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PubMedDate not supplied

[Predictive value of consultation reasons in the diagnosis of leprosy in Bamako (Mali)].

INTRODUCTION: One of the weak points in the strategy for eliminating leprosy is the poor quality of screening. To overcome this, the World Health Organization (WHO) encourages endemic countries to run campaigns for the elimination of leprosy by circulating educational messages and mobilizing the medical community for early screening of cases. The aim of our study was to identify the motives for consultation with high predictive value for the diagnosis of leprosy and to determine the late diagnosis factors and hence assist the staff on site to improve the results of their leprosy elimination campaigns. PATIENTS AND METHODS: The study consisted, during the second trimester of 1999, in interviewing all the patients consulting for the first time the Marchoux Institute or the units screening for leprosy in the Bamako area. The interview recorded the motives for consultation, the delay before consulting and the reasons for late consulting. To assess their positive predictive value, the motives for consultation were related to the diagnosis retained (leprosy or not). RESULTS: One thousand one hundred and seventy seven patients were interviewed. The motive for consulting, "suspected leprosy", scored the highest positive predictive value (PPV) (80 p. 100): 12 cases of leprosy were diagnosed by 15 consultants having suspected leprosy. Neurological problems were the second motive for consultation (PPV=61.9 p. 100). The most frequent motive for consultation was spots or "macules" (20 p. 100 of consultations), but only provided a positive predictive value of 19 p. 100. Prior consultations and non-specialized treatments were identified as factors of delay in diagnosing leprosy (P<0.001). CONCLUSIONS: Diagnosis of leprosy cannot be based on the motives for dermatological consultation alone. The macules are the most apparent signs, but of low predictive value. Nevertheless, they are an early but non-specific sign of leprosy and are often neglected by the patient. Other than macules, attention must be paid to the neurological signs (dysesthesia, motor disorders) when screening for leprosy. These signs may appear early on, or be observed at a late stage in the progression of the disease.

Adolescent↗
PubMedDate not supplied

Frequency of ocular complications of leprosy in institutionalized patients in NWFP Pakistan.

BACKGROUND: There is no systemic disease, which so frequently gives rise to disorders of the eye as leprosy does. The study was conducted to determine the prevalence and gravity of ocular complications in institutionalized leprosy patients in NWFP. It is important to provide necessary information to leprosy health workers and general physicians in order to sensitize them to early detection and treatment or referral to appropriate centre. METHODS: A prospective study of ocular complications of leprosy patients was conducted at the leprosy centre of Lady Reading Hospital Peshawar and the Leprosy Hospital Balakot, district Mansehra. The study included a record of the name, age, sex, type, duration of disease and completion of multi-drug therapy (MDT). Classification of the patients was done according to Ridley and Jopling 5-group system. Visual acuity was tested by Snellen chart and those patients having a vision of less than 3/60 were labelled as blind. Ocular adnexa were examined by naked eye and lacrimal sac regurgitation test was done. Slit lamp biomicroscopy was done for anterior segment examination and direct ophthalmoscope was used for fundoscopy. RESULTS: The authors studied 143 patients in the above mentioned leprosy centres. Out of these, 59 had lepromatous leprosy, 39 borderline tuberculoid leprosy, 9 tuberculoid leprosy, 33 borderline lepromatous leprosy, and 33 borderline leprosy. The majority of patients came from the northern districts of NWFP, including Malakand division and district Mansehra. The male to female ratio was 4:1. The age of the patients ranged from 14 to 80 years and the duration of the disease ranged from 1 year to 48 years. Ocular complications were found in 73% of the patients. These complications included loss of eyebrows in 57 patients, loss of eyelashes in 37, corneal changes (including opacity, ulceration, and/or anaesthesia) in 44, iridocyclitis in 31, lagophthalmos in 36, ectropion in 13, and chronic dacryocystitis in 3. Of the total of 15 (11%) patients who went blind from ocular complications, 16 eyes did so due to corneal opacities, 6 eyes due to cataract, 5 eyes due to chronic anterior uveitis and one eye due to corneal ulcer, panophthalmitis and phthisis bulbi each. CONCLUSIONS: A significant number of leprosy patients (73%) have ocular complications. The frequency of ocular complications increases with the increasing age and duration of disease of the patients.

