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PubMed2003

Effectiveness of multidrug therapy in multibacillary leprosy: a long-term follow-up of 34 multibacillary leprosy patients treated with multidrug regimens till skin smear negativity.

The World Health Organization (WHO) Field Trials of multidrug therapy (MDT) started at Schieffelin Leprosy Research and Training Centre (SLR & IC), Karigiri, India in December 1981. The patients were treated with two MDT regimens. The first (regimen A) consisted of 600mg rifampicin and 300mg of clofazimine given under supervision on 2 consecutive days monthly, 225mg injection of acedapsone bimonthly and dapsone 100mg daily. The second regimen (regimen B) was the conventional MDT (WHO/MDT), rifampicin 600mg and clofazimine 300mg supervised once a month, dapsone 100mg and clofazimine 50mg daily, unsupervised. Both the regimens were administered for a minimum period of 2 years or until skin smear negativity, whichever occurred later. Thirty-four newly detected previously untreated MB patients, 16 of whom received regimen A and 18 regimen B, were reassessed. Both regimens were well accepted and well tolerated by the patients. Clofazimine discolouration was the only adverse effect of MDT seen in these patients. After completion of treatment with MDT, the patients were followed up for a total duration of 466 person-years with a mean of 13.7 +/- 1.4 years per patient. No relapse was seen.

Acedapsone↗
PubMed2004

Death caused by strongyloides hyperinfection in a leprosy patient on treatment for a type II leprosy reaction.

Strongyloides stercoralis is present worldwide and can cause hyperinfection in patients on long-term immunosuppressive doses of steroids, as is sometimes the case for patients treated for leprosy reactions. Strongyloides hyperinfection can present with ileus, as is discussed in this case report. Physicians, including surgeons, should be aware of this entity in order to avoid an unnecessary laparotomy. Though patients may survive if diagnosed at an early stage, strongyloides hyperinfection syndrome has a mortality rate of 87% and prevention is therefore of utmost importance.

Adult↗
PubMed1988

Influence of acetylator phenotype of the leprosy patient on the emergence of dapsone resistant leprosy.

The half time of disappearance of dapsone and monoacetyl dapsone and the acetylator phenotype of the leprosy patients who harboured dapsone sensitive and dapsone resistant M. leprae was assessed in 27 subjects. Sixteen patients were rapid acetylators, five were slow and six were intermediate acetylators. The mean T 1 1/2 lives of dapsone (30.26 +/- 11.0) and monoacetyl dapsone (31.11 +/- 12.0) were also studied in the above patients. The percentage of different acetylators in both resistant and sensitive groups were similar showing no correlation between the emergence of drug resistance and the phenotype of the patient. The mean time of disappearance of DDS and MAD in the different acetylators did not show significant difference. The ratios of MAD/DDS in an individual at 3, 6 or 24 hours after the dose were similar. The mean T 1 1/2 lives of DDS and MAD in resistant and sensitive patients also showed no difference. Neither T 1 1/2 lives of DDS or MAD nor the acetylator phenotype seem to influence the emergence of dapsone resistance.

Acetylation↗
PubMed1979

Lymphocyte transformation test in healthy contacts of patients with leprosy. I. Influence of exposure to leprosy within a household.

Fifty-three household contacts of lepromatous patients, 37 household contacts of tuberculoid patients, and 91 control persons were examined with the lymphocyte transformation test (LTT) for their responses to whole and sonicated antigen preparations from M. leprae, to BCG, M. avium, M. gordonae, and phytohemagglutinin (PHA). The study was carried out in the Gurage area of Ethiopia in 15 households with a leprosy patient and 15 matched control households. Household contacts of lepromatous patients showed significantly greater LTT responses to antigens from M. leprae than the controls, whereas household contacts of tuberculoid patients did not respond differently from controls. Household contacts of lepromatous patients had significantly greater responses to M. leprae antigens when the index patients were "active," i.e., highly bacilliferous, than when they were "inactive," i.e., having a low bacillary load. The degree of sensitization, as indicated by the LTT response, in different exposure groups paralleled the degree of probable infectivity of the index patient. A preparation of antigen from whole M. leprae proved to be more sensitive and more specific in the LTT than did a sonicated preparation. A significant degree of cross-reactivity was found among the various mycobacteria in their LTT responses.

