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PubMed1980

Antibodies against Mycobacterium leprae antigen 7 from birth to 18 months of age: an indicator of intra-uterine infection in leprosy.

All babies of three non-leprosy mothers and ten tuberculoid leprosy mothers and four of five babies of mothers with inactive lepromatous leprosy showed a decline in serum concentration of antibodies against M. leprae antigen 7 during the first 4 months of life, as expected from catabolism of maternal IgG. By contrast, ten of twenty babies of mothers with active lepromatous leprosy showed a decline in concentration of anti-M. leprae 7 antibodies considerably less than expected. This indicates that these babies have been stimulated by M. leprae antigen 7, either as free antigen or by viable M. leprae before birth, and thus that leprosy may occur as a congenital infection. Studies of anti-M. leprae antibodies in repeated serum samples obtained during the first 18 months of life indicated that children of mothers with bacilliferous leprosy are frequently exposed to M. leprae to a sufficient extent to stimulate the immune system of the baby to production of anti-M. leprae antibodies during this period. The consequences of this exposure to M. leprae should be ascertained by careful clinical studies.

Aging↗
PubMed1982

Tuberculoid leprosy or sarcoidosis? A diagnostic dilemma.

During an intensive survey in a leprosy endemic area in South India, a young male adult was detected with infiltrated skin lesions and diagnosed as a case of major tuberculoid leprosy. The presence of leprosy in the individual could not be clinically established, despite a histological diagnosis of tuberculoid leprosy made on his skin biopsy. In a eighteen year follow up during which he was examined on six occasions, the skin patches continued very much the same in appearance with a progressive increase in size; he was re-biopsied from the same lesion thrice and was declared tuberculoid or borderline tuberculoid leprosy. At no time did the clinical findings warrant a diagnosis of leprosy but suggested that it could be sarcoidosis or lupus vulgaris. The biopsy done for the fifth time from the same skin lesion during the seventh examination and from the site of Kveim test confirmed the condition to be sarcoidosis.

Adult↗
PubMed1981

Leprosy in Punjab - an analysis of 4 years O.P.D. data.

185 new leprosy cases were seen, of whom 52 (28 2%) were Punjabis and 133 (71.8%) were Non-Punjabi patients. A minimum of 13 (25%) Punjabi leprosy cases were indigenous. The Punjabi cases were drawn from several districts in Punjabi. Among the Punjabi patients, the mean age at onset of leprosy was 43.6 years, and 30.8% of them had infectious type of leprosy. BT was the most common type of leprosy (38.5%), and the age at onset was also highest in BT (49.8 years), among the Punjabi patients. The migrant labourers from Bihar and Eastern U.P. are the probable source of leprosy in Punjab.

Adolescent↗
PubMed1980

Lymphocytotoxins in leprosy and in asymptomatic hepatitis B virus infection.

Serum lymphocytotoxic antibodies (LCAs) were detected in 67% of Papua New Guinean lepromatous leprosy patients who were persistent carriers of hepatitis B surface antigen (HBsAg). Lymphocytotoxins were not associated with asymptomatic HBsAg in either healthy controls or tuberculoid leprosy patients. It was apparent that, although HBsAg itself is a poor indicator of in vitro lymphocytotoxicity, when the antigen occurred in a host with impaired immune response, lymphocytotoxicity, when the antigen occurred in a host with impaired immune response, lymphocytotoxicity was enhanced. In contrast to this finding, lepromatous leprosy patients without HBsAg had significantly depressed LCA production in comparison with tuberculoid patients and controls. The interaction between leprosy and hepatitis B virus was highly significant (P = 0.001) in an analysis of variance of cytotoxicity scores. It is proposed that the previously reported equivocal results regarding autoantibodies in leprosy patients may be explained by this unusual interaction between lepromatous leprosy and hepatitis B virus infection.

Adolescent↗
PubMed1995

Biometals in skin and sera of leprosy patients and their correlation to trace element contents of M. leprae and histological types of the disease; a comparative study with cutaneous tuberculosis.