Adolescent↗
PubMed2006

Knowledge of and attitudes to leprosy among patients and community members: a comparative study in Uttar Pradesh, India.

The roles of literacy and gender in enhancing help seeking behaviour in leprosy need further research in order to maximize the effectiveness of health education programmes. A study on leprosy knowledge and attitudes was carried out in Uttar Pradesh, one of the hyper endemic states for leprosy in north India, on a random sample of 130 leprosy patients, 120 non-leprosy patients, and 150 community members. A questionnaire was prepared, tested and administered in Hindi, the local language, by a qualified interviewer. Statistical analyses were done in each group by gender and literacy, and compared. Almost everyone in the three groups knew of leprosy, but only a larger proportion of leprosy patients (60%) mentioned anaesthetic patch, as compared to about 20% or less in the other groups. A vast majority in all groups mentioned bad blood, or divine curse as the cause. Even among leprosy patients, less than 10% of illiterates and only about 40% of literates cited infection as the cause of leprosy. Literates had a better, though still quite a poor knowledge on the symptoms as well as the causation of leprosy. However, almost all stated that leprosy was curable, though they couldn't mention MDT specifically. They felt that not all patients need have deformity. About 20-30% of the leprosy affected, but nearly 50-60% in the other groups stated that there was discrimination. Nearly 70% felt that leprosy affected social participation, over 90% attributing this to adverse social stigma. Multivariate analyses, adjusted for sex, confirmed the significant association of literacy with both knowledge and attitudes. In the light of massive health education and IEC campaigns, the findings from this study are disappointing. Adult literacy programmes combined with more innovative focused approaches to suit various target audiences can impact knowledge and attitudes better.

Adult↗
PubMed1998

Evaluation of a sustained 7-year health education campaign on leprosy in Rufiji District, Tanzania.

To assess the impact of a 7-year intensive health education campaign about leprosy delivered by workers of the Kindwitwi Leprosy Trust to schoolchildren and general public in Rufiji District. Knowledge, attitude and beliefs towards leprosy were measured in Rufiji and compared to neighbouring Kisarawe District as control. Lessons learned from this analysis may be useful for the planning and evaluating of health education campaigns. Interview of schoolchildren, general public, community leaders, traditional healers and medical staff in both districts. A stratified randomized sampling scheme was used, with stratification for urban and rural settings. A representative sample of schoolchildren, general public, community leaders, traditional healers and medical staff in Rufiji District and in the control area of Kisarawe District was interviewed. The interviews were partly structured and partly open. The results of the interviews were analysed in the context of epidemiological leprosy data from 1985 till 1995, and demographic data of both districts. Data entry and statistical analysis was done using FileMaker Pro, Stata and Excel computer packages. We did not observe positive effects of the health education campaign on the indicators regarding early diagnosis of leprosy with less disability. Leprosy case detection was declining in both districts. We found that the campaign had a favourable impact on the knowledge and the attitude of schoolchildren in Rufiji District. We could demonstrate a relationship between increased knowledge of leprosy and a positive, less stigmatizing attitude. Knowledge of leprosy was better in Rufiji as compared to Kisarawe, but only among schoolchildren. We found indications that low level of education, rural residence, older age, female gender and Moslem religion were associated with stigmatizing attitudes and beliefs towards leprosy. Knowledge about leprosy reactions among medical staff interviewed was not optimal. The exact outcome of the sustained campaign in Rufiji District was difficult to assess because no comparison could be made with the situation prior to the campaign. However, the health education campaign was associated with increased knowledge and diminished tendency to stigmatize leprosy among schoolchildren. Health education campaigns have to be sustained and have to cover a broad sector of the society in order to induce behavioural changes in the community. The focus of health education should be rural communities and schools, and pay special attention to women, religious leaders and traditional healers. Awareness of diagnosis and treatment of leprosy reactions among medical staff should be improved.

