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Utpal Sengupta

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I am basically a Veterinary Pathologist and obtained a PhD degree in Pathology from The Postgraduate Institute of Medical Education and Research, Chandigarh. Specialized later as an Immunopathologist and worked in Leprosy for last 42 years. Presently engaged in research in leprosy and working as a Research Consultant with The Leprosy Mission Trust India. Retired from the position of Director of The National JALMA Institute of Leprosy and Other Mycobacterial Diseases (Indian Council of Medical Research), Agra, Uttar Pradesh.
Phone: +919457715111
Address: 266 Goragacha, Lakewood Estate, Tower 2, 8C, Patuli, Garia

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Papers by Utpal Sengupta

Ofloxacin resistance in multibacillary new leprosy cases from Purulia, West Bengal: a threat to effective secondary line treatment for rifampicin-resistant leprosy cases

Journal of Global Antimicrobial Resistance

Mimicking B and T cell epitopes between Mycobacterium leprae and host as predictive biomarkers in type 1 reaction in leprosy

Scientific Reports, Dec 24, 2021

Cell-mediated immune response to mimicking T cell epitopes. We observed that among four mimicking... more Cell-mediated immune response to mimicking T cell epitopes. We observed that among four mimicking T cell epitopes of 50S ribosomal protein and Lysyl tRNA synthetase of M. leprae, significantly higher stimulation index (SI) in the T1R group was found with 50ST2 and LMT1 when compared to NR (p < 0.01 and p < 0.01, respectively) and HC (p < 0.001 and p < 0.01, respectively). Similarly, among three mimicking T cell epitopes of MBP (similar with 50S ribosomal protein of M. leprae), we found higher SI in the T1R group with MBP50ST2 and MBP50ST3, when compared to NR (p < 0.01 and p < 0.01, respectively) and HC (p < 0.01 and p < 0.001, respectively). Among two mimicking T cell epitopes of MBP (similar to lysyl tRNA synthetase of M. leprae), we found significantly higher SI in the T1R group with MBPLMT2, when compared to NR (p < 0.01) and HC (p < 0.001). We also found higher SI in the T1R group with keratin (Sigma, USA) and MBP (Sigma, USA), when compared to NR (p = ns and p < 0.001, respectively) and HC (p < 0.01 and p < 0.001) (Table 5, Figs. 5, 6, 7 and 8).

Corroboration of cross-reactivity between Mycobacterium leprae and hosts’ salivary and cutaneous proteins: A hope for prognostic biomarkers for the pathogenesis of reactions in leprosy

Frontiers in Microbiology, Dec 6, 2022

Corroboration of cross-reactivity between Mycobacterium leprae and hosts' salivary and cutaneous ... more

Drug resistance in Mycobacterium Leprae in the context of zero leprosy

Indian Dermatology Online Journal, 2021

© 2021 Indian Dermatology Online Journal | Published by Wolters Kluwer Medknow Leprosy is a chron... more © 2021 Indian Dermatology Online Journal | Published by Wolters Kluwer Medknow Leprosy is a chronic infectious disease caused by Mycobacterium leprae and/or by Mycobacterium lepromatosis.[1,2] The disease mainly affects the peripheral nerves, skin, and mucous membranes and if left untreated it may lead to nerve damage and deformity. Use of diamino diphenyl sulphone (DDS), also called dapsone, for treatment of leprosy began in 1945[3] and DDS monotherapy continued till the appearance of primary and secondary DDS resistance during the 1970s.[4,5] Most of these DDS‐resistant cases originated from fully treated relapse cases. However, it was noted that low doses of dapsone and irregular treatment were the major causes of relapse.[5] Later when rifampicin, a bactericidal drug, was tried in a mono‐therapeutic mode, M. leprae developed resistance also to this drug.[6] Considering the above, the multidrug therapy (MDT) approach was adopted like tuberculosis chemotherapy[7] in leprosy elimination by combining DDS with bactericidal drug, rifampicin, and an anti‐bacterial drug, clofazimine with anti‐inflammatory activity. After finding this MDT combination effective in curing leprosy, it was implemented in 1982 worldwide by the World Health Organization (WHO) for the elimination of leprosy.[8] Because of this robust MDT regimen, the prevalence of leprosy was brought down to <1 case/10,000 population (an elimination figure assigned by WHO) by the year 2002 worldwide.[9] Similarly, in India, the prevalence of leprosy which was 25.9/10,000 in 1991 was brought down to <1/10,000 in 2005 after the introduction of MDT under the elimination program.[10]

Neuroimaging in leprosy: The nerves and beyond

Radiology of Infectious Diseases, 2020

Objective: To elucidate the spectrum of findings on neuroimaging in leprosy with special referenc... more Objective: To elucidate the spectrum of findings on neuroimaging in leprosy with special reference to magnetic resonance imaging (MRI). Material and methods: We retrospectively reviewed the neuroimaging findings on MRI in thirty-one patients with leprosy where dedicated plexus, brain and spine imaging had been performed. High resolution ultrasound of the peripheral nerves and plexus was also carried out, and the findings documented. Results: Twenty-one patients had positive findings on imaging. Six patients showed involvement of the peripheral nerves as thickening and formation of micro or macroabscesses. The brachial plexus showed thickening and hyperintensity in ten patients, with involvement of the lumbosacral plexus in one patient. Four patients showed spinal cord involvement as discrete T2 hyperintense lesions with postcontrast enhancement. Intracranial lesions involving the nucleus ambiguus and facial colliculus were seen in two patients. Conclusion: Neuroimaging in Hansen's disease has brought several new findings to the fore. Besides peripheral nerves, involvement of the centrally located plexuses, spinal cord and brain has also been seen which thus expands the imaging spectrum of the disease.