The present study has provided information on the biometal contents of killed and dried Mycobacterium leprae as well as dermal granulomas induced by the invading mycobacteria in various histological types of leprosy patients. For comparison, the biometal contents of the contralateral leprosy-unaffected skin of the same patients also were measured. The study also reports changes of serum levels of the biometals in these patients which were compared with those in healthy control subjects and patients with skin tuberculosis. These data show that M. leprae is rich in zinc. During the course of the evolution of the disease there is gross alteration of the dynamics of the inflammatory cell population that infiltrates into leprosy granulomas, resulting in the alterations of trace element contents of the disease-affected skin lesions. Interestingly, the changes of the biometal contents in the granulomas of the patients with skin tuberculosis are similar to those in leprosy patients. It is postulated that the significant decrease of the contents of copper, zinc, iron, calcium and magnesium in the disease-affected skin in comparison to that of the contralateral healthy skin is a local effect, perhaps due to erosion or influx of biometal-deficient inflammatory cells into the affected skin with eventual loss of connective tissue of skin and mobilization of tissue-bound microelements into the vascular compartment. On the contrary, the changes in biometal levels in the sera of leprosy patients appear to be a general effect perhaps due to the release of interleukin-1, a product of inflammatory cells, causing hypercupremic, hypozincemic and hypoferremic responses in the hosts. Moreover, growth and multiplication of M. leprae, especially in polar lepromatous leprosy patients with a high bacillary load, demand essential biometals which may be mobilized into the bacterial bodies from the hosts. This perhaps results in the change in the homeostasis of the essential biometals in the hosts.

Adult↗
PubMed1995

[Antileprosy polychemotherapy in the member states of the OCCGE: a decade of implementation (1983-19930). The National Coordinators of the Leprosy Program of the 8 states of the OCCGE].

MDT for leprosy recommended by WHO in 1981 has been introduced and implemented in 8 Member States of OCCGE (an organization for leprosy control in francophone West Africa). This implementation from 1983 to 1993 can be divided in two phases: 1983-1987: introduction phase by pilot projects; 1988-1993: extension phase by national leprosy control programmes. During the ten years, MDT coverage rose to 68%, leprosy prevalence rate widely decreased (40.71 to 6.56 per 10,000), while annual detection rate weakly varied (1.89 to 1.26 per 10,000). Factors influencing this evolution of leprosy are brought out and recommendations are made about strategies to be developed for leprosy control up to year 2000.

Africa, Western↗
PubMed1994

Immunoprecipitation of mycobacterial antigens with sera from patients with leprosy.

Pooled sera from leprosy patients across the clinical spectrum, tuberculosis patients and healthy individuals were tested for their reactivity with antigens of Mycobacterium leprae and a panel of cultivable mycobacteria by immunoprecipitation technique. Sera from lepromatous leprosy patients demonstrated exclusive reactivity with the 26-kDa protein of M. tuberculosis H37Ra, 28-kDa protein of M. kansasii, 45-kDa protein of M. smegmatis, and 158, 40 and 14 kDa proteins of M. phlei. Sera from patients with borderline tuberculoid leprosy, tuberculoid leprosy, tuberculosis and health individuals failed to identify these antigens. Our studies indicate that analysis and characterization of immunodominant antigenic epitopes present on proteins of cultivable mycobacteria, sharing cross-reactive epitopes with M. leprae may prove to be important in the serodiagnosis of multibacillary leprosy as well as for developing vaccines for immunotherapy of leprosy.

Antigens, Bacterial↗
PubMed1994

Prevalence of HIV infection and high-risk characteristics among leprosy patients of south India; a case-control study.

With the observation of the occurrence of the human immunodeficiency virus (HIV) infection among leprosy patients in our pilot study carried out in Tamil Nadu, South India, a case-control study was planned to explore whether HIV infection is a risk factor for leprosy and to understand the characteristics of HIV infection and high-risk behaviors among leprosy patients. We screened 556 patients and 1004 nonleprosy controls (matching 502 cases for age, sex and area of residence) for HIV-1 and HIV-2 antibodies. They also were interviewed for personal information on history of blood transfusion, intravenous drug abuse, high-risk sexual behavior, and sexually transmitted diseases. Of the 1019 total cases screened (of both pilot and extended studies), 5 were found to be position for HIV antibodies (HIV-1 = 4, HIV-2 = 1); of the 1019 nonleprosy controls, 6 were positive for HIV-1 antibodies. An analysis by odds ratio revealed no association between leprosy and HIV infection (OR = 0.824, 95% CI = 0.201-3.593). A strong association was found only between high-risk behavior and HIV infection (OR = 5.186, 95% CI = 1.717-15.667). However, unmarried, unmarried after 30 years of age, exposure to spouses of the leprosy patients, and a history of surgery were all observed to be significantly more common among leprosy patients than the controls.

Adolescent↗
PubMed1976

Lymphocyte transformation test in leprosy; correlation of the response with inflammation of lesions.

