Leprosy self-care is essential for preventing disability and preserving dignity but remains challenging in resource-constrained settings like Nigeria. Traditional behavioural approaches often fail to address the broader social and material factors influencing self-care sustainability. This study employs Social Practice Theory (SPT) to reconceptualise leprosy self-care as a socially embedded practice, moving beyond individual-focused interventions. Conducted over four months in a leprosy-designated village in North Central Nigeria, the research utilised a qualitative methodology grounded in hermeneutic phenomenology. Data were collected through 20 in-depth interviews with individuals affected by leprosy, five key informant interviews, and 16 hours of non-participant observation. Thematic analysis, guided by SPT’s framework of competences, materials, and meanings, revealed that self-care is shaped by dynamic interactions among skills, resource availability, and cultural interpretations. Challenges included inadequate supplies, inconsistent healthcare support, and stigma, which often undermined engagement. Religious practices and daily routines, such as ablution, sometimes supported self-care, while competing activities like street begging posed barriers. The study distinguishes between replaceable and irreplaceable materials, highlighting their impact on practice sustainability. Family and peer involvement further influenced outcomes, either reinforcing or weakening self-care efforts. By framing self-care as a social practice, this research underscores the need for systemic, contextually sensitive interventions that integrate material provision, skill development, and stigma reduction. SPT offers a robust framework for designing multi-level strategies to enhance self-care for leprosy and other chronic conditions, promoting sustainable health outcomes in marginalised communities.

Hansen’s disease is a chronic granulomatous disease caused by Mycobacterium leprae that still poses challenges for clinicians because of its wide range of presentations, including atypical forms. Atypical manifestations of the disease—such as lazarine leprosy, psoriasiform leprosy, verrucous plaques, histoid leprosy, erythema annulare centrifugum, erythema gyratum repens, subcorneal pustular dermatosis, livedoid plaques, Sweet’s syndrome-like lesions and reactions resembling erythema multiforme or urticarial vasculitis and Lucio phenomenon—can mimic a variety of dermatological and systemic disorders, posing considerable diagnostic challenges, as reported in the literature. Misdiagnosis or delayed diagnosis is common, leading to preventable morbidity, disability, and ongoing transmission. This issue is further amplified in non-endemic areas where clinical suspicion is low. Variability in presentation is influenced by factors such as disease endemicity and host immune status. Unusual forms can obscure recognition. Some cases present with asymptomatic nodules, erythromelalgia, or spontaneous ulceration, further complicating diagnosis. A detailed clinical history, high diagnostic suspicion, and confirmatory investigations—including slit-skin smears and histopathology—are crucial for accurate diagnosis. Early identification of atypical leprosy presentations allows timely treatment, reduces complications, and limits disease spread. We present six cases of leprosy with unusual clinical manifestations, namely, secondary syphilis, hand ulcers, mycetoma, sporotrichosis, purpura fulminans and Sweet’s syndrome. This case series emphasises the diverse clinical spectrum of leprosy and the need for heightened clinical awareness to avoid misdiagnosis, especially in atypical or rare presentations.

Background Dapsone is an essential component of multidrug therapy (MDT) for Hansen’s disease but is associated with rare, potentially life-threatening adverse events such as Dapsone Hypersensitivity Syndrome (DHS). Case We report a 67-year-old male with borderline tuberculoid leprosy who developed generalized exfoliative dermatitis, fever, eosinophilia, hepatosplenomegaly, and hypoxia three weeks after starting MDT. Cutaneous examination revealed diffuse skin exfoliation sparing old Hansen’s plaques, along with a trophic ulcer and nerve tenderness. Investigations showed leucocytosis, transaminitis, and CT scan findings consistent with hypersensitivity pneumonitis. MDT was withheld, and the patient was managed with systemic corticosteroids and oxygen support. Clinical and biochemical parameters improved, and MDT was reintroduced without dapsone under steroid cover. Conclusion DHS may mimic a Type 1 lepra reaction, leading to diagnostic difficulty. Early recognition and prompt management are crucial to prevent severe complications. This case underscores the importance of considering DHS in patients presenting with systemic symptoms following dapsone initiation.

