[Serological diagnosis of leprosy].
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Biomedical subjects
Publications and source records attributed to W R Faber.
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In a retrospective study the data concerning 49 patients with cutaneous leishmaniasis were analysed. The group included 39 patients seen in Amsterdam in the period 1979-1988 in the Royal Institute for the Tropics and the University Medical Centre and 10 patients seen in the University Hospital of Leiden in the period 1970-1982. Mediterranean countries, especially Spain, were important sources of infection. In 26 patients, one skin lesion was found. All but one of the patients had (papulo)nodules, nodules with central scab formation and/or ulcerative skin lesions. In most cases the lesions were localized on the face and extremities, one patient had a mucosal lesion of the nose, three had sporotrichoid extension and six, lymphadenitis. For demonstration of the parasite, aspiration, smear, biopsy and culture were used with varying frequencies. The biopsy and culture methods contributed most to the diagnosis. The treatment in 22 patients consisted in parenteral administration of sodium stibogluconate while 13 received primary cryotherapy. In addition, four patients were subjected to cryotherapy because of a recurrence after, or side effects of the treatment with sodium stibogluconate. In three patients, spontaneous healing was awaited. Owing to incomplete follow-up, the ultimate condition was not known of all patients; the skin lesions treated with cryotherapy all healed. In case of nodular and ulcerative skin lesions in a person who has lived in the (sub)tropics, cutaneous leishmaniasis should be considered; the geographical anamnesis is of great importance in this respect.
The polymerase chain reaction (PCR) based on the selective amplification of a 530-bp fragment of the gene encoding the proline-rich antigen of Mycobacterium leprae was applied on sections of fixed or frozen biopsy samples from leprosy patients. A simple procedure for the extraction of DNA from M. leprae in clinical specimens that provided suitable template DNA for amplification was developed. When PCR was applied on frozen sections, positive amplification in samples from all untreated acid-fast bacillus (AFB)-positive patients and in samples from 56% of the untreated AFB-negative patients could be detected, while biopsy samples from patients with skin diseases other than leprosy were all PCR negative. With neutral Formalin-fixed biopsy samples, positive amplification in 92% of the samples from untreated AFB-positive patients and in 61% of the samples from untreated AFB-negative patients could be detected by PCR. Biopsy samples exposed to mercuric chloride or nonbuffered formaldehyde containing fixatives were not suitable for application of PCR. This PCR holds promise as a tool for studies on M. leprae infection.
Forty-eight leprosy patients in The Netherlands were re-examined 10 years after initial examination. Forty-six of these patients had received a course of multidrug therapy (MDT), according to the World Health Organization recommendation, at the time of their initial examination. Two patients had burned-out disease and had been merely under observation. Out of 40 patients, who initially did not show eye complications due to leprosy, 37 patients were essentially the same 10 years later. The eyes had changed in 3 multibacillary patients: 1 patient had developed a late type 1 reaction with facial nerve involvement and lagophthalmos; 2 patients had undergone intra-ocular surgery for cataract and acute glaucoma, respectively. Out of 8 patients with pre-existing eye involvement, 1 patient recovered and the lesions in 2 patients remained unaltered. One patient showed progression of pre-existing exposure keratitis. Four patients had undergone cataract extractions; all four patients were lepromatous, with a long history of disease and signs of iris involvement at the first examination. The main progressive lesions were cataracts in lepromatous patients.
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Fifty-nine basal cell carcinomas of the eyelids were treated by cryosurgery and followed up for at least three years. Only one recurrence was seen after three years. All lesions except one healed with good cosmetic results.
A panel of 17 mouse monoclonal antibodies (MoAb) raised against Mycobacterium leprae (M. leprae) antigens was used to detect antigenic determinants in normal human skin. An indirect immunoperoxidase technique was used. Eight of the MoAb detected epidermal antigens similar to patterns well known for human sera. Five of these MoAb detected determinants in the dermis, too. These observations may indicate a certain degree of similarity between the antigenic determinants occurring in M. leprae and in the human host. We propose that such a similarity on the one hand may facilitate the survival of M. leprae in the human host when the antigens are not recognized as "non-self," a situation which seems to occur in lepromatous leprosy, when the patients' tissues are loaded with bacteria virtually without any immune response. On the other hand, M. leprae antigens which mimic host antigens may induce an auto-immune reaction against the host's own antigens, which could explain the immune reaction in tuberculoid leprosy and during a "reversal reaction" when M. leprae is not observed in the host tissues, but extensive granuloma formation occurs.
Sensory testing by means of a graded bristle technique was performed following cryosurgical treatment of 183 skin lesions in 169 patients. Mild, generally transient, sensory loss was found in 28% of the treated lesions. This sensory loss appeared not to be influenced by differences in the cryosurgical procedures nor by postoperative complications in wound healing, but was dependent on the area of the body where cryosurgery was performed. Treated lesions on the trunk and neck and on the arms and legs showed the most profound and longest lasting sensory loss.
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Certain complement inhibitors, namely chlorpromazine, suramin, 2-hydroxystilbamidine and chlorophenothiazine sulphonate were tested for their ability to suppress complement deposition and vascular injury at the site of an Arthus reaction. Deposition of complement was suppressed in the order 2-hydroxystilbamidine greater than suramin greater than chlorpromazine. All the above mentioned four compounds strongly protected vascular injury as observed by electron microscopic studies. At Arthus reaction sites prepared without drug treatment venules ranged from normal to severely altered and damaged. Discontinuities in endothelial linings varied from small to longer stretches. In the latter situation remaining endothelial cells were degenerated and endothelial remnants did not have an intact basal lamina. After treatment with the above complement inhibitors, at arthus reaction sites some venules appeared normal, whereas others were altered but in all cases the endothelium and its basal lamina remained intact.
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In an open trial, 35 patients suffering from a variety of dermatologic conditions were treated with thalidomide. The drug was shown to be a valuable addition to the therapeutic armamentarium; however, the occurrence of a peripheral neuropathy will limit its use just as its teratogenic side effects have done for many years.
Pityriasis rosea is a skin disease which is obscure in its etiology and pathogenesis. We studied its immunopathology by immunophenotyping the inflammatory cells in situ using monoclonal antibodies that define leukocyte subsets. Findings as to T-cells and their major subsets did not reveal disease-specific data. Monocytes stained only rarely. Neither natural killer cells, B-cells nor plasma cells were ever found. An unexpected finding was the presence within the infiltrates and rarely within the epidermis of cells having the immunophenotype of interdigitating cells (RFD1+). Intense and dendritic staining with anti-T6 and anti-HLA-DR indicated Langerhans cells to be present in the dermal infiltrates, in between these infiltrates in the papillary dermis, and focally within the parakeratotic horny layer. This Langerhans' cell pattern provides evidence for dermal Langerhans cell compartmentalization and transepidermal Langerhans' cell elimination. Such a distribution indicates a change in Langerhans' cell migration processes in pityriasis rosea pathogenesis.
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We describe three patients with pemphigus vulgaris, who during treatment with low doses of immunosuppressive drugs developed persistent keratotic or vegetating skin lesions. Direct immunofluorescence (IF) examination of these lesions showed the typical findings of pemphigus.
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