Lymphocyte transformation tests (LTT) using 'whole washed" and 'sonicated" preparations of Mycobacterium leprae (M. leprae) as antigen were studied in eighty-one patients with borderline leprosy. The results were correlated with the histological and the clinical pictures. There was a good correlation with the histological spectrum, LTT responses generally being higher in the borderline tuberculoid leprosy patients and lower in the borderline lepromatous. However, considerable variation was noted in each group of the borderline leprosy spectrum, and it was found that this was due in part to the degree of inflammation in the skin. Thus those with 'inflamed" skin lesions had higher responses than those with 'silent" lesions, and even those with borderline lepromatous leprosy with inflamed lesions had higher responses than those with borderline tuberculoid leprosy whose lesions were silent. Those who had reversal reactions, where inflammation is very marked, had very high LTT responses which fell with treatment of the reaction with steroids. It thus appears that the LTT in leprosy is influenced by the occurrence of hypersensitivity reactions as well as by the patient's ability to resist bacillary multiplication.

Adolescent↗
PubMed1993

Case finding survey for leprosy in Botswana.

A baseline survey to establish the point prevalence of leprosy was carried out in July and August, 1991 in northern Botswana, where cases of leprosy have existed over the years. A total of 799 contacts of 127 index cases and 8235 school children from 18 schools were clinically screened for leprosy. In all, 44 active cases of leprosy were registered and started on multidrug therapy recommended by World Health Organization. Of these cases, 32% were newly identified during the survey. Due to the moderate outcome, surveillance and control of leprosy has been integrated with existing TB control programme. This is the first time ever a systematic attempt was made to establish a programme for control of leprosy in Botswana.

Adolescent↗
PubMed1993

Anti-PGL1 levels in leprosy patients and their contacts.

1. We determined the anti-PGL1 levels of 402 individuals from the Ribeirão Preto region since the phenolic glycolipid (PGL1) is a specific Mycobacterium leprae antigen. This group consisted of 47 leprosy patients (26 with the lepromatous form, 16 with the tuberculoid form and 5 with the borderline form), 12 tuberculosis patients, 19 leprosy contacts, and 324 healthy blood donors from the Hemocenter of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Anti-PGL1 levels were detected by ELISA. 2. Anti-PGL1 levels were normal in patients with tuberculoid and borderline leprosy, in tuberculosis patients and in almost all of the healthy blood donors. Patients with untreated lepromatous leprosy had elevated anti-PGL1 levels while most patients under treatment (9/16) had normal anti-PGL1 levels. Only 3% of blood donors (10/324) had elevated anti-PGL1 levels, but when these individuals were submitted to clinical and bacilloscopic examination no signs of disease were found. To complete the clinical investigation, these 10 subjects were submitted to the Mitsuda reaction which was negative in 3 of them. All of these 10 subjects are being monitored, since they may be at risk to develop leprosy. 3. On the basis of the present data, it seems that ELISA is a potentially important assay for the detection and chemotherapy of subclinical leprosy, permitting the control of epidemic centers of the disease.

Adolescent↗
PubMedDate not supplied

The role of protein malnutrition in the pathogenesis of ulcerative "Lazarine" leprosy.

1. Clinical and necropsy observations in lepromatous leprosy associated with severe emaciation and accompanying hypoproteinemia suggest that protein deprivation may be of pathogenic significance in the ulcerative phenomenon that is designated "Lazarine leprosy". 2. An experimental utilizing Wiersung rats infected with Mycobacterium lepraemurium and maintained on a protein-free diet was developed for the purpose of studying the effect of protein starvation on the course of chronic mycobacterial disease similar to lepromatous leprosy with respect to pathogen and host inflammatory response. 3. It was possible to maintain the experimental animals on a protein-free diet for up to 18 weeks of concomitant M. lepraemurium infection. This was long enough for the infection to disseminate to a degree that was evident in control animals only several weeks later. 4. The protein-deprived animals showed decreased inflammatory response to the pathogen, presented more rapid dissemination of the infection and harbored more bacilli per macrophage than did animals similarly infected but maintained on a protein adequate diet. This indicates impairment of native cellular immunity by protein deprivation through decrease in ability of macrophages to inhibit bacillary multiplication. 5. There was no evidence of impairment of macrophage ability to phagocytose the pathogens. 6. Morphologically the increased dissemination of pathogens and decrease in inflammatory response was similar to the increase in number and extent of visceral lesions seen in Lazarine leprosy. Decreased ability to dispose of the infecting bacilli was similar in the two models, human and animal. The animal model does not, as does lepromatous leprosy, involve the skin in the infection. Hence comparable ulcerative phenomena were not replicated in the animals. 7. It is suggested that Lazarine leprosy may result from enhanced lepromatous leprous infection occurring as a result of protein malnutrition. The pathogenic mechanism appears to be impairment of cellular immunity probably enhanced by concomitant impairment of humoral antibody immunity resulting also in decreased resistance to pyogenic and other secondary pathogens. The tissue edema attendant on decreased serum osmotic pressure due to lowering of the serum protein fractions enhances the probability of ulceration.