Objectives This study aimed to describe the prevalence of carpal tunnel syndrome (CTS) in leprosy household contacts, as well as its morphological and electroneuromyographical patterns. Matherials and methods A prospective, cross-sectional study in which 28 HHCs were recruited with symptoms of carpal tunnel syndrome (CTS), who underwent ultrasonography (US) and electroneuromyography (ENMG). In the US, the cross-sectional area (CSA) of the median nerve was measured at the carpal tunnel (Mt) and 4 centimetres proximally to it (Mpt). In the ENMG, motor and sensory conduction studies were performed, assessing conduction velocities (CV), distal motor latencies (DML), amplitudes of sensory nerve action potentials (SNAP), and compound muscle action potentials (CMAP). Results and discussion The HHCs with CTS had a mean age of 52.7 (35.4) years, with a predominance of females (78.6%; 22/28). Bilateral involvement was observed in 67.8% (19/28) and unilateral in 32.2% (9/28), totalling 47 nerves evaluated. In the sensory conduction study by ENMG, 100% (47/47) showed reduced conduction velocity (CV), and 19.1% (9/47) showed reduced SNAP amplitude, with no evidence of asymmetry between the different sensory branches evaluated. In the motor conduction study by ENMG, 34.0% (16/47) showed prolonged distal motor latency (DML), 6.1% (3/47) had reduced CV, and no HHC showed reduced CMAP amplitudes. On US, 36.2% (17/47) showed increased CSA at the carpal tunnel (Mt), and none at the proximal segment (Mpt). None of the 28 subjects had any skin signs suggesting leprosy; 12 of them did, however, show other evidence of pure neural leprosy and were treated as such. The evidence suggested that the carpal tunnel syndrome in these cases was unrelated to the underlying leprosy infection. Conclusion Even though CTS has been described as a possible presentation of leprosy neuropathy in an at-risk population, CTS alone does not by itself indicate the presence of leprosy neuropathy.

On May 23–25, 2024, a multidisciplinary expert group met in Bergen, Norway, the site of the first description of Mycobacterium leprae (M. leprae) in 1873, to discuss advancements and remaining knowledge gaps in the transmission of M. leprae at the Global Partnership for Zero Leprosy Zero Transmission Symposium. Research and operational approaches to interruption of transmission were identified; the research approaches from the symposium are described here. Updates since a previous symposium at the National School of Tropical Medicine, Baylor College of Medicine in Houston (USA), in 2014 from these fields of research are presented here: epidemiology; microbiological diagnosis; immunodiagnostics; genotyping; geospatial mapping; leprosy elimination monitoring and transmission under low-endemic circumstances; leprosy post-exposure prophylaxis (PEP); modelling relevant to interruption of transmission of M. leprae; OneHealth; environmental transmission of M. leprae; social determinants; control programmes relevant to interruption of transmission of M. leprae; and organizations of persons affected. Progress and outstanding gaps since 2014 are identified, and recommendations for relevant research in these areas to achieve interruption of transmission are presented. These include research into human reservoirs, including platforms for field-friendly diagnostics; routes of entry/exit of M. leprae; the roles of animals or vectors in transmission; the role of social determinants in transmission; host-pathogen interactions; transmission networks; and enhanced epidemiological data. Fulfilment of these research recommendations and further understanding of which settings require intensified control efforts, will help to advance the aim of achieving complete interruption of transmission of M. leprae and the elimination of leprosy disease.

Chronic ulcerating ENL is a challenging clinical manifestation. Presentation delay and clinical factors result in loss of overlying skin, leading to non-healing infections, gangrene, and potentially severe disability. Tibial drilling will stimulate granulation for healing of wounds over bone. A patient with ulcerating ENL and exposed tibia for over 3 years was treated with tibial drilling, in addition to the standard protocol for ENL management. After the procedure, two open wounds (19 cm × 7 cm and 15 cm × 5 cm) over the right and left legs, respectively, healed completely in 8 months.

