To determine the drug resistance patterns of M. leprae in Malaysia.

Mouse footpad (MFP) culture of all skin biopsy samples from patients with borderline lepromatous and lepromatous leprosy sent to the Leprosy Unit, National Public Health Laboratory, Sungai Buloh, Malaysia between 1997–2013 were retrospectively studied.

There were 651 MFP cultures performed. The mean age of patients was 41 years old (range: 6–88). The male:female ratio was 3.8:1. Four hundred and fortyfour patients (69.1%) were Malaysian. The rate of positive M. leprae culture was 66.6% (433 of 651). The mean Bacteriological Index (BI) and median Morphological Index (MI) for those with positive culture were 3.7 and 2.8 respectively. The mean BI and MI of those which failed to grow in the MFP were significantly lower than those with positive cultures (P < 0.001). Dapsone has the highest resistance rate of 55% (238 of 433). Nevertheless, high degree dapsone resistance (0.01%) was 6.24%. There were 407 MFP tests using rifampicin 0.003% and 12 (2.9%) were resistant to it. Clofazimine has the lowest intermediate degree (0.001%) resistance rate of 0.2% (1 of 429). There were no significant differences between the drug resistance pattern and the gender or the nationality of the patients.

More than half of our positive MFP cultures showed low-level resistance to dapsone; less than 3% were resistant to rifampicin, and clofazimine resistance remained very low.

A retrospective analysis of all biopsy proven PNL cases (total 23) over the past 16 years was done. Detailed histopathological examination of the nerve was performed. Myelin and axonal status were evaluated using luxol fast blue/ Periodic acid Schiff (LFB/PAS) stain and immunohistochemistry (IHC) for neurofilament protein (NFP) respectively.

Clinically a diagnosis of HD was suspected in 70%, mononeuritis multiplex in 12%, vasculitis and demyelination in 9% cases each. Moderate to severe epineurial and endoneurial inflammation were seen in 91% and 96% of cases respectively. Granulomatous inflammation was seen both in the endoneurial (70%) and epineurial (17%) location. Foam cell infiltration was more common in the endoneurial (60%) than the epineurial (22%) location. Occasional cases showed necrosis (4%) and vasculitis (13%). Severe myelin and axonal loss was seen in 74%. Leprosy bacilli were identified in 12 (52%) cases. One case showed normal morphology although leprosy bacilli were present.

Although PNL is known to cause endoneurial inflammation, epineurial inflammation or even granulomas can be seen. Necrosis and vasculitis are rarely seen in PNL. Myelin and axonal loss are almost universal. Even if morphologically the biopsy is normal, staining for leprosy bacilli should be performed on all suspected PNL cases.

A cross-sectional study was conducted in northwest Bangladesh. A Bengali version of the RAND 36-Item Health Survey 1.0 (SF-36) was administered to people under treatment for ENL (n = 29) and controls affected by MB leprosy (n = 46) matched for: sex, treatment status, age, Disability grade at diagnosis, education level and housing type. Chi Square and Wilcoxon RST were used to analyse the data using the R statistical package.

Patients with ENL had significantly (P < .001) worse Health Related Quality of life (HRQoL) scores on all eight SF-36 health concepts: physical functioning, pain, role limitations due to physical and emotional limitations, emotional well-being, social functioning, energy/fatigue, and general health perceptions. Cohen’s d indicated a large effect (d = .96 to 1.67). The results are compared with results of other published works which examined similar populations

HRQoL is significantly impaired in Bangladeshi people suffering from ENL compared with people with MB leprosy and no ENL. ENL affects all areas of a person’s HRQoL measured by the SF-36. Health care providers need to spend time addressing other aspects of a person’s life and not just the physical symptoms.