Circulatory and Localized mRNA Expression Profiles of Interleukin-17F and Interleukin-23 in Type 1 (Reversal) Reactions of Leprosy

Introduction: Leprosy is a chronic infectious disease which mainly affects skin and peripheral ne... more Introduction: Leprosy is a chronic infectious disease which mainly affects skin and peripheral nerves. In the borderline immunological spectrum of the disease, patients experience episodes of delayed type hypersensitivity reactions called Type 1 or reversal reactions which cause nerve damage leading to deformities. Early detection of these reactions will help in early treatment intervention and prevention of nerve damage. Interleukin 17F (IL 17F) and Interleukin 23 (IL 23) are the proinflammatory cytokines that play a crucial role in the regulation of peripheral inflammations. We investigated the possible association of serum circulatory levels and lesional skin mRNA expression levels of IL 17F and IL 23 with manifestation of type 1 Reactions in Leprosy. Methods: Serum levels of IL 17F and IL 23 were measured in 80 leprosy cases in Type 1 reactions (T1R) and 80 leprosy cases without reactions (NR) using commercial ELISA Kits (R & D Systems) and Skin Biopsy samples were collected fro...

Efficacy of fixed duration multidrug therapy for the treatment of multibacillary leprosy: A prospective observational study from Northern India

Indian Journal of Dermatology, Venereology and Leprology

Background: In endemic regions of several countries, the prevalence of leprosy has not come down ... more Background: In endemic regions of several countries, the prevalence of leprosy has not come down to the level of elimination. On the contrary, new cases are being detected in large numbers. Clinically, it is frequently noted that despite completion of multibacillary multidrug therapy for 12 months, the lesions remain active, especially in cases with high bacteriological indices. Aim: The present study focused on finding out the viable number of Mycobacterium leprae during the 12-month regimen of multibacillary multidrug therapy, at six and 12 months intervals and, attempting to determine their role in disease transmission. Methods: Seventy eight cases of multibacillary leprosy cases were recruited from leprosy patients registered at The Leprosy Mission hospitals at Shahdara (Delhi), Naini (Uttar Pradesh) and Champa (Chhattisgarh), respectively. Slit skin smears were collected from these patients which were transported to the laboratory for further processing. Ribonucleic acid was ex...

Analysis of bacteriological Index between fixed multidrug therapy and new WHO recommended alternative regimen with ofloxacin, minocycline and clofazimine of rifampicin resistant cases from the hospitals of The Leprosy Mission, India

Journal of Global Antimicrobial Resistance, 2020

Survival of Mycobacterium leprae and association with Acanthamoeba from environmental samples in the inhabitant areas of active leprosy cases: A cross sectional study from endemic pockets of Purulia, West Bengal

Infection, Genetics and Evolution, 2019

Background Mycobacterium leprae being an obligate intracellular parasite cannot be cultured in an... more Background Mycobacterium leprae being an obligate intracellular parasite cannot be cultured in any artificial culture media but it has been shown to reside in wild armadillos in North America. Many studies suggested that M. leprae could be found in the environment and may have a role in continuing transmission of the disease. The exact role of the environment in the transmission dynamics is still speculative. The present study was undertaken to find out the presence of viable M. leprae around patients' environment like soil and water and association of free living pathogenic protozoa, Acanthamoeba which might play an important role in transmission of the disease. Methods Seven hundred soil and 400 water samples were collected from the surroundings of the houses of leprosy patients from endemic villages. Two hundred soil and 80 water samples were also collected from the surroundings of normal inhabitants from non-endemic villages as controls. These samples were screened for the presence of M. leprae and Acanthamoeba using DNA PCR detection of M. leprae and Acanthamoeba.

Symposium on emerging needs in leprosy research in the post elimination era: The Leprosy Mission Trust India

by Ravindra Turankar and Utpal Sengupta

Leprosy review, 2016

In situ demonstration of Mycobacterium leprae antigens in leprosy lesions using monoclonal antibodies

Immunology letters, 1990

Ten untreated patients of leprosy were selected from the outpatient clinic o f the Central JALMA ... more Ten untreated patients of leprosy were selected from the outpatient clinic o f the Central JALMA Institute for Leprosy, Agra, India. They were classified as per criteria of Ridley-Jopling [5]. Skin and nerve biopsies from 5 patients each of tuberculoid (BT/TT) and lepromatous (LL) leprosy were taken for the study. In addition, as controls, normal skin,

Existence of viable Mycobacterium leprae in natural environment and its genetic profiling in a leprosy endemic region

