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PubMed1988

A second sooty mangabey monkey with naturally acquired leprosy: first reported possible monkey-to-monkey transmission.

The existence of naturally acquired leprosy in a second sooty mangabey monkey has been documented. The disease has the clinical and histopathological characteristics of subpolar lepromatous leprosy (LLs), and microbiological studies thus far confirm the etiologic agent as Mycobacterium leprae. This mangabey had been housed in direct contact with the first mangabey in which naturally acquired leprosy was diagnosed in 1979. Clinical symptoms appeared in the second mangabey in 1986, almost 7 years after the appearance of skin lesions in the first monkey. It is likely that the second mangabey contracted leprosy from the first mangabey or that both animals contracted the disease by contact with an unknown common third source. This is the only known possible natural transmission of leprosy from monkey to monkey, and suggests that a potential zoonosis exists in wild monkeys that may serve as a reservoir for the disease in areas where human leprosy is endemic.

Animals↗

PubMed1987

Histopathological examination of skin biopsies from an epidemiological study of leprosy in northern Malawi.

This report describes the histopathological findings in 686 biopsies obtained from 664 individuals during the course of a total population survey for leprosy in Northern Malawi. The criteria for the selection of cases for biopsy, the biopsy technique using a 4-mm punch, fixation method, transport of biopsies from Africa to the United Kingdom, and the method of coding histopathological results are described. Fifty-two percent (354) of the biopsies showed definite evidence of leprosy on histopathological examination. Using the Ridley-Jopling system, these biopsies were classified as follows: TT = 60 (17%); TT/BT = 68 (19%); BT = 194 (55%); BT/BB = 4 (1%); BB = 4 (1%); BB/BL = 4 (1%); BL = 7 (2%); BL/LL = 3 (1%); LL = 6 (2%). In addition, four (1%) biopsies were classified as "indeterminate" on histology, meaning that although there was evidence of leprosy it was not possible to provide a precise classification. A further 117 biopsies (17% of the total) had abnormal changes, often including epithelioid cell granulomas, possibly caused by leprosy but lacking specific criteria for that diagnosis. Finally, 203 (30%) of the biopsies had nonspecific (often minimal) changes, and 11 (2%) of the total showed evidence of some dermatological condition other than leprosy. Histopathological examination of biopsies in this study confirmed the clinical classification in 98% of the cases in which the histopathologist found evidence of leprosy, and supplied further evidence for the very high proportion of paucibacillary cases in this part of the world.

Biopsy↗

PubMedDate not supplied

A study of palmar ridge malformation in leprosy.

Palmar ridge malformation of 150 male leprosy patients (50 multibacillary and 100 paucibacillary) were compared with matched controls. Significantly high incidence of ridge malformation was found on the palms of multibacillary leprosy patients. The acquired ridge atrophy was found in 32% multibacillary leprosy, 4.5% paucibacillary leprosy and 0% controls. The congenital ridge dissociation was found in 46% multibacillary leprosy, 20% paucibacillary leprosy and 22% controls. The difference is statistically significant.

Adolescent↗

PubMed1987

An investigation of family size and birth order as risk factors in leprosy.

To investigate if early exposure to Mycobacterium leprae is a factor determining development of Hansen's disease in general, or of a particular form of the disease, we have studied the sibship size and birth order distribution of 187 leprosy cases and 528 hospitalized control patients. By the Greenwood-Yule analysis, a small deficit of cases in the earlier birth order in the tuberculoid form was observed. Such a deficit was not observed in lepromatous leprosy patients. In the multivariate analysis, where socioeconomic factors, current age, and leprosy status of the parents were taken into account, it was found that sibship size becomes a nonsignificant and nonconsistent predictor of leprosy in general or of a particular form of the disease. On the other hand, the logistic analysis supports the impression that tuberculoid leprosy patients belong to the later birth order in both sexes. Although the contrast is statistically nonsignificant in either sex, it suggests that early exposure in life predisposes to the tuberculoid form of leprosy.