Adolescent↗
PubMed1981

BCG vaccination of children against leprosy in Uganda: final results.

A total of 19 200 children, all contacts or relatives of known leprosy patients, and all free of visible leprosy lesions, were included in a controlled trial of BCG vaccination against leprosy in Uganda between 1960 and 1964. They were followed for an average of 8 years, during which time 261 developed early leprosy lesions. A less comprehensive follow-up was carried out for a further 5 years, when 8 more cases of leprosy were identified.In the main intake, between 1960 and 1962, 16 150 tuberculin-negative or weakly tuberculin-positive (Heaf Grades O-II) children were allocated by an effectively random process to either a BCG-vaccinated or an unvaccinated control group. Both groups were seen and examined in an identical fashion for leprosy at approximately 2-year intervals, and precautions were taken to ensure unbiased assessment of new cases of leprosy. After 8 years, 41 cases of leprosy had been identified in the BCG-vaccinated group, and 201 in the control group, a percentage reduction in the BCG-vaccinated group compared with the control group of 80%. The percentage reduction was similar for those initially tuberculin-negative, and for those initially weakly positive, and did not depend upon the age at vaccination. It was also similar for both sexes, for contacts of lepromatous and contacts of non-lepromatous leprosy, for children having contact with one or more than one patient, and for differing grades of physical contact and genetic relationship with a patient. The protective effect of BCG vaccination continued over the 8-year period, although it may have fallen off slightly at the end.In a group of 1074 strongly tuberculin-positive (Heaf Grades III-IV) children followed in parallel with the other two groups a total of 16 cases of leprosy were identified. When adjusted for age, this incidence is 58% lower than that in the unvaccinated control children who were initially tuberculin-negative, indicating a protective effect against leprosy of naturally-acquired strong tuberculin sensitivity.Between 1970 and 1975, one new case of leprosy was identified in a child who had initially been strongly tuberculin-positive and had therefore not been vaccinated, one in a BCG-vaccinated child, and 6 in control children. Although the follow-up in this period was less comprehensive than that in the main part of the trial, the ascertainment of cases was unlikely to have been biased towards either vaccinated or control children. These results indicate a continuing protective effect of BCG up to 12-13 years after vaccination.

Adolescent↗
PubMed2005

Prevention of blindness in leprosy and the role of the Vision 2020 Programme.

Leprosy control programmes are highly successful. As a result, leprosy control will be more and more integrated into the general health services. The existing vertical, specialized control programmes will be dismantled. Eye complications in leprosy have decreased. This is a result of earlier diagnosis and highly effective multidrug treatment (MDT) of leprosy, combined with timely treatment of secondary nerve damage by steroids. Most ocular morbidity is now found among elderly and disabled leprosy patients who were diagnosed before effective MDT treatment became available. Many of these patients live in leprosy settlements. Age-related cataract has become the leading cause of blindness in leprosy. The second cause of blindness is corneal opacification, mainly as a result of neglected exposure keratitis and corneal anaesthesia. The miotic pupils in late multibacillary leprosy, in combination with small central lens opacities, may also lead to blindness. The Vision 2020 Initiative prioritises cataract surgery. Leprosy patients should be actively included. Disabled leprosy patients can also benefit from screening programmes for refractive errors and the provision of spectacles and low vision aids. Determining the most feasible surgical methods for lagophthalmos surgery remains a challenge. For all health and eye care staff, training in leprosy and its eye complications is needed, as well as a change in attitude towards leprosy patients. Staff must be prepared to welcome them in the general health services.

Blindness↗
PubMed2002

Leprosy in a high-prevalence Egyptian village: epidemiology and risk factors.