Frontiers in tropical diseases, Aug 19, 2022

Introduction: Molecular epidemiology of leprosy is very important to study leprosy transmission d... more Introduction: Molecular epidemiology of leprosy is very important to study leprosy transmission dynamics and to enhance our understanding of leprosy in endemic areas by utilizing the molecular typing method. Nowadays our understanding of leprosy transmission dynamics has been refined by SNP typing and VNTR marker analysis of M. leprae strains. Objective: This study was carried out to find out the presence of viable M. leprae in the soil and water samples from residing areas of leprosy patients staying in different blocks of Purulia district of West Bengal, understanding their genotypes and compared with that of M. leprae present in patients. Material and methods: Slit-skin smear (SSS) samples (n=112) were collected from the active multibacillary leprosy patients from different blocks of leprosy endemic area. Soil samples (n=1060) and water samples (n=620) were collected from residing areas of leprosy patients. SNP subtyping was performed by PCR followed by sequencing. Multiplex PCR was performed using fifteen ML-VNTR loci and results were analysed. Results: We observed high PCR positivity in soil samples (344 out of 1060; 32%) and water samples (140 out of 620; 23%). These PCR positive samples when further screened for viability, it was observed that 150 soil samples (44%) and 56 water samples (40%) showed presence of 16S rRNA. SNP typing of M. leprae revealed presence of predominantly type 1. SNP subtype 1D (83%) was most prevalent in all the blocks of Purulia followed by subtype 1C (15%) and subtype 1A (2%). SNP subtype 2F was noted in only one sample. SNP and VNTR combination showed presence of similar strain type in certain pockets of Purulia region which was responsible for transmission.

Potential of nanoparticles encapsulated drugs for possible inhibition of the antimicrobial resistance development

Biomedicine & Pharmacotherapy, 2021

The immune system is a dynamic network of cells and cytokines are the major mediators of immune r... more The immune system is a dynamic network of cells and cytokines are the major mediators of immune responses which combat pathogens. Based on the cytokine production, effector T cells differentiate into subsets known as Th1, Th2, Th17, or Treg. This system serves as a barrier to intracellular pathogens, bacterial infections and stimulates the production of reactive oxygen species (ROS), reactive nitrogen intermediates, and nitric oxide, which diffuses across membranes and engulfs intracellular pathogens. Oxidative stress occurs when ROS, reactive nitrogen species (RNS) production, and antioxidant defences become imbalanced. Oxidative stress generated by infected cells produces a substantial amount of free radicals which enables the killing of intracellular pathogens. Intracellular pathogens are exposed to endogenous ROS as part of normal aerobic respiration, also exogenous ROS and RNS are generated by the host immune system in response to infection. Nanoparticles which are designed for drug delivery are capable of trapping the desired drug in the particles which protect the drug from enzymatic degradation in a biological system. The subcellular size of nanoparticles enables higher intracellular uptake of the drug which results in the reduction of the concentration of free drugs reducing their toxic effect. Research on the modulation of immune response and oxidative stress using nanoparticles used to encapsulate drugs has yet to be explored fully. In this review, we illustrate the immune activation and generation of oxidative stress properties which are mediated by nanoparticle encapsulated drug delivery systems which can make the therapy more effective in case of diseases caused by intracellular pathogens.

Paucibacillary Leprosy: Reappraisal using Ziehl-Neelsen staining of slit skin smears and 16S rRNA Real Time Polymerase Chain Reaction of nasal swabs

Leprosy Review, 2018

RAVINDRA P. TURANKAR*, MALLIKA LAVANIA*, ITU SINGH*, VIKRAM SINGH*, MADHVI AHUJA*, VINAY KUMAR PA... more RAVINDRA P. TURANKAR*, MALLIKA LAVANIA*, ITU SINGH*, VIKRAM SINGH*, MADHVI AHUJA*, VINAY KUMAR PATHAK*, PRASHANT JAKHMOLA*, LORETTA DAS**, JOYDEEPA DARLONG***, UJJWAL HEMBROM****, V. RAMESH*****, NEENA KHANNA******, ANNAMMA S. JOHN* & UTPAL SENGUPTA* *Stanley Browne Laboratory, TLM Community Hospital, Nand Nagri Delhi-110093, India **The Leprosy Mission Hospital, Naini, Uttar Pradesh 211008, India ***The Leprosy Mission Home & Hospital, Purulia, West Bengal 2723 101, India ****The Leprosy Mission Hospital, Muzaffarpur 842002, Bihar *****Safdarjung Hospital, New Delhi 110029, India ******All India Institute of Medical Science, New Delhi 110029, India

VDR polymorphism, gene expression and vitamin D levels in leprosy patients from North Indian population

by Ravindra Turankar and Utpal Sengupta

PLOS Neglected Tropical Diseases, 2018

Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects skin, p... more Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves. Vitamin D receptor (VDR) gene polymorphism has been found to be associated with leprosy. Vitamin D has been shown to control several host immunomodulating properties through VDR gene. Vitamin D deficiency was also found to be linked to an increased risk for several infections and metabolic diseases. In the present study, we investigated the association of VDR gene polymorphism, mRNA gene expression of VDR and the vitamin D levels with leprosy and its reactional states. A total of 305 leprosy patients consisting of tuberculoid (TT), borderline tuberculoid (BT), borderline lepromatous (BL), lepromatous leprosy (LL), as well as 200 healthy controls were enrolled in the study. We identified single nucleotide polymorphisms (SNPs) of VDR Taq1, Fok1 and Apa1, as well as the expression of VDR mRNA gene using PCR-based restriction fragment length polymorphism (RFLP) analysis and real-time PCR respectively. We also performed ELISA to measure vitamin D levels. We observed that SNP of VDR gene (Fok1 and Taq1) are associated with the leprosy disease. The allelic frequency distribution of T and t allele (p = 0.0037), F and f allele (p = 0.0024) was significantly higher in leprosy patients and healthy controls. ff genotype of Fok1 was found to be associated with leprosy patients [p = 0.0004; OR (95% CI) 3.148 (1.662-5.965)]. The recessive model of Fok1 genotype was also found to be significantly associated in leprosy patients in comparison to healthy controls [p = 0.00004; OR (95% CI) 2. 85 (1.56-5.22)]. Leprosy patients are significantly associated with t-F-a haplotype. Further, VDR gene expression was

