Clinico-pathological overview of lepra reactions in the era of leprosy elimination
DOI:
https://doi.org/10.66344/jpad.v31i3.1696Abstract
Backgound Lepra reactions are a chronic debilitating public health problem. It causes nerve damage, loss of limbs and deformities. They may occur during the natural course of the disease, throughout treatment or after it. Wide variations in clinical presentation make histopathology an important tool. There needs to be more inclusive histologic criteria for diagnosing lepra reactions.
Objective This study aims to analyse clinical diagnosis with histopathological findings, different histological types of lepra reactions and their changes, and the frequency of mycobacterial positive cases in lepra reaction cases using Modified Fite’s stain.
Methods The clinically suspected cases of lepra reactions, irrespective of age and sex attending OPD in Department of Dermatology, at North Bengal Medical College and Hospital were biopsied.
Results Histopathological features based on the type of infiltrate predominance of neutrophilic infiltration, vasculitis, and supporting features like vasculitis, neutrophilic abscess formation within the dermis will help in clinching a diagnosis of ENL, while a predominant lymphocytic infiltrate, intra granuloma oedema along with presence of giant cells and oedema of papillary dermis will be commoner in T1LR.
Conclusion Histopathology along with clinical findings will help in proper identification of atypical cases.
References
1. Rao PN, Suneetha S. Current situation of leprosy in india and its future implications. Indian Dermatol Online J.2018;9:83-9.
2. Mondal A, Kumar P, Das NK, Datta PK. A clinicodemographic study of lepra reaction in patients attending dermatology department of a tertiary care hospital in Eastern India. J Pak Assoc Dermatol.2015; 25(4):252-8.
3. Nery JAC, Sales AM, Illarramendi X, Duppre NC, Jardim MR, Machado AM. Contribution to the diagnosis and management of the reactional states: A practical approach. An Bras Dermatol.2006; 81(4):367–75.
4. Kahawita IP, Walker SL, Lockwood DNJ. Leprosy type 1 reactions and erythema nodosum leprosum. An Bras Dermatol.2008;83:75–82
5. Scollard DM, Smith T, Bhoopat L, Theetranont C, Rangdaeng S, Morens DM. Epidemiologic characteristics of leprosy reactions. Int J Lepr Other Mycobact Dis.1994;62:559-67.
6. Pocaterra L, Jain S, Reddy R, Muzaffarullah S, Torres O, Suneetha S, et al. Clinical course of erythema nodosum leprosum: An 11-year cohort study in Hyderabad, India. Am J Trop Med Hyg.2006;74:868-79.
7. Naafs B. Leprosy reactions. New knowledge. Trop Geogr Med.1994;46:80-4.
8. Lockwood DN, Lukas SB, Desikan KV, Ebenezer G, Suneetha S, Nicholls P. The histological diagnosis of leprosy type 1 reactions: Identification of key variables and an analysis of the process of histological diagnosis. J Clin Pathol.2008;61:595-600.
9. Adhe V, Dongre A, Khopkar U. A retrospective analysis of histopathology of 64 cases of lepra reactions. Indian J Dermatol.2012;57:114-7
10. Debi B, Mohanty HC. Reactional states of leprosy: a clinical assessment. Indian J Lepr. 1977;49(2):229.
11. Sharma N, Patel NM, Mahakal N. Lepra Reactions-A Clinical & Histopathological Study. Int J Sci Res.2013;2:ISSN 2277-8179
12. Kumar B, Dogra S, Kaur I. Epidemiological characteristics of leprosy reactions: 15 years’ experience from north India. Int J Lepr Other Mycobact Dis.2004;72:125-33.
13. Nigam P, Mukhija RD. Leprosy-a Study of Reactions Among 398 Patients of Leprosy. Indian J Dermatol Venereol Leprol.1975; 41(5):181.
14. DhanamjayaRao T, Devojee M, LalithaSree K, Histopathological Study of Skin Biopsies in Lepra Reaction. J Med Dent Sci.2016; 5:134-161
15. Thomas EA, Williams A, Jha N, Samuel CJ. A Study on Lepra Reactions from a Tertiary Care Center in North India. Int J Med Res Prof.2017;3(3):162-6.
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Copyright (c) 2021 SWARNENDU PAL, Dr. Rajesh Kumar Mandal, Dr. Pranati Bera

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