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Epidermotropism of lepra bacilli in a patient with histoid Hansen's disease.

Vora RV, Pilani A - Indian Dermatol Online J (2014)

Bottom Line: It is a variant of lepromatous leprosy with a very high bacillary load.Transmission by the respiratory route is also gaining ground.There are other possibilities such as transmission through insects, which cannot be completely ruled out.

View Article: PubMed Central - PubMed

Affiliation: Department of Skin and VD, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India.

ABSTRACT
Histoid leprosy is a rare form of multibacillary leprosy with distinct clinical and histopathological features. It is a variant of lepromatous leprosy with a very high bacillary load. It appears in patients as relapse after dapsone monotherapy and resistance or rarely, "de novo." Although leprosy is slowly declining the exact mode of transmission is unclear. At least until recently, the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. Transmission by the respiratory route is also gaining ground. There are other possibilities such as transmission through insects, which cannot be completely ruled out. However, the present case report possibly suggests the role of skin as a portal of both exit and entry for the bacillus in histoid leprosy transmission. De novo form of histoid leprosy has numerous solid staining bacteria inside the epidermis. The reports show that these bacilli can be eliminated from the intact epidermis, which indicate an unusual role of the skin in the transmission of leprosy.

No MeSH data available.


Related in: MedlinePlus

Slit skin smear showing numerous acid fast bacilli
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Figure 6: Slit skin smear showing numerous acid fast bacilli

Mentions: A 21-year-male presented with papular lesions on his face since 20 days. He had no complains of fever, epistaxis or slippage of sandals. On examination, multiple shiny papulonodular lesions were found over his forehead, ears, and cheeks [Figure. 1] Nasal stuffiness, congestion and watering from eye were present. Bilateral ulnar, greater auricular, common peroneal, anterior tibial, and posterior tibial nerves were thickened. Glove and stocking anesthesia was present up to the elbows and knees. Corneal and conjunctival sensations were normal. Motor examination was normal. All routine investigations were normal. On histopathological examination, sections showed extensive cellular infiltration in the dermis mainly composed of macrophages, lymphocytes and plasma cells. There are clear Grenz zones below the flattened epidermis. Hematoxylin and eosin stain showed histiocytes arranged in a storiform pattern with classical histiocytic granulomas [Figure. 2] and heavy bacillary load on Wade Fite stain. Slit skin smear revealed acid fast bacilli with a bacteriological index of 6.[Figure. 6] Wade Fite stain revealed numerous solid staining acid fast bacilli arranged discretely and in clumps inside the dermis, including the Grenz zone, and surprisingly also inside the epidermis, inside vacuoles in the prickle cell layer and in the stratum granulosum.[Figure. 3–5] The presence of bacilli at various levels inside the epidermis suggested their movement upward along with epidermal cell maturation.


Epidermotropism of lepra bacilli in a patient with histoid Hansen's disease.

Vora RV, Pilani A - Indian Dermatol Online J (2014)

Slit skin smear showing numerous acid fast bacilli
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228654&req=5

Figure 6: Slit skin smear showing numerous acid fast bacilli
Mentions: A 21-year-male presented with papular lesions on his face since 20 days. He had no complains of fever, epistaxis or slippage of sandals. On examination, multiple shiny papulonodular lesions were found over his forehead, ears, and cheeks [Figure. 1] Nasal stuffiness, congestion and watering from eye were present. Bilateral ulnar, greater auricular, common peroneal, anterior tibial, and posterior tibial nerves were thickened. Glove and stocking anesthesia was present up to the elbows and knees. Corneal and conjunctival sensations were normal. Motor examination was normal. All routine investigations were normal. On histopathological examination, sections showed extensive cellular infiltration in the dermis mainly composed of macrophages, lymphocytes and plasma cells. There are clear Grenz zones below the flattened epidermis. Hematoxylin and eosin stain showed histiocytes arranged in a storiform pattern with classical histiocytic granulomas [Figure. 2] and heavy bacillary load on Wade Fite stain. Slit skin smear revealed acid fast bacilli with a bacteriological index of 6.[Figure. 6] Wade Fite stain revealed numerous solid staining acid fast bacilli arranged discretely and in clumps inside the dermis, including the Grenz zone, and surprisingly also inside the epidermis, inside vacuoles in the prickle cell layer and in the stratum granulosum.[Figure. 3–5] The presence of bacilli at various levels inside the epidermis suggested their movement upward along with epidermal cell maturation.

Bottom Line: It is a variant of lepromatous leprosy with a very high bacillary load.Transmission by the respiratory route is also gaining ground.There are other possibilities such as transmission through insects, which cannot be completely ruled out.

View Article: PubMed Central - PubMed

Affiliation: Department of Skin and VD, Pramukhswami Medical College, Karamsad, Anand, Gujarat, India.

ABSTRACT
Histoid leprosy is a rare form of multibacillary leprosy with distinct clinical and histopathological features. It is a variant of lepromatous leprosy with a very high bacillary load. It appears in patients as relapse after dapsone monotherapy and resistance or rarely, "de novo." Although leprosy is slowly declining the exact mode of transmission is unclear. At least until recently, the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. Transmission by the respiratory route is also gaining ground. There are other possibilities such as transmission through insects, which cannot be completely ruled out. However, the present case report possibly suggests the role of skin as a portal of both exit and entry for the bacillus in histoid leprosy transmission. De novo form of histoid leprosy has numerous solid staining bacteria inside the epidermis. The reports show that these bacilli can be eliminated from the intact epidermis, which indicate an unusual role of the skin in the transmission of leprosy.

No MeSH data available.


Related in: MedlinePlus