Age Factors↗

PubMedDate not supplied

Study of finger print patterns in leprosy.

Finger print patterns of 150 male leprosy patients (100 paucibacillary and 50 multibacillary leprosy) were compared with 50 matched controls. Significant differences were found in finger print patterns of multibacillary leprosy patients and controls. No differences in dermatoglyphic patterns were observed between paucibacillary leprosy and controls. The total finger ridge count (TFRC) in both types of leprosy was slightly lower than controls. A significant difference in individual finger ridge count on digit 1 of right hand was noted in paucibacillary leprosy cases as compared to controls.

Dermatoglyphics↗

PubMed1979

The significance of changes in the nasal mucosa in indeterminate, tuberculoid and borderline leprosy.

A study of nasal biopsies from 137 leprosy patients classified on the basis of clinical, microbiological and skin biopsy as Indeterminate, Tuberculoid, Borderline-tuberculoid and Borderline-leproma was undertaken. Changes suggestive of leprosy viz., nerve and smooth muscle inflammation with a few acid fast bacilli in a proportion of the biopsies were seen in all groups of patients examined. This suggests, that even in Indeterminate and Tuberculoid leprosy the disease becomes generalised by the time clinical manifestations appear in skin. Tuberculoid granuloma was seen in two nasal biopsies from Borderline-tuberculoid leprosy patients, one of which was located in the wall of a vein, suggesting the possibility of intravascular dissemination of the disease even in non-lepromatous leprosy. 33 of the patients were children 15 years and below and they also showed changes such as nerve and smooth muscle inflammation but bacilli were seen only in the Borderline group. These findings suggest involvement of the nasal mucosa early in the course of the disease as 70% of the children had the skin lesion for less than one year. The nasal mucosa offers favourable conditions for the growth of the organisms and is readily accessible to infection by droplets, and therefore, it could be one of the primary sites of involvement in leprosy.

Adolescent↗

PubMedDate not supplied

Serum cations (calcium and magnesium) in leprosy.

Serum cations (calcium and magnesium) were studied in 80 leprosy patients and 40 normal healthy individuals to find out the correlation between the clinical status of leprosy with these cations levels in the serum. There was significant decrease of serum calcium in lepromatous leprosy (7.42 +/- 0.7 mg%, t = 14.12, P less than 0.001), which seems to be related with the extent of leprosy lesions and duration of illness as few patients (22.2%) with minimal lesions and shorter duration of illness had serum calcium within normal range. Serum magnesium was significantly decreased in all types of leprosy cases and lepromatous leprosy patients showed highly significant decrease in serum magnesium level (1.02 +/- 0.2 mEq/L, t = 14.54, P less than 0.001).

Adolescent↗

PubMed1985

Leprosy in a mangabey monkey--naturally acquired infection.

Naturally acquired leprosy was detected in an otherwise normal "sooty" mangabey monkey (Cercocebus atys). This animal was imported from West Africa in 1975 and developed clinical symptoms of leprosy in 1979. Histopathologic findings were those of subpolar-lepromatous to borderline-lepromatous leprosy in the Ridley-Jopling classification. The disease was progressive, with crippling neuropathic deformities of the hands and feet. The disease regressed under specific therapy. The etiologic agent was identified as Mycobacterium leprae by the following criteria: invasion of nerves of host, staining properties, electron microscopic findings, noncultivable on mycobacteriologic media, DOPA-oxidase positive, lepromin reactivity, infection patterns in mice and armadillos, sensitivity to sulfone, and DNA homology. We believe the animal acquired the disease from a patient with active leprosy. The mangabey monkey offers promise as a primate model for leprosy, and adds a third reported species to animals with naturally acquired leprosy.

Animals↗

PubMedDate not supplied

Alpha-1-antitrypsin in leprosy.

