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Biomedical subjects

K V Desikan

Publications and source records attributed to K V Desikan.

At least 19 recordsLinked to original sources
PubMed2005

The INFIR Cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India.

The aim of this study was to find predictors of neuropathy and reactions, determine the most sensitive methods for detecting peripheral neuropathy, study the pathogenesis of neuropathy and reactions and create a bank of specimen, backed up by detailed clinical documentation. A multi-centre cohort study of 303 multibacillary leprosy patients in Northern India was followed for 2 years. All newly registered MB patients requiring a full course of MDT, who were smear positive and/or had six or more skin lesions and/or had two or more nerve trunks involved, were eligible. A detailed history was taken and physical and neurological examinations were performed. Nerve function was assessed at each visit with nerve conduction testing, warm and cold detection thresholds, vibrometry, dynamometry, monofilaments and voluntary muscle testing. Because the latter two are widely used in leprosy clinics, they were used as 'gold standard' for sensory and motor impairment. Other outcome events were type 1 and 2 reactions and neuritis. All subjects had a skin biopsy at registration, repeated at the time of an outcome event, along with a nerve biopsy. These were examined using a variety of immunohistological techniques. Blood sampling for serological testing was done at every 4-weekly clinic visit. At diagnosis, 115 patients had an outcome event of recent onset. Many people had skin lesions overlying a major nerve trunk, which were shown to be significantly associated with an increased of sensory or motor impairment. The most important adjusted odds ratios for motor impairment were, facial 4.5 (1.3-16) and ulnar 3.5 (1.0-8.5); for sensory impairment they were, ulnar 2.9 (1.3-6.5), median 3.6 (1.1-12) and posterior tibial 4.0 (1.8-8.7). Nerve enlargement was found in 94% of patients, while only 24% and 3% had paraesthesia and nerve tenderness on palpation, respectively. These increased the risk of reactions only marginally. Seven subjects had abnormal tendon reflexes and seven abnormal joint position sense. In all but one case, these impairments were accompanied by abnormalities in two or more other nerve function tests and thus seemed to indicate more severe neuropathy. At diagnosis, 38% of a cohort of newly diagnosed MB leprosy patients had recent or new reactions or nerve damage at the time of intake into the study. The main risk factor for neuropathy found in this baseline analysis was the presence of skin lesions overlying nerve trunks. They increased the risk of sensory or motor impairment in the concerned nerve by 3-4 times. For some nerves, reactional signs in the lesions further increased this risk to 6-8 times the risk of those without such lesions. Patients with skin lesions overlying peripheral nerve trunks should be carefully monitored for development of sensory or motor impairment.

Adolescent↗
PubMed2002

Initial experiences of implementation of functional integration (FI) in LEPRA India projects in Orissa.

In 2000, the Government of the State of Orissa (population 37 million) in India decided to introduce functional integration for the control of leprosy, in place of the long-established vertical programme, using the general health services and the primary health care system. This paper describes the initial (9 months) experience of implementing this strategy in two projects run by LEPRA India. One of these, in the district of Koraput, was established in 1991 and covers a population of 1.5 million people. The other, in Kalahandi district, started in 1997 and covers a population of 600,000. Both projects operate under difficult conditions with regard to terrain, the use of numerous tribal languages, illiteracy, water shortage, poor roads and communications. The preparatory phase included intensive health education of the public on leprosy, using a wide range of educational media and techniques. At the same time, LEPRA India supported the Government in the training and orientation of trainers, medical officers, primary health care staff and female health workers at village level. In all, over 2000 were trained. This paper describes all aspects of the implementation of functional integration in these two areas. In the 9-month period, 4207 suspect cases were referred to medical officers by health workers, but only 256 (6%) were confirmed as having leprosy. There were 169 confirmed self-reporting cases. Despite the clearly understood intention to involve primary health staff in case detection, 67% of all cases were in fact detected by LEPRA India, possibly due to overlapping attendance at clinics by vertical and general staff. There is obviously a need for further training of the general staff since only 6% of cases referred by them were confirmed as having leprosy. Steps must also be taken to ensure that the emphasis on case detection, confirmation and treatment shifts from the vertical to the general health staff. The supply of anti-leprosy drugs and steroids to primary health centers needs improvement. Appropriate teaching and learning material is urgently needed for both field staff and medical officers.

Delivery of Health Care, Integrated↗
PubMed2001

Cytodiagnosis of histoid leprosy.

This paper presents cytomorphological features of the histoid variety of lepromatous leprosy. Fine needle aspiration of a lepromatous nodule showed cytological features consistent with those of histoid leprosy. Simultaneously, a biopsy of the nodule was also performed and the case confirmed as histoid leprosy. The advantages of the fine needle aspiration technique are that it is simple, quickly reportable, and less traumatizing. Multiple aspirations from different sites may be obtained, which would add to the value of sampling. The need to differentiate a histoid nodule from a conventional lepromatous nodule is explained.

