Association of CC-chemokine ligand-2 gene polymorphisms with leprosy reactions.

BACKGROUND: C-C motif chemokine ligand 2, a gene that codes for a protein involved in inflammation. Certain SNPs in the CCL2 gene have been studied for their potential associations with susceptibility to various diseases. These SNPs may affect the production and function of the CCL2 protein, which is involved in the recruitment of immune cells to the site of inflammation. Variations in CCL2 may influence the immune response to Mycobacterium leprae infection. OBJECTIVE: To investigate the association of the C-C motif chemokine ligand-2 single nucleotide polymorphisms with leprosy. METHODS: CCL2 single nucleotide polymorphisms were analyzed in a total of 975 leprosy patients and 357 healthy controls. Of those, 577 leprosy and 288 healthy controls were analyzed by PCR-RFLP for CCL2 -2518 A>G, 535 leprosy and 290 controls for CCL2 -362 G>C, 295 leprosy and 240 controls for CCL2 -2134 T>G, 325 leprosy and 288 controls for CCL2 -1549 A>T SNPs by melting curve analysis using hybridization probe chemistry and detection by fluorescence resonance energy transfer (FRET) technique in Realtime PCR. The levels of CCL2, IL-12p70, IFN-γ, TNF-α, and TGF-ß were estimated in sera samples and correlated with CCL2 genotypes. RESULTS: The frequency of the GCT (-2518 A>G, -362 G>C, -2134 T>G) haplotype is observed to be higher in leprosy patients compared to healthy controls (P = 0.04). There was no significant difference observed in genotypic frequencies between leprosy patients and healthy controls {(-2518A>G, p = 0.53), (-362 G>C, p = 0.01), (-2134 T>G, p = 0.10)}. G allele at the -2134 site is predominant in leprosy (borderline) without any reaction (8 %) compared to borderline patients with RR reactions (2.1 %) (P = 0.03). GG genotype (p = 0.008) and G allele at -2518 (p = 0.030) of the CCL 2 gene were found to be associated with patients with ENL reaction. An elevated level of serum CCL2 was observed in leprosy patients with the -2518 AA and AG genotypes (p = 0.0001). CONCLUSIONS: G allele and GG genotype at the CCL2 -2518 site are associated with a risk of ENL reactions.

Lepra reactions: A study of 130 cases from Pakistan.

OBJECTIVE: To determine the occurrence and characteristics of lepra reactions in leprosy patients. METHODS: The retrospective study was conducted at the Marie Adelaide Leprosy Centre, Karachi, and comprised data of patients admitted between January 1, 2013, and December 31, 2015, for the management of lepra reactions. Data was noted on a detailed proforma and was analysed using Microsoft Excel and applying chi-square test. RESULTS: Of the 130 cases, 95(73%) were males and 35(27%) were females. Mean age at onset of the first episode was 39±14 years. Borderline lepromatous was the most common classification 76(58%), with 40(53%) of them having type 1 reaction as the first episode and 36(47%) having a type 2 reaction Risk factors associated with recurrence were skin lesions, fever, lymphadenopathy and type of reaction (p<0.05). CONCLUSION: Healthcare providers need to be aware of the clinical manifestations of lepra reactions in order to diagnose them early.

Leprosy in Pregnancy: A Case Series in 4 Dermatology Clinics in Malaysia

IntroductionManagement of leprosy in pregnancy is challenging. Here we aim to describe the clinical characteristicsand the management of leprosy in pregnancy.MethodsThis is a retrospective study on pregnant women with leprosy managed in the Department ofDermatology in Hospital Kuala Lumpur, Hospital Pulau Pinang, Hospital Sultanah Bahiyah andHospital Queen Elizabeth between 1994 and 2015.ResultsThere were ten patients with 12 pregnancies with a median age of 27.5 years (range: 16-33). Fivewere foreigners. There were four cases of lepromatous leprosy, two cases of borderline lepromatous,two cases borderline tuberculoid leprosy and one case each for tuberculoid and mid borderline leprosy.Seven pregnancies (58%) were documented to have reactions. Four reversal reactions (33%), threeerythema nodusom leprosum (25%) and two Lucio’s phenomenon (17%) were documented. Bothpatients with Lucio’s phenomenon had undiagnosed leprosy and presented with preterm labour,anemia, oligohydramnios and intrauterine growth restriction. Mortality was recorded in one patientdue to dapsone induced hypersensitivity syndrome complicated with septicaemia. All patients wereprescribed multidrug therapy but in three pregnancies, the patients chose to defer the treatment. Therewas a spontaneous miscarriage at second trimester and a case of early neonatal death. The neonatalcomplications recorded for the 10 live deliveries were low birth weight, jaundice and clofazimineinducedhyperpigmentation.ConclusionThe majority of our patients with leprosy had complications throughout the pregnancies. Earlydetection and prompt treatment can prevent unfavorable fetal outcome & threatened maternal health.