LEPROSY AND HUMAN IMMUNODEFICIENCY VIRUS COINFECTION: A RARE CASE REPORT

eva lydiawati, Chukmol Sirithida, Sou Vannda, Hak Vortey, Heng Ratana, M. Yulianto Listiawan, Indropo Agusni

= http://dx.doi.org/10.20473/ijtid.v7i4.8869
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Abstract


Leprosy, or Hansen disease, is a chronic infectious disease caused by Mycobacterium leprae which is associated with inflammation that may damage the skin and the peripheral nerves. Leprosy remains an important public health problem in Southeast Asia, America, and Africa. It has been speculated that, as with TB, HIV infection may exacerbate leprosy lesions and/or lead to increased susceptibility to leprosy. We report the case of leprosy and HIV co-infection and reveals its clinical manifestation. A 34-year-old female came to outpatient clinic complaining of rednessplaque on her face of 2-months duration. It was also accompanied with thick sensation but without itchy or burning sensation. We found thick erythematous plaque with sharp margin and hypoesthesia on her face and body. There were no madarosis, saddle nose, lagophthalmos, nor sign of neuritis. The slit-skin smear revealed BI 1+ globi and MI 2%. From laboratory examination we found CBC was within normal limit, IgM anti PGL-1 titer was 1265 u/mL and IgG anti PGL-1 was 834 u/mL Both histological examination on her ear lobe and extremity revealed that was similar to the lesion of leprosy. The detection of HIV antibody was positive with CD4 count on 325 cells/μL. We treat her with MDT for MB leprosy along with ART (Tenofovir, Lamivudine, and Efavirenz). After 6-months follow-up we observed no progression of the lesions though the slit-skin smear after completing 6 months of therapy become negative. M. leprae does not seem to accelerate the decline of immune function when associated with HIV infection. HIV infection does not seem to affect the clinical classification and progression of leprosy. Treatment of the HIV-leprosy co-infected patient consists of the combination of ARTs and anti-leprosy agents. So that, the treatment of leprosy and HIV co-infection does not differ from that of a seronegative leprosy patient.


Keywords


leprosy, Hansen disease, HIV co-infection, leprosy-HIV, MH

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References


Region EA, Region M. Global leprosy situation. Week Epid Rec 2012; (August 2012): 2011–2015.

Massone C, Talhari C, Ribeiro-Rodrigues R, Sindeaux RHM, Mira MT, Talhari S, et al. Leprosy and HIV coinfection: a critical approach. Expert Rev Anti Infect Ther 2011; 9(6): 701–10.

Global leprosy situation. Wkly Epidemiol 2010; Rec. 85(35): 337-48

Naafs B. Leprosy and HIV: an analysis. Hansen Int 2000; 25(1): 63-6.

Naafs B. Some observations from the past year. Hansen Int 2004; 29: 51-6.

Lockwood DNJ, Lambert SM. Human immunodeficiency virus and leprosy: An update. Dermatol Clin 2011; 29(1): 125–128.

Kwobah CM, Wools-Kaloustian KK, Gitau JN, Siika AM. Human immunodeficiency virus and leprosy coinfection: Challenges in resource-limited setups. Case Rep Med 2012; 2012: 2–3.

Talhari C, Mira MT, Massone C, Braga A, Chrusciak‐Talhari A, Santos, M, et al. Leprosy and HIV coinfection: a clinical, pathological, immunological, and therapeutic study of a cohort from a Brazilian referral center for infectious diseases. J Infect Dis 2010; 202(3): 345–354.

Kumar B, Kar HK. IAL Textbook of Leprosy, The health sciences publisher. London, 2nd edition. 2017. P 343-47.

Pires CAA, de Miranda MFR, Bittencourt M, de JS, de Brito AC, Xavier MB. Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients. Ana Bras Dermatol 2015; 90(1): 27–34.

Rahman S, Gudetta B, Fink J. Compartmentalization of immune responses in human tuberculosis: few CD8+ effector T cells but elevated levels of FoxP2+ regulatory T cells in the granulomatous lesions. Am J Pathol 2009; 174: 2211-24.

Ribeiro-Rodriguez R, Hirsch CS, Boom WH. A role for CD4+ CD25+ T cells in regulation of the immune response during human tuberculosis. Clin Exp Emmunol 2006; 144: 25-34.

Toossi Z, Mayanja-Kizza H, Hirsch CS. Impact of tuberculosis (TB) on HIV-1 activity in dually infected patients. Am J Clin Exp Immunol 2001; vol. 123, no. 2: 233–8.

Falvo JV, Ranjbar S, Jasenosky LD, Goldfeld AE. Arc of a vicious circle: pathways activated by Mycobacterium tuberculosis that target the HIV-1 long terminal. Am J Respir Cell Mol Biol 2011; vol. 45, no. 6: 1116–24.

CDC. HIV testing and treatment among tuberculosis patients—Kenya 2006–2009. Morb Mortal Wkly Rep (MMWR) 2010; vol. 59, no. 46: 1514–7.

Ustianowski AP, Lawn SD, Lockwood DN. Interactions between HIV infection and leprosy: a paradox. Lancet Infect Dis 2006; 6(6): 350–60.

Gupta TSC, Sinha PK, Murthy VS, Kumari GS. Leprosy in an HIV-infected person. Indian J Sex Transm Dis 2007; 28 (2): 100-2.

Whalen C, Horsburgh CR, Hom D, Lahart C, Simberkoff M, Ellner J. Accelerated course of human immunodeficiency virus infection after tuberculosis. Am J Respir Crit Case Med 1995; 151: 129-35.

Whalen CC, Nsubuga P, Okwera A, Johnson JL, Hom DL, Michael NL, et al. Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda. AIDS 2000; 14: 1219-28.

Pereira GAS, Stefani MMA, Araujofilho JA, Souza LCS, Stefani GP, Martelli SMT. Human immunodeficiency virus type 1 (HIV-1) and Mycobacterium leprae coinfection: HIV-1 subtypes and clinical, immunologic, and histopathologic profiles in a Brazilian cohort. Am J Trop Med Hyg 2004; 71(5): 679-84.

Deps P, Lucas S, Porro AM, Maeda SM, Tomimori J, Guidella C, et al. Clinical and histological features of leprosy and human immunodeficiency virus coinfection in Brazil. Clin Exp Dermatol 2013; 38: 470-7.

Sarno EN, Illarramendi X, Nery JA, Sales AM, Gutierrez-Galhardo MC, Penna ML, et al. HIV-M. leprae interaction: can HAART modify the course of leprosy? Public Health Rep 2008; 123: 206-12.

Britton WJ, Lockwood DNJ. Leprosy. Lancet 2004; 363: 1209-19.


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