Adolescent↗
PubMed1978

[Effect of L-tetramisol associated with rifampicin in patients with lepromatous leprosy. L-tetramisol in patients with lepromatous leprosy].

In this work are presented results obtained in the treament of thirty patients suffering of lepromatous leprosy. In a group of fifteen patients L-tetramisol was administrated in association to antimocrobian drugs. The control group received only the last medication. Immunological modifications were not observed in any case. However, in six patients treated with L-tetramisol associated to rifampicin during three months it was possible to observe a notable improvement of the clinical state. In the patients that received L-tetramisol associated to other drugs or in those that received only antimicrobian drugs the clinical improvement was very low or null.

Adolescent↗
PubMedDate not supplied

Immunological studies in leprosy. III-Cutaneous response to antigens in spectrum of leprosy.

Delayed type of hypersensitivity response was assessed in 65 cases of leprosy of different types, and 18 control using lepromin (Dharmendra) and candida antigens. 0.1 ml of antigen was injected intra-dermally and results were recorded after 48 hours. The induration of 5 mm or more was taken as positive for early (Fernandez) reaction in lepromin test, and also for candida reaction. Both types of tests were positive in decreasing order from tuberculoid to borderline type while negative in borderline lepromatous and lepromatous type.

Antigens, Fungal↗
PubMed1980

Phagocytosis in leprosy. III. Defective adhesive and endocytic abilities of circulating leukocytes in lepromatous leprosy.

Two aspects of the phagocytic process in normal and lepromatous polymorphonuclears (PMN) and monocytes (MN) were studied. These aspects were endocytosis and adherence to surfaces. These 2 phenomena are closely related to each other and to the whole phagocytic process as they depend on membrane activity. It was found that both lepromatous phagocytes (PMN and MN) show, on the average, a depressed ability to endocytose opsonized Mycobacterium lepraemurium when compared to normal phagocytes. This impairment, however, does not seem to be related to intrinsic defects in the phagocytic cells themselves but to the presence in lepromatous serum of factors that interfere with the endocytic function. This conclusion was drawn from the fact that lepromatous serum causes a similar diminution in the endocytic ability of normal phagocytes. On the other hand, lepromatous plasma but not indeterminate leprosy nor normal plasmas interfere with the capacity of PMN leukocytes to adhere in vitro to plastic surfaces. These impairments in the phagocytic function might help to better understand the depressed overall inflammatory responses observed in vivo in lepromatous patients with a long-lasting disease.

Adult↗
PubMed1980

Prevalence of secondary dapsone resistance in Gudiyattam Taluk, the leprosy control area of the Schieffelin Leprosy Research and Training Centre, Karigiri. 1. Preliminary report.

A preliminary study of the prevalence rate of secondary dapsone resistance among leprosy patients in Gudiyattam Taluk, Tamil Nadu, was undertaken. During the period March 1978 to February 1979, there were 1580 lepromatous and borderline lepromatous patients considered to be at risk of developing secondary resistance. Of them, 1431 were examined clinically, and reactivation and/or relapse was found in 114 patients. Of these, 46 had a bacteriological index of 2,000 and more. Skin biopsies were taken from 26 patients for mouse foot pad studies. Resistance to dapsone at the highest drug concentration was found in 22 and partial resistance in two patients. The organisms from two patients were sensitive to dapsone. Twenty patients were not biopsied because they had been absent from treatment for significant periods of time. These patients are now under observation. Prior to this study, nine patients had been confirmed to have dapsone resistance in the control area, and during the present study 24 additional patients with secondary resistance have so far been detected. Thus 33 patients with dapsone resistance among the 1431 patients examined yields a crude prevalence rate of 2.3% in Gudiyattam Taluk.