BACKGROUND: The epidemiology of leprosy in rural Egypt is unknown. This prospective household survey was conducted in a high-prevalence Egyptian village in order to explore the epidemiologic characteristics of the disease and to determine the possible socioeconomic and HLA genotype risk factors. METHODS: The subjects of the study were the residents of Kafr-Tambul village in the Dakahlia governorate, Egypt. There were 10,503 inhabitants of the village, of whom 9643 (91.8%) had a complete visual skin examination, and suspected leprosy patients were subjected to histopathological examination and slit skin smears. Each household was interviewed to record personal data on family members, family size, education, occupation, crowding index at sleep, social score and source of water supply. Human leukocyte antigen (HLA) class II genotypes were analyzed in all leprosy patients and in a number of both household (N = 124) and non-household (N = 30) contacts. RESULTS: The overall prevalence of clinical leprosy in the village studied was 24.9/10,000 (95%CI = 16.3-37.6). Individuals above the age of 40 years were 4 times more likely to develop leprosy (OR = 4, P= 0.01). The degree of education, crowding index at sleep, social score and source of water supply were found to be unlikely to increase the risk of leprosy (P > 0.05). The frequencies of HLA-DR2 and -DQ1 were significantly associated with leprosy (OR = 3.33 and 5.4; CI = 0.95-12.07 and 1.08-30.19, respectively, all P < 0.05). CONCLUSIONS: Our study provides the first picture of the epidemiology of leprosy in a high-prevalence village in rural Egypt. Leprosy detection campaigns should be initiated and directed towards high-prevalence villages. Provision of leprosy control activities in rural health units is necessary in order to detect new cases. The risk for leprosy is associated with HLA-DR2 and -DQ1 markers, and these markers appear to increase personal susceptibility to leprosy in this village.

Adult↗
PubMed1994

Multidrug therapy and eye disease in leprosy: a cross-sectional study in the People's Republic of China.

BACKGROUND: Factors associated with leprosy-related eye disease in a multidrug therapy (MDT) treated population in China were assessed to determine if status prior to inclusion in the MDT programme (newly diagnosed leprosy patient or leprosy patient on prior dapsone monotherapy) contributed to the prevalence of ocular pathology. METHODS: Trained leprosy paramedical workers in Sichuan Province examined 974 leprosy patients in a standardized fashion. Univariate analyses and multiple logistic regression were used to assess the contribution of demographic and clinical parameters to leprosy-related eye disease. RESULTS: In both groups (prior dapsone and new MDT) leprosy-related eye disease was associated with a longer distance to leprosy health worker or health centre. Among patients with a history of prior dapsone monotherapy, age and duration on dapsone monotherapy were also associated with leprosy-related ocular morbidity. Among newly diagnosed leprosy patients the prevalence of ocular morbidity remained between 8% and 11% regardless of when the patient started MDT. CONCLUSIONS: Our findings suggest that, even when case detection is good, ocular pathology will still occur in MDT treated leprosy patients. There remains an important role for health workers in the prevention of ocular morbidity. Our data also demonstrated that pooling of results from all patients (newly diagnosed and on prior dapsone monotherapy) in a leprosy control programme will likely give rise to inadequate estimates of risk of ocular disease due to variable clinical disease histories in these groups.

Adult↗
PubMed2003

Should household contact examination in a low endemic situation of leprosy continue?

After more than 40 yrs of effort, leprosy is finally under control in Shandong province with only 50 to 70 new cases detected each year in the past 10 yrs. Contact examination is still compulsory and household contacts will be followed for 5 to 10 yrs, as directed by the guidelines of the national leprosy control program. In order to assess the value of contact examination in terms of case finding in a low endemic situation of leprosy in Shandong, we analyzed the data regarding all newly diagnosed leprosy cases in the past 11 yrs using the data abstracted from the national leprosy recording and reporting system, and a questionnaire-based survey to see how many incident leprosy cases would be detected if we followed the policy for contact examination of leprosy in Shandong. The results showed that 252 out of 547 leprosy cases diagnosed from 1990 to 2001 reported they had contact with different categories of primary leprosy cases. Among them, 90 cases had household primary leprosy cases. The mean incubation of the 252 index cases was 23 yrs. If we followed the national policy for contact tracing for 5 or 10 yrs, then only 12 (13.3%) and 10 (11.1%) of the 90 cases whose source of infection was household contacts would have been detected, respectively. Therefore, other approaches should be sought, in order to detect the few incident leprosy cases as early as possible in such a low endemic situation of leprosy in Shandong.

