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PubMedDate not supplied

HLA-DR, -DQ DNA genotyping and T-cell receptor RFLPs in leprosy.

HLA-DR and -DQ restriction fragment length polymorphisms (RFLPs) were examined in Melanesian leprosy patients and controls from New Caledonia. This permitted DNA subtyping of DQw1, a broad serological specificity previously implicated in predisposition to lepromatous leprosy. The DQw1c subtype, found in linkage disequilibrium with DR1, w10, w14, and some Pacific Island variants of DRw6 and DRw8, was significantly reduced in leprosy patients. Since the association between HLA-DR genes and leprosy is not strong, some candidate non-MHC genes for leprosy susceptibility were examined also. T-cell receptor -alpha, -beta, and -gamma gene RFLPs revealed no germ-line defects or major clonal T-cell expansion in either lepromatous or tuberculoid leprosy patients. The human homologue of the murine Ity locus which determines murine susceptibility to Mycobacterium lepraemurium was sought by examining linkage disequilibrium with RFLPs in the human gamma-crystallin genes, since this gene family forms a syntenic group with isocitrate dehydrogenase-1 in both mouse and man and, in the mouse, this cluster is closely linked to the Ity locus. These RFLPs were not associated with leprosy susceptibility in man.

Crystallins↗
PubMed1988

Leprosy in six isolated residents of northern Louisiana. Time-clustered cases in an essentially nonendemic area.

Northern Louisiana has been essentially free of indigenous leprosy, and now it is not. Six new cases of leprosy have been diagnosed: three in 1986, the other three in 1985, 1983, and 1982, respectively. The patients had been lifelong residents of six scattered rural parishes. Leprosy had never been reported from five of them. No patient had had contact with human leprosy. The patients were white; four were women; the mean +/- SD age at onset was 60.3 +/- 16.4 years (age range, 31 to 80 years); and the mean +/- SD interval to diagnosis was 1.2 +/- 1.4 years. One patient had Hodgkin's disease at the age of 25 years and leprosy at the age of 31 years; another patient had cervical carcinoma. All rural northern Louisiana residents coexist with armadillos (Dasypus novemcinctus), some of which are infected with Mycobacterium leprae, the significance of which is unknown. Hypothetically, exposure to an unknown human case, reactivation of "asymptomatic" leprosy through immunosenescence or immunosuppression, or infection from an environmental source might have occurred. Because the patients lacked contact, travel, residence, and exposure risk factors, the origin of leprosy in the new indigenous cases is noteworthy and is not understood.

Adult↗
PubMed1988

Cataract surgery on leprosy patients.

All patients who had cataract surgery at the Schieffelin Leprosy Research and Training Centre, Karigiri, India, between January 1979 and April 1985 were studied to find out the outcome of that surgery. These patients included 291 leprosy cases and 89 nonleprosy cases. Postoperative complications were slightly higher among leprosy patients compared to the nonleprosy cases. Visual recovery was marred by preoperative corneal opacities in some of the leprosy patients. Eyes with chronic insidious type of iridocyclitis did not produce any devastating results postoperatively. Patients whose skin smears were still positive for leprosy bacilli did not show any major complication. All leprosy patients should be offered the benefit of cataract surgery for restoring sight because blindness in leprosy would mean a double handicap if they are already suffering from insensitive, deformed hands and feet.

Adult↗
PubMed1986

Hepatitis B virus (HBV) serum markers in Greek leprosy patients.

