Leprosy other diagnostic studies: Difference between revisions

Jump to navigation Jump to search
Line 15: Line 15:
According to the pole of leprosy in that patient, typical findings include:<ref name="EichelmannGonzález González2013">{{cite journal|last1=Eichelmann|first1=K.|last2=González González|first2=S.E.|last3=Salas-Alanis|first3=J.C.|last4=Ocampo-Candiani|first4=J.|title=Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment|journal=Actas Dermo-Sifiliográficas (English Edition)|volume=104|issue=7|year=2013|pages=554–563|issn=15782190|doi=10.1016/j.adengl.2012.03.028}}</ref>
According to the pole of leprosy in that patient, typical findings include:<ref name="EichelmannGonzález González2013">{{cite journal|last1=Eichelmann|first1=K.|last2=González González|first2=S.E.|last3=Salas-Alanis|first3=J.C.|last4=Ocampo-Candiani|first4=J.|title=Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment|journal=Actas Dermo-Sifiliográficas (English Edition)|volume=104|issue=7|year=2013|pages=554–563|issn=15782190|doi=10.1016/j.adengl.2012.03.028}}</ref>
* '''Tuberculoid pole''':
* '''Tuberculoid pole''':
:* ''[[Bacilli]]'' are commonly not observed.
:* ''[[Bacilli]]'' are commonly not observed
:* [[Granulomas]] commonly found, containing:
:* [[Granulomas]] commonly found, containing:
::* Differentiated [[macrophages]].
::* Differentiated [[macrophages]]
::* [[Epithelioid]] [[cells]].
::* [[Epithelioid]] [[cells]]
::* [[Giant cells]].
::* [[Giant cells]]
::* [[Lymphocytic]] infiltrate, with predominance of CD4+ T cells.
::* [[Lymphocytic]] infiltrate, with predominance of CD4+ T cells
::* [[Langerhans cells]].
::* [[Langerhans cells]]
:* Common [[nerve]] involvement.
:* Common [[nerve]] involvement


* '''Lepromatous pole''':<ref name="BhatPrakash2012">{{cite journal|last1=Bhat|first1=Ramesh Marne|last2=Prakash|first2=Chaitra|title=Leprosy: An Overview of Pathophysiology|journal=Interdisciplinary Perspectives on Infectious Diseases|volume=2012|year=2012|pages=1–6|issn=1687-708X|doi=10.1155/2012/181089}}</ref><ref name="pmid6216407">{{cite journal| author=Van Voorhis WC, Kaplan G, Sarno EN, Horwitz MA, Steinman RM, Levis WR et al.| title=The cutaneous infiltrates of leprosy: cellular characteristics and the predominant T-cell phenotypes. | journal=N Engl J Med | year= 1982 | volume= 307 | issue= 26 | pages= 1593-7 | pmid=6216407 | doi=10.1056/NEJM198212233072601 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6216407  }} </ref>
* '''Lepromatous pole''':<ref name="BhatPrakash2012">{{cite journal|last1=Bhat|first1=Ramesh Marne|last2=Prakash|first2=Chaitra|title=Leprosy: An Overview of Pathophysiology|journal=Interdisciplinary Perspectives on Infectious Diseases|volume=2012|year=2012|pages=1–6|issn=1687-708X|doi=10.1155/2012/181089}}</ref><ref name="pmid6216407">{{cite journal| author=Van Voorhis WC, Kaplan G, Sarno EN, Horwitz MA, Steinman RM, Levis WR et al.| title=The cutaneous infiltrates of leprosy: cellular characteristics and the predominant T-cell phenotypes. | journal=N Engl J Med | year= 1982 | volume= 307 | issue= 26 | pages= 1593-7 | pmid=6216407 | doi=10.1056/NEJM198212233072601 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6216407  }} </ref>

Revision as of 19:08, 7 July 2014

Leprosy Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Leprosy from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Tertiary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Leprosy other diagnostic studies On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Leprosy other diagnostic studies

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Leprosy other diagnostic studies

CDC on Leprosy other diagnostic studies

Leprosy other diagnostic studies in the news

Blogs on Leprosy other diagnostic studies

Directions to Hospitals Treating Leprosy

Risk calculators and risk factors for Leprosy other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Studies such as biopsy of skin lesions and skin smear tests have an important contribution for the diagnosis of leprosy in patients whose clinical examination is suspicious of the disease.