Paucibacillary Leprosy: Reappraisal using Ziehl-Neelsen staining of slit skin smears and 16S rRNA Real Time Polymerase Chain Reaction of nasal swabs

by Ravindra Turankar, Utpal Sengupta, and Dr. Vikram Singh

Leprosy Review

Utility of multiplex PCR for early diagnosis and household contact surveillance for leprosy

Diagnostic Microbiology and Infectious Disease, 2019

Early diagnosis of leprosy is important for limiting the severity of disease, which may lead to d... more Early diagnosis of leprosy is important for limiting the severity of disease, which may lead to disabilities and deformities if not treated timely. Multiplex PCR employing more than one gene, specific to target DNA, is more efficient detection tool. In the present study, slit skin scrapings, blood, nasal swabs and saliva from Paucibacillary (PB) and Multibacillary (MB) cases as well as household contacts of PB cases were tested by multiplex PCR using three different gene targets namely RLEP, 16SrRNA and sodA. We found an increase in overall diagnostic positivity for M. leprae DNA detection by M-PCR as compared to individual PCR. In case of nasal swabs using M-PCR the PPV, NPV were 0.5454, 0.8333 respectively. There is remarkable increase in PPV in SSS of PB cases and nasal swabs of HHCs using M-PCR. Conclusively, our finding suggests the utility of M-PCR for early diagnosis and household contact surveillance for leprosy.

Symposium on emerging needs in leprosy research in the post elimination era: The Leprosy Mission Trust India

Leprosy Review, 2016

After the declaration of Elimination of leprosy in 2005, attention to leprosy has gradually dimin... more After the declaration of Elimination of leprosy in 2005, attention to leprosy has gradually diminished. In the last 10 years the leprosy scenario has not shown the improvement that was expected in the post elimination era the number of new cases each year show no significant decline, and the complications of leprosy continue to cause disability and deformity which leads thousands to dehabilitation and untold suffering. With the shrinking of available funds, research into leprosy has been neglected and now remaining only in a few organizations where fundamental studies on the disease are being carried out. To improve the situation, several strategies have been adopted by leprosy groups in enhancing research, capacity building on topics which are of priority to Government of India (GOI), WHO and ILEP, hoping that this would generate evidence based knowledge and learning to accelerate the eradication of the causes and consequences of leprosy.

Relapse and Drug Resistance in Leprosy : Present Scenario and Critical Issues

The symposium was organized by The Leprosy Mission Trust India (TLMTI) on the 29 November, 2017 a... more The symposium was organized by The Leprosy Mission Trust India (TLMTI) on the 29 November, 2017 at India Habitat Centre, Lodi Road, New Delhi, India. The meeting was organized for the stakeholders who are engaged in the leprosy elimination programme for an exposure to the recently emerging scenario on relapse and drug resistance in leprosy. A total of sixty three participants including representatives from Government of India, WHO, ILEP, GLRA, LEPRA India, NLR, DFIT, BLP, FMR, NIMHANS, ICMR-NJIL & OMD and ICMR gathered in the symposium. Most of the famous advisors of the country, leprologists and dermatologists of TLM, Safdarjung, Guru Tegh Bahadur hospitals, PGIMER (Chandigarh, India), DLO and SLO of Delhi participated in the symposium. Leprosy researchers and scientists from different organizations across the country also gathered for the deliberations and discussions. The symposium began with a welcome address from the Executive Director, TLM which was followed by inaugural keyno...

A comparative study of homoeopathic medicine - Sulphur with the Multidrug therapy in the treatment of paucibacillary leprosy

Indian Journal of Research in Homoeopathy

Background: Substantial number of patients with paucibacillary leprosy may still have active skin... more Background: Substantial number of patients with paucibacillary leprosy may still have active skin lesions at the end of MD treatment because of the continuing immune responses, though this does not denote failure of treatment. A clinical trial was conducted to compare efficacy of a homoeopathic medicine with MDT for the cure of leprosy. Aim: To compare the effect of a homoeopathic medicine - Sulphur with the Multi drug in the treatment of Paucibacillary leprosy according to WHO guidelines. Materials and Methods: Out of total 90 patients enlisted, 60 confirmed Borderline Tuberculoid (BT) leprosy patients of the age 14 years to less than 60 years were registered under this trial. All the patients were allotted a precoded number, randomly and equally divided in two groups. One group was treated with Sulphur in 200 potency in liquid orally once in week for two years and the other group received Paucibacillary (PB) regimen as recommended by WHO. At the end of two years findings were corroborated. Results: The study showed that MDT therapy (PB regimen) and homoeopathic medicine were found equally effective as histopathology of skin showed no granulomatous lesion. The most significant clinical sign observed in all cases treated with Sulphur was reappearance of normal skin colour and regain of loss of sensation of the skin lesion. Conclusions: MD therapy (PB regimen) and homoeopathic medicine were found equally effective. The patients of paucibacillary leprosy could get rid of the skin symptoms if treatment with Sulphur (is also given with MDT).

