NFκB activation in cutaneous lesions of leprosy is associated with development of multibacillary infection

Figures & data

Figure 1 Representative photomicrographs of skin biopsies submitted for Southwestern histochemistry for detection of activated NFκB (original magnification 200×).

Notes: Arrows demonstrate purple nuclear staining. Detection was quantified by an NFκB activation index, which values ranged from zero to four. (A) NFκB activation index of 0: no nuclear staining (negative control); (B) NFκB activation index of 1: up to 10% nuclear staining in sparse lymphocytes from a tuberculoid lesion; (C) NFκB activation index of 2: 11%–25% nuclear staining in cells from a superficial lymphohistiocytic infiltrate and fibroblasts (arrows) from a borderline tuberculoid lesion; (D) NFκB activation index of 3: 26%–50% nuclear staining in cells from a perivascular and perineural inflammatory infiltrate, involving the superficial and mid dermis. There was staining of histiocytes, lymphocytes, fibroblasts, and vascular endothelium (arrow tip) from a lepromatous lesion; (E) NFκB activation index of 4: >50% nuclear staining in cells from a dense perineural and perivascular inflammatory infiltrate. There was staining of fibroblasts, histiocytes, and lymphocytes from a borderline lesion.

Abbreviation: NFκB, nuclear factor kappa B.

Table 1 Data from 38 leprosy patients evaluated for activation of NFκB

	n (%)	NFκB index median (range)	Activated NFκB n (%)	Fisher’s exact P-value
Age group
<18 years	4 (10.5)	1 (0–2)	1 (25.0)	0.480
18–60 years	22 (57.9)	1 (0–3)	6 (27.3)	0.071
>60 years	12 (31.6)	2 (0–4)	8 (66.7)	0.025*
Sex
Male	22 (57.9)	1.5 (0–3)	11 (50)	0.11
Female	16 (42.1)	1 (0–4)	4 (25)
Leprosy classification
Tuberculoid	7 (18.4)	1 (0–1)	0 (0.0)	0.019*
Borderline tuberculoid	9 (23.7)	1 (0–2)	3 (33.3)	0.490
Borderline	5 (13.2)	2 (1–4)	4 (80.0)	0.069
Borderline lepromatous	8 (21.1)	1.5 (1–3)	4 (50.0)	0.385
Lepromatous	9 (23.7)	1 (0–3)	4 (44.4)	0.510
WHO classification
Multibacillary	22 (57.9)	2 (0–4)	12 (54.5)	0.028*
Paucibacillary	16 (42.1)	1 (0–2)	3 (18.8)
Biopsy acid-fast bacilli (Fite–Faraco stain)
Present	29 (76.3)	1 (0–4)	13 (44.8)	0.208
Absent	9 (23.7)	1 (0–2)	2 (22.2)
Total	38 (100.0)	1 (0–4)	15 (39.5)

Note:

* P<0.05.

Abbreviations: n, number of patients; NFκB, nuclear factor kappa B; WHO, World Health Organization.

Table 2 Logistic regression analysis of activated NFκB according to leprosy classification, adjusted by age group and sex

	Activated NFκB n (%)	Odds ratio	95% CI	P-value
Age group
<18 years	1 (25.0)	1	–	–
18–60 years	6 (27.3)	0.12	0.01–3.06	0.205
>60 years	8 (66.7)	1.20	0.06–25.34	0.905
Sex
Male	11 (50)	4.53	0.64–32.03	0.129
Female	4 (25)	1	–	–
Leprosy classification
Tuberculoid or borderline tuberculoid	3 (33.3)	1	–	–
Borderline	4 (80.0)	32.70	1.92–557.49	0.016*
Borderline lepromatous	4 (50.0)	4.86	0.47–50.21	0.185
Lepromatous	4 (44.4)	1.77	0.20–15.83	0.608

Note:

* P<0.05.

Abbreviations: CI, confidence interval; NFκB, nuclear factor kappa B; n, number of patients.

Table 3 Distribution of NFκB activation indexes by leprosy classification and WHO classification

Leprosy classification	NFκB activation indexes
	0 n (%)	1 n (%)	2 n (%)	3 n (%)	4 n (%)	Activated NFκB (>1) n (%)
Tuberculoid (n=7)	1 (14)	6 (86)	0 (0)	0 (0)	0 (0)	0 (0)
Borderline tuberculoid (n=9)	4 (44)	2 (22)	3 (33)	0 (0)	0 (0)	3 (33)
Borderline (n=5)	0 (0)	1 (20)	2 (40)	1 (20)	1 (20)	4 (80)
Borderline lepromatous (n=8)	0 (0)	4 (50)	3 (38)	1 (13)	0 (0)	4 (50)
Lepromatous (n=9)	1 (11)	4 (44)	1 (11)	3 (33)	0 (0)	4 (44)
WHO classification
Paucibacillary (n=16)	5 (31)	8 (50)	3 (19)	0 (0)	0 (0)	3 (19)
Multibacillary (n=22)	1 (5)	9 (41)	6 (27)	5 (23)	1 (5)	12 (55)

Abbreviations: NFκB, nuclear factor kappa B; n, number of patients; WHO, World Health Organization.