Estimation of Alpha-1-antitrypsin (AAT) levels was carried out in 52 patients of various types of leprosy. Fifty age and sex matched healthy individuals served as controls. The mean level of AAT in controls was 290.12 +/- 59.56 mg/dl. In patients of tuberculoid leprosy (TT), borderline tuberculoid leprosy (BT) and borderline leprosy (BB), the AAT levels were found to be 284 +/- 47.03, 314.37 +/- 31.56 and 324.44 +/- 32.05 mg/dl respectively. These were statistically insignificantly raised when compared with controls. In borderline lepromatous leprosy (BL), lepromatous leprosy without erythema nodosum leprosum (LL without ENL) and in LL with ENL there was a statistically significant rise in AAT levels. The maximum levels of AAT were observed in patients of LL with ENL (mean 500.8 +/- 93.44 mg/dl. P less than 0.001).

Adolescent↗

PubMed1985

Muramidase (lysozyme) findings in sural and radial nerve biopsies in leprosy patients after varying periods of treatment.

Using the immunoperoxidase staining method, tissue muramidase (lysozyme) activity was studied in 34 nerve biopsies from leprosy patients and compared to findings in the skin. In a majority of lepromatous and borderline-lepromatous leprosy patients, the enzyme was seen to form a saccular pattern within the cells; whereas a granular pattern was found at the tuberculoid end of the leprosy spectrum, as well as during reversal reactions. Indeed, the most intense enzymatic activity was found in four patients with reversal reactions. Compared to the skin, muramidase activity was found to be more intense and persisted longer in the nerves. Successful antileprosy treatment reduced the enzymatic activity in both the nerves and the skin, but more so in the skin. Schwann cells and axons did not show muramidase activity, indicating that the muramidase-positive cells are not of neuronal origin. Our results suggest that a high percentage of mononuclear cells infiltrating the peripheral nerves in leprosy are derived from blood monocytes. The function of tissue muramidase in leprosy is not yet clear. Its peculiar intracellular distribution pattern in the different forms of leprosy, however, warrants further study to elucidate its role in the pathogenesis of the disease.

Adolescent↗

PubMed1982

Electrophoretic pattern of proteins in lepromatous leprosy.

Serum total proteins and the various protein fractions were studied in fifty cases of lepromatous leprosy and in eleven cases of lepromatous leprosy with lepra reaction. The study revealed a significant increase in serum total proteins in both lepromatous leprosy and lepra reaction groups, when compared with normal healthy subjects. The percentage rise was found to be 14.5% and 22.95% for lepromatous leprosy and lepra reaction respectively. The globulin fraction showed a significant elevation, while albumin showed a decrease. Thus a reversal of A/G ratio was observed in both the disease groups. Alpha-1 and Alpha-2 globulins were found to be significantly increased in both the disease groups. Beta globulins did not reveal any significant alteration. It was interesting to note the presence of an additional globulin fraction in seventeen patients of lepromatous leprosy and two cases of lepra reaction. Gammaglobulin showed a significant rise in lepromatous leprosy (56.16%) and in lepra reaction (60.72%). The significance of the above findings are discussed in the light of available literature.

Alpha-Globulins↗

PubMed1983

T cell subsets in leprosy lesions: in situ characterization using monoclonal antibodies.

Cryostat sections of dermal lesions from 30 untreated leprosy patients were studied by indirect immunofluorescence using monoclonal antibodies defining T cell subsets and Ia like antigens. Most lymphocytes in leprosy lesions were positive for OKT3 and Ia like antigens indicating thereby the presence of activated T cells. Maximal numbers of these cells were seen in localized paucibacillary tuberculoid leprosy lesions in close association with epithelioid cells. A decline in their numbers was observed over the leprosy spectrum with a marked reduction in disseminated, multi-bacillary, lepromatous leprosy where only scattered OKT3+ cells were visualized. OKT4 and OKT8 positive cells defining T cell subsets, were frequently found within the OKT3+ lymphocytes throughout the leprosy spectrum. The ratio of OKT4+/OKT8+ cells ranged from 1.2 to 5.0 in tuberculoid and from 0.2 to 1.0 in lepromatous lesions. Macrophages in the granulomas stained intensely with anti-Ia antisera. Ia like antigens were expressed to the same degree on macrophages with or without intracellular acid fast bacilli.

