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PubMed1986

Human behavioural research applied to the leprosy control programme of Sarawak, Malaysia.

In 1984, in Sarawak, there were a total of 1,099 recorded cases of leprosy for a population of 1.3 million. However, for each case recorded, it is estimated that two others remain undiagnosed as a consequence of the stigmatization associated with leprosy. For the five year period, 1979-1983, an average of 29 new cases were detected each year of which 8.6 (30%) were deformed due to the late stages at which it was being reported. To increase the case-finding rate, human behavioural research was applied to the leprosy control programme so as to develop culture-specific health education packages aimed at self diagnosis and self referral in order to detect the large pool of undiagnosed cases hidden behind the veil of aversion, fear and ignorance. This was achieved through anthropological studies to identify how the various major ethnic groups perceived leprosy and their attitudes towards leprosy. Taking into account these findings, health education packages aimed at adults as well as children were developed for the Chinese as well as the non-Chinese, and consisted of newspaper articles, cartoon tape-slides, cartoon story books and posters.

Attitude to Health↗
PubMed1986

Psycho-social and environmental factors in triad model for the management of control programme: focus on leprosy.

The study addresses the question of how the qualitative aspect of the interaction between the people involved in the leprosy control programme affects the process of patients (P), service providers (SP) and satellite informants (SI) composed of community leaders, in the delivery of basic leprosy control services in two high leprosy endemic villages in La Union province, the Philippines. The interaction between P, SP and SI as an independent variable is imagined to be linked in a form of a triad, influenced by psycho-social and environmental variables. Data was gathered by conventional methods as interviews, historical research and use of rating scales as well as non-conventional methods as PUP, a locally developed standardized instrument which measures variables that determine a Filipino's adjustment to social situations, and photographic documentation. Statistical analysis was made on the independent variable and the dependent variable - an improved Leprosy Control Programme. It was observed that the stigmatization of Hansenites had deep historical roots with the policy of colonial administrations to isolate and segregate Hansenites. This stigma remains to the present and was observed to exist even among service providers: Low knowledge levels of patients on the causes of the disease on the one hand, and service providers on the cure, particularly on the use of Multiple Drug Therapy. The reorganization scheme of the Health Ministry also resulted in the slow down of leprosy control activities thereby affecting delivery of services. Individual personality traits and other psycho-social factors of P, SP and SI further contributed to the lag in service delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMedDate not supplied

Clinical and histopathological observations on pure neuritic leprosy.

Pure neuritic leprosy is a well accepted clinical entity. In the absence of skin lesions there is a greater possibility of missing the diagnosis of leprosy due particularly to a wide variety of pure neural manifestations that may mimic other peripheral neuropathies. Histopathological studies of pure neuritic leprosy have received less attention for ethical reasons and limitations of surgery. Classification of pure neuritic leprosy poses problems since the histological spectrum (e.g. Ridley-Jopling scale) is based chiefly on the skin picture. Review of the past literature shows conflicting reports about comparability of the skin and nerve pictures. This paper presents clinical and histopathological observations on twelve patients of pure neuritic leprosy, the interesting observations being that all the patients showed lepromin positivity and a narrower histological spectrum, ranging from TT to BB only.

Adolescent↗
PubMed1987

[Differential diagnosis of leprosy in developing countries--the skin and oral cavity].

There are some skin diseases which are frequently mistaken for leprosy and in consequence, often treated like it for a long period of time. The rate of false diagnoses is especially high in leprosy control programs of developing countries. However, a wrong diagnosis of leprosy can mean psychological disaster to the patient because of the stigma still attached to leprosy. According to the literature and our own observations in Sierra Leone, Ethiopia, and the Sudan, we present data on the differential diagnosis of leprosy concerning the skin and oral cavity.

Developing Countries↗
PubMedDate not supplied

Clinico-histopathological evaluation of modified pilocarpine test in early diagnosis of leprosy.

Modified pilocarpine test was done in 112 patients of which 89 cases were under investigation (Group I) and 23 cases were confirmed tuberculoid leprosy cases (Group II). In group I, 70 cases (78.6%) showed deficient sweating of varying degree and 36 cases (40.4%) showed definite histopathological changes of paucibacillary leprosy in skin. 22 cases (95.6%) in Group II showed deficient sweating. 24 cases under investigation who had deficient sweating but did not show definite histopathological changes of leprosy initially were followed up for one year and at the end of one year 10 cases (41.6%) showed confirmatory changes of leprosy on histopathological examination. The modified pilocarpine test has been found to be a simple and very useful test in early diagnosis of leprosy.

Humans↗
PubMedDate not supplied

Correlation between serum choline esterase and serum albumin in leprosy.

The clinical material included 255 cases of leprosy consisting of Tuberculoid leprosy (74), Lepromatous leprosy (116), Lepromatous leprosy with lepra reaction. Liver biopsy could be performed on 50 cases of Lepromatous leprosy. Specific granulomatous changes and parenchymal cell damage were the significant findings. Serum choline esterase and serum albumin are synthesized in liver. Serum Choline esterase levels in the present study decreased abruptly with exacerbation of the disease but the serum albumin levels declined gradually and slowly. Possible hypothesis to explain the correlation and uneven fall in activity is discussed at the cellular level.

Cholinesterases↗
PubMedDate not supplied

Epidemiological and clinical aspects of leprosy in Indian armed forces.

Epidemiological and clinical aspects of leprosy in 1911 cases of the disease in armed forces personnel were studied. Typewise distribution of cases was Tuberculoid 53.53%, Lepromatous 20.57%, Indeterminate 8.74%, Borderline 11.67% and Polyneuritic 5.49%. Maximum leprosