuberculoid leprosy at the site of vaccination scar from this highly endemic region for leprosy .…”

Section: Discussionmentioning

confidence: 99%

“…Considering the pear‐shaped configuration of the skin lesion spreading around a central vaccination scar and histopathological findings, it appears to be a case of tuberculoid leprosy developing probably through inoculation during vaccination. There have also been scant reports of leprosy lesions developing at the site of vaccination and injury . However, it is not easy to pinpoint the mode of acquisition of infection in this particular case, as the period between entry of the organism (through vaccination scar as well as tattooing) and development of leprosy lesion can vary from a few years to a few decades .…”

Section: Discussionmentioning

confidence: 99%

“…Several factors, including the inoculum's size, its depth along with genetic factors, and environmental microorganisms could modulate the development of inoculation leprosy . The author had earlier suggested that if one or two leprosy lesions are found in exposed and trauma prone or abraded parts of the body, a possibility of inoculation leprosy should be entertained …”

Section: Discussionmentioning

confidence: 99%

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