Antibodies, Monoclonal↗

PubMed1984

Pathological findings on peripheral nerves, lymph nodes, and visceral organs of leprosy.

Pathological findings in a) 103 autopsies, b) biopsy material of peripheral nerve tissue from 210 tuberculoid patients, and c) inguinal lymph nodes from 106 leprosy cases are presented. Overall, lesions in peripheral nerves were most common in the ulnar (85.7% in the TT type, 98.3% in LL), peroneal (77.8% in TT, 97.9% in LL), median (80% in TT, 90.2% in LL), radial (66.6% in TT, 82% in LL), and the great auricular, tibial and supraorbital nerves. The ratio of bilateral nerve involvement in the same nerve was higher than unilateral involvement (approximately 5:1). Lesions of the peripheral nerve ganglion were seen in the LL type (22 cases, 61.1%) and the TT type (8 cases, 53.3%). These have seldom been mentioned in past literature. Superficial lymph nodes were most commonly affected in all types of leprosy. Lymph nodes in the hepatic and splenic portal areas were sometimes involved in lepromatous or borderline cases. Between the two polar types of leprosy, the lesions in the lymph nodes showed gradual transitions in a spectrum-like pattern which were similar to the changes in the lesions in the skin. In lepromatous leprosy, lesions could be found in 85.3% of the cases in the liver, 41.1% in the spleen, 86.7% in the testes, approximately 50% in the upper respiratory tract (including 36.4% in the nasopharynx), and 34.4% in the adrenal gland. Three cases had ophthalmologic lesions. In borderline leprosy, biphasic lesions of leprosy were found in various internal organs.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMedDate not supplied

Diagnostic efficiency of paramedical workers involved in leprosy case detection programme.

The diagnostic efficiency and accuracy in classification of leprosy and its activity status, by four senior trained Paramedical Workers (PMWs) involved in leprosy case detection programme, was assessed on 1394 cases detected by them and concurrently confirmed by an experienced medical officer. The inter-observer variation between two experienced PMWs in diagnosis and classification of leprosy on 216 patients, was also studied. Of the 1394 cases detected by PMWs, 257 (18.44%) were wrongly diagnosed as leprosy, mostly as non-lepromatous (N) type. Though all lepromatous (L) and 98% of N-type cases were correctly classified by PMWs, 25.64% of borderline (N ? L) cases were either under-diagnosed as N-type (17.95%) or over-diagnosed as L-type (7.69%). The activity status of 19% cases was wrongly assessed by PMWs, including 8% active lesions assessed as inactive. The discrepancy between two PMWs in diagnosis, classification and assessment of activity status of leprosy was found in 1.39%, 7.41% & 25.67% cases, respectively. The implications of these observations, and the suggestions to improve the technical skills of workers for an efficient and effective implementation of leprosy control programme, are discussed in this communication.

Allied Health Personnel↗

PubMed1983

A clinico-pathological study of primary neuritic leprosy.