Adult↗
PubMed2000

Modified leprosy elimination campaign (MLEC) for case detection in a remote tribal area in the State of Orissa, India.

A leprosy project was established in a difficult to reach area under guidelines of Government of India. The leprosy services were provided by Koraput Leprosy Eradication Project (KORALEP) and general health services by Primary Health Care (PHC). Leprosy elimination campaigns (LECs) were suggested by WHO to detect more cases in the community. A modified leprosy elimination campaign (MLEC), carried out utilizing the services of primary health care workers is discussed in this paper. Apart from the trained health workers, Anganwadi workers along with some literate people from the district were also included in the search teams. In all, 1543 cases were shortlisted from the suspects identified and on re-examination 576 cases were confirmed as active cases. Sixty percent of the cases detected were very early cases with two to three skin lesions. This could be achieved with a very brief training of health workers and involving village voluntary workers. MLEC was found to be a useful tool for case finding in such areas.

Adolescent↗
PubMed1997

Detection of S-100 protein and anticeramide antibodies in leprosy patients by ELISA.

The status of assay for S-100 antigen protein and anticeramide antibodies in serum in understanding nerve damage in different forms of leprosy were evaluated by the enzyme immunoassay. Based on the clinical and smear examination, patients were classified as indeterminate (Ind), tuberculoid (TT), borderline tuberculoid (BT), borderline lepromatous (BL) and lepromatous (LL). Antibody levels against ceramide were observed in sera of leprosy patients with 37.5% of Ind, 28% of TT, 66% BT, 78% BL and 62% LL patients positive as against 8% endemic normal sera. The mean OD ranged from 0.141 to 0.275 in different groups of leprosy. In contrast, S-100 was detected in 71.4% Ind, 88.8% TT, 76.4% BT, 100% BL and 95.8% LL, while 5% of ENL samples were positive for S-100 antigen. Mean S-100 levels in these different categories of patients were significantly higher Ind--0.45 ng/ml, TT--0.32 ng/ml, BT--0.23 ng/ml, BL--0.23 ng/ml, LL--0.19 ng/ml as compared to that of normal 0.07 ng/ml. In general S-100 seems to be a more sensitive and reliable marker than anticeramide antibodies for nerve damage. Five out of 7 indeterminate cases show increased levels of S-100, showing an extent of nerve damage similar to that of TT and could be a useful marker for assessing nerve damage in indeterminate patients for better management.

Antibodies, Bacterial↗
PubMed1995

Persistence of lepromatous granuloma in clinically cured cases of leprosy.

Multibacillary (MB) leprosy patients are declared cured when they become bacteriologically negative and their lesions do not show any signs of clinical activity. Whether there is also a corresponding histological clearance of skin lesions is not known. The present study was carried out on the histopathology of the skin of 40 MB cases who were declared cured with multidrug (MDT). In 22 of them, small lepromatous granulomas were seen to persist, although acidfast bacilli were not found in them. The presence of these granulomas was not found to have any significant associated with the duration of the disease, length of treatment, or the period of cessation of therapy.

Adult↗
PubMed1995

Extended studies on the viability of Mycobacterium leprae outside the human body.

Very little is known in leprosy regarding the transmission of the infection from the source to the susceptible host. One of the important factors which governs the transmission of the disease is the viability of Mycobacterium leprae outside the human body. In this study M. leprae obtained from untreated patients have been subjected to several adverse conditions. Their viability was verified by their multiplication in the footpads of normal mice. After drying in the shade the organisms were viable up to 5 months. On wet soil, they remained alive for 46 days. Kept in saline at room temperature, the organisms lived for 60 days. Surprisingly on exposure to direct sunlight for 3 hours a day the bacteria survived for 7 days. On refrigeration at 4 degrees C, the bacteria could be preserved for 60 days. On the other hand, keeping at -70 degrees C, the bacteria could be maintained in a living condition for only 28 days. On exposure to antiseptics like Savlon (R) and alcohol, the bacteria were rapidly killed. These results indicate the survival outside the human body of M. leprae under different environmental conditions in India where the disease is endemic. Transmission of infection by indirect contact and occurrence of new cases in the absences of any known source, are consistent with M. leprae being viable outside the human body for varying periods of time. The findings could also be pointers to understand the epidemiology of leprosy.

Animals↗
PubMed1991

A clinical, immunological, and histological study of neuritic leprosy patients.

