Neural leprosy is rare. This is a report of a 63-year-old Indian man who had long standing multiple peripheral neuropathy. The slit skin smear for acid-fast bacilli of Mycobacterium leprae was positive. The skin and nerve biopsies were normal. He was treated with rifampicin, dapsone and clofazimine.
OBJECTIVES: Leprosy remains a public health concern in Malaysia and globally. We aim to review the characteristics of leprosy patients in a tertiary institution in urban Malaysia.
DESIGN: This is a case series of 27 leprosy patients who presented between 2008 and 2013.
RESULTS: The majority of our patients consisted of male (74.1%), Malaysian (63.0%), blue collar workers (51.9%) and married (59.3%) patients; 48.1% had lepromatous leprosy. All except one of the patients presented with skin lesions, 25.9% had nerve involvement and 33.3% developed lepra reactions. Forty-four point four percent (44.4%) of the cases seen initially in the primary care setup were misdiagnosed.
CONCLUSIONS: Doctors need to have a high index of suspicion for leprosy when patients present with suggestive skin, nerve or musculoskeletal lesions. Immigrants accounted for 37% of cases and these patients may become a reservoir of infection, thus accounting for the rise in incidence. An increasing trend in multibacillary cases may be attributed to the spread from migrants from countries with a high burden of leprosy.
The response to lepromin and Kveim antigens was compared and studied in 15 leprosy patients who were tuberculin negative. Of the 11 lepromin positive tuberculoid patients, 4 were Kveim positive, 1 was equivocal, and the rest were negative. Of the four lepromin negative lepromatous patients, one gave a positive Kveim test while the other three were negative. It has been shown that false-positive Kveim reactions are found in a higher percentage of South Indian leprosy patients than in those of other backgrounds, such as Japanese and Malaysian Chinese patients. It is also suggested that no definite relationship exists between the reaction of leprosy patients to lepromin and Kveim antigens. We further suggest that the anergy exhibited by lepromatous patients to the antigen of M. leprae is specific, as evidenced by the positive Kveim response in one lepromatous patient.
Leprosy and tuberculosis (TB) are endemic to India, however, their coinfection is not frequently encountered in clinical practice. Here, we report a 32-year-old female patient who presented with a history of high-grade intermittent fever, cough and painless skin lesions since a month, along with bilateral claw hand (on examination). The haematological profile was suggestive of anaemia of chronic disease, chest radiograph showed consolidation, sputum smears were positive for Mycobacterium tuberculosis, and skin slit smear confirmed leprosy. The patient was prescribed WHO recommended multidrug therapy for multibacillary leprosy with three drugs. Additionally, prednisolone was added to her regimen for 2 weeks to treat the type 2 lepra reaction. For treatment of TB, she was placed on the standard 6-month short course chemotherapy. She was lost to follow-up, and attempts were made to contact her. Later, it came to our notice that she had discontinued medications and passed away 3 months after diagnosis.
This paper reviews a number of biomedical engineering approaches to help aid in the detection and treatment of tropical diseases such as dengue, malaria, cholera, schistosomiasis, lymphatic filariasis, ebola, leprosy, leishmaniasis, and American trypanosomiasis (Chagas). Many different forms of non-invasive approaches such as ultrasound, echocardiography and electrocardiography, bioelectrical impedance, optical detection, simplified and rapid serological tests such as lab-on-chip and micro-/nano-fluidic platforms and medical support systems such as artificial intelligence clinical support systems are discussed. The paper also reviewed the novel clinical diagnosis and management systems using artificial intelligence and bioelectrical impedance techniques for dengue clinical applications.