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A neglected illness still present nowadays: Tuberculoid leprosy
Lepra tuberculoide, todavía presente en nuestro medio
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illness still present nowadays: Tuberculoid leprosy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "344" "paginaFinal" => "345" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Arantxa Berzosa-Sánchez, Beatriz Soto-Sánchez, Juana Begoña Cacho-Calvo, Sara Guillén-Martín" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Arantxa" "apellidos" => "Berzosa-Sánchez" "email" => array:1 [ 0 => "aranire@msn.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Soto-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Juana Begoña" "apellidos" => "Cacho-Calvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span 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"etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1214 "Ancho" => 750 "Tamanyo" => 50309 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Skin lesion: ring-shaped, erythematous, with raised border and hypo-pigmented centre.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">As leprosy is a rare chronic disease in our setting, especially in the paediatric population,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> we present a case report that we consider of interest.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a girl referred to the paediatric infectious medicine clinic while her father, of Brazilian origin, was having tests for non-erythematous, non-pruritic, non-painful infiltrated skin lesions on his chin, pinnae and nose; these were associated with multiple erythro-pigmentary macular lesions on his trunk and limbs, and numbness in the distal region of the left leg.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our three-year-old patient, born in Spain and with no medical history of interest, had a ring-shaped lesion with a raised, erythematous border and a flatter, hypopigmented centre, 5 cm in diameter, on the medial aspect of her left forearm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The lesion had been there for a year and had not responded to topical corticosteroids. The decision was made to biopsy the lesion.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The pathology report confirmed the presence of chronic, granulomatous nodular inflammation, with giant cells and a perivascular, periadnexal and perineural lymphocytic crown (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). It was stained with the Fite-Faraco technique, with no bacilli observed. A sample of the biopsy was sent for polymerase chain reaction (PCR) for <span class="elsevierStyleItalic">Mycobacterium leprae (M. leprae)</span> with <span class="elsevierStyleItalic">M. leprae-</span>specific-repetitive-element PCR positive, <span class="elsevierStyleItalic">M. leprae</span> Ag 18-kDa PCR positive and GenoType <span class="elsevierStyleItalic">Leprae</span>-DR negative. Nasal exudate smear microscopy was negative.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Both clinically and bacteriologically, this seemed to be a case of paucibacillary leprosy, according to the WHO classification, or tuberculoid leprosy (pathologically), one of the most common forms in childhood. Treatment was started with rifampicin (15 mg/kg/dose monthly) and dapsone (2 mg/kg/day) for six months.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A skin biopsy was also performed in the father, who had a dermal histiocytic infiltrate with acid-alcohol-fast bacilli compatible with leproma, and he was diagnosed with lepromatous leprosy.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Leprosy in children is an epidemiological indicator of active foci in adults and recent transmission.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Diagnosis is difficult, even in countries with a higher prevalence of leprosy (Brazil, India).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In Spain, 168 cases of leprosy were diagnosed from 2003 to 2013, with 128 foreign patients; mainly (71.9%) from South America (Brazil).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In our setting, a high degree of clinical suspicion based on an adequate epidemiological investigation is necessary to arrive at the diagnosis. The route of transmission is not very clear, but it is believed that the contagion is by respiratory secretions and not by contact with the skin lesions.