Other Diagnostic Studies

Smear test

May be obtained from any skin lesion, nasal mucosa and/or the ear lobe. This test has sensitivity of 50% and specificity of 100%. After collection of the specimen, to visualize the bacteria, the Ziehl-Neelsen stain should be used. According to the Global Initiative from the WHO, in countries where leprosy is endemic, the diagnosis should be based on clinical signs and results of the smear test, despite the existence of more sophisticated tests, such as serology tests, these are expensive and often not available.[1][2][3][4]

Skin Biopsy

A biopsy of the skin lesion should be performed and stained according to the Fite-Faraco technique (a especially designed protocol for staining the leprosy bacilli). According to the pole of leprosy in that patient, typical findings include:[1]

  • Tuberculoid pole:

Lepromin Test

Although not a diagnostic test, the lepromin skin test is used to classify and determine the prognosis of the condition. For this test it is used the inactivated form of Mycobacterium leprae, extracted from lepromas, as follows:[1]

1. Early reaction (Fernandez reaction):
2. Later reaction (Mitsuda reaction):

Serology

The serology test using the PGL-1 antibody titer (Phenolic Glycolipid 1) is a useful diagnostic tool, particularly for multibacillary cases. However, it is not a good test for paucibacillary cases. Due to its lack of sensitivity, the test is not in the United States.[1][7][8][9][10]

Polymerase Chain Reaction

The detection of the bacillus with PCR has high sensitivity and specificity. It is an important tool, particularly when histological features are inconclusive. However, it is a very expensive test, which limits its use, particularly in developing countries with very little resources and infrastructures.[1]

References

  1. 1.0 1.1 1.2 1.3 1.4 Eichelmann, K.; González González, S.E.; Salas-Alanis, J.C.; Ocampo-Candiani, J. (2013). "Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment". Actas Dermo-Sifiliográficas (English Edition). 104 (7): 554–563. doi:10.1016/j.adengl.2012.03.028. ISSN 1578-2190.
  2. Hatta M, van Beers SM, Madjid B, Djumadi A, de Wit MY, Klatser PR (1995). "Distribution and persistence of Mycobacterium leprae nasal carriage among a population in which leprosy is endemic in Indonesia". Trans R Soc Trop Med Hyg. 89 (4): 381–5. PMID 7570870.
  3. Aggarwal A, Pandey A (2010). "Inverse sampling to study disease burden of leprosy". Indian J Med Res. 132: 438–41. PMID 20966523.
  4. Ramaprasad P, Fernando A, Madhale S, Rao JR, Edward VK, Samson PD; et al. (1997). "Transmission and protection in leprosy: indications of the role of mucosal immunity". Lepr Rev. 68 (4): 301–15. PMID 9503866.
  5. Bhat, Ramesh Marne; Prakash, Chaitra (2012). "Leprosy: An Overview of Pathophysiology". Interdisciplinary Perspectives on Infectious Diseases. 2012: 1–6. doi:10.1155/2012/181089. ISSN 1687-708X.
  6. Van Voorhis WC, Kaplan G, Sarno EN, Horwitz MA, Steinman RM, Levis WR; et al. (1982). "The cutaneous infiltrates of leprosy: cellular characteristics and the predominant T-cell phenotypes". N Engl J Med. 307 (26): 1593–7. doi:10.1056/NEJM198212233072601. PMID 6216407.
  7. Silva EA, Iyer A, Ura S, Lauris JR, Naafs B, Das PK; et al. (2007). "Utility of measuring serum levels of anti-PGL-I antibody, neopterin and C-reactive protein in monitoring leprosy patients during multi-drug treatment and reactions". Trop Med Int Health. 12 (12): 1450–8. doi:10.1111/j.1365-3156.2007.01951.x. PMID 18076551.
  8. Banerjee S, Sarkar K, Gupta S, Mahapatra PS, Gupta S, Guha S; et al. (2010). "Multiplex PCR technique could be an alternative approach for early detection of leprosy among close contacts--a pilot study from India". BMC Infect Dis. 10: 252. doi:10.1186/1471-2334-10-252. PMC 2942881. PMID 20735843.
  9. Martins AC, Miranda A, Oliveira ML, Bührer-Sékula S, Martinez A (2010). "Nasal mucosa study of leprosy contacts with positive serology for the phenolic glycolipid 1 antigen". Braz J Otorhinolaryngol. 76 (5): 579–87. PMID 20963340.
  10. Butlin CR, Soares D, Neupane KD, Failbus SS, Roche PW (1997). "IgM anti-phenolic glycolipid-I antibody measurements from skin-smear sites: correlation with venous antibody levels and the bacterial index". Int J Lepr Other Mycobact Dis. 65 (4): 465–8. PMID 9465156.


Template:WikiDoc Sources