Ofloxacin resistance in multibacillary new leprosy cases from Purulia, West Bengal: a threat to effective secondary line treatment for rifampicin-resistant leprosy cases

Journal of Global Antimicrobial Resistance

Mimicking B and T cell epitopes between Mycobacterium leprae and host as predictive biomarkers in type 1 reaction in leprosy

Scientific Reports, Dec 24, 2021

Cell-mediated immune response to mimicking T cell epitopes. We observed that among four mimicking... more Cell-mediated immune response to mimicking T cell epitopes. We observed that among four mimicking T cell epitopes of 50S ribosomal protein and Lysyl tRNA synthetase of M. leprae, significantly higher stimulation index (SI) in the T1R group was found with 50ST2 and LMT1 when compared to NR (p < 0.01 and p < 0.01, respectively) and HC (p < 0.001 and p < 0.01, respectively). Similarly, among three mimicking T cell epitopes of MBP (similar with 50S ribosomal protein of M. leprae), we found higher SI in the T1R group with MBP50ST2 and MBP50ST3, when compared to NR (p < 0.01 and p < 0.01, respectively) and HC (p < 0.01 and p < 0.001, respectively). Among two mimicking T cell epitopes of MBP (similar to lysyl tRNA synthetase of M. leprae), we found significantly higher SI in the T1R group with MBPLMT2, when compared to NR (p < 0.01) and HC (p < 0.001). We also found higher SI in the T1R group with keratin (Sigma, USA) and MBP (Sigma, USA), when compared to NR (p = ns and p < 0.001, respectively) and HC (p < 0.01 and p < 0.001) (Table 5, Figs. 5, 6, 7 and 8).

Corroboration of cross-reactivity between Mycobacterium leprae and hosts’ salivary and cutaneous proteins: A hope for prognostic biomarkers for the pathogenesis of reactions in leprosy

Frontiers in Microbiology, Dec 6, 2022

Corroboration of cross-reactivity between Mycobacterium leprae and hosts' salivary and cutaneous ... more

Drug resistance in Mycobacterium Leprae in the context of zero leprosy

Indian Dermatology Online Journal, 2021

© 2021 Indian Dermatology Online Journal | Published by Wolters Kluwer Medknow Leprosy is a chron... more © 2021 Indian Dermatology Online Journal | Published by Wolters Kluwer Medknow Leprosy is a chronic infectious disease caused by Mycobacterium leprae and/or by Mycobacterium lepromatosis.[1,2] The disease mainly affects the peripheral nerves, skin, and mucous membranes and if left untreated it may lead to nerve damage and deformity. Use of diamino diphenyl sulphone (DDS), also called dapsone, for treatment of leprosy began in 1945[3] and DDS monotherapy continued till the appearance of primary and secondary DDS resistance during the 1970s.[4,5] Most of these DDS‐resistant cases originated from fully treated relapse cases. However, it was noted that low doses of dapsone and irregular treatment were the major causes of relapse.[5] Later when rifampicin, a bactericidal drug, was tried in a mono‐therapeutic mode, M. leprae developed resistance also to this drug.[6] Considering the above, the multidrug therapy (MDT) approach was adopted like tuberculosis chemotherapy[7] in leprosy elimination by combining DDS with bactericidal drug, rifampicin, and an anti‐bacterial drug, clofazimine with anti‐inflammatory activity. After finding this MDT combination effective in curing leprosy, it was implemented in 1982 worldwide by the World Health Organization (WHO) for the elimination of leprosy.[8] Because of this robust MDT regimen, the prevalence of leprosy was brought down to <1 case/10,000 population (an elimination figure assigned by WHO) by the year 2002 worldwide.[9] Similarly, in India, the prevalence of leprosy which was 25.9/10,000 in 1991 was brought down to <1/10,000 in 2005 after the introduction of MDT under the elimination program.[10]

Neuroimaging in leprosy: The nerves and beyond

Radiology of Infectious Diseases, 2020

Objective: To elucidate the spectrum of findings on neuroimaging in leprosy with special referenc... more Objective: To elucidate the spectrum of findings on neuroimaging in leprosy with special reference to magnetic resonance imaging (MRI). Material and methods: We retrospectively reviewed the neuroimaging findings on MRI in thirty-one patients with leprosy where dedicated plexus, brain and spine imaging had been performed. High resolution ultrasound of the peripheral nerves and plexus was also carried out, and the findings documented. Results: Twenty-one patients had positive findings on imaging. Six patients showed involvement of the peripheral nerves as thickening and formation of micro or macroabscesses. The brachial plexus showed thickening and hyperintensity in ten patients, with involvement of the lumbosacral plexus in one patient. Four patients showed spinal cord involvement as discrete T2 hyperintense lesions with postcontrast enhancement. Intracranial lesions involving the nucleus ambiguus and facial colliculus were seen in two patients. Conclusion: Neuroimaging in Hansen's disease has brought several new findings to the fore. Besides peripheral nerves, involvement of the centrally located plexuses, spinal cord and brain has also been seen which thus expands the imaging spectrum of the disease.