</p><p id="par0040" class="elsevierStylePara elsevierViewall">According to the Ridley-Jopling classification (based on the patient's clinical and immunological status), two main forms are described<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>: tuberculoid leprosy, one or a few hypo- or hyper-pigmented lesions with or without loss of sensation; and lepromatous leprosy, with multiple skin lesions and nerve involvement. Between these two forms there is a broad clinical spectrum (borderline-tuberculoid, borderline-borderline and borderline-lepromatous). In the cases tending towards lepromatous, the histology shows inflammatory infiltrates with Virchow cells full of bacilli and absence of appendages. The tuberculoid polarity involves tuberculoid granulomas with epithelioid cells, Langerhans cells and lymphocytic infiltrates with the absence of bacilli. According to the WHO, leprosy is classified as paucibacillary (1–5 skin lesions, only one affected nerve trunk, negative smear microscopy) and multibacillary (>6 skin lesions, more than one affected nerve trunk and positive smear microscopy).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Key to microbiological diagnosis is a skin biopsy, which enables the presence of bacilli to be visualised by Fite-Faraco staining. It has not been possible to isolate <span class="elsevierStyleItalic">M. leprae</span> in the usual culture media for mycobacteria. Smear microscopy has a specificity of 100% and a sensitivity of 50% in samples of nasal mucosa, earlobe and skin lesions. In tuberculoid (paucibacillary) leprosy, bacilli are very difficult to detect and genome amplification (PCR) techniques for the detection and identification of <span class="elsevierStyleItalic">M. leprae</span> have meant a significant advance in these cases.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The sensitivity of PCR in paucibacillary forms is from 50% to 80%. The GenoType Leprae-DR technique also makes it possible to analyse resistance to rifampicin, quinolones and dapsone.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The WHO recommends combined therapy<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>; double therapy with rifampicin and dapsone in paucibacillary forms for six months and, in multibacillary forms, adding a third drug (clofazimine) and prolonging the duration of treatment to 12 months. Chemoprophylaxis in cohabitants is not indicated.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In this case, we wish to highlight the importance of studying contacts who live with leprosy patients, especially with multibacillary forms, as leprosy is a curable disease if properly treated and this prevents transmission to other people.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">No funding was received for the preparation of this document.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:2 [ "identificador" => "xack475541" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Berzosa-Sánchez A, Soto-Sánchez B, Cacho-Calvo JB, Guillén-Martín S. Lepra tuberculoide, todavía presente en nuestro medio. Enferm Infecc Microbiol Clin. 2020;38:344–345.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0090" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0020" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1214 "Ancho" => 750 "Tamanyo" => 50309 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Skin lesion: ring-shaped, erythematous, with raised border and hypo-pigmented centre.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 542 "Ancho" => 1250 "Tamanyo" => 175245 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Pathology of the skin biopsy. Chronic, granulomatous inflammation with the presence of giant cells and a peripheral dense lymphocytic crown with a perivascular, periadnexal and perineural distribution. Haematoxylin-eosin ⋅10 (A) and ⋅20 (B).</p>" ] ] 2 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.zip" "ficheroTamanyo" => 212037 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imported and autochthonous leprosy presenting in Madrid (1989-2015): a case series and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Norman" 1 => "Ch Fanciulli" 2 => "J.A. Pérez Molina" 3 => "B. Monge-Maillo" 4 => "R. Lopez-Velez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Travel Med Infect Dis" "fecha" => "2016" "volumen" => "14" "paginaInicial" => "331e" "paginaFinal" => "349e" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leprosy in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Gonçalves Barreto" 1 => "M.A. Cipriani Frade" 2 => "F. Bernardes Filho" 3 => "M.B. da Silva" 4 => "J.S. Spencer" 5 => "G.C. Salgado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11908-017-0577-6" "Revista" => array:5 [ "tituloSerie" => "Curr Infect Dis Rep" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28444521" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "WHO" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Global