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Leprosy type 1 reactions and erythema nodosum leprosum
Kahawita, Indira P.;Walker, Stephen L.;Lockwood, Diana N.J.;
Anais Brasileiros de Dermatologia , 2008, DOI: 10.1590/S0365-05962008000100010
Abstract: leprosy reactions are a major cause of nerve damage and morbidity in a significant proportion of leprosy patients. reactions are immunologically mediated and can occur even after successful completion of multi-drug therapy. this review focuses on the epidemiology, pathology and treatment of leprosy type 1 reactions, erythema nodosum leprosum and silent neuropathy.
Management of erythema nodosum leprosum by mycophenolate mofetil  [cached]
Banerjee Kalyan,Banerjee Raghubir
Indian Journal of Dermatology , 2008,
Abstract: Mycophenolate mofetil has been tried in 20 cases of chronic relapsing erythema nodosum leprosum reaction where long use of systemic steroid produce complications or are contraindicated. Excellent results have been observed in all the cases to arrest the reaction followed for a period of six to eight months duration.
The Mortality Associated with Erythema Nodosum Leprosum in Ethiopia: A Retrospective Hospital-Based Study  [PDF]
Stephen L. Walker ,Eglantine Lebas,Shimelis N. Doni,Diana N. J. Lockwood,Saba M. Lambert
PLOS Neglected Tropical Diseases , 2014, DOI: 10.1371/journal.pntd.0002690
Abstract: Background Erythema nodosum leprosum (ENL) is a debilitating multisystem disorder which complicates leprosy. It is characterised by fever, malaise and painful erythematous cutaneous nodules. ENL is often recurrent or chronic in nature and frequently severe. Patients often require prolonged treatment with high doses of oral corticosteroids. There are no data on the mortality associated with treated ENL. Methodology The notes of patients who were admitted, discharged, transferred to another facility or died with a diagnosis of leprosy or a leprosy-related complication for a five year period were reviewed. Result/Discussion 414 individuals were identified from the ward database. 312 (75.4%) patient records were located and reviewed. Ninety-nine individuals had ENL and 145 had a Type 1 reaction. The median age of individuals with ENLwas 25 years. Eight patients with erythema nodosum leprosum died compared with two diagnosed with Type 1 reaction. This difference is statistically significant (p = 0.0168, Fisher's Exact Test). There is a significant mortality and morbidity associated with ENL in this Ethiopian cohort. The adverse outcomes seen are largely attributable to the chronic administration of oral corticosteroids used to control the inflammatory and debilitating symptoms of the condition.
Histopathological study of ocular erythema nodosum leprosum and post-therapeutic scleral perforation: A case report  [cached]
Rathinam S,Khazaei Hadi,Job C
Indian Journal of Ophthalmology , 2008,
Abstract: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae , clinically present either as tuberculoid, borderline or lepromatous type. Erythema nodosum leprosum (ENL) is an acute humoral response in the chronic course of lepromatous leprosy. Although very severe ENL reactions are known in systemic leprosy, such severity is rare in ocular tissues. A leprosy uveitis patient suffered from a severe form of post-therapeutic ENL reaction which resulted in perforation of the globe at the site of preexisting subconjunctival leproma. Painful blind eye was enucleated. Histopathological study revealed infiltration of numerous polymorphs and macrophages packed with acid-fast bacilli in the conjunctiva, cornea, ciliary body, ora serrata and sclera. A profuse influx of neutrophils on a background of macrophages packed with M. leprae confirmed the ocular ENL reaction. This case is reported to alert the ophthalmologists to a rare ocular complication of ENL.
A Systematic Review on the Epidemiological Data of Erythema Nodosum Leprosum, a Type 2 Leprosy Reaction  [PDF]
Carlijn G. N. Voorend,Erik B. Post
PLOS Neglected Tropical Diseases , 2013, DOI: 10.1371/journal.pntd.0002440
Abstract: Background Erythema Nodosum Leprosum (ENL) is a humoral immunological response in leprosy that leads to inflammatory skin nodules which may result in nerve and organ damage, and may occur years after antibiotic treatment. Multiple episodes are frequent and suppression requires high doses of immunosuppressive drugs. Global occurrence is unknown. Methodology/Principal Findings Systematic review of evidence on ENL incidence resulted in 65 papers, predominantly from India (24) and Brazil (9), and inclusive of four reviews. Average incidences are based on cumulative incidence and size of study populations (n>100). In field-based studies 653/54,737 (1.2%) of all leprosy cases, 194/4,279 (4.5%) of MB cases, and 86/560 (15.4%) of LL cases develop ENL. Some studies found a range of 1–8 per 100 person-years-at-risk (PYAR) amongst MB cases. Hospital samples indicate that 2,393/17,513 (13.7%) of MB cases develop ENL. Regional differences could not be confirmed. Multiple ENL episodes occurred in 39 to 77% of ENL patients, with an average of 2.6. Some studies find a peak in ENL incidence in the first year of treatment, others during the second and third year after starting MDT. The main risk factor for ENL is a high bacteriological index. Conclusions/Significance Few studies reported on ENL as a primary outcome, and definitions of ENL differed between studies. Although, in this review averages are presented, accurate data on global and regional ENL incidence is lacking. Large prospective studies or accurate surveillance data would be required to clarify this. Health staff needs to be aware of late reactions, as new ENL may develop as late as five years after MDT completion, and reoccurrences up to 8 years afterwards.
Immunological status of ENL (Erythema Nodosum Leprosum) patients: its relationship to bacterial load and levels of circulanting IL-2R
Vieira, Leila M.M.;Sampaio, Elisabeth P.;Nery, José A.C.;Duppre, Nadia C.;Albuquerque, Edson CA;Scheinberg, Morton A;Sarno, Euzenir N;
Revista do Instituto de Medicina Tropical de S?o Paulo , 1996, DOI: 10.1590/S0036-46651996000200004
Abstract: recent data suggest that the clinical course of reactional states in leprosy is closely related to the cytokine profile released locally or systemically by the patients. in the present study, patients with erythema nodosum leprosum (enl) were grouped according to the intensity of their clinical symptoms. clinical and immunological aspects of enl and the impact of these parameters on bacterial load were assessed in conjunction with patients' in vitro immune response to mycobacterial antigens. in 10 out of the 17 patients tested, bi (bacterial index) was reduced by at least 1 log from leprosy diagnosis to the onset of their first reactional episode (enl), as compared to an expected 0.3 log reduction in the unreactional group for the same mdt (multidrug therapy) period. however, no difference in the rate of bi reduction was noted at the end of mdt among enl and unreactional lepromatous patients. accordingly, although tnf-a (tumor necrosis factor) levels were enhanced in the sera of 70.6% of the enl patients tested, no relationship was noted between circulating tnf-a levels and the decrease in bi detected at the onset of the reactional episode. evaluation of bacterial viability of m. leprae isolated from the reactional lesions showed no growth in the mouse footpads. only 20% of the patients demonstrated specific immune response to m. leprae during enl. moreover, high levels of soluble il-2r (interleukin-2 receptor) were present in 78% of the patients. circulating anti-neural (anti-ceramide and anti-galactocerebroside antibodies) and anti-mycobacterial antibodies were detected in enl patients' sera as well, which were not related to the clinical course of disease. our data suggest that bacterial killing is enhanced during reactions. emergence of specific immune response to m. leprae and the effective role of tnf-a in mediating fragmentation of bacteria still need to be clarified.
Production of Fructoligsaccharides by Aureobasidium Pullulans Using Immobilization Technique
M.A. Ganaie,L.K. Pathak,U.S. Gupta
Journal of Food Technology , 2013, DOI: 10.3923/jftech.2011.91.94
Abstract: The high content of fructooligosaccharides production from sucrose using fructosyltransferase from aureobasidium pullulans was investigated in the laboratory by using immobilizing technique. The FOS production was obtained using both extracellular and intracellular enzyme from Aureobasidium pullulans. Optimum conditions for enzyme production and enzyme reaction have been determined.