Circulatory and Localized mRNA Expression Profiles of Interleukin-17F and Interleukin-23 in Type 1 (Reversal) Reactions of Leprosy

Introduction: Leprosy is a chronic infectious disease which mainly affects skin and peripheral ne... more Introduction: Leprosy is a chronic infectious disease which mainly affects skin and peripheral nerves. In the borderline immunological spectrum of the disease, patients experience episodes of delayed type hypersensitivity reactions called Type 1 or reversal reactions which cause nerve damage leading to deformities. Early detection of these reactions will help in early treatment intervention and prevention of nerve damage. Interleukin 17F (IL 17F) and Interleukin 23 (IL 23) are the proinflammatory cytokines that play a crucial role in the regulation of peripheral inflammations. We investigated the possible association of serum circulatory levels and lesional skin mRNA expression levels of IL 17F and IL 23 with manifestation of type 1 Reactions in Leprosy. Methods: Serum levels of IL 17F and IL 23 were measured in 80 leprosy cases in Type 1 reactions (T1R) and 80 leprosy cases without reactions (NR) using commercial ELISA Kits (R & D Systems) and Skin Biopsy samples were collected fro...

Efficacy of fixed duration multidrug therapy for the treatment of multibacillary leprosy: A prospective observational study from Northern India

Indian Journal of Dermatology, Venereology and Leprology

Background: In endemic regions of several countries, the prevalence of leprosy has not come down ... more Background: In endemic regions of several countries, the prevalence of leprosy has not come down to the level of elimination. On the contrary, new cases are being detected in large numbers. Clinically, it is frequently noted that despite completion of multibacillary multidrug therapy for 12 months, the lesions remain active, especially in cases with high bacteriological indices. Aim: The present study focused on finding out the viable number of Mycobacterium leprae during the 12-month regimen of multibacillary multidrug therapy, at six and 12 months intervals and, attempting to determine their role in disease transmission. Methods: Seventy eight cases of multibacillary leprosy cases were recruited from leprosy patients registered at The Leprosy Mission hospitals at Shahdara (Delhi), Naini (Uttar Pradesh) and Champa (Chhattisgarh), respectively. Slit skin smears were collected from these patients which were transported to the laboratory for further processing. Ribonucleic acid was ex...

Analysis of bacteriological Index between fixed multidrug therapy and new WHO recommended alternative regimen with ofloxacin, minocycline and clofazimine of rifampicin resistant cases from the hospitals of The Leprosy Mission, India

Journal of Global Antimicrobial Resistance, 2020

Survival of Mycobacterium leprae and association with Acanthamoeba from environmental samples in the inhabitant areas of active leprosy cases: A cross sectional study from endemic pockets of Purulia, West Bengal

Infection, Genetics and Evolution, 2019

Background Mycobacterium leprae being an obligate intracellular parasite cannot be cultured in an... more Background Mycobacterium leprae being an obligate intracellular parasite cannot be cultured in any artificial culture media but it has been shown to reside in wild armadillos in North America. Many studies suggested that M. leprae could be found in the environment and may have a role in continuing transmission of the disease. The exact role of the environment in the transmission dynamics is still speculative. The present study was undertaken to find out the presence of viable M. leprae around patients' environment like soil and water and association of free living pathogenic protozoa, Acanthamoeba which might play an important role in transmission of the disease. Methods Seven hundred soil and 400 water samples were collected from the surroundings of the houses of leprosy patients from endemic villages. Two hundred soil and 80 water samples were also collected from the surroundings of normal inhabitants from non-endemic villages as controls. These samples were screened for the presence of M. leprae and Acanthamoeba using DNA PCR detection of M. leprae and Acanthamoeba.

Symposium on emerging needs in leprosy research in the post elimination era: The Leprosy Mission Trust India

by Ravindra Turankar and Utpal Sengupta

Leprosy review, 2016

In situ demonstration of Mycobacterium leprae antigens in leprosy lesions using monoclonal antibodies

Immunology letters, 1990

Ten untreated patients of leprosy were selected from the outpatient clinic o f the Central JALMA ... more Ten untreated patients of leprosy were selected from the outpatient clinic o f the Central JALMA Institute for Leprosy, Agra, India. They were classified as per criteria of Ridley-Jopling [5]. Skin and nerve biopsies from 5 patients each of tuberculoid (BT/TT) and lepromatous (LL) leprosy were taken for the study. In addition, as controls, normal skin,

Existence of viable Mycobacterium leprae in natural environment and its genetic profiling in a leprosy endemic region