Animals↗
PubMed1993

Extent, origin, and implications of observer variation in the histopathological diagnosis of suspected leprosy.

Identical slides from 100 biopsies obtained from individuals suspected of having leprosy, ascertained in a total population survey in Malawi, were examined twice, independently, by three histopathologists. Results were reported in a standard protocol, and were compared among themselves and with a standardized clinical assessment of each "suspect." The proportion of biopsies considered to show definite evidence of leprosy ranged from 29 to 55 among the six evaluations (twice by each of three histopathologists). Comparisons of variations within and between histopathologists revealed three different patterns. Two of the pathologists were very consistent as individuals, but differed markedly between themselves in that one was the least inclined and the other the most inclined to report definite evidence of leprosy. The third pathologist was less consistent, reporting appreciably more definite leprosy on the first than on the second examination of the same biopsies. Although acid-fast bacilli (AFB) were reported on at least 1 examination in 40 of the biopsies, they were observed in all six examinations of only six of the biopsies. There was greater agreement regarding classification than regarding diagnosis, except with reference to the indeterminate category which was employed more frequently by one histopathologist than by the other two. A workshop of participants at the end of the investigation highlighted several reasons for the variations observed. The fact that AFB were reported in only nine biopsies by one histopathologist but in 33 by another reveals the importance of the examination method and time in arriving at a diagnosis of leprosy. The differences in the interpretation of cellular evidence of inflammation revealed the need for further studies of nerve-related pathology in nonleprosy conditions to serve as a reference against which to judge possible evidence of leprosy per se.

Biopsy↗
PubMed1993

[Suspected adult-onset Still's disease: unexpected manifestation of leprosy].

A 23-year old male from Sri Lanka was admitted to hospital with symmetrical inflammatory peripheral polyarthritis, fever of 39 degrees C and poly-lymphadenopathy. At first we suspected adult onset Still's disease. The histological findings from axillary lymph node biopsy strongly suggested the diagnosis of leprosy, for which we had had little evidence thus far. Typical skin lesions were absent, skin smears were negative and neurological symptoms only became obvious much later when fever and arthritis had subsided under anti-inflammatory treatment. At this time a right ulnar palsy developed, with atrophy of the interosseous muscles and thickening of the ulnar nerves at both medial epicondyles. Fite-stains of a sural nerve biopsy confirmed the diagnosis when mycobacteria were detected. Leprosy displays a clinico-pathological spectrum caused by variations in host resistance. A widely accepted classification is the five group system of Ridley and Jopling. At one extreme of this spectrum are patients with lepromatous or low resistance leprosy with numerous bacilli, and at the other those with high resistance or tuberculous leprosy where few or no bacilli are found. The numerous bacilli in the sural nerve biopsy classified the disease as lepromatous in our case. Of the various manifestations of the lepra reaction occurring in lepromatous leprosy, one is acute arthritis, but a more common one is erythema nodosum leprosum. Our patient's clinical presentation was interpreted to be a rheumatic manifestation of a type-2 reaction. This form of immunological response in leprosy is an immune complex syndrome and may mimic different rheumatic diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

A clinico-epidemiological study of leprosy in arid north-west Rajasthan, Jodhpur.

A detailed clinical, bacteriological and histopathological study of 1373 patients of leprosy who sought medical advice at the Department of Skin, STD and Leprosy of Dr. Sampurnanand Medical College, Jodhpur, during 1975-1993 is reported. The disease was observed in 1.54 patients per 1000 cases attending in the skin department out-patients. More than 50% of them had polar type of lepromatous leprosy. The disease was found 2.42 times more often in males than in females and was found mainly in the age group 11-70 years. Family history of leprosy was obtained in 130 (9.5%) of the cases. Lepra reactions were seen in 151 (11%) cases, of which 30 had type 1 reaction (19.2%) and 121 type 2 reaction (80.1%). The majority of leprosy cases (966 or 70.4%) were from Jodhpur district, followed by 109 (7.9%) from Nagaur district and then from, Barmer, Jaisalmer and Jalore etc. All cases of leprosy responded well to the WHO regimens of multidrug therapy. The reactional cases were satisfactorily managed with higher doses of clofazimine along with oral prednisolone.

