Pediatric Leprosy Workup
- Author: Benjamin Estrada, MD; Chief Editor: Russell W Steele, MD more...
While in contact with patients with leprosy, healthcare workers should employ standard precautions. It has been suggested that M leprae is sensitive to ultraviolet light, and this sensitivity may be useful in sterilization and disinfection practices.
M leprae cannot be cultured in vivo; however, some laboratory studies are available that can be useful in the diagnosis of leprosy. Measurement of phenolic glycolipid-1 antibodies may be helpful in epidemiologic studies and follow-up treatment.
Detection of M leprae by polymerase chain reaction (PCR) is promising; however, PCR detection is not widely available and has not been standardized. RNA gene probes have been used to assist in the diagnosis and response to treatment among patients with paucibacillary (PB) and multibacillary (MB) disease. The absence of M leprae rRNA in skin samples of previously diagnosed patients correlates with response to treatment. Probes targeting 16S rRNA and 16S rDNA have been used in the diagnosis of smear-negative MB disease.[14, 15, 16, 17]
Drug resistance can be tested in vivo by inoculation of mouse footpad. This type of test is not widely accessible, and results are not usually available until 6 months after inoculation.
Lepromin testing is an intradermal skin test that contains heat-killed M leprae. Patients with PB leprosy and individuals who are asymptomatic but live in endemic areas usually present an area of induration after the antigen administration; however, patients with MB leprosy rarely react to the administration of this antigen. The use of this test has no practical diagnostic value and has recently been discouraged.
Tissue Analysis and Histologic Findings
Skin biopsies and smears are helpful not only in establishing the diagnosis of leprosy but also in the process of establishing the difference between PB and MB disease. Skin biopsy specimens obtained from patients with leprosy should always be stained with hematoxylin and eosin (H&E) and an acid-fast stain.
In PB leprosy, giant cells in skin and nerves may accompany accumulation of epithelioid-lymphocyte granulomas. Bacilli are rare in this type of leprosy, and they are not present in nerves. In LL leprosy, bacilli are abundant; they can be observed in the areas surrounding blood vessels and are also present in nerves.
Cortés SL, Rodríguez G. Leprosy in children: association between clinical and pathological aspects. J Trop Pediatr. 2004 Feb. 50(1):12-5. [Medline].
McNabb SJ, Jajosky RA, Hall-Baker PA, et al. Summary of notifiable diseases--United States, 2006. MMWR Morb Mortal Wkly Rep. 2008 Mar 21. 55(53):1-92. [Medline].
Imbiriba EB, Hurtado-Guerrero JC, Garnelo L, et al. Epidemiological profile of leprosy in children under 15 in Manaus (Northern Brazil), 1998-2005. Rev Saude Publica. 2008 Dec. 42(6):1021-6. [Medline].
Chen XH, Xiong JH, Ning Y, Wen Y, Liu J, Mao C, et al. IL-10 promoter SNPs and susceptibility to leprosy in ethnic groups from southwest China. Genet Mol Res. 2013 Aug 12. 12(3):2876-85. [Medline].
Mohite RV, Mohite VR, Durgawale PM. Differential trend of leprosy in rural and urban area of western Maharashtra. Indian J Lepr. 2013 Jan-Mar. 85(1):11-8. [Medline].
Scheelbeek PF, Balagon MV, Orcullo FM, Maghanoy AA, Abellana J, Saunderson PR. A retrospective study of the epidemiology of leprosy in cebu: an eleven-year profile. PLoS Negl Trop Dis. 2013 Sep 19. 7(9):e2444. [Medline].
King K, Browning JC, Metry DW, et al. Leprosy and international adoption: a case report and review of diagnostic and treatment dilemmas. Pediatr Infect Dis J. 2009 Apr. 28(4):322-5. [Medline].
Kar BR, Job CK. Visible deformity in childhood leprosy--a 10-year study. Int J Lepr Other Mycobact Dis. 2005 Dec. 73(4):243-8. [Medline].
Fakhouri R, Sotto MN, Manini MI, Margarido LC. Nodular leprosy of childhood and tuberculoid leprosy: a comparative, morphologic, immunopathologic and quantitative study of skin tissue reaction. Int J Lepr Other Mycobact Dis. 2003 Sep. 71(3):218-26. [Medline].
Pandhi D, Mehta S, Agrawal S, Singal A. Erythema nodosum leprosum necroticans in a child--an unusual manifestation. Int J Lepr Other Mycobact Dis. 2005 Jun. 73(2):122-6. [Medline].
Saunderson P, Bizuneh E, Leekassa R. Neuropathic pain in people treated for multibacillary leprosy more than ten years previously. Lepr Rev. 2008 Sep. 79(3):270-6. [Medline].
Lawn SD, Lipman MC, Easterbrook PJ. Immune reconstitution disease associated with mycobacterial infections. Curr Opin HIV AIDS. 2008 Jul. 3(4):425-31. [Medline].
Truman RW, Gillis TP. The effect of ultraviolet light radiation on Mycobacterium leprae. Int J Lepr Other Mycobact Dis. 2000 Mar. 68(1):11-7. [Medline].
Kamal R, Dayal R, Katoch VM, Katoch K. Analysis of gene probes and gene amplification techniques for diagnosis and monitoring of treatment in childhood leprosy. Lepr Rev. 2006 Jun. 77(2):141-6. [Medline].
Job CK, Drain V, Williams DL, et al. Comparison of polymerase chain reaction technique with other methods for detection of Mycobacterium leprae in tissues of wild nine-banded armadillos. Lepr Rev. 1991 Dec. 62(4):362-73. [Medline].
Dayal R, Agarwal M, Natrajan M, et al. PCR and in-situ hybridization for diagnosis of leprosy. Indian J Pediatr. 2007 Jul. 74(7):645-8. [Medline].
Dayal R, Gupta R, Mathur PP, et al. Study of gene probes in childhood leprosy. Indian J Pediatr. 1998 Jan-Feb. 65(1):99-105. [Medline].
Williams DL, Lewis C, Sandoval FG, Robbins N, Keas S, Gillis TP, et al. Drug Resistance in Leprosy Patients in the United States. Clin Infect Dis. 2013 Sep 24. [Medline].
Alangaden GJ, Lerner SA. The clinical use of fluoroquinolones for the treatment of mycobacterial diseases. Clin Infect Dis. 1997 Nov. 25(5):1213-21. [Medline].
Ji B, Jamet P, Perani EG, et al. Powerful bactericidal activities of clarithromycin and minocycline against Mycobacterium leprae in lepromatous leprosy. J Infect Dis. 1993 Jul. 168(1):188-90. [Medline].
Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005 Dec 30. 54:1-141. [Medline]. [Full Text].
Dong L, Li F, Jiang J, Zhang G. Techniques for covering soft tissue defects resulting from plantar ulcers in leprosy: Part II--First toe web and dorsal foot flaps. Indian J Lepr. 1999 Jul-Sep. 71(3):297-309. [Medline].
Cunha SS, Rodrigues LC, Pedrosa V, et al. Neonatal BCG protection against leprosy: a study in Manaus, Brazilian Amazon. Lepr Rev. 2004 Dec. 75(4):357-66. [Medline].
Zodpey SP, Ambadekar NN, Thakur A. Effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of leprosy: a population-based case-control study in Yavatmal District, India. Public Health. 2005 Mar. 119(3):209-16. [Medline].