Immunologic aspects of lepromatous leprosy with special reference to the study of antibodies.
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Biomedical subjects
Publications and source records attributed to K Saha.
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Immunoglobulin levels in the ocular fluids have been estimated in normal subjects and lepromatous leprosy patients. In the normal tear, IgA is the major immunoglobulin while IgG is the only immunoglobulin detected in the aqueous humor. The immunoglobulin profiles in the tear and the aqueous humor in normal subjects are different. The mean IgA level in the tears of the lepromatous leprosy group is significantly lower than in the control patients. IgA and IgG levels are raised in the aqueous humor of some leprosy cases who had suffered from uveitis in the past and also in all cases with active endogenous uveitis. Therefore, in lepromatous leprosy the pattern of immunoglobulin alteration in the tear and the aqueous humor is not parallel.
Forty-two asymptomatic children of leprosy patients were studied for possible hepatic lesions. Hepatic lesions were observed in 47% while acid-fast bacilli in the liver were found in 9.5%. The most frequent lesions encountered included granuloma in 9.5%, focal areas of necrosis in 14%, portal triaditis in 17%, and Kupffer cell hyperplasia in 33%. Occasionally more than one lesion was observed in a biopsy. No correlation with the occurrence of the various hepatic lesions could be made with a history of BCG vaccination or results of skin tests done with tuberculin and lepromin.
Macroscopic sperm agglutination in gelatin, sperm immobilization and tanned red cell hemagglutination tests could detect antispermatozoal antibodies respectively in 41%, 37%, and 23% sera of 35 leprosy patients, including 5 female cases. Interestingly, all of the above tests were positive in one serum from a female patient with borderline leprosy. Sperm antibodies were detected in both lepromatous and tuberculoid forms of leprosy by the above three technics and no significant difference was observed in their incidences among the two groups of patients. A three dimensional correlation was observed in 57% of 42 tests performed with 14 sera. Head-to head type of agglutination was the predominant feature of spermagglutination observed in the sera of these patients. In the control group, only 1 of 50 normal fertile male showed a positive spermagglutination test. Not one in this group showed positive sperm immobilization and tanned red cell hemagglutination tests. Antihuman globulin consumption test, presumably a very sensitive test, was also employed to demonstrate sperm-specific antibodies in the sera of these leprosy patients. These antibodies were adsorbed on the surface of the normal donor's spermatozoa when the latter were incubated with the patients sera. Antispermatozoal antibody could be demonstrated by this sensitive technic in the sera of two female patients. Moreover, antihuman globulin was consumed more intensely by the antispermatozoal antibodies present in the sera in the lepromatous than in the tuberculoid and borderline leprosy groups.
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An aliquot of 24-hour urine collected from leprosy patients was concentrated and examined for the presence of albumin, transferrin, IgG, IgA, IgM, IgD, D3, kappa and lambda light chains by the gel diffusion technic using respective monospecific antisera. Urinary protein excretion profile in lepromatous leprosy patients showed that while excretion of transferrin in the urine was negligible; that of IgG molecules, a substance of higher molecular weight, was significant. It is suggested that the immunoglobulins excreted in the urine may not be plasma-derived, but extravascular in origin. They are probably synthesized in the urinary tract. In the present study, out of 25 leprosy patients, 2 female patients having severe lepra reactions developed urinary tract infections. E. coli and Klebsiella were isolated from their urine. The urinary IgG levels in those two cases were found to be the highest in the series.
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