Frontiers in tropical diseases, Aug 19, 2022

Introduction: Molecular epidemiology of leprosy is very important to study leprosy transmission d... more Introduction: Molecular epidemiology of leprosy is very important to study leprosy transmission dynamics and to enhance our understanding of leprosy in endemic areas by utilizing the molecular typing method. Nowadays our understanding of leprosy transmission dynamics has been refined by SNP typing and VNTR marker analysis of M. leprae strains. Objective: This study was carried out to find out the presence of viable M. leprae in the soil and water samples from residing areas of leprosy patients staying in different blocks of Purulia district of West Bengal, understanding their genotypes and compared with that of M. leprae present in patients. Material and methods: Slit-skin smear (SSS) samples (n=112) were collected from the active multibacillary leprosy patients from different blocks of leprosy endemic area. Soil samples (n=1060) and water samples (n=620) were collected from residing areas of leprosy patients. SNP subtyping was performed by PCR followed by sequencing. Multiplex PCR was performed using fifteen ML-VNTR loci and results were analysed. Results: We observed high PCR positivity in soil samples (344 out of 1060; 32%) and water samples (140 out of 620; 23%). These PCR positive samples when further screened for viability, it was observed that 150 soil samples (44%) and 56 water samples (40%) showed presence of 16S rRNA. SNP typing of M. leprae revealed presence of predominantly type 1. SNP subtype 1D (83%) was most prevalent in all the blocks of Purulia followed by subtype 1C (15%) and subtype 1A (2%). SNP subtype 2F was noted in only one sample. SNP and VNTR combination showed presence of similar strain type in certain pockets of Purulia region which was responsible for transmission.

Potential of nanoparticles encapsulated drugs for possible inhibition of the antimicrobial resistance development

Biomedicine & Pharmacotherapy, 2021

The immune system is a dynamic network of cells and cytokines are the major mediators of immune r... more The immune system is a dynamic network of cells and cytokines are the major mediators of immune responses which combat pathogens. Based on the cytokine production, effector T cells differentiate into subsets known as Th1, Th2, Th17, or Treg. This system serves as a barrier to intracellular pathogens, bacterial infections and stimulates the production of reactive oxygen species (ROS), reactive nitrogen intermediates, and nitric oxide, which diffuses across membranes and engulfs intracellular pathogens. Oxidative stress occurs when ROS, reactive nitrogen species (RNS) production, and antioxidant defences become imbalanced. Oxidative stress generated by infected cells produces a substantial amount of free radicals which enables the killing of intracellular pathogens. Intracellular pathogens are exposed to endogenous ROS as part of normal aerobic respiration, also exogenous ROS and RNS are generated by the host immune system in response to infection. Nanoparticles which are designed for drug delivery are capable of trapping the desired drug in the particles which protect the drug from enzymatic degradation in a biological system. The subcellular size of nanoparticles enables higher intracellular uptake of the drug which results in the reduction of the concentration of free drugs reducing their toxic effect. Research on the modulation of immune response and oxidative stress using nanoparticles used to encapsulate drugs has yet to be explored fully. In this review, we illustrate the immune activation and generation of oxidative stress properties which are mediated by nanoparticle encapsulated drug delivery systems which can make the therapy more effective in case of diseases caused by intracellular pathogens.

Paucibacillary Leprosy: Reappraisal using Ziehl-Neelsen staining of slit skin smears and 16S rRNA Real Time Polymerase Chain Reaction of nasal swabs

Leprosy Review, 2018

RAVINDRA P. TURANKAR*, MALLIKA LAVANIA*, ITU SINGH*, VIKRAM SINGH*, MADHVI AHUJA*, VINAY KUMAR PA... more RAVINDRA P. TURANKAR*, MALLIKA LAVANIA*, ITU SINGH*, VIKRAM SINGH*, MADHVI AHUJA*, VINAY KUMAR PATHAK*, PRASHANT JAKHMOLA*, LORETTA DAS**, JOYDEEPA DARLONG***, UJJWAL HEMBROM****, V. RAMESH*****, NEENA KHANNA******, ANNAMMA S. JOHN* & UTPAL SENGUPTA* *Stanley Browne Laboratory, TLM Community Hospital, Nand Nagri Delhi-110093, India **The Leprosy Mission Hospital, Naini, Uttar Pradesh 211008, India ***The Leprosy Mission Home & Hospital, Purulia, West Bengal 2723 101, India ****The Leprosy Mission Hospital, Muzaffarpur 842002, Bihar *****Safdarjung Hospital, New Delhi 110029, India ******All India Institute of Medical Science, New Delhi 110029, India

VDR polymorphism, gene expression and vitamin D levels in leprosy patients from North Indian population

by Ravindra Turankar and Utpal Sengupta

PLOS Neglected Tropical Diseases, 2018

Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects skin, p... more Leprosy is a chronic infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves. Vitamin D receptor (VDR) gene polymorphism has been found to be associated with leprosy. Vitamin D has been shown to control several host immunomodulating properties through VDR gene. Vitamin D deficiency was also found to be linked to an increased risk for several infections and metabolic diseases. In the present study, we investigated the association of VDR gene polymorphism, mRNA gene expression of VDR and the vitamin D levels with leprosy and its reactional states. A total of 305 leprosy patients consisting of tuberculoid (TT), borderline tuberculoid (BT), borderline lepromatous (BL), lepromatous leprosy (LL), as well as 200 healthy controls were enrolled in the study. We identified single nucleotide polymorphisms (SNPs) of VDR Taq1, Fok1 and Apa1, as well as the expression of VDR mRNA gene using PCR-based restriction fragment length polymorphism (RFLP) analysis and real-time PCR respectively. We also performed ELISA to measure vitamin D levels. We observed that SNP of VDR gene (Fok1 and Taq1) are associated with the leprosy disease. The allelic frequency distribution of T and t allele (p = 0.0037), F and f allele (p = 0.0024) was significantly higher in leprosy patients and healthy controls. ff genotype of Fok1 was found to be associated with leprosy patients [p = 0.0004; OR (95% CI) 3.148 (1.662-5.965)]. The recessive model of Fok1 genotype was also found to be significantly associated in leprosy patients in comparison to healthy controls [p = 0.00004; OR (95% CI) 2. 85 (1.56-5.22)]. Leprosy patients are significantly associated with t-F-a haplotype. Further, VDR gene expression was