China↗
PubMed2002

[Present and future of leprosy works].

Convinced with an effectiveness of MDT for curing leprosy as an infections disease since 1982, WHO has presented to the 44th World Health Assembly (WHA) in May 1991, a resolution on "The Elimination of Leprosy, as a public health problem, by year 2000", with a numerical target of achieving a prevalence of leprosy of one case per 10,000 population, and it was unanimously adopted. Since then all the leprosy endemic countries of the world has expanded their MDT programmes to cover the whole country, aided by free availability of MDT drugs through WHO since 1995, and succeeded in reaching the target on global basis at the end of 2000, with reduction of leprosy endemic countries down to 12 from nearly 100. At the WHA of 2000, WHO has put a new resolution to achieve the same target, at a national level, by 2005, and the programme is progressing reasonably well in terms of reducing the number of cases registered. However this single minded endeavor of WHO is causing some difficulties, in terms of more comprehensive care of patients, specially in POD and rehabilitation activities. In addition, WHO's public announcements give a strong impression that by the end of 2005 all leprosy problems will be solved with nothing more to do beyond that time. In this presentation, what has been achieved so far, and what needs to be done will be presented briefly. Then various issues facing us currently will be discussed in relation to a realistically perceived final goal, which the speaker defines as "A World without Leprosy related Problems, both medical and social", rather than more commonly accepted "Eradication of Leprosy" or "A World without Leprosy", and explains the reasons. Finally leprosy within the context of human history is discussed rather briefly, pointing out that leprosy patients, throughout history and almost everywhere in the world, suffered a worst case of human rights violation to any minority groups, because they have been conceived as a group of people totally alien to the society. The speakers believe that true understanding of the basic nature of leprosy problems and efforts to solve them will contribute to improved human relationship in general in the world, where any minorities need not to suffer any more, and able to coexist with the surrounding majorities.

Communicable Disease Control↗
PubMedDate not supplied

Transmission of leprosy within households.

As part of the leprosy control program, population follow-up studies were carried out during 1962 to 1970 in Gudiyatham Taluk, an administrative unit in South India (population: 400,000). More than 97% of the 23,285 contacts from 5,088 families having a leprosy patient were clinically examined using accepted methodology and confirmed as having or not having leprosy. New cases developing among household contacts of leprosy (secondary attack rates) were determined and studied in relation to characteristics of the index case and that of contacts. The secondary attack rate is defined as the number of new cases discovered in the contacts of leprosy patients per 1,000 person-years, which is equivalent to observing 1,000 persons per year. Nearly two-thirds of all new cases were of the tuberculoid type of leprosy and another one-sixth of indeterminate type. Lepromatous and borderline cases each constituted about ten percent of the total new cases. The total secondary attack rate was 6.8 per 1,000 person-years. Compared to an annual incidence rate of 0.8 per 1,000 in the total population, this incidence rate among the contacts is nearly ten times higher. Such enhanced risks are observed clearly and consistently when studied by the number of patients within a family for both sexes and in various age-groups. The rate for females (6.3 per 1,000 person-year) though less, was not significantly different from that of males (7.1 per 1,000 person-year). The differences observed between males and females for each type of leprosy were also not statistically significant. The risks for children (less than 15 years) are significantly higher than those for adults. Among boys, the maximum risk was observed in the age-group 5-14 years, whereas for females the risk is highest in the age-group 5-9 years, dropping down significantly after that. Furthermore, it was observed that significant differences existed between children and adults only in males but not in females. The secondary attack rates almost doubled when there were multiple index cases in the family. Regardless of the number of index cases, the male-female differences were not statistically significant. Attack rates were significantly enhanced when there was a bacilliferous type of leprosy (lepromatous or borderline) in the family. This was true for the specific attack rates of each type of leprosy too. However, a significantly higher proportion of lepromatous and borderline types is also seen when there is a bacilliferous type of leprosy present. The study reiterates the differences in susceptibility to leprosy among males and females, especially during younger ages. Further immunological studies are necessary to determine the differences in host responses in males and females that produce such a characteristic sex-ratio in prevalence of leprosy. There is still a great need to obtain more data on incidence rates both in general population and among contacts on the basis of prospective observation using acceptable statistical technics in design and analysis.