Background The host immune responses associated with the clinical phenotypes of Mycobacterium leprae infection are not fully understood. The inflammatory complications of leprosy, leprosy reactions, particularly erythema nodosum leprosum (ENL), present therapeutic challenges. Thalidomide is an effective drug for ENL but is not widely available due to teratogenicity. Thalidomide binds cereblon (CRBN), a substrate receptor for the E3 ligase complex, promoting ubiquitination. Thus, we investigated the CRBN expression in human peripheral blood mononuclear cells (PBMCs) in response to in vitro stimulation with M. leprae with/without CRBN blockade peptide. Methods Blood samples were obtained from apparently BCG-vaccinated and BCG-unvaccinated healthy volunteers. PBMC was isolated and stimulated with irradiated M. leprae with or without CRBN blockade peptide. CRBN, NF-kB, and PARK2 proteins were determined by ELISA, and their gene expression by qPCR. Results Stimulation with M. leprae significantly increased CRBN gene expression and protein production. Incubation of PBMCs with M. leprae with CRBN blockade significantly increased NF-kB expression. In a subgroup analysis, CRBN and NF-kB gene expression following stimulation with M. leprae (p ≤ 0.05) was significantly higher in PBMCs from Mycobacterium bovis bacillus Calmette–Guérin (BCG)-vaccinated individuals compared to those from unvaccinated participants. PARK2 gene expression and parkin protein were significantly decreased in PBMCs stimulated with M. leprae compared to unstimulated PBMCs (p ≤ 0.05). In a subgroup analysis, PARK2 gene expression and parkin protein were decreased in the PBMCs from BCG-unvaccinated individuals following incubation with M. leprae compared to those from BCG-vaccinated individuals. Stimulation of the PBMCs with M. leprae with CRBN blockade increased PARK2 gene expression and parkin protein production (p ≤ 0.05). Conclusion The findings are evidence that CRBN may have a role in modulating PARK2 and NF-kB gene expression in response to M. leprae infection. This needs further investigation in individuals with leprosy. The differential gene expression of CRBN and PARK2 in BCG-vaccinated and BCG-unvaccinated individuals could be further explored to understand the mechanism of BCG protection against leprosy.

Objectives This study aims to evaluate the differences in the degree and the distribution of nerve enlargement at multiple sites along the peripheral nerves between patients with Charcot-Marie-Tooth 1A (CMT1A) and patients with primary neural leprosy (PNL). Methods This is an observational analysis of 79 patients with PNL and 20 with CMT1A who underwent ultrasound (US) of peripheral nerves for morphological evaluation and investigation of neural thickening. We evaluated the cross sectional areas (CSA) of the ulnar, median, peroneal, and tibial nerves at several points, through US. Results 72.1% of leprosy patients and 100.0% of CMT had at least one thickened nerve (p = 0.0075). Of the 280 nerves evaluated in CMT, 85.4% were thickened, while of the 1106 assessed in leprosy, 36.5% were altered (p < 0.0001). The average abnormality in CMT was 12.0 thickened nerves/patient and in leprosy 5.1 (p < 0.0001). Asymmetry of 2 or more nerves was observed in 15% in the CMT group and 53.2% in leprosy (p = 0.0022). The CSA averages were higher in CMT in all nerves evaluated (p < 0.0001): median wrist, median pre-wrist, ulnar in the cubital canal, ulnar proximal to the cubital canal, fibular in the head of the fibula, tibial ankle and tibialis in the distal leg. Conclusions Multi-segmental US is helpful for the differential diagnosis of leprosy neuropathy, but neural thickening is not a pathognomonic finding. In leprosy, thickening occurs with an asymmetrical and regional/non-uniform pattern.