leprosy update, 2015: time for action, accountability and inclusion. Weekly epidemiological record 2 September 2016, 91th year. No 35" "fecha" => "2016" "volumen" => "91" "paginaInicial" => "405" "paginaFinal" => "420" "itemHostRev" => array:3 [ "pii" => "S0165178115301980" "estado" => "S300" "issn" => "01651781" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of leprosy in Spain: the role of the international migration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Ramos" 1 => "D. Romero" 2 => "I. Belinchón" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pntd.0004321" "Revista" => array:4 [ "tituloSerie" => "PLoS Negl Trop Dis." "fecha" => "2016" "volumen" => "10" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27657909" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lepra: puesta al día. Definición, patogénesis, clasificación, diagnóstico y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Eichelmann" 1 => "S.E. González González" 2 => "J.C. Salas-Alanis" 3 => "J. Ocampo- Candiani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2012.03.028" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2013" "volumen" => "104" "paginaInicial" => "554" "paginaFinal" => "563" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23870850" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "PCR-based techniques for leprosy diagnosis: from the laboratory to the clinic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.N. Nóbrega Martinez" 1 => "C. Talhari" 2 => "M.O. Moraes" 3 => "S. Talhari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pntd.0002655" "Revista" => array:5 [ "tituloSerie" => "PLoS Negl Trop Dis." "fecha" => "2014" "volumen" => "8" "paginaInicial" => "e2655" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24722358" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regional Office for South-East Asia. Guidelines for the diagnosis, treatment and prevention of leprosy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2018" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack475541" "titulo" => "Acknowledgements" "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">To Dr Juan José Palacios Gutiérrez, Medicine Laboratory, Microbiology Section, Hospital Universitario Central de Asturias, for the molecular diagnosis of <span class="elsevierStyleItalic">M. leprae</span>.</p><p id="par0075" class="elsevierStylePara elsevierViewall">To Dr José Ramón Gómez Echevarría, Medical Director of Lepra Fontilles, director of Leprology courses, for his help with the clinical orientation, diagnosis and treatment of the case.</p><p id="par0080" class="elsevierStylePara elsevierViewall">To Dr Joanny Alejandra Duarte Luna, Pathology Department, Hospital Universitario de Getafe, for the pathology diagnosis on the skin biopsy.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003800000007/v1_202008020607/S2529993X20301179/v1_202008020607/en/main.assets" "Apartado" => array:4 [ "identificador" => "63562" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003800000007/v1_202008020607/S2529993X20301179/v1_202008020607/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X20301179?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 5 | 8 |
| 2024 October | 36 | 42 | 78 |
| 2024 September | 50 | 34 | 84 |
| 2024 August | 26 | 24 | 50 |
| 2024 July | 26 | 18 | 44 |
| 2024 June | 28 | 22 | 50 |
| 2024 May | 22 | 16 | 38 |
| 2024 April | 20 | 8 | 28 |
| 2024 March | 33 | 15 | 48 |
| 2024 February | 52 | 14 | 66 |
| 2024 January | 44 | 16 | 60 |
| 2023 December | 41 | 13 | 54 |
| 2023 November | 42 | 17 | 59 |
| 2023 October | 88 | 23 | 111 |
| 2023 September | 30 | 13 | 43 |
| 2023 August | 31 | 24 | 55 |
| 2023 July | 54 | 28 | 82 |
| 2023 June | 39 | 20 | 59 |
| 2023 May | 35 | 26 | 61 |
| 2023 April | 29 | 14 | 43 |
| 2023 March | 34 | 19 | 53 |
| 2023 February | 29 | 16 | 45 |
| 2023 January | 44 | 27 | 71 |
| 2022 December | 30 | 14 | 44 |
| 2022 November | 30 | 19 | 49 |
| 2022 October | 29 | 15 | 44 |
| 2022 September | 24 | 18 | 42 |
| 2022 August | 28 | 32 | 60 |
| 2022 July | 35 | 18 | 53 |
| 2022 June | 23 | 19 | 42 |
| 2022 May | 21 | 14 | 35 |
| 2022 April | 31 | 18 | 49 |
| 2022 March | 39 | 10 | 49 |
| 2022 February | 34 | 7 | 41 |
| 2022 January | 52 | 3 | 55 |
| 2021 December | 28 | 7 | 35 |
| 2021 November | 35 | 9 | 44 |
| 2021 October | 35 | 10 | 45 |
| 2021 September | 19 | 4 | 23 |
| 2021 August | 25 | 0 | 25 |
| 2021 July | 13 | 7 | 20 |
| 2021 June | 21 | 8 | 29 |
| 2021 May | 20 | 4 | 24 |
| 2021 April | 36 | 10 | 46 |
| 2021 March | 9 | 2 | 11 |
| 2021 February | 5 | 6 | 11 |
| 2021 January | 1 | 0 | 1 |
| 2020 August | 2 | 0 | 2 |
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