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-
1.
Ramu G. Dharmendra, 1978. Acute exacerbation in leprosy. Dharmendra, ed. Leprosy. 1st ed. Bombay, India: Kothari Medical Publishing House, 108–139.
-
2.
Ridley DS, 1988. Reactions. Ridley DS, ed. Pathogenesis of Leprosy and Related Diseases. 1st ed. Amsterdam, Netherlands: Elsevier, 118–130.
-
3.
Ridley DS, Ridley MJ, 1986. Classification of nerves is modified by the delayed recognition of Mycobacterium leprae. Int J Lepr Other Mycobact Dis 54: 596–606.
-
4.
Gupta SK, Nigam S, Mandal AK, Kumar V, 2006. S‐100 as a useful auxiliary diagnostic aid in tuberculoid leprosy. J Cutan Pathol 33: 482–486.
-
5.
Tirumalae R, Stany AI, Shanubhogue S, Yeliur IK, 2014. S-100 immunostaining in the distinction of borderline tuberculoid leprosy from other cutaneous granulomas. Indian J Dermatol 59: 421.
-
6.
Sharma A, Sharma R, 2017. S-100 immmunostain as an ancillary aid in the diagnosis of tuberculoid leprosy. JK Sci 19: 103–106.
-
7.
Sangh HK, 2018. Role of S-100 immunostaining in differentiation of borderline leprosy from other granulomatous diseases of skin. Indian J Lepr 90: 289–296.
-
8.
World Health Organization, 2022. Guidelines for the Diagnosis, Treatment and Prevention of Leprosy. Available at: https://www.who.int/publications/i/item/9789290226383. Accessed November 27, 2022.
-
9.
Walker SL, Nicholls PG, Butlin CR, Nery JA, Roy HK, Rangel E, Sales AM, Lockwood DN, 2008. Development and validation of a severity scale for leprosy type 1 reactions. PLoS Negl Trop Dis 2: e351.
-
10.
Walker SL et al.; Erythema Nodosum Leprosum International Study Group, 2017. A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale. PLoS Negl Trop Dis 11: e0005716.
-
11.
Groenen G, Saunderson P, Ji B; ILEP Medico Social Commission; International Federation of Anti-Leprosy Associations, 2003. ILEP Learning Guide Three: How to Do a Skin Smear Examination for Leprosy. London, United Kingdom: International Federation of Anti-Leprosy Associations.
-
12.
Ridley DS, Radia KB, 1981. The histological course of reactions in borderline leprosy and their outcome. Int J Lepr Other Mycobact Dis 49: 383–392.
-
13.
Thomas MM, Jacob M, Chandi SM, George S, Pulimood S, Jeyaseelan L, Job CK, 1999. Role of S-100 staining in differentiating leprosy from other granulomatous diseases of the skin. Int J Mycobacteriol 67: 1–5.
-
14.
Mahapatra SB, Ramu G, 1976. Transformation from lepromatous to borderline leprosy under clofazimine therapy. Lepr India 48: 172–176.
-
15.
Britton WJ, 1998. The management of leprosy reversal reactions. Lepr Rev 69: 225–234.
-
16.
Van Brakel WH, Anderson AM, Withington SG, Croft RP, Nicholls PG, Richardus JH, Smith WC, 2003. The prognostic importance of detecting mild sensory impairment in leprosy: A randomized controlled trial (TRIPOD 2). Lepr Rev 74: 300–310.
-
17.
Ridley DS, 1976. Hypersensitivity and immunity reactions and classification. Editorial. Lepr Rev 47: 171–174.
-
18.
Naafs B, van Hees CL, 2016. Leprosy type 1 reaction (formerly reversal reaction). Clin Dermatol 34: 37–50.
-
19.
Ridley MJ, Waters MF, Ridley DS, 1987. Events surrounding the recognition of Mycobacterium leprae in nerves. Int J Lepr 55: 99–108.
-
20.
Renault CA, Ernst JD, 2015. Mycobacterium leprae (leprosy). Bennett JE, Dolin R, Blaser MJ, eds. Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: W. B. Saunders, 2819–2831.
| Past two years | Past Year | Past 30 Days | |
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Study of Dermal Nerve Pathology in Upgrading and Downgrading Type 1 and Type 2 Leprosy Reactions
Savitha Sharath
Savitha Sharath
Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India;
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Arvind Ahuja
Arvind Ahuja
Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Surabhi Sinha
surabhi2310@gmail.com
Surabhi Sinha
Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India;
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Kabir Sardana
Kabir Sardana
Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India;
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ABSTRACT.
Nerve destruction is central to the pathogenesis and clinical manifestation of leprosy reactions (LRs). However, pathological changes in dermal nerves in LRs have not been clearly elucidated. Hematoxylin and eosin (H&E) staining may fail to accurately identify fragmented nerves, and special stains may be required. We recruited 56 patients with clinically diagnosed LRs as cases and 30 patients with nonreactional leprosy as controls. Number and level of nerves, nerve edema, relation of granulomas to nerves, perineuritis, pattern of nerve involvement, and quantification of each nerve pattern were noted on H&E stain and S-100 immunostain on skin biopsy sections. Most of the cases were borderline tuberculoid (BT; 32.8%) and lepromatous leprosy (32.8%) types, whereas most controls were classified as BT (44.8%). We found greater dermal nerve infiltration, fragmentation, and destruction during reactions when compared with nonreactional leprosy (fragmented nerves on S-100: P <0.0001). Nerve fragmentation (P = 0.037), subcutaneous nerve involvement (P = 0.014), and severe nerve edema (P = 0.0005) were higher in type 2 reaction (T2R) compared with type 1 reaction (T1R; on S-100), mostly attributed to the higher number of severe T2Rs (n = 23/25) among our cases. Intact nerves were higher in downgrading T1R compared with upgrading T1R (P = 0.038 on H&E and P = 0.004 on S-100). Thus, the identification and quantification of different patterns of nerves using special stains, such as S-100, may shed more light on nerve fiber involvement and destruction in LRs and may help us predict the prognosis of such cases.
