Renal manifestations of leprosy.
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Biomedical subjects
Publications and source records attributed to S Kaur.
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Testicular involvement in leprosy was studied in 30 multi-bacillary (BL/LL) patients. Ten (33.3%) gave past history of type II reactions, of whom nine (30%) gave history of testicular pain and/or swelling. Decreased libido was a common complaint (63.3%). Gynaecomastia was noted in 3 patients (10%) and altered hair pattern in 11 patients (36.7%). Testicular sensation was impaired in 10 (33.3%) patients. Testicular volume was assessed objectively using the Prader orchidometer and found to be reduced in nine (30%) patients. Reduction in testicular volume correlated with longer duration of disease and a past history of type II reaction.
189 leprosy patients including 20 from a leprosy colony having disabilities and deformities were graded by the WHO (1960) classification and their disability indices were calculated. Disabilities occurred more frequently in males and the disability index was significantly higher in those with longer duration of the disease and in multibacillary patients. Majority of the disabled patients (82.5%) were manual workers, but the highest disability index was observed in beggars. Irregularly treated and untreated patients had significantly higher disability indices (DI 2.40 and DI 1.40) than those taking regular treatment (DI 1.09). No correlation was found between severity of disability and occurrence of type I and type II reactions. Disabilities of hands and feet occurred with equal frequency.
Prostaglandin F2 alpha was estimated in the sera of fifty patients in the leprosy spectrum to find out the status of prostaglandins in response to Mycobacterium leprae. Contrary to expectation, PGF2 alpha could be detected in only twenty-eight percent of leprosy patients. This preliminary finding is discussed in detail in the paper.
Seventy-six patients of multibacillary leprosy received clofazimine as part of multidrug therapy (MDT) for periods ranging between 6 and 24 months. Complete ocular examination including slit lamp microscopy and examination of tears was carried out in all these patients. Reddish brown conjunctival and corneal pigmentation was seen in 46% and 53% of the patients respectively. Clofazimine crystals in tears were found in 32% of the patients. Apart from this no other eye changes or symptoms attributable to clofazimine were observed.
Age-related changes in epoxide hydrolase (EH) activity in the liver, kidney, lung, and intestine were studied in male C57BL/6 mice of 1 through 30 months of age. Hepatic cytosolic EH activity increased until 15 months after which there was a decline of 59% during senescence (30 months). Hepatic EH activity in the mitochondrial fraction increased until 4 months and decreased thereafter with a 43% decline by 30 months. The hepatic microsomal EH activity increased until 6 months followed by decline of 32% by 30 months. All of these increases and declines were statistically significant. Renal cytosolic EH showed maximum activity at 6 months after which the activity decreased significantly with age. However, renal EH activity in the mitochondrial fraction, in general, did not change substantially with age. Although changes in renal microsomal EH activity were small, the decrease in activity at 9-18 months was significantly lower than at 1 month and 23-30 months. EH activity in the cytosolic, mitochondrial and microsomal fractions of kidney was 2.5-, 2-, and 10-fold less, respectively, than that found in similar subcellular fractions of liver. Cytosolic EH activity in lung and intestine and lung microsomal EH showed variations with age. The intestinal microsomal EH was not detectable under the experimental conditions used.
Activity of the enzyme gamma-glutamyl transpeptidase (GGT) was measured in 21 patients of BL or LL disease and 10 age matched healthy controls. None of the patients had any systemic or hepatic diseases. Mean values in the patients (53.67 +/- 9.67 U/L) were significantly higher (p less than 0.05) compared to that of controls (34.2 +/- 5.69 U/L).
Nine patients of leprosy, 5 BL and 4 LL who developed jaundice during the course of disease were investigated. Two LL patients developed jaundice during ENL reaction. There was slight hepatomegaly in 5 patients and moderate splenomegaly in 3 only. There was significant alterations in liver enzymes and serum bilirubin in all patients. The abnormalities of the enzymes levels persisted for abnormally long periods even when the serum bilirubin had come down and the patients had become asymptomatic. Blood for HBsAg and anti-HAV IgM was negative in all the patients except one in whom HBsAg was positive. Drugs could not be implicated as the cause of jaundice, all patients maintained recovery even after restarting antileprosy drugs. The possibility of non A, non B viruses producing hepatitis during the course of disease is brought out. Course of prolonged jaundice in leprosy is compared with other diseases which could result in a similar situation.