Adolescent↗
PubMed2002

Leprosy in Mpumalanga Province, South Africa--eliminated or hidden?

In South Africa, leprosy has been a notifiable condition since 1921. Although the WHO elimination target of less than one case per 10,000 population has been achieved at country level, the distribution of leprosy in the country is distinctly heterogeneous, with a prominent 'leprosy belt' of greater prevalence stretching across Mpumalanga Province into northern Kwa-Zulu Natal. The highest prevalence in this 'belt' has historically been in Ermelo District. Recent trends of few newly detected leprosy patients in this district raised concerns that health system changes may have resulted in failure to detect leprosy cases. Thus a large-scale community awareness campaign was conducted followed by an intensively advertised screening programme of 3-month duration at schools and central gathering points in villages and farms from 1 June to 31 August 2000. One thousand one hundred and seventy-seven people presented for clinical screening at designated points, while 790 scholars were screened at schools and an additional 1433 people were screened at their homes by the field team. Forty-four people with skin or nervous system lesions compatible with leprosy were referred for specialized assessment and biopsy where indicated. Four new leprosy patients were diagnosed, including an elderly lady with pronounced disability. Two of these patients had prior contact with the health service due to dermatological manifestations of leprosy without diagnosis being made. All patients provided a history of close prolonged contact with known leprosy patients. Ongoing intense tracing and follow-up of close contacts of proven leprosy cases may be a more efficient method of detecting leprosy cases in areas with relatively stable populations that have accomplished 'leprosy elimination', than resource intensive community surveys.

Adult↗
PubMed1985

HLA-linked control of predisposition to lepromatous leprosy.

In order to investigate if genes conferring susceptibility to leprosy and/or predisposition to a particular leprosy type are linked to HLA, we performed HLA-A and HLA-B typing on members of 29 families containing at least two siblings affected with leprosy from a leprosy endemic area in Jiangsu Province, People's Republic of China. Moreover, we performed a lepromin test in nearly all of the members of eight families containing at least two siblings affected with lepromatous leprosy. For 26 families the data permitted analyses of the segregation of parental HLA-haplotypes observed among children in relation to leprosy status. Siblings affected with lepromatous (LL or BL) leprosy shared parental HLA-haplotypes significantly more often than expected (p less than 0.05), and a highly significant deficit (p less than 0.0005) of shared HLA-haplotypes was observed among affected siblings discordant for leprosy type. These data confirm the HLA-linked control of leprosy type and, in particular, recently obtained evidence for linkage of predisposition to lepromatous leprosy with HLA. Healthy siblings did not share a haplotype more often than expected, and those haplotypes which were shared among all leprosy patients of a sibship did not occur less frequently than expected among the healthy siblings of the same sibship. The latter data confirm the absence of linkage of genes conferring susceptibility or resistance to leprosy with HLA. An analysis of the lepromin test results observed among healthy siblings showed no evidence for cosegregation of the results with HLA.

Child↗
PubMed1994

Agreement between histopathological results in clinically diagnosed cases of indeterminate leprosy in São Paulo, Brazil.