Paucibacillary Leprosy: Reappraisal using Ziehl-Neelsen staining of slit skin smears and 16S rRNA Real Time Polymerase Chain Reaction of nasal swabs

by Ravindra Turankar, Utpal Sengupta, and Dr. Vikram Singh

Leprosy Review

Utility of multiplex PCR for early diagnosis and household contact surveillance for leprosy

Diagnostic Microbiology and Infectious Disease, 2019

Early diagnosis of leprosy is important for limiting the severity of disease, which may lead to d... more Early diagnosis of leprosy is important for limiting the severity of disease, which may lead to disabilities and deformities if not treated timely. Multiplex PCR employing more than one gene, specific to target DNA, is more efficient detection tool. In the present study, slit skin scrapings, blood, nasal swabs and saliva from Paucibacillary (PB) and Multibacillary (MB) cases as well as household contacts of PB cases were tested by multiplex PCR using three different gene targets namely RLEP, 16SrRNA and sodA. We found an increase in overall diagnostic positivity for M. leprae DNA detection by M-PCR as compared to individual PCR. In case of nasal swabs using M-PCR the PPV, NPV were 0.5454, 0.8333 respectively. There is remarkable increase in PPV in SSS of PB cases and nasal swabs of HHCs using M-PCR. Conclusively, our finding suggests the utility of M-PCR for early diagnosis and household contact surveillance for leprosy.

Symposium on emerging needs in leprosy research in the post elimination era: The Leprosy Mission Trust India

Leprosy Review, 2016

After the declaration of Elimination of leprosy in 2005, attention to leprosy has gradually dimin... more After the declaration of Elimination of leprosy in 2005, attention to leprosy has gradually diminished. In the last 10 years the leprosy scenario has not shown the improvement that was expected in the post elimination era the number of new cases each year show no significant decline, and the complications of leprosy continue to cause disability and deformity which leads thousands to dehabilitation and untold suffering. With the shrinking of available funds, research into leprosy has been neglected and now remaining only in a few organizations where fundamental studies on the disease are being carried out. To improve the situation, several strategies have been adopted by leprosy groups in enhancing research, capacity building on topics which are of priority to Government of India (GOI), WHO and ILEP, hoping that this would generate evidence based knowledge and learning to accelerate the eradication of the causes and consequences of leprosy.

Relapse and Drug Resistance in Leprosy : Present Scenario and Critical Issues

The symposium was organized by The Leprosy Mission Trust India (TLMTI) on the 29 November, 2017 a... more The symposium was organized by The Leprosy Mission Trust India (TLMTI) on the 29 November, 2017 at India Habitat Centre, Lodi Road, New Delhi, India. The meeting was organized for the stakeholders who are engaged in the leprosy elimination programme for an exposure to the recently emerging scenario on relapse and drug resistance in leprosy. A total of sixty three participants including representatives from Government of India, WHO, ILEP, GLRA, LEPRA India, NLR, DFIT, BLP, FMR, NIMHANS, ICMR-NJIL & OMD and ICMR gathered in the symposium. Most of the famous advisors of the country, leprologists and dermatologists of TLM, Safdarjung, Guru Tegh Bahadur hospitals, PGIMER (Chandigarh, India), DLO and SLO of Delhi participated in the symposium. Leprosy researchers and scientists from different organizations across the country also gathered for the deliberations and discussions. The symposium began with a welcome address from the Executive Director, TLM which was followed by inaugural keyno...

A comparative study of homoeopathic medicine - Sulphur with the Multidrug therapy in the treatment of paucibacillary leprosy

Indian Journal of Research in Homoeopathy

Background: Substantial number of patients with paucibacillary leprosy may still have active skin... more Background: Substantial number of patients with paucibacillary leprosy may still have active skin lesions at the end of MD treatment because of the continuing immune responses, though this does not denote failure of treatment. A clinical trial was conducted to compare efficacy of a homoeopathic medicine with MDT for the cure of leprosy. Aim: To compare the effect of a homoeopathic medicine - Sulphur with the Multi drug in the treatment of Paucibacillary leprosy according to WHO guidelines. Materials and Methods: Out of total 90 patients enlisted, 60 confirmed Borderline Tuberculoid (BT) leprosy patients of the age 14 years to less than 60 years were registered under this trial. All the patients were allotted a precoded number, randomly and equally divided in two groups. One group was treated with Sulphur in 200 potency in liquid orally once in week for two years and the other group received Paucibacillary (PB) regimen as recommended by WHO. At the end of two years findings were corroborated. Results: The study showed that MDT therapy (PB regimen) and homoeopathic medicine were found equally effective as histopathology of skin showed no granulomatous lesion. The most significant clinical sign observed in all cases treated with Sulphur was reappearance of normal skin colour and regain of loss of sensation of the skin lesion. Conclusions: MD therapy (PB regimen) and homoeopathic medicine were found equally effective. The patients of paucibacillary leprosy could get rid of the skin symptoms if treatment with Sulphur (is also given with MDT).