The prevalence of HBsAg, anti-HBs, and anti-HBc in the sera of 217 patients with the two polar types of leprosy and 382 hospital controls was studied in order to investigate the degree of exposure of Greek leprosy patients to HBV and the ability of these patients to clear HBV from the blood. Two distinct serological patterns were analyzed: effective exposure, characterized by the presence of one or more of the three serological markers, and active infection, characterized by the presence of HBsAg. From the statistical analysis it was found that TT as well as LL cases had a higher prevalence of effective exposure in comparison to controls (p less than 10(-5) and p less than 10(-6)). No significant difference was found between the two polar leprosy types (p greater than 0.30) or between bacteriologically positive and negative LL cases (p greater than 0.30). As far as the prevalence of active infection is concerned among the effectively exposed subjects of all groups, no significant difference existed between TT cases and controls, LL cases and controls, the two polar leprosy cases combined and controls, the two polar leprosy groups, and LL cases positive and negative for Mycobacterium leprae (p for all comparisons greater than 0.30). It is concluded that leprosy cases are at a high risk of HBV infection, but the prevalence of active infection among those effectively exposed does not differ between leprosy cases and hospital controls.

Adult↗
PubMedDate not supplied

An evaluation of palmar flexion creases and dermatoglyphics in leprosy.

The palmar flexion creases and dermatoglyphics of 150 male leprosy patients (100 paucibacillary and 50 multibacillary leprosy) were compared with 50 matched controls. Among palmar dermatoglyphics a significantly high frequency (P less than 0.001) of palmar pattern in thenar/1st interdigital area was noticed on left palm of multibacillary leprosy patients. Slight increase in frequency of distal axial triradii (t' and t'') was also seen on palms of leprosy patients. No difference in values of atd angle and C-line types were observed between patients and controls. Among palmar flexion creases a significantly high frequency of Single Radial Base Crease (SRBC) and lower frequency of Double Radial Base Crease (DRBC) was noticed on palms of leprosy patients as compared to controls (P less than 0.001). The difference mainly exist on left palm. A significantly high frequency of Simian Crease was also observed on palms of multibacillary leprosy patients (P less than 0.001) and paucibacillary leprosy patients (P less than 0.05) as compared to controls.

Dermatoglyphics↗
PubMedDate not supplied

Knowledge, attitude and practices of the community and patients regarding leprosy in Mangalore--a study.

To get acquainted with the knowledge, attitude and practices of the community and the patients towards leprosy so as to evolve a suitable health education programme, a study was conducted in Mangalore as per the schedule prepared for the purpose. The information so collected has been summarised below. Very few people among the community know that leprosy is caused by a germ (8%). Knowledge regarding this was slightly better (22%) among patients. Only 15% of the community members and 42% of the patients were aware of the early signs of the disease. 54% of the community members and 41% of the patients felt that leprosy is contagious. 60% of the community and 86% of the patients were of the opinion that leprosy is curable. Many believe that leprosy is associated with deformities and disabilities (community 64%, patients 76%). Most of the community members (79%) and patients (88%) said it is necessary to attend a hospital for treatment when leprosy is suspected. 60% of the community members and 56% of the patients felt that it is necessary to segregate leprosy patients. The findings are highlighted and discussed in the article.

Attitude to Health↗
PubMed1979

Serum immunoglobulins in leprosy.

Serum immunoglobulins were quantitated by radial immunodiffusion in 25 cases each of tuberculoid and lepromatous leprosy. Immunoglobulins estimated from 50 normal healthy adults were the control. Serum IgG was markedly raised in both tuberculoid (mean 2420 mg/dl) and lepromatous leprosy (mean 2493 mg/dl) when compared with the controls (mean 1288 mg/dl) and the difference was significant (p less than 0.01). However the difference in serum IgM and IgA levels in cases as compared to controls were not statistically significant. Serum IgM was slightly raised, the mean values obtained being 222 mg/dl in tuberculoid leprosy, 221 mg/dl in lepromatous leprosy and 202 mg/dl in control. Serum IgA was reduced in lepromatous leprosy (mean 129 mg/dl) as compared to the controls (mean 168 mg/dl) and the cases of tuberculoid leprosy (mean 165 mg/dl). The range of values obtained in both groups of patients showed greater scatter than the controls and a few cases of both forms of leprosy showed very low values of both serum IgA and IgM.

Adolescent↗
PubMedDate not supplied

[Lucio-Latapí leprosy and the Lucio phenomenon].