Histopathological slides from skin biopsies of fifty-seven self-reporting patients diagnosed as indeterminate leprosy by the Leprosy Control Programme in São Paulo, were sent to three independent histopathologists. Agreement between the reports were based on the following diagnosis: "indeterminate leprosy", "suggestive leprosy" or "no leprosy". A great variation was observed in the interpretation of the histopathological examination. The three pathologists reported "indeterminate leprosy" respectively in 7.0%, 54.4% and 84.2%, of the cases studied. A kappa index of agreement between any two pathologists ranged from 0.08 to 0.32, showing poor agreement between observers. Agreement improved by pooling together the reports "suggestive leprosy" and "indeterminate leprosy". The three pathologists agreed in the results of 24 biopsies of the 27 classified as leprosy by any one of the three observers. Eight cases were considered as "no leprosy" by all pathologists. Higher agreement indices were obtained for positive and negative proportionate concordance between any two examiners. The implications of the variation in the diagnosis of indeterminate leprosy and early leprosy are discussed in the context of public health and case-management.

Brazil↗
PubMed2006

Histopathological study of apparently normal skin of patients with leprosy.

BACKGROUND: Several clinical and laboratory observations point to the possible microscopical affection of normal-looking skin in leprosy. OBJECTIVE: This study was carried out to verify the microscopical affection of apparently normal-looking skin in different types of leprosy. PATIENTS AND METHODS: The study included 50 patients with different clinical types of leprosy. Biopsies from both skin lesions and normal-looking skin were obtained from each patient and examined for microscopical evidence of leprosy. RESULTS: Microscopical affection of normal-looking skin was detected in 52% of our cases, with higher incidence of affection towards the lepromatous end of the disease. CONCLUSION: Our findings underscore that the incidence of microscopical affection of normal-looking skin in leprosy is much higher on the lepromatous end of the spectrum of leprosy than on the tuberculoid end; during treatment, the leprosy granulomas may disappear from the normal skin before the clinical lesions. Moreover, the microscopic picture of indeterminate leprosy can be observed in the normal-looking skin of patients with tuberculoid leprosy or lepromatous leprosy, and this description appears not to be confined to the entity known as indeterminate leprosy.

Adolescent↗
PubMed2003

Citrus leprosis and its status in Florida and Texas: past and present.

According to published reports from 1906 to 1968, leprosis nearly destroyed the Florida citrus industry prior to 1925. This was supported with photographs showing typical leprosis symptoms on citrus leaves, fruit, and twigs. Support for the past occurrence of citrus leprosis in Florida includes: (1) presence of twig lesions in affected orange blocks in addition to lesions on fruits and leaves and corresponding absence of similar lesions on grapefruit; (2) yield reduction and die-back on infected trees; and (3) spread of the disease between 1906 and 1925. Transmission electron microscopy (TEM) examination of tissue samples from leprosis-like injuries to orange and grapefruit leaves from Florida in 1997, and fruits from grapefruit and sweet orange varieties from Texas in 1999 and 2000 did not contain leprosis-like viral particles or viroplasm inclusions. In contrast, leprosis viroplasm inclusions were readily identified by TEM within green non-senescent tissues surrounding leprosis lesions in two of every three orange leaf samples and half of the fruit samples obtained from Piracicaba, Brazil. Symptoms of leprosis were not seen in any of the 24,555 orange trees examined across Florida during 2001 and 2002. The authors conclude that citrus leprosis no longer exists in Florida nor occurs in Texas citrus based on: (1) lack of leprosis symptoms on leaves, fruit, and twigs of sweet orange citrus varieties surveyed in Florida: (2) failure to find virus particles or viroplasm inclusion bodies in suspect samples from both Florida and Texas examined by TEM; (3) absence of documented reports by others on the presence of characteristic leprosis symptoms in Florida; (4) lack of its documented occurrence in dooryard trees or abandoned or minimal pesticide citrus orchard sites in Florida. In view of the serious threat to citrus in the U.S., every effort must be taken to quarantine the importation of both citrus and woody ornamental plants that serve as hosts for Brevipalpus phoenicis (Geijskes), B. californicus (Banks), and B. obovatus Donnadieu (Acari: Tenuipalpidae) from countries where citrus leprosis occurs.