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Author Notes
Current contact information: Savitha Sharath and Kabir Sardana, Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India, E-mails: savitharavivarma@gmail.com and kabirijdvl@gmail.com. Arvind Ahuja, Department of Pathology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India, E-mail: drarvindahuja@gmail.com. Surabhi Sinha, Department of Dermatology, Venereology and Leprosy, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India,, E-mail: surabhi2310@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Ramu G. Dharmendra, 1978. Acute exacerbation in leprosy. Dharmendra, ed. Leprosy. 1st ed. Bombay, India: Kothari Medical Publishing House, 108–139.
-
2.
Ridley DS, 1988. Reactions. Ridley DS, ed. Pathogenesis of Leprosy and Related Diseases. 1st ed. Amsterdam, Netherlands: Elsevier, 118–130.
-
3.
Ridley DS, Ridley MJ, 1986. Classification of nerves is modified by the delayed recognition of Mycobacterium leprae. Int J Lepr Other Mycobact Dis 54: 596–606.
-
4.
Gupta SK, Nigam S, Mandal AK, Kumar V, 2006. S‐100 as a useful auxiliary diagnostic aid in tuberculoid leprosy. J Cutan Pathol 33: 482–486.
-
5.
Tirumalae R, Stany AI, Shanubhogue S, Yeliur IK, 2014. S-100 immunostaining in the distinction of borderline tuberculoid leprosy from other cutaneous granulomas. Indian J Dermatol 59: 421.
-
6.
Sharma A, Sharma R, 2017. S-100 immmunostain as an ancillary aid in the diagnosis of tuberculoid leprosy. JK Sci 19: 103–106.
-
7.
Sangh HK, 2018. Role of S-100 immunostaining in differentiation of borderline leprosy from other granulomatous diseases of skin. Indian J Lepr 90: 289–296.
-
8.
World Health Organization, 2022. Guidelines for the Diagnosis, Treatment and Prevention of Leprosy. Available at: https://www.who.int/publications/i/item/9789290226383. Accessed November 27, 2022.
-
9.
Walker SL, Nicholls PG, Butlin CR, Nery JA, Roy HK, Rangel E, Sales AM, Lockwood DN, 2008. Development and validation of a severity scale for leprosy type 1 reactions. PLoS Negl Trop Dis 2: e351.
-
10.
Walker SL et al.; Erythema Nodosum Leprosum International Study Group, 2017. A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale. PLoS Negl Trop Dis 11: e0005716.
-
11.
Groenen G, Saunderson P, Ji B; ILEP Medico Social Commission; International Federation of Anti-Leprosy Associations, 2003. ILEP Learning Guide Three: How to Do a Skin Smear Examination for Leprosy. London, United Kingdom: International Federation of Anti-Leprosy Associations.
-
12.
Ridley DS, Radia KB, 1981. The histological course of reactions in borderline leprosy and their outcome. Int J Lepr Other Mycobact Dis 49: 383–392.
-
13.
Thomas MM, Jacob M, Chandi SM, George S, Pulimood S, Jeyaseelan L, Job CK, 1999. Role of S-100 staining in differentiating leprosy from other granulomatous diseases of the skin. Int J Mycobacteriol 67: 1–5.
-
14.
Mahapatra SB, Ramu G, 1976. Transformation from lepromatous to borderline leprosy under clofazimine therapy. Lepr India 48: 172–176.
-
15.
Britton WJ, 1998. The management of leprosy reversal reactions. Lepr Rev 69: 225–234.
-
16.
Van Brakel WH, Anderson AM, Withington SG, Croft RP, Nicholls PG, Richardus JH, Smith WC, 2003. The prognostic importance of detecting mild sensory impairment in leprosy: A randomized controlled trial (TRIPOD 2). Lepr Rev 74: 300–310.
-
17.
Ridley DS, 1976. Hypersensitivity and immunity reactions and classification. Editorial. Lepr Rev 47: 171–174.
-
18.
Naafs B, van Hees CL, 2016. Leprosy type 1 reaction (formerly reversal reaction). Clin Dermatol 34: 37–50.
-
19.
Ridley MJ, Waters MF, Ridley DS, 1987. Events surrounding the recognition of Mycobacterium leprae in nerves. Int J Lepr 55: 99–108.
-
20.
Renault CA, Ernst JD, 2015. Mycobacterium leprae (leprosy). Bennett JE, Dolin R, Blaser MJ, eds. Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: W. B. Saunders, 2819–2831.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 388 | 388 | 143 |
| Full Text Views | 18 | 18 | 5 |
| PDF Downloads | 18 | 18 | 7 |