Lepra Bubalorum, a Potential Reservoir of Mycobacterium leprae

In 1926, a mycobacterial skin disease was observed in water buffaloes by researchers in Indonesia. The disease was designated as skin tuberculosis, though it was hypothesized that it might be a form of leprosy or a leprosy-like disease. In a follow-up study (Ph.D. thesis Lobel, 1934, Utrecht University, Netherlands) a similar nodular skin disease was described in Indonesian water buffaloes and named “lepra bubalorum” or “nodular leprosy.” Two decades later Kraneveld and Roza (1954) reported that, so far, the diagnosis lepra bubalorum had been made in 146 cases in Indonesia. After a final series of research reports by Indonesian veterinarians in 1961, no subsequent cases were published. Based on information from these reports, it can be concluded that, even though evidence of nerve involvement in buffaloes was not reported, similarities exist between lepra bubalorum and Hansen’s disease (leprosy), i.e., nodular skin lesions with a chronic course and microscopically granulomatous reactions with AFB in globi in vacuoles. This raises the question as to whether these historical cases might indeed have been caused by Mycobacterium leprae, Mycobacterium lepromatosis or another representative of the M. leprae complex. The future use of state-of-the-art molecular techniques may answer this question and may also help to answer the question whether water buffaloes should be considered as a potential natural reservoir of the causative pathogen of Hansen’s disease.

Disseminated Cutaneous Tuberculosis like Fungal Sporotrichosis Successfully Treated With Terbinafine: A Rare Case Report

Occurrence of Sporotrichosis is uncommon in Nepal. Here, we describe a case of cutaneous Sporotrichosis of 43 years old adult male working as a farmer from Pokhara-30, Nepal with unusual skin tuberculosis like presentation since 3 years, initiating from the unusual location in right pinna. Histopathological observation was suggestive of cutaneous tuberculosis, lupus vulgaris, cutaneous leishmaniasis due to overlapping findings during biopsy. The case was diagnosed by the pharma­cological intervention observing the effect of drugs i.e., terbinafine. The purpose of reporting this serendipitous case is to enhance timely diagnosis, avoid the diagnostic dilemma for future references.

PATHOMORPHOSIS OF EXTRAPULMONARY TUBERCULOSIS IN CHILDREN

Aim. To study clinical and epidemiological aspects of pathomorphosis of extrapulmonary tuberculosis clinical forms. Materials and Methods. Retrospective analysis of 138 case histories in children aged to 15 years, obtaining extrapulmonary tuberculosis treatment in a specialized children's hospital during 1988-2015 was carried out. Among them, in 103 children, clinical forms of extrapulmonary tuberculosis combined with respiratory tuberculosis and in 35 children independent forms of extrapulmonary tuberculosis were found. Studied stage (1988-2015) was divided into 3 periods: I – 1988-1997, II – 1998-2007, III – 2008-2015. During 2008-2015, incomparison to previous periods, the number of cases of peripheral lymph node tuberculosis (PLN), meninges and central nervous system tuberculosis, bones and joints tuberculosis, and ocular tuberculosis decreased. In 2008-2015, the share of combined forms of meninges and central nervous system tuberculosis and ocular tuberculosis remained at 1998-2007 level. During 2008-2015, skin tuberculosis was not diagnosed. Nevertheless, in 2008-2015, in6.8±10.2 % of cases extrapulmonary tuberculosis combined with miliary tuberculosis, and in 5.8±10.4 % of cases the process characterized by lethal outcome, moreover 4.9±10.7% from them – in recent years. It is important that during period I, in 19.6±13.2 % of cases extrapulmonary tuberculosis combined with respiratory tuberculosis in reverse development phases, during period II – in 12.9±19.3 % of cases, during period III – in 23.8±21.2 % of cases. Conclusion. Despite the reduction, extrapulmonary tuberculosis combined with severe forms of respiratory tuberculosis, which led to lethal outcome in children in 5.8±10.4% of cases. Tuberculosis epidemiological situation worsening, reversion of severe forms of tuberculosis with the development of extrapulmonary one and several organs injuries in children shows the necessity of social, preventive and therapeutic measures intensification among children.

Clinico-epidemiological profile of childhood cutaneous tuberculosis

Introduction: Although cutaneous tuberculosis constitutes a small percentage of extra pulmonary tuberculosis, it has not been fully documented in Nepal and more so in the pediatric population. Objectives: The aim of the study was to assess the epidemiology and clinical profile of childhood cutaneous tuberculosis at Kathmandu Medical College and Teaching Hospital, Nepal. Material and Methods: Children (below 15 years of age) with cutanesous tuberculosis who attended the teaching hospital between April 2008 and March 2014 were studied. Results: A total of 17 children with skin tuberculosis were identified during the study period, which constituted 34% of all patients with skin tuberculosis. There were 11 boys and 6 girls with a mean age of 8.8 years. The duration of the lesions ranged from 1 month to 4 years and 13 (76.5%) were brought for medical help after six months of onset of the disease. Lower limb was the most common site of involvement. Of the various patterns of cutaneous tuberculosis; scrofuloderma was the most common 7 (41.2%) followed by lupus vulgaris 6 (35.3%), erythema nodosum 2 (11.7%) and gumma 1 (5.8%). Combination of lupus vulgaris and scrofuloderma was noted in one patient. Three patients (17.6%) had internal organ involvement as pulmonary tuberculosis. Conclusion: The pattern of skin tuberculosis had wide variation with a few of them having systemic involvement. Therefore, these patients need a thorough evaluation or an uniform standard therapeutic regimen to cover both internal organ and cutaneous tuberculosis.NJDVL Vol. 13, No. 1, 2015 Page: 45-51

DIFFERENTIAL DIAGNOSIS OF ROSACEA AND SKIN TUBERCULOSIS AS AN EXAMPLE OF A CLINICAL CASE

In this paper for a clinical observation of a patient with rosacea, and patients with a flat form of lupus tuberculosis presented a differential clinical diagnosis of tuberculosis of the skin.