The Lucio-Latapí's leprosy or diffuse lepromatous leprosy is a clinical variety of lepromatous leprosy first described by Lucio and Alvarado in 1852 and reidentified by Latapí in 1936. It is frequent in Mexico (23%) and in Costa Rica and very rare in other countries. It is characterized by a diffuse infiltration of all the skin which never is transformed into nodule, by a complete alopecia of eyebrows and eyelashes and body hair, by anhydrotic and dysesthesic zones of the skin and by a peculiar type of lepra reaction named Lucio's phenomenon or necrotic erythema which is a vascularitis of vessels especially of the dermohypodermic union and of the hypodermis. Clinically this vascularitis is represented by well-shaped erythematous spots, later becoming necrotic with scabs, ulcerations and scars. Three points of confusion are stressed: the differences between nodules and nudosities, Lucio's leprosy and Lucio's phenomenon and necrotic erythema and necrotic erythema nodosum leprosum. The differences between the pure and primitive form of Lucio's leprosy and the secondary one is also discussed such as the laboratory findings, histopathological data, pronostic and treatment. Lucio's leprosy is considered the most anergic one of the all immunological spectrum of leprosy.

Drug Therapy, Combination↗
PubMed1984

NADH-methemoglobin reductase and methemoglobinemia among leprosy patients.

The NADH-methemoglobin reductase activity as well as hemoglobin and methemoglobin levels were investigated in blood samples of 182 adult leprosy patients and 137 Brazilian army enlisted men. The level of sulfones in the blood samples of the leprosy patients, all of them ingesting a daily dose of 100 mg dapsone, was also investigated. The mean value of NADH-methemoglobin reductase activity exhibited by the leprosy patients did not differ from that observed among the healthy individuals. However, the variance of the former group was significantly higher than that observed among the healthy subjects. As a consequence, the proportion of individuals showing a partial deficiency of NADH-methemoglobin reductase was significantly higher among the leprosy patients (22.5%) than among the healthy individuals (2.9%). The activity of this enzyme among the leprosy patients was negatively correlated to the hemoglobin level and slightly positively correlated to age. The concentration of methemoglobin among the leprosy patients was slightly but significantly higher as compared to the healthy individuals. The increase of the methemoglobin level among the leprosy patients was influenced by the amount of sulfones in the blood. However, no case in which dapsone was ingested in a daily dose of 100 mg presented the signs or symptoms of toxic methemoglobinemia.

Adult↗
PubMed1984

Salivary immunoglobulins and antibody activities in leprosy.

The technics of immunodiffusion and the fluorescent leprosy antibody absorption (FLA-ABS) test were used to determine the levels of immunoglobulins and their antibody activities against Mycobacterium leprae in the serum and the saliva collected from a total of 110 patients with leprosy (50 lepromatous, 24 borderline, and 36 tuberculoid). The average levels of serum IgG, IgM, and IgA were not significantly different among these patients. In saliva, however, IgM was detected in only two cases with lepromatous leprosy and three tuberculoid cases. Salivary IgG and IgA levels and their ratios to those in the sera were not significantly different according to the classification of leprosy. The percentages of positive FLA-ABS tests in the sera and saliva were compared by using fluorescent antibodies specific for IgG, IgM, and IgA, respectively. The results indicated that M. leprae-specific antibodies in the serum were mainly found in IgG and IgM and, less frequently, in IgA. IgG antibodies were found more frequently in lepromatous and borderline patients than in tuberculoid cases. On the other hand, salivary IgA antibodies against M. leprae were found in a significant number of specimens; whereas IgG and IgM antibodies were scarcely found. However, the percentage of positive FLA-ABS tests caused by salivary IgA antibodies was higher in the patients with tuberculoid or borderline leprosy than in those with lepromatous leprosy. A significant number of patients with tuberculoid or borderline leprosy secreted M. leprae-specific IgA antibodies into saliva without detection of circulating IgA antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A clinical study of eye complications in leprosy.