Redefinition of Aureobasidium pullulans and its varieties
P. Zalar,C. Gostin?ar,G.S. de Hoog,V. Ur?i?
Studies in Mycology , 2008,
Abstract: Using media with low water activity, a large numbers of aureobasidium-like black yeasts were isolated from glacial and subglacial ice of three polythermal glaciers from the coastal Arctic environment of Kongsfjorden (Svalbard, Spitsbergen), as well as from adjacent sea water, sea ice and glacial meltwaters. To characterise the genetic variability of Aureobasidium pullulans strains originating from the Arctic and strains originating pan-globally, a multilocus molecular analysis was performed, through rDNA (internal transcribed spacers, partial 28 S rDNA), and partial introns and exons of genes encoding β-tubulin (TUB), translation elongation factor (EF1) and elongase (ELO). Two globally ubiquitous varieties were distinguished: var. pullulans, occurring particularly in slightly osmotic substrates and in the phyllosphere; and var. melanogenum, mainly isolated from watery habitats. Both varieties were commonly isolated from the sampled Arctic habitats. However, some aureobasidium-like strains from subglacial ice from three different glaciers in Kongsfjorden (Svalbard, Spitsbergen), appeared to represent a new variety of A. pullulans. A strain from dolomitic marble in Namibia was found to belong to yet another variety. No molecular support has as yet been found for the previously described var. aubasidani. A partial elongase-encoding gene was successfully used as a phylogenetic marker at the (infra-)specific level. Taxonomic novelties: Aureobasidium pullulans var. subglaciale Zalar, de Hoog & Gunde-Cimerman, var. nov.; Aureobasidium pullulans var. namibiae Zalar, de Hoog & Gunde-Cimerman, var. nov.
Erythema nodosum in psittacosis  [cached]
Tharakaram S,Chapman R
Indian Journal of Dermatology, Venereology and Leprology , 1990,
Abstract: A 23-year-old woman developed erythema nodosum on her lower legs, two weeks after a respiratory infection manifesting with generalised bodyache, rhinorrhoea, sore throat, cough and sputum. Her pet budgerigar had been unwell two weeks previously. CFT for psittacosis showed a high titre. Oral tetracycline 4 gm a day for 3 weeks was effective.
Erythema Nodosum in Children  [cached]
Solmaz ?elebi,Mustafa Hac?mustafao?lu,Meryem Berfu Yüceer,Fatma Deniz Aygün
Cocuk Enfeksiyon Dergisi , 2011,
Abstract: Objective: Erythema nodosum (EN) is a rare inflammatory disease of the subcutaneous tissue. EN has been associated with various infections and chronic inflammations. The aim of this study was to evaluate the epidemiology, etiology, clinical findings and course of EN in children. Material and Methods: A total of 14 patients diagnosed with EN between January 2005 and March 2011 at Uludag University, Pediatric Infectious Diseases Outpatient Clinic, were studied retrospectively. Results: The mean age of patients was 9.2±3.7 years (range, 3-15 years) and 57% were male. The mean duration of the skin manifestation before admission was 20.7±13.8 days (range, 7-60 days). Tularemia was the most common cause (28.6%), followed by tuberculosis (21.4%), streptococcal infection (14.2%) and gastroenteritis due to Salmonella spp. (14.2%). In one-fifth of cases, no specific cause could be identified. The duration of the recovery of lesions varied from 6 to 15 days (mean, 10.1±3.2 days). Recurrences were noted in 2 children (2 episodes in 1 child and 4 episodes in the other). Conclusion: EN has been associated with numerous diseases. This study revealed tularemia and tuberculosis as the main etiologies of EN.
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