68 patients with paucibacillary disease were started on various regimes of multi drug therapy, consisting of ethionamide, rifampicin or clofazimine administered with dapsone. Serial skin biopsies were taken from 32 patients at one, two and three years and even later after the initial pre treatment biopsy. Actual material was available for study from 9 patients. All regimens were tolerated well except the one with ethionamide. However the therapeutic response was equal in all combination therapies as supported by histopathology. Compared to that with dapsone monotherapy the response was quicker with combination. Dapsone plus rifampicin combination was best tolerated and it worked out to be economical as well. No relapse was noted in any group during two or more years follow up.
Swiss albino mice were inoculated in the footpads with Mycobacterium leprae obtained from untreated lepromatous patient. The kidneys obtained from the animals sacrificed during different periods were processed for histopathology, presence of AFB and immunofluorescence studies. Renal lesions, AFB and immune complex deposits were seen in the infected animals. Such findings have not been studied in great detail in experimental leprosy earlier.
Swiss albino mice (normal as well as thymectomised and irradiated were inoculated into the footpads with Mycobacterium leprae and divided into two main phases of study. Phase I comprised of animals not given preformed immune complexes (IC). Uninfected controls were however included. Phase II consisted of animals given in vitro prepared IC at zero day period (OdIC), three month period (3mIC) or six month period (6mIC) to both uninfected and infected groups. Splenic lymphocytes were isolated to quantify T and B cells and their responses to M. leprae antigen and four different mitogens. Significant decrease in T cell counts and blast transformation was seen in the M. leprae infected animals which were also administered with immune complexes. Immunosuppression by IC was therefore seen to be enhanced in the presence of M. leprae infection.
The prevalence of cutaneous, medical and surgical disorders was studied in 846 leprosy patients. Common cutaneous disorders among leprosy patients were pityriasis versicolor, tinea, pyodermas, warts, acquired ichthyosis, scabies, pediculosis and callosities. Only pityriasis versicolor had higher incidence when compared to general population. Common medical diseases were tuberculosis, infective hepatitis and diabetes mellitus. The epidemiological importance of their co-existence with leprosy is discussed and relevant literature of other diseases found to be frequently associated with leprosy is reviewed.
Swiss albino mice were inoculated with Mycobacterium leprae obtained from untreated lepromatous patients. Histopathological study of sciatic nerves showed no abnormality. However a few free acid fast bacilli (AFB) were detected in the sciatic nerves taken from the inoculated limbs during the early stages of infection, suggesting the nerve-fibre route of travel as seen in humans in experimental leprosy, too.
Normal and immunosuppressed mice were inoculated with Mycobacterium leprae obtained from untreated lepromatous patients. Besides monitoring the AFB counts in the footpads at 3,6 and 9 months post inoculation, antibody dependent cellular cytotoxicity (ADCC) function was studied. The ADCC function seen to be largely unaltered in the M. leprae infected animals, comparable to the observation made in human leprosy.
Mycobacterium leprae infection was produced through the footpads in normal and immunosuppressed mice. Circulating immune complexes were detected by specific binding test and by conglutinin binding assay for specific and total immune complexes respectively in the sera of these mice during different periods of infection. Out of the total 30 samples tested from the infected groups, 3 were positive by specific binding test and 5 by conglutinin binding ELISA. The implications of the findings in relation to human leprosy are discussed.
25 cases of bacillary positive leprosy patients and 25 age and sex matched controls were investigated for assessment of cochleo-vestibular status. Impaired hearing was complained of by 4 patients. None had tinnitus, dizziness or vertigo. On testing 44% patients were found to have unilateral or bilateral perceptive deafness. Specialised tests of hearing indicated that the deafness was of cochlear type. The vestibular functions were not affected. Leprosy seems to selectively involve the cochlea.
Local and systemic side effects of clofazimine in 514 Leprosy and 26 vitiligo patients who had taken the drug in different doses (100 mg to 300 mg daily) for variable periods of time. The commonest side effect noted was reddish brown pigmentation of skin in 77.8% patients. In an equal number of patients, ichthyotic changes on the peripheral parts of the body were noticed. GIT symptoms occurred only in 0.04% patients in the form of abdominal pain, epigastric distress, mild transient nausea and anorexia. Other minor side effects noted were reddish coloration of sweat, urine and tears. Schilling's, d-xylose tests and faecal fat excretion were near normal in the 21 patients in whom these parameters were done. No abnormality in the Jejunal mucosal biopsy was observed after therapy. No abnormality in the EKG or serum biochemistry occurred even after prolonged therapy. We found the drug to be very safe in the usual doses.