A study was conducted to find out the incidence of ocular complications in leprosy. The ocular lesions were found in 6.6% of lepromatous leprosy and 1.6% in nonlepromatous leprosy. Out of 150 patients with eye lesions 74% were males and 80% belonged to lepromatous leprosy. The age group in all the patients varied from 3rd to 6th decade. Mean duration of leprosy ln lepromatous leprosy was 6.2 years. The important eye complication observed were lagophthalmos (8.1%), corneal ulcers (10%) and iridocyclitis (24%). The loss of eye-brows (76%) was found to be most frequent in this study followed by corneal lesion (62%). It is concluded that examination of eyes are essential in all types of leprosy.

Adult↗
PubMed1982

The in situ characteristics of mononuclear cell infiltrates in dermal lesions of leprosy.

The in situ nature of mononuclear cell infiltrates in the dermal lesions of 38 untreated leprosy patients was studied by means of conventional surface marker techniques using erythrocytes coated with AET, anti-erythrocyte IgG antibody, hemolysin and complement for the identification of T cells, and cells bearing Fc and C3 receptors, respectively. In general, T cells were the predominant lymphocytes in the leprosy lesions. They were mostly seen to be associated with epithelioid cell granulomas and showed maximal density in tuberculoid leprosy. A graded reduction of T cells was observed in borderline leprosy with a severe reduction/absence in polar lepromatous leprosy. The cells of the mononuclear phagocyte series in the various granulomas of the leprosy spectrum showed the presence of Fc and C3 receptors. Cells bearing a higher density of these receptors had a peripheral localization; whereas cells showing diffuse staining for nonspecific esterase were located more in the central regions of the granulomas. The differences in the individual cells of the phagocytic series appeared to be related to cell maturity; whereas the quantity of T cell infiltration in the lesions showed a correlation with the leprosy spectrum.

Complement C3↗
PubMed1981

Cancer and other causes of death among leprosy patients.

A follow-up study was done on the mortality from 1956 to 1975 among 2,383 Japanese patients with leprosy who were admitted to a leprosarium in Japan. The leprosy was classified into two types: lepromatous and tuberculoid. Irrespective of the type of leprosy or the sex of leprosy patient, mortalities were increased from tuberculosis, pneumonia and bronchitis, nephritis and nephrosis, and from total causes. The suicide rate was high among female patients. Deaths from total malignant neoplasms were higher than expected among patients with lepromatous leprosy for both sexes (49 observed vs. 44.02 expected), whereas they were lower than expected among patients with tuberculoid leprosy (35 observed vs. 36.83 expected); however, the differences were not statistically significant. Mortalities from cancers of the cervix and the esophagus among females with lepromatous leprosy were significantly higher. The risk of lymphoreticular cancers was not increased.

Age Factors↗
PubMed1977

Recent advances in microbiology in leprosy.

The recent advances in microbiology of leprosy are reviewed. Till now the leprosy bacillus had not been cultivated in laboratory media; the recent claims of success have not been confirmed. There has been a breakthrough in the experimental transmission of leprosy to experimental animals--the white mice, the immune depressed white mice, and the nine-banded armadillo. Apart from providing definite proof for the causative relationship of the bacillus discovered by Hansen and the disease leprosy, the experimental transmission to animals have considerably advances our knowledge about the disease. The mouse has provided a suitable model for screening of antileprosy drugs, detecting development of drug resistance, ascertaining viability of the bacilli and determining the genuineness of a supposed culture of the leprosy bacillus. The armadillo has provided a model for making basic studies of the disease as it occurs in man. Further, the generalised infection in armadillo has provided large amounts of leprosy bacilli for preparing standardised lepromin, for preparing a specific skin-testing antigen containing the active protein fraction of the bacillus, and a step towards the production of a vaccine against leprosy. It is interesting to note that the fact that the protein fraction of the bacillus was responsible for the positive lepromin reaction was discovered by Dharmendra far back in 1941.

Animals↗
PubMed1982

An epidemiologic evaluation of leprosy in New York City.

