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PubMed1994

Leprosy and infection with the human immunodeficiency virus in Uganda; a case-control study.

Both leprosy and infection with the human immunodeficiency virus (HIV) are endemic in Uganda. Various speculations about a possible interaction between the two infections have been put forward but not confirmed. A case-control study involving 189 new leprosy patients and 481 matched controls, resident in eight Ugandan districts, was carried out to investigate if any relationship exists between leprosy and infection with HIV-1 in Uganda. Serum samples from 23 (12.2%) of the 189 leprosy patients tested positive for HIV-1 antibodies as compared to 88 (18.3%) of the 481 control sera. The two proportions of HIV seropositivity are not different statistically. A stratified analysis of the data by districts was done and showed a negative relationship between leprosy and HIV infection in the case of Rakai District (0.04 < odds ratio < 0.61, p = 0.002). It is recommended that studies seeking to observe the clinical progress of dually infected patients might help to reveal new knowledge about a possible relationship between HIV and leprosy and about the immunology of leprosy in general.

Adolescent↗
PubMed1993

Clinical and histopathological correlation in the classification of leprosy.

This study reports our observations on the correlation between clinical and histopathological diagnoses of the classification of leprosy. The histopathological classification of leprosy in 1351 cases was done per Ridley-Jopling criteria and was compared with the clinical diagnoses of the same cases. These 1351 cases included 79 cases diagnosed clinically as having a "reaction." However, the histopathologists could not detect any evidence of reaction in 16 of these 79 cases (20%). Of the remaining 1272 cases, 68 (5%) were reported as "no evidence of leprosy" by the histopathologists; 37 of these 68 were found to be from the clinically indeterminate type of leprosy. Histopathological and clinical diagnoses of the classification of leprosy coincided in 69% of the cases. Concordance between the clinical and histopathological diagnoses for different types of leprosy was: indeterminate (I) = 36%, tuberculoid (TT) = 50%, borderline tuberculoid (BT) = 77%, borderline (BB) = 26%, borderline lepromatous (BL) = 43%, and lepromatous (LL) = 91%. When some of the types were combined (BT with TT, BL with LL), the overall concordance figure was 76%; concordance for the TT/BT group was 80%, for the BL/LL group it was 93%. Since both TT and BT are considered paucibacillary and LL or BL are considered multibacillary for treatment purposes, differentiating TT from BT or BL from LL is, perhaps, therapeutically irrelevant. However, for classification purposes it appears that the weight given to different signs and/or histopathological parameters for classifying leprosy cases (especially TT, BB and I) needs to be reassessed.

Biopsy↗
PubMed1993

BCG vaccination protects against leprosy in Venezuela: a case-control study.

A total of 64,570 household and other close contacts of about 2000 leprosy cases were screened for eligibility for entry into a trial of a new leprosy vaccine. The screening procedure included a clinical examination for leprosy and for the presence of BCG and lepromin scars. Ninety-five new cases of leprosy were identified, and the prevalence of BCG and lepromin scars among them was compared with similar data from matched controls selected from among those with no evidence of leprosy. The difference in the prevalence of BCG scars in the two groups was used to estimate the protection against leprosy conferred by BCG vaccination. One or more BCG scars was associated with a protective efficacy of 56% (95% confidence limits 27% to 74%). There was a trend of increasing protection with four or more BCG scars, but this was not statistically significant. There was no evidence that the efficacy of BCG varied with age or according to whether or not the contact lived in the same household as a case. The protective effect was significantly higher among males, and was significantly greater for multibacillary than for paucibacillary leprosy.

Adolescent↗
PubMedDate not supplied

Women and leprosy in Turkey.

Women in Turkey have many social, cultural and economical problems. Women with leprosy have problems in common with other women as well as those related to physical and social consequences of leprosy. There are 2,414 patients with leprosy in Turkey, registered to Istanbul Leprosy Hospital and 829 of them are females. The mean age and duration of disease of our female leprosy patients are high. Most women with leprosy were born in eastern part of Turkey where prevalence of leprosy is higher and most have moved to western regions. The proportion of women who have some kind of social security is very low. Their economic status is also not good and 79% of patients had stigma about their disease. Three fourths of these cases have been hospitalized some time, for different reasons. Most of them (97.2%) have inactive disease at present. Disability degrees of patients are high. Patients with disability degrees over one constitute 54% of total for eyes, 55% for hands and 51% for feet. High percentage of multibacillary form and long duration of disease, delayed diagnosis, insufficient self-care of patients due to low socio-economic and cultural status and failure of health personnel to control patients periodically may be among the reasons for such high ratios of moderate and severe disabilities. In the light of the data obtained in our study, some measures to alleviate the problems of patients resulting from their socio-economic, cultural and social status have been suggested.

