Importance of good quality skin smears to a peripheral worker in Leprosy Eradication Programme.
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Biomedical subjects
Publications and source records attributed to V N Bhatia.
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Certain structures which indicate probable involvement of a filamentous phase in life cycle of M. leprae have been noted in preserved skin biopsy suspensions from lepromatous leprosy cases. These include (i) filaments with empty or pink round spaces within them (ii) conidia-like structures and (iii) membranes with acid fast bacilli. These structures were rare in the fresh material.
A comparative study on the microbiological and spectrophotometric methods for estimation of rifampicin in urine was carried out in 15 individuals. The urinary levels of rifampicin were determined on 2nd, 8th and 15th days at 3 hour, 6 hour and 24 hour samples by the above methods after administration of 600 mg rifampicin. The results suggest that the microbiological assay is more sensitive than spectrophotometric method. The difference was highly significant in all the cases by paired t-test. Incidentally it was also noticed that urinary excretion of rifampicin was comparatively more on 15th day.
A double blind controlled clinical trial to assess the role of anti-histamines as a supplement in the treatment of leprosy was conducted in multi-bacillary cases of leprosy. In all, 120 patients with lepromatous or borderline leprosy were randomly allocated to a regimen of clofazimine and dapsone for 12 months with or without a supplement of pheniramine maleate for the first 3 months. During the 12-month period, 92% of the patients who received the supplement and 86% of the patients who had not received it had moderate or marked clinical improvement. The BI values decreased from 4.1 to 3.4 and 4.2 to 3.3, respectively. The results over the 12-month period showed that the addition of the antihistamine had not enhanced the efficacy of the regimen as evidenced by clinical and bacteriological findings.
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Serum LDH (total) and LDH isoenzymes were studied in leprosy patients undergoing multidrug treatment. Serum LDH (total) did not show any significant difference between normal human subjects and patients but LDH isoenzymes have shown elevated levels in LDH4 and LDH5 in leprosy patients. The M/H ratios were high in leprosy patients and they exhibited a further rise in patients on treatment.
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A preliminary report is presented on the finding in a patient with lepromatous leprosy relapsing after maintaining clinical inactivity and bacterial negativity with dapsone monotherapy for a period of 23 years. Interestingly, Mycobacterium leprae from the fresh skin lesions revealed resistance to both clofazimine and dapsone by standard mouse foot pad testing.
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The proportions of dapsone resistant strains of M. leprae in cases from the field and in patient institutionalized for treatment were compared. Identification of dapsone resistance was done by mouse-foot-pad experiments carried out in the Laboratory in Central Leprosy Teaching and Research Institute, Chengalpattu. A higher percentage of resistance was detected among institutional patients as compared to field cases. The distribution of M.I. ranges of M. leprae in dapsone resistant subjects was not different from that in dapsone sensitive cases.
A retrospective analysis was made of the mouse foot-pad growth of M. leprae from 35 cases of lepromatous leprosy with B.I. ranging from 1.33 to 4.0 (Dharmendra scale). Of these 35 cases, 6 were found to be harbouring dapsone resistant bacilli and 18 cases sensitive bacilli. In 11 of them there was no growth in the control group of animals. The analysis showed that there was no difference in the mean B.I. between those showing no growth and those showing growth in the 1st, 2nd or 3rd harvest. A minimum B.I. around 1.5 is considered adequate for positive foot-pad takes. Another interesting observation made in the study was that the growth rate in the control group foot-pads was consistently higher in mice receiving dapsone resistant bacilli as compared to those inoculated with bacilli, sensitive to the drug.
Swabs from trophic ulcers from 108 cases were studied by culture. 37 cases yielded single organism (Ps. aeruginosa, 18, Proteus species 11, Staph. pyogenes 4, Others 4). 71 cases yielded mixed growth with two or more organisms. Ps. aeruginosa, Proteus species and Diphtheroids were the predominant organisms in these cultures. Ps. aeruginosa was sensitive to Gentamycin (96.6%), Streptomycin (62.7%) and Chloramphenicol (33.9%). Other organisms although comparatively more sensitive showed a similar pattern.
332 nose-blow specimens have been examined from 73 untreated multibacillary patients of leprosy before and periodically after they were put on a maximal, minimal or an intermediate multi-drug regimen. 80% of these specimens were found to be positive for acid fast bacilli initially. Bacillary positivity rate was more in samples containing pus or blood. Bacilli were seen in LL, LI as well as BL patients. Nearly half of the cases became negative for AFB in their nose-blow specimens within 3 months of initiation of treatment whereas none of these patients has become negative in skin smears. However, a few cases have continued to discharge bacilli in their nasal secretions even after 12 months of multi-drug regimen therapy.