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Table 2 Systems with a significant degree of M. Leprae infiltration and/or dysfunction

From: A case of leprosy in Malawi. Making the final push towards eradication: a clinical and public health perspective

System Complication(s) Reference(s)
Renal system Secondary amyloidosis can develop in several organs although it commonly causes kidney damage by glomerulonephritis (incidence up to 50 %), interstitial nephritis, nephrotic syndrome, pyelonephritis and acute tubular necrosis. [4, 18]
Respiratory system M. leprae can infiltrate the upper respiratory tract including the nose, pharynx, larynx, epiglottis and trachea. Common symptoms include cough, hoarseness, and, occasionally, dyspnoea. The bronchi and lungs are usually spared. [1820]
Cardiovascular system Leprosy (particularly multibacillary) has been associated with arrhythmias, dyspnoea, ventricular hypertrophy and ST segment abnormalities. M. Leprae can invade the cardiac autonomic system. Coronary artery disease and arteriographic abnormalities affect approximately 11 and 50 % of patients respectively. [4, 18]
Endocrine system Approximately 90 % of men develop orchitis, commonly with involvement of the epididymis. This can lead to infertility, sexual impotence and gynaecomastia. Approximately 30 % of patients develop cortical adrenal lesions. [18, 20, 21]
Hepato-biliary system The incidence of liver involvement is estimated at between 48 % and almost 100 %. Lepromatous hepatitis describes portal and centrolobular granulomas, and fibrosis with acid-fast bacilli. Infrequently, secondary amyloidosis can cause hepatic damage. The gall bladder, biliary system and pancreas are usually spared. [18, 22]
Haematology 90 % of lepromatous patients show bacillaemia. Bone marrow infiltration can lead to pancytopaenia. A widespread lymphadenopathy can also occur. [4, 18]
Reproductive system Approximately 90 % of infected males develop orchitis. Foamy macrophages often form granulomas which replace the testicular parenchyma. Otherwise, parenchymal fibrosis and hyalinization of the spermatopoietic tubules may occur. If left untreated this will eventually cause testicular atrophy and infertility. There is very little involvement of the female genital tract. [18, 20]
  1. Systemic involvement is fully reviewed by Klioze et al. [18]. Organ dysfunction correlates with: (i) the degree of infiltration; and (ii) interaction with other factors including amyloid infiltration, infection, leprosy reactions and concomitant drug use [18]