Adolescent↗
PubMed1995

Immunological parameters in leprosy patients with and without arthritis.

Twelve patients of leprosy with arthritis and 161 patients without arthritis were studied for immunological parameters like immunoglobulins (IgG, IgM, IgA), C-reactive proteins and rheumatoid factor. There was increase in the levels of IgG, IgA value in leprosy patients with and without arthritis compared to healthy control. IgM level was decreased in both the groups compared to control, but significant decrease was observed (p < .01) in patients with arthritis. C-reactive protein was significantly positive in leprosy with arthritis group (p < .01) and positive in 12 cases of leprosy without arthritis group compared to negative control group. Rheumatoid factor was present in leprosy with arthritis (16.6%) compared to both the control group and leprosy without arthritis group. This study concluded the presence of arthritis in leprosy patients as a definite entity which showed changes in immunological parameters.

Adult↗
PubMed1995

[Contemporary problems in the epidemiology and clinical pathology of leprosy].

Contemporary problems have been presented, related to pathogenesis, clinical pathology and epidemiology of leprosy. It has been stressed that intensity of cell mediated immune response in the patient determines not only resistance or susceptibility to infection with Mycobacterium leprae but also defines traits of clinical pathology in leprosy, thus providing the basis for modern clinical classification. Present aims and investigative methods in lepra epidemiology have been shown. Current data have been provided on spread of leprosy in various parts of the world, mainly those remaining under monitoring by the World Health Organization. The data point to significant decrease in registered leprosy cases in the regions beginning from 1986 and, in particular, in years 1990-1994. The decrease has resulted from adequate verification of the disease stage in the patients and from applying the recommended multidrug therapy. The needs and perspectives of actions aiming at combatting leprosy have been described, aiming at eradication of leprosy as the international health problem till the year 2000. It has been stressed that at present, leprosy is no longer a hopeless disease and that it can be cured when sufficiently early diagnosed and properly treated.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

A study of pure neuritic leprosy: clinical experience.

Pure neuritic leprosy is a well-recognized clinical entity. Manifestations of leprosy in pure neuritic form accounted for 179 patients out of the total 3853 leprosy patients (4.6%) attending our Poona Urban Leprosy Investigation Centre clinics. Patients with pure neuritic leprosy are prone to develop nerve damage. Eight-seven (48.6%) of our pure neuritic patients presented with deformities. Involvement of upper extremity and right ulnar nerve in particular was the most common clinical feature. Patients presenting with involvement of two nerves of the same extremity was also quite common. None of our patients developed skin lesions while on anti-leprosy treatment. It is important to recognize neuritic symptoms early and suspect leprosy even in the absence of skin lesions.

Adult↗
PubMedDate not supplied

Study of deformities in children with leprosy: an urban experience.

A study was conducted to assess the deformities in children with leprosy. Eyes, hands and feet were examined for leprosy-related deformities. The influence of age, sex, duration of disease, type of disease, occurrence of leprosy reactions and anti-leprosy treatment on the occurrence of deformities was studied. In our urban leprosy project the percentage of children (0-14 years) suffering from leprosy is 7% of the total number of leprosy patients. The response to multidrug therapy, health education and physiotherapy was good.

Adolescent↗
PubMedDate not supplied

Socio cultural factors in leprosy: implications for control programmes in the post leprosaria abolition years in Nigeria.

A questionnaire was administered to 53 male and female leprosy patients aged 17-78 years, randomly selected from four clinics in two Local Government Areas of the Eastern part of Nigeria to determine the impact of socio cultural factors on, and also to predict the chances of compliance at, leprosy control measures. About 60% of the patients indicated that traditional concepts were the likely factors explaining the aetiology of leprosy. Four patients were convinced about the microbial aetiology of leprosy. Traditional concepts of leprosy aetiology were significantly associated with mode of entry into the control programme (P < 0.025) and tendency to live within the vicinity of the leprosy clinics (P < 0.01) but not with clinic attendance rate of leprosy patients. The distance of patient's abode from clinic attended, some formal education and whether or not patient's spouses were alive, were not significantly associated with clinic attendance rate. There was a significant association between maleness, age less than 55 years (P < 0.025) as well as negative family attitude (P < 0.05) and irregular clinic attendance. Its implications therefore are to broadly categorize these at risk group at first contact and target towards them patient-holding methods as well as health education, targetted towards patients, their relations and the community.