Adolescent↗
PubMedDate not supplied

Leprosy neuropathy: correlation of clinical and electrophysiological tests.

This report describes the neurological and electrophysiological examination of 35 subjects with leprosy (average duration of symptoms 3.4 years, average time since diagnosis 7.5 months). Clinical examination in the distribution of non-dominant median and ulnar nerves was performed with the following clinical methods: touch sensation with 0.05 gm. Monofilament nylon, thermal sensation with a thermal sensitivity testing device, voluntary muscle testing and nerve palpation. At least one abnormality was found in 22 ulnar and 13 median nerves (63% and 37%, respectively). Nerve palpation was the most frequent clinical abnormality, while the other methods had similar frequencies of abnormality. Electrophysiological studies were performed on the ipsilateral side of the leprosy subjects and on 32 age-matched normal subjects. Electrophysiological responses from the leprosy subjects were evaluated by criteria established from normal subject data. Abnormal or absent responses were found in 21/35 ulnar sensory, 12/35 ulnar motor, 9/35 median sensory and 6/35 median motor responses among the leprosy subjects. The most important electrodiagnostic findings were: (i) low sensory amplitudes and (ii) drops in amplitude and NCV over the across-elbow segment of the ulnar nerve. Both clinical and nerve conduction abnormalities were positively associated with duration of leprosy symptoms. The four clinical methods were compared for concordance with nerve conduction data by cross-tabulation. The two sensory measures, monofilaments and the thermal sensitivity device, had the highest concordances. Usefulness of clinical tests for nerve damage in leprosy may vary depending on whether the purpose is for diagnosis, patient education or clinical follow-up.

Adult↗
PubMedDate not supplied

Pregnancy and leprosy neuropathy.

Women with leprosy (even apparently cured) run a serious risk of deterioration in nerve function when they become pregnant. During pregnancy and lactation the woman with leprosy may suffer: relapse, reactivation and transient exacerbation maximally in late pregnancy; ENL in the first and third trimesters, continuing with nerve damage postpartum; RR maximally postpartum, even after MDT and RFT; neuritis affecting almost 50% of women in any pregnancy/lactation, in most cases as "silent" neuritis with new motor and sensory loss, even after MDT-RFT, and stocking-and-glove anaesthesia even in PB women and post MDT-RFT. Those incubating the infection develop overt disease frequently in reaction. This tragic cycle can only be stopped by a combination of: (i) leprologists and leprosy control personnel understanding the problems of leprosy in pregnant and lactating mothers; (ii) well-planned health education for leprosy patients, and both leprosy and maternal health care workers and (iii) the highest standard of clinical supervision during pregnancy, prolonged lactation and at regular intervals during the woman's reproductive life, even after she would normally be released from surveillance after completion of multiple drug treatment (MDT).

Female↗
PubMed1996

Microbial colonizers in leprosy skin ulcers and intensity of inflammation.

The microflora of 55 patients with leprosy skin ulcers was studied and related to a weighted inflammatory score (IS). The control group consisted of 18 ulcers with different underlying pathology. Leprosy ulcers were characterized by the exclusive presence of two types of branching gram-positive rods; a particular interesting proposal is that Mycobacterium leprae share common antigens with these unusual "leprosy ulcer associated" organisms and group G beta-hemolytic streptococci. In the leprosy group, corynebacteria and branching rods accounted for 97% of gram-positive bacilli and Bacillus species constituted only 3%. In the control group, B. species formed 50% of gram-positive rods; the rest were corynebacteria (p = 0.03). In the leprosy group, one third of the gram-positive bacteria were branching rods; none of them was acid fast. Ten of them were identified as Arcanobacterium haemolyticum, and the remaining 7 could not be identified. The IS of leprosy patients was lower than in the control group. The presence of more than two species of facultative or aerobic gram-negative rods or single species of pyogenic gram-positive cocci correlated with a high IS. The presence of two or more different pyogenic cocci resulted in a lower IS. Further studies into the nature of leprosyunique organisms as well as the inflammation inhibition factors in mixed infections are warranted. It is recommended that management of ulcers should consist of the application of local disinfection and early treatment of episodes of inflammation with a combination of fluoroquinolone and penicillin.

Actinomycetaceae↗