Investigation of neuropathic pain in treated leprosy patients in Ethiopia: a cross-sectional study.

Pain can be a significant problem for treated leprosy patients. It can be nociceptive due to tissue inflammation occurring during episodes of immune mediated reactions, or neuropathic due to leprosy affecting the somatosensory system. There are sparse epidemiological data on the prevalence and impact of neuropathic pain in treated leprosy patients. Tools for assessing neuropathic pain have not been validated in leprosy. We have examined nature of pain in a cross-sectional study to determine the prevalence of neuropathic pain (NP) in 80 recently treated leprosy patients in Ethiopia. Pain and depression were evaluated using the General Health Questionnaire (GHQ-12) and the Brief Pain Inventory (BPI) questionnaire. The Douleur Neuropathique en 4 Questions (DN4) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used as screening tools for NP. Pain of any type was experienced by 60% of the patients. Pure nociceptive pain was experienced by 43%, pure NP by 11%, and mixed pain by 6%. Of the 14 patients who had NP either alone or in combination with nociceptive pain, 12 had high GHQ-12 scores, indicating possible depression. The DN4 had sensitivity and specificity of 100% and 45%, whereas the LANSS had 85% and 42%, respectively. This is the first study to differentiate nociceptive from NP in leprosy patients. The prevalence of NP is high in recently treated Ethiopian leprosy patients. We have validated the use of DN4 in leprosy and it is easier to use than LANSS. Depression is a common co-morbidity in patients with NP. The high prevalence and morbidity of NP in treated leprosy patients warrant clinical trials to assess the efficacy of pain therapies for leprosy-associated NP.

Angiolymphoid hyperplasia with eosinophilia in a 29 years old Ethiopian patient, diagnosed using clinicopathologic correlation.

We report a case of Angiolymphoid hyperplasia with eosinophilia in a 29 years old female Ethiopian patient. This case was diagnosed by establishing a clinicopathologic correlation. This is the first case of its kind ever reported in Ethiopia. The clinical features, dermatohistopathological findings, and treatment options are discussed with review of literature.

Neuropathic pain in people treated for multibacillary leprosy more than ten years previously.

OBJECTIVES: To identify patients with typical symptoms of neuropathic pain in a well-defined cohort of multibacillary patients being followed up as part of a relapse study in Ethiopia; to identify risk factors for the development of neuropathic pain. DESIGN: 96 patients who had completed MDT more than 10 years previously participated in the study, through a questionnaire. RESULTS: 28 (29%) had symptoms of neuropathic pain and it was reported as severe in 12. Because the past history of these subjects is well documented, a risk factor analysis was carried out. The presence of leprosy-related impairment was the only significant risk factor for neuropathic pain that was identified. CONCLUSIONS: Neuropathic pain is an important problem in a proportion of people previously treated for leprosy. Further research into the management of the condition is required.

Disseminated form of syringoma (eruptive syringoma) sparing the face-a rare presentation causing diagnostic challenge.

Syringomas are benign neoplasms of the skin commonly appearing around the eye lids. Though common in middle-aged women, it affects all age groups. The lesions are asymptomatic, firm, discrete, translucent or skin colored flat-topped papules. Once papules of syringoma come into being, which usually is after puberty, they remain as they are for a lifetime. Disseminated lesions appearing on the abdomen, scalp and genital area has been described earlier. We report the disseminated form (eruptive) syringoma involving the trunk, the neck, and the upper extremities while sparing the face. Our case created a diagnostic difficulty because of the unusual distribution of lesions. The case is presented and discussed with review of literature.

Effect of thalidomide on the expression of TNF-alpha m-RNA and synthesis of TNF-alpha in cells from leprosy patients with reversal reaction.

Hypersensitivity reactions called reversal reaction (RR) and erythema nodosum leprosum (ENL) occur in leprosy. They are characterized by an increase in tumor necrosis factor-alpha (TNF-alpha). Thalidomide is an effective treatment for ENL but not RR. Its effectiveness in ENL is attributed to inhibition of TNF-alpha, and this does not explain its failure to treat RR. We assessed thalidomide's effect on TNF-alpha in RR. Mononuclear cells from RR and non-RR patients and healthy individuals were treated with thalidomide and M.leprae (AFB), a cytosol fraction of M. leprae or Dharmendra lepromin. Thalidomide suppressed TNF-alpha, but when some RR patients' cells were stimulated with AFB, it enhanced TNF-alpha.

Prevalence of mental distress in the outpatient clinic of a specialized leprosy hospital. Addis Ababa, Ethiopia, 2002.

Leprosy is a chronic disease that leads to physical disability as a result of nerve damage. Stigma and associated psychosocial problems are common and may increase the risk of mental disorders. This study was conducted to estimate the prevalence of mental distress amongst people attending a Specialized Leprosy and Dermatology Hospital, ALERT, Addis Ababa. Alternate patients from the daily register of outpatients were interviewed for symptoms of mental distress using the Self Reporting Questionnaire (SRQ). This questionnaire was administered by two specially trained nurses. The study population consisted of 786 people. Of these, 60% had leprosy and the remainder had other skin diseases. The sex distribution of the study population was approximately equal. The overall prevalence of mental distress was found to be 34.6%. Among people with leprosy the prevalence was 52.4%, compared with 7.9% in those with other skin conditions. This represented a 7-fold increased risk of mental distress in people with leprosy, adjusted OR = 7.14 (95% CI; 4.15, 12.35). Physical disability was also strongly associated with mental distress. This study showed that the 1-month prevalence of mental distress was significantly higher in patients with leprosy compared to patients with other dermatological conditions. Such a study allows identification of non-specific mental distress. Thus, future work should be directed at further characterizing the nature and severity of mental disorder in this group. However, our study has indicated a need for the integration of psychosocial care into our current medical treatment of patients with leprosy.