Adolescent↗
PubMed1997

A comparison of the expression of NGFr, PGP 9.5 and NSE in cutaneous lesions of patients with early leprosy using immunohistochemistry.

We examined the immunohistochemical expression of the neuronal proteins NGFr, PGP 9.5, and NSE in cutaneous lesions of patients with early leprosy and in the skin of normal individuals. PGP 9.5- and NSE-immunoreactive nerve fibers were decreased in the skin of leprosy patients. This reduction was topographically unrelated to the early leprosy infiltrate. However, no difference in the expression of NGFr was found between the leprosy patient and normal groups. It was shown that there is a selective alteration in the expression of neuronal proteins in early leprosy lesions which seems to be unrelated to the inflammatory infiltrate in the initial stages of leprosy. Pathogenic mechanisms other than inflammation, which are intrinsic to the Mycobacterium leprae-nerve relationship, may thus contribute to the nerve damage in leprosy neuropathy.

Adolescent↗
PubMedDate not supplied

Studies on rapid assessment methods in leprosy.

A study was undertaken in Pudukottai district, Tamilnadu, India to test rapid assessment methods: viz (i) sample surveys with lower coverages for clinical examination in estimating the disease problem in the community, (ii) utility of registered case prevalence for estimating the actual prevalence in a given area, (iii) leprosy in school-going children and its utility in estimating leprosy prevalence in the community, and (iv) information on disability and smear positivity in estimating leprosy prevalence; and develop correction factors for estimating leprosy situation. A sample of 23 clusters from 582 clusters of contiguous villages and hamlets was further divided into two random sub-samples for two surveys with differing coverages. One team covered nine clusters comprising 34 villages with a population of 17,562 and examined 15,596 with a population of 26,927 and examined 16,622 (62%) persons for leprosy. The results showed that: (i) leprosy sample surveys with lowered coverages would tend to miss valuable information, in terms of quality and quantity; (ii) from 'known case' registers, to estimate the true burden of leprosy disease and to monitor its trend over time is inadequate; (iii) school surveys are of limited value for estimating the disease burden in the community or to monitor its trend over time; (iv) the number of smear-positive cases is to small to serve as an indicator for the total case load in the community; and (v) the prevalence of active disease and that of grade 2 disability in the community are poorly correlated. Reliable methods other than those used here need to be developed for evaluation and monitoring of the disease burden particularly in the post-MDT era.

Adolescent↗
PubMedDate not supplied

Study of ocular changes in leprosy patients.

In this study, 997 leprosy patients were examined, 528 of them with lepromatous leprosy (53%), 199 with borderline leprosy (20%), 167 with tuberculoid leprosy (16%) and 103 (10.3%) with indeterminate leprosy. Changes in the ocular bulb were noted in 314 patients (31.5%) specially in those with lepromatous leprosy. These alterations were greater with increasing age of the patient and length of disease. Severe ocular lesions were rare, probably due to previous systemic treatment. The "pearls" in the fundus of the eye resulting from leprosy were also studied.

Adolescent↗
PubMed1998

Does MDT arrest transmission of leprosy to household contacts?

The multidrug therapy program with the World Health Organization (WHO)-recommended treatment (WHO/MDT) regimens has given the hope of early case detection and rendering a leprosy patient, especially a multibacillary (MB) patient, noninfectious within a short period of time. Hence, the duration of exposure for household contacts to infection is expected to be remarkably less when compared to exposure to MB leprosy patients on dapsone monotherapy. A total of 1661 household contacts of skin-smear-positive leprosy patients were recorded from 1984 to 1994. Follow up of these individuals [8403 person-years at risk (PYR)] revealed that the incidence of leprosy was 7.7 per 1000 PYR, which was 8 times more than that of the general population. The risk was more if there was a coprevalent case in the family. The incidence of leprosy declines from the third year of surveillance onward, and declines more so in children. Although disease transmission should have been arrested as soon as the index case was started on MDT, the incidence of leprosy among the household contacts was still high when compared to that of the total population. Effective intervention needs to be introduced to reduce the risk of contacts developing leprosy.