Leprosy is a transmissible disease that is propagated from human to human. At the US Public Health Service hospital, New York City, the number of new leprosy cases per year during the 1970s was about three times greater than in the previous decade. This review of our 100 most recent leprosy patients shows that 60% were of the lepromatous and borderline lepromatous type. Ninety-nine of the patients were foreign born, originating in more than 26 countries. This emphasizes that, at this time, the leprosy problem in New York City is almost exclusively a reflection of immigration patterns. The majority of the patients were asymptomatic at the time of entering the United States. The average latent period from entering the United States until onset of symptoms was 4.8 years, with a range of 0 to 38 years. These figures emphasize the need for physicians to be aware that leprosy can occur as long as five to 40 years after emigration from endemic areas. For all types of leprosy, the average lag from the onset of symptoms to the time of diagnosis was 29.0 months (range, 0 to 245 months). Our experience indicates that a program of urban leprosy treatment using available drugs and supportive care is feasible.

Diagnosis, Differential↗
PubMed1981

Survey of eye complications in leprosy in Prakasam District (Andhra Pradesh).

A field study was conducted to find out the incidence of eye complications in leprosy. The ocular lesions were found in 4.72% of lepromatous leprosy and in 1.15% of non-lepromatous leprosy cases. Out of 130 patients with eye ailments, 60% were males; age varied from 9 to 70 years; 38 were suffering from lepromatous leprosy and 92 from non-lepromatous type. Mean duration of leprosy was 8.63 years in lepromatous and 6.42 years in non-lepromatous leprosy. The important eye complications observed were corneal anesthesia, lagophthalmos and anterior uveitis. The corneal lesions (63.1%) were found to be the most common in this study. It is suggested that a periodical ocular examination of all leprosy patients is essential for the early diagnosis and treatment of eye complications, which finally result in blindness if left untreated.

Adolescent↗
PubMedDate not supplied

Diagnostic problems of early leprosy in field studies.

A Series of exercises were undertaken in order to develop methodology for consistency and reliability of clinical diagnosis of leprosy under field conditions in longitudinal studies. It was observed in initial studies that the field investigators could miss about 35% of cases of leprosy, mostly those with early manifestations. After training and experience, the proportion of missed cases came down to about 20%. In about 14% of females with patches suggestive of leprosy the patches were present in the covered areas of the body and so are likely to be missed during examination in field situations. One hundred forty two individuals with suspicious and definite leprosy lesions detected by paramedical workers were examined by a senior medical officer experienced in leprosy on two different occasions at an interval of three months for leprosy diagnosis. The concordance rates for diagnosis and classification of leprosy were about 80% and 70% respectively; and corresponding values for kappa were 0.59 and 0.62 similar to earlier experiences in inter-observer variation studies.

Adolescent↗
PubMedDate not supplied

Intraocular pressure in leprosy patients without clinically apparent anterior segment pathology.

A widely prevalent notion is that intraocular pressures are generally lower in leprosy patients than in normal individuals. Applanation intraocular pressures were recorded in one hundred sixty-six leprosy patients who had no clinically visible anterior segment pathology and in one hundred and eleven healthy controls. Mean (SD) intraocular pressures in leprosy patients (13.6 (3.0) mm Hg) did not differ significantly from that of controls (13.1 (2.7) mm Hg). Eyes of only 1.5% of the leprosy patients had pressures of 7 mm Hg or less. Correlation coefficients (r) between age, sex and intraocular pressures were not statistically significant both in leprosy patients and in controls. No statistically significant differences in mean intraocular pressures were noted when leprosy patients were grouped according to the Ridley and Jopling classification. Duration of disease also did not affect the intraocular pressures. Neither did smear positivity or differing bacterial indices. This study questions the widely held belief that low intraocular pressures are a common feature in leprosy and contends that in the era of MDT where ocular complications associated with low intraocular pressures are thought to be less, the occurrence of low intraocular pressure may not be as common a phenomenon as it is believed to be.

Adolescent↗