Dapsone↗
PubMed1981

A study of social stigma among leprosy patients attending leprosy clinic in Gwalior.

The present study is a longitudinal study and was undertaken from November 1977 to January 1979. The study included 344 cases of leprosy patients from different areas. The data was collected, tabulated and analysed which revealed the following salient features. 26.45% cases were having one, or more than one type of social stigma, 42.86% cases showed social stigma from their neighbours. 62.64% cases were having stigma for touch, 30.77% cases were in age group of 45--54 years. Males were more victims of social stigma, than females. The social stigma was more prevalent in illiterates and low socio-economic group patients. 69.03% cases were in need of social rehabilitation.

Adult↗
PubMed1980

Study of evolution of nerve damage in leprosy. Part II--Observations on the index branch of the radial cutaneous nerve in contacts of leprosy.

A total of 35 contacts from 20 families of lepromatous index cases were screened clinically. All of them were subjected for nerve conduction velocity (NCV) studies of both left and right index branch of the radial cutaneous (IRC) nerve. Fifteen of these nerves were biopsied. Out of 15 IRC nerves biopsied 10 had slightly reduced average NCV values and 5 were normal. Four nerves out of 10 where average NCV was reduced and 1 nerve out of 5 where NCV was normal showed significant ultrastructural changes and higher percentage of segmental demyelination (10%--13%). There was a striking similarity between the changes seen in the IRC nerves of early cases of leprosy and of contacts.

Fingers↗
PubMed1994

[Results of 466 nerve decompressions in 123 leprosy patients during polychemotherapy with a minimum follow-up of one year. Value of preventive surgery in a leprosy control program].

The clinical expression of leprosy is primarily cutaneous but its serious neurologic manifestations are maiming. Mutilations mainly of limb ends are due to peripheric nerves compression and may appear before or during the clinical treatment of the illness. Their appearance which is not automatically related to multiple Hansen's bacilli, may be prevented surgically by nervous decompression. The authors report their experiences of 466 nervous decompressions of 123 patients (89 men and 34 women), among them, 14 were pauci-bacillary and 109 multi-bacillary. They conclude that very good results (complete recovery or improvement of sensitivity, disappearing of pain) have been obtained through simple and easy-to-learn surgeries.

Adolescent↗
PubMedDate not supplied

Risk of relapse in leprosy. The Leprosy Unit, WHO.

Until the introduction by WHO of the standard regimens using multidrug therapy (MDT) for the treatment of leprosy, there was a general unwillingness to release patients from treatment. This was mainly due to the high risk of relapse after dapsone monotherapy. After almost a decade of MDT implementation and after releasing more than 4 million patients, it was necessary for WHO to review the risk of relapse following WHO-recommended MDT. The results of this study, carried out on more than 20,000 MB and 50,000 PB patients, revealed that the risk of relapse is very low, 0.77% for MB and 1.07% for PB, nine years after stopping MDT. In comparison to dapsone monotherapy, the risk is 10-times lower. Thus, over the last decade, MDT implementation has probably prevented close to half-a-million relapses.

Humans↗
PubMed1998

DNA amplification for detection of leprosy and assessment of efficacy of leprosy chemotherapy.

Polymerase chain reaction (PCR) for the detection of Mycobacterium leprae was applied to fresh skin biopsies and slit-skin smears from 122 untreated leprosy patients. The PCR positivity rates in biopsies were 95.6% in multibacillary (MB) cases and 44.2% in paucibacillary (PB) cases. Following 1 month of treatment, MB cases declined by 54.3% and PB cases by 61.8% of initial values. Six-month values also declined from initial positivity rates to 50.3% and 53.8% of initial values in MB and PB, respectively. Larger declines in the rate of positivity were seen for skin-smear samples at 1 and 6 months in both MB and PB, but overall PCR positivity rates were lower than biopsy rates for M. leprae.

Adolescent↗