Drug Therapy, Combination↗
PubMed1998

Why relapse occurs in PB leprosy patients after adequate MDT despite they are Mitsuda reactive: lessons form Convit's experiment on bacteria-clearing capacity of lepromin-induced granuloma.

It is amazing how after years of scientific research and therapeutic progress many simple and basic questions about protective immunity against Mycobacterium leprae remain unanswered. Although the World Health Organization (WHO) has recommended short-term multidrug therapy (WHO/MDT) for the treatment of paucibacillary (PB) leprosy patients, from time to time several workers from different parts of the globe have reported inadequate clinical responses in a few tuberculoid and indeterminate leprosy patients following adequate WHO/MDT despite the fact that they are Mitsuda responsive. A few borderline tuberculoid patients harbor acid-fast bacilli (AFB) in their nerves for many years even though they become clinically inactive following MDT, a fact which has been ignored by many leprosy field workers. Keeping these patients in mind, we have attempted to investigate the cause of the persistence of AFB in PB cases and have looked into the question of why Mitsuda positivity in tuberculoid and indeterminate leprosy patients, as well as in healthy contacts, is not invariably a guarantee for protectivity against the leprosy bacilli. We have: a) analyzed the histological features of lepromin-induced granulomas, b) studied the bacteria-clearing capacity of the macrophages within such granulomas, and c) studied the in vitro leukocyte migration inhibition factor released by the blood leukocytes of these subjects when M. leprae sonicates have been used as an elicitor. The results of these three tests in the three groups of subjects have been compared and led us to conclude that the bacteria-clearing capacity of the macrophages within lepromin-induced granuloma (positive CCB test) may be taken as an indicator of the capability of elimination of leprosy bacilli and protective immunity against the disease. This important macrophage function is not invariably present in all tuberculoid and indeterminate leprosy patients or in all contacts even though they are Mitsuda responsive and are able to show a positive leukocyte migration inhibition (LMI) test. It is likely but not certain that this deficit of the macrophage is genetically predetermined and persists after completion of short-term WHO/MDT. Thus, after discontinuation of treatment slow-growing, persisting M. leprae multiply within macrophages leading to relapse.

Adolescent↗
PubMedDate not supplied

[Leprosy as a cause of physical disability in rural and urban areas of Mali].

We performed a cross-sectional study of populations from two areas of Mali, in May and June 1996. The aim of the study was to assess the extent to which leprosy causes physical disability in Mali. One area was rural (Circle of Bougouni), the other urban (Bamako District). We used a cluster sampling method, with 500 households selected for study in each of the two areas. All members of the households randomly selected were included in the study. For all survey sites, the number of households was proportional to the number of inhabitants. The total study population was 8,175, including 172 cases of physical handicap, 76 in Bamako and 96 in Bougouni. The prevalence of physical handicap was 21 per 1,000 inhabitants (25.3 per 1,000 in rural areas and 17.3 per 1,000 in the city). The difference in the prevalence of physical handicap between the two areas was statistically significant (p = 0.01). Ten per cent of the disabilities were caused by leprosy. The most common causes of disability other than leprosy were trauma and poliomyelitis. Leprosy mostly caused disabilities in rural areas. In both areas, leprosy caused more disabilities in men and boys (64% of cases) than in women and girls. The frequency of disabilities caused by leprosy increased with age, whereas the frequency of handicaps with other causes decreased with age. This study shows that leprosy is still a major cause of disability in countries in which it is endemic, such as Mali. Disability prevention measures and physical rehabilitation programs should be incorporated into the national program for the elimination of epilepsy.

Adult↗
PubMedDate not supplied

Peripheral vascular deficit in leprosy.