Animals↗
PubMedDate not supplied

Markers of platelet, endothelial cell and blood coagulation activation in leprosy patients with antiphospholipid antibodies.

OBJECTIVE: To evaluate plasma levels of markers of platelet, endothelial cell and blood coagulation activation in leprosy patients with or without antiphospholipid antibodies (aPL) and to compare them to those found in patients with antiphospholipid syndrome (APS). METHODS: 42 patients with leprosy (35 lepromatous and 7 borderline): 29 aPL(+) and 13 aPL(-), as well as 26 healthy subjects as normal controls (NC) and 79 control aPL patients without leprosy (59 with and 20 without APS) were included in the study. Plasma soluble P and E selectin (sPsel and sEsel), and VCAM-1 (sVCAM-1), prothrombin F1 + 2 fragment (F1 + 2), thrombin-antithrombin complexes (TAT) and D dimer (DD) were measured by ELISA. The protein C pathway was assessed by the ProC global test. RESULTS: Leprosy patients with aPL presented increased median levels of sPsel [ng/ml (82.0 vs 36.0, p < 0.001)] and sVCAM-1 [ng/ml (495 vs 335, p < 0.001)] compared to NC, as observed in control aPL patients without leprosy. Levels of sPsel in aPL(+) patients with leprosy were significantly higher than in aPL(-) ones (52.5 ng/ml), p = 0.005. However, plasma markers of thrombin generation were increased in control aPL patients without leprosy but not in those with leprosy. ProcC global test was abnormal in 24.1% of leprosy patients with aPL compared to 4.4% of NC (p < 0.024), and to 57.2% of control patients with aPL without leprosy (p = 0.005). CONCLUSIONS: We demonstrated that although patients with leprosy present a high prevalence of aPL, and platelet and endothelial cell activation in vivo to the same extent than patients with APS, they do not show a procoagulant state.

Adolescent↗
PubMed2001

Leprosy. Recognition and treatment.

Leprosy is a slowly progressive, chronic infectious disease caused by the bacillus Mycobacterium leprae. It is a very serious, multilating and stigmatizing disease in many parts of the world and early diagnosis and therapy is the most important strategy for its control. The skin and peripheral nerves are the most affected organs. It is highly infective, but has low pathogenicity and low virulence with a long incubation period. The geographical distribution of leprosy has varied greatly with time and it is now endemic only in tropical and subtropical regions such as India and Brazil. The diagnosis of leprosy is made from the clinical picture, but must be complimented by skin bacilloscopy and histopathology. Leprosy has a number of distinct clinical presentations. Indeterminate leprosy is frequently the initial form consisting of a few lesions that either evolves into the other forms or resolves spontaneously. Lepromatous leprosy is the more contagious form and affects mainly the skin. In addition, some peripheral nerves may be thickened and other symptoms maybe present. The tuberculid form affects the skin and nerves, although usually there are few lesions. There is also a form borderline between the lepromatous and tuberculoid forms. Current treatment of leprosy involves use of 3 drugs: rifampicin (rifampin); clofazimine; and dapsone. Multidrug therapy aims to effectively eliminate M. leprae in the shortest possible time to prevent resistance from occurring. The duration of therapy was recently reduced from 24 to 12 months. Other treatment options are under evaluation in both preclinical and clinical trials and a number show promise. The combination of rifampicin, ofloxacin and minocycline given as a single dose has been recommended for the treatment of paucibacillar leprosy. Only when physicians, other health workers, and the population in endemic countries become fully aware of, and able to recognize, the disease in its initial phase, will it be possible for therapy to be instituted at the very beginning with either the standard scheme or the newer ones. Intervention at such an early stage will avoid the onset of the more serious signs and symptoms, meaning that leprosy will eventually become a less important public health problem. Therefore, efforts must be made to alert populations at risk and all health workers of the importance of an early diagnosis and treatment in leprosy infection.

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