An assessment has been made of 108 neuritic leprosy patients to find out if the number of affected nerves and the clinical presentations of these patients give any indication of the underlying severity (classification) of the disease. Detailed clinical recordings, skin smears, lepromin testing with Dharmendra antigen, and a leukocyte migration inhibition test (LMIT) using sonicated Mycobacterium leprae antigens were done in these patients. Nerve biopsies of available affected nerves were taken in 39 patients. The results show that neuritic leprosy patients also have a spectrum. However, none of the clinical parameters, including the number and distribution of affected nerves, the immune response and the nerve histology, were found to be inter-related. Further, even though all of the patients were skin-smear negative, a significant proportion showed lepromatous histology and nearly two thirds had a moderate-to-heavy bacterial load within the nerves.

Adolescent↗
PubMed1990

Histological changes in tuberculoid leprosy after fixed duration multidrug therapy for six months.

The length of treatment advocated for leprosy has been very long and arbitrary. During the past few years, attempts have been made to reduce the length of treatment required. World Health Organization (WHO) has recommended six months therapy for paucibacillary leprosy. The present study was undertaken to see the extent of histological changes that occur with this therapy. Thirty four untreated tuberculoid (TT/BT) leprosy patients were biopsied initially and after completion of fixed course of this treatment. Clinically, 50 percent of the patients showed regression of disease activity at the end of six months. Morphology of the lesions was studied, in clinically active and inactive cases on completion of therapy. It was found that after six month's therapy, histology of the lesions was similar, whether the case was active or not. After the prescribed treatment, biopsy showed marked reduction in the extent of granuloma, along with significant increase in lymphocytes and a increase in epithelioid cells in these granulomas.

Dapsone↗
PubMed1988

Reliability of direct skin smear microscopy in leprosy.

Skin smear direct microscopy is an important tool for diagnosis of leprosy. The study was planned to understand the reproducibility of skin smear reading by a trained technician. Skin smears were collected from known patients of leprosy from the field area. They were stained for acid fast bacilli following the standard cold staining procedure and were read following the Ridley scale. A sample of smears was re-examined on two occasions by the same technician, following blind procedure. There was a systematic under reading on the second occasion, which was attributed to the defective storage of the slides. However, the agreement between second and third examinations was very good (Concordance 81.34%, Kappa 0.74). The finding was confirmed on a repeat examination. It can be concluded that the Direct Skin Smear Microscopy is a reliable and reproducible technique under experimental conditions.

Humans↗
PubMed1988

Antibodies to HIV-1 in sera from patients with mycobacterial infections.

Sera from 478 persons (348 leprosy patients, 33 tuberculosis patients, 29 healthy contacts of leprosy patients, 38 normal healthy Indians, and 30 normal healthy Europeans) were screened for anti-HIV-1 IgG antibodies by ELISA. None was positive. In addition, 132 samples (from 43 leprosy patients, 21 tuberculosis patients, 5 healthy contacts of leprosy patients, 33 normal healthy Indians, and 30 normal healthy Europeans) were also tested by Western blot assay for anti-HIV-1 IgG antibodies. Only 1 of the 63 healthy subjects expressed a prominent p17 band. One or more bands were found in 44 (leprosy patients 33/43, tuberculosis patients 7/21, and leprosy contacts 4/5) of the remaining 69 sera. Antibody to the HIV-1-specific antigen p24 was expressed by 17 of these subjects (14/43 leprosy patients, 1/21 tuberculosis patients, and 2/5 leprosy contacts), either as a single band or in combination with other bands. This raises the possibility of a common antigenic pattern between HIV-1 and mycobacteria, especially Mycobacterium leprae.

Blotting, Western↗
PubMed1988

Evaluation of the efficacy of candidate vaccines against M. leprae infection in mice.

Delayed-typed hypersensitivity (DTH) response and protection value of some of the candidate vaccines alone and in combination with BCG has been investigated. It was observed that both M.w. and BCG gave heightened DTH and good protection. On the other hand both M. leprae and ICRC evoked moderate DTH and gave poor protection. However on combining any of these candidate vaccines with live BCG, the lowering of DTH and poor protection was observed except in the M. leprae combination which in spite of low DTH gave better protection.

Animals↗
PubMed1988

A follow up study of borderline tuberculoid leprosy under sulphone monotherapy.

A retrospective study is presented herewith of 94 cases classified as BT and treated with sulphone monotherapy. A system of scoring based on the number and extent of lesions, and nerve involvement was followed. It was observed that cases with a clinical score of 2 or having more than 15 lesions or patients with extensive lesions covering 3 or more of 7 sectors of the body had a bad prognosis in respect of time taken for subsidence, occurrence of deformities and most importantly occurrence of relapses. Hence it is suggested that such cases should be considered as Multibacillary and treated as such, despite bacteriological findings which may be either negative or a bacteriological positivity of less than 2 at any one site.

Biopsy↗