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Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - part 1.

Lastória JC, Abreu MA - An Bras Dermatol (2014 Mar-Apr)

Bottom Line: Transmission occurs through inhalation of bacilli present in upper airway secretion.The nasal mucosa is the main entry or exit route of M. leprae.The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease.

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil.

ABSTRACT
Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It is still endemic in many regions of the world and a public health problem in Brazil. The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The mechanism of transmission of leprosy consists of prolonged close contact between susceptible and genetically predisposed individuals and untreated multibacillary patients. Transmission occurs through inhalation of bacilli present in upper airway secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease. This article aims to update dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects.

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Related in: MedlinePlus

Erythema nodosum leprosum: inflammatory nodules in the upper limb
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f10: Erythema nodosum leprosum: inflammatory nodules in the upper limb

Mentions: Type 2 reaction or ENL is related to humoral immunity and does not mean immunologicalimprovement. It is believed to represent the body's reaction to substances releasedby the destroyed bacilli, with deposition of immune complexes in the tissues. It ismanifested by sudden worsening, especially during treatment in the LL individualsand, more rarely, in BL patients. Symmetrically distributed subcutaneous inflammatorynodules or target lesions of erythema multiforme occur in any region (Figure 10). There are general symptoms, such asfever, malaise, myalgia, edema, arthralgia, and lymphadenomegaly. Neuritis andinternal involvement, such as liver or kidney damage, may also occur.98,102 Inflammatory laboratory tests show abnormal results. There maybe necrosis because of obliteration of the vascular lumen (necrotic ENL), probablydue to vasculitis with leukocytoclasia due to deposition of immune complexes withinvessel walls, with formation of thrombi and ischemia. This should not be confusedwith Lucio's phenomenon, which occurs in Lucio's leprosy and classic lepromatousleprosy, where a large amount of bacilli infect the capillary endothelium leading toendothelial proliferation, thrombosis, and vascular occlusion.103


Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - part 1.

Lastória JC, Abreu MA - An Bras Dermatol (2014 Mar-Apr)

Erythema nodosum leprosum: inflammatory nodules in the upper limb
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4008049&req=5

f10: Erythema nodosum leprosum: inflammatory nodules in the upper limb
Mentions: Type 2 reaction or ENL is related to humoral immunity and does not mean immunologicalimprovement. It is believed to represent the body's reaction to substances releasedby the destroyed bacilli, with deposition of immune complexes in the tissues. It ismanifested by sudden worsening, especially during treatment in the LL individualsand, more rarely, in BL patients. Symmetrically distributed subcutaneous inflammatorynodules or target lesions of erythema multiforme occur in any region (Figure 10). There are general symptoms, such asfever, malaise, myalgia, edema, arthralgia, and lymphadenomegaly. Neuritis andinternal involvement, such as liver or kidney damage, may also occur.98,102 Inflammatory laboratory tests show abnormal results. There maybe necrosis because of obliteration of the vascular lumen (necrotic ENL), probablydue to vasculitis with leukocytoclasia due to deposition of immune complexes withinvessel walls, with formation of thrombi and ischemia. This should not be confusedwith Lucio's phenomenon, which occurs in Lucio's leprosy and classic lepromatousleprosy, where a large amount of bacilli infect the capillary endothelium leading toendothelial proliferation, thrombosis, and vascular occlusion.103

Bottom Line: Transmission occurs through inhalation of bacilli present in upper airway secretion.The nasal mucosa is the main entry or exit route of M. leprae.The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease.

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil.

ABSTRACT
Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It is still endemic in many regions of the world and a public health problem in Brazil. The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The mechanism of transmission of leprosy consists of prolonged close contact between susceptible and genetically predisposed individuals and untreated multibacillary patients. Transmission occurs through inhalation of bacilli present in upper airway secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease. This article aims to update dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects.

Show MeSH
Related in: MedlinePlus