Normally neural involvement in leprosy is an ascending neuritis from the nerve involvement in the dermal lesions. However, in some cases neural involvement is seen in the absence of any dermal lesions. In some of these pure neuritic cases, dermal lesions appear sometime later. It is, therefore, more appropriate to designate such cases as 'primary neuritic' cases. This study is aimed at diagnosing primary neuritic leprosy among patients presenting with only neuritic symptoms. An attempt is also made to classify primary neuritic leprosy on a clinical and histopathological basis. During the period 1979-80, 30 patients reported to the out patient department of Schieffelin Leprosy Research and Training Centre, Karigiri with complaints of neuritic origin. In addition to clinical examination and routine skin smears, investigations such as skin, nerve and nasal biopsies, nerve conduction velocity and lepromin testing were carried out where feasible. 17 of these patients were diagnosed as primary neuritic leprosy and in 7 patients other neurological conditions were diagnosed. The remaining 6 patients were kept under observation and have not shown evidence of leprosy during a two year period of following-up. It is interesting that 4 of the 17 primary neuritic cases developed patches during follow-up period of two years. In the final analysis 7 patients (41.2%) were classified into the lepromatous group and 10 patients (58.8%) in the non-lepromatous group (Table-6). This classification will have a bearing on duration of treatment and for their subsequent release from control.

Adult↗

PubMed1983

Clinico-pathological study of lymph node involvement in leprosy.

One hundred and five leprosy patients including 37 cases of LL and LI, 22 cases of BL, 3 cases of BB, 17 cases of BT, 23 cases of TT and 3 cases of indeterminate type during the period of 1980-81 have been examined clinically. All the patients of LL, LI, BL and BB types, 94% of BT, 70% of TT and 66.6% of indeterminate type have showed clinical enlargement of lymph nodes. In order of frequency the enlarged nodes are inguinal (76.2%) cervical (69.5%), axillary (69.5%), epitrochlear (64.7%) and lastly pre-auricular (9.5%). Although both regional and distant groups of lymph node enlargement have been observed in all cases of LL, LI and BL, in majority of the non-lepromatous cases there is only involvement of regional lymph nodes. Biopsies of lymph nodes are made from 51 leprosy patients, 22 from LL and LI cases, 11 from BL cases, 2 from BB cases, 8 from BT cases, 6 from TT cases and 2 from indeterminate leprosy cases. Major histopathological changes have been studied in different types of leprosy. The humoral antibody response and the cellular immune response are well reflected on the histopathological finding of the lymph nodes belonging to different immunological spectrum of leprosy patients. The examination of lymph nodes is recommended as a useful adjunct for the diagnosis and classification of leprosy.

Adult↗

PubMed1982

Social factors and leprosy in Lamjung, West Central Nepal: implication for disease control.

Such is the ability of leprosy to generate misconceptions and fears, that many patients are reluctant to be identified. Deformity and paralysis which may occur compound the stigma attached to this rare disease of slow insidious onset. Epidemiological studies of leprosy refer only to known disease and often to highly selected groups of the population. Cohorts are therefore incomplete, and variations in prevalence may reflect social attitudes and data reliability. This paper describes the demographic and spatial distribution of leprosy in Lamjung, a district of west central Nepal. Variations in known leprosy prevalence between sexes, ethnic groups and areas are related to social and physical factors. An apparent paradox of low leprosy prevalence in an ethnic group with a high proportion of infectious leprosy is associated with adverse social attitudes and poor survey coverage. Although the data are too limited for an epidemological analysis variations associated with social and physical factors have crucial implications for disease control.

Attitude to Health↗

PubMed1980

Ocular leprosy in Papua New Guinea.

The eyes may be damaged in leprosy by three pathological processes; by direct bacillary invasion, secondary to the involvement of the Vth and VIIth cranial nerves leading to corneal anaesthesia and lagophthalmos respectively, and by sensitization to Mycobacterial antigen or immune complexes during type II reactions. The prevalance of ocular leprosy varies widely throughout the world, depending on a number of factors, including the type of disease which is most prevalent, the duration of the disease, the ophthalmological facilities available, and possibly the race of the patient. Shields et al, have reported prevalence rates of ocular leprosy varying from 6% to 90% in different series. In Port Moresby, Dethlefs found a prevalence of 12% of potentially sight threatening lesions in a small group of leprosy patients: in his series however, little detail was paid to the leprosy aspects of the patients. A study was therefore undertaken of ocular lesions in leprosy patients paying particular attention to type, duration and activity of the disease.

Adolescent↗