There is considerable controversy regarding the frequency and significance of vascular lesions in leprosy. Thirty-five patients of leprosy under 40 years of age, without any local and systemic arterial disease, with normal looking hands and feet, were subjected to brachial arteriography. One patient also had posterior tibial arteriography. Diagnosis of leprosy was confirmed by bacteriologic and histopathologic technics. Biopsy material was studied from the area of radiographic abnormality, similar material was obtained from nine matched control subjects at autopsy. Skin thermometry and reflex vasodilatation were studied in eight cases. Various fractions of serum lipids and cholesterol were estimated in all patients and found to be within normal range. Arteriographic abnormalities such as occlusion, narrowing, tortuosity, dilatation, poststenotic dilatation, irregularity and incomplete filling of the lumen by radio-opaque material, were seen in more than two vessels in 50% of the arteriograms in wrist and palm; digital vessels showed abnormality in 75% to 94% of cases. The ulnar artery was more frequently involved (74%) than the radial (50%). Superficial and deep palmar arches were equally affected. Increased vascularity in hypothenar eminence area was seen in three arteriograms. Marked increase in arcuate vessels was noted in 60% of patients. Some arcuate vessels were serving as collaterals. Histologically, all grades of vessels including capilaries showed changes in nearly half of the patients. Reflex vasodilatation was lost in three patients of dimorphous leprosy, and impaired or absent in three of five patients of lepromatous leprosy. There was no predilection for any form of leprosy to show arterial changes more than others. This study clearly demonstrates that the vascular involvement in leprosy is very frequent and must be playing an important role in causing mutilations and deformities of hands and feet.

Adult↗
PubMed1991

An isoelectric focusing method for the study of the humoral response against the antigen 85 complex of Mycobacterium bovis BCG in the different forms of leprosy.

Isoelectric focusing was used to separate the three components of the antigen 85 complex of Mycobacterium bovis BCG. Antibody responses of leprosy patients against each Mycobacterium bovis BCG. Antibody responses of leprosy patients against each component were quantitated by densitometric analysis of immunoblot assays. The 85A component was recognized by 40% (8/20) of the lepromin positive and negative healthy subjects, by 76% (19/25) of the tuberculoid and by 96% (24/25) of the lepromatous leprosy sera. In contrast, the 85B component was not stained by the control sera, nor by the tuberculoid leprosy sera but by 64% (16/25) of the lepromatous leprosy sera. The results suggest that antigen 85B contains one or several epitopes that are specifically recognized by sera of lepromatous leprosy patients only.

Antibodies, Bacterial↗
PubMed2000

Production of transforming growth factor-beta 1 (TGF-beta1) by blood monocytes from patients with different clinical forms of leprosy.

In the present study, the concentration of TGF-beta1 secreted by adherent cells isolated from human peripheral blood mononuclear cells (PBMC) and either stimulated with PGL-1 or lipopolysaccharide (LPS) or left unstimulated was determined by ELISA. The cells were isolated from untreated patients with different clinical forms of leprosy and healthy individuals. The adherent cells exhibited spontaneous release of TGF-beta1 in all clinical forms of leprosy and in healthy individuals; however, lepromatous leprosy/borderline leprosy (LL/BL) patients presenting erythema nodosum leprosum (ENL) displayed significantly higher concentrations of TGF-beta1 than either the other patients studied or the controls. These high TGF-beta1 levels were consistently observed when LL/BL ENL cells were stimulated with phenolic glycolipid (PGL-1) or LPS, and even in the absence of a stimulus (P < 0.01). The most significant differences in TGF-beta1 levels were observed when comparing the results in the presence of PGL-1 from ENL with, in order of significance: tuberculoid leprosy (TT) patients (P < 0.001), LL/BL patients without ENL (P < 0.01), healthy individuals (P < 0.01) and borderline-borderline/borderline-tuberculoid (BB/BT) patients with reversal reaction (RR) (P < 0.01). The BB/BT patients produced equivalent levels of TGF-beta1 compared with LL/BL patients without ENL, for all types of stimuli (P > 0.05). In contrast, TT patients produced the lowest levels of TGF-beta1 among all the subjects studied (both patients and healthy controls), especially following PGL-1 stimulation (P < 0.001, and P < 0.05, respectively). In conjunction with our previous data regarding TGF-beta1 expression in dermal lesions, it appears that TGF-beta1 probably plays different roles in leprosy: (i) to mediate a suppressive action locally, associated with the presence of PGL-1, and (ii) to induce proinflammatory effects when secreted systemically by monocytes, thereby acting as a modulatory cytokine in the acute inflammatory reactions of ENL and associated with the Th2 immune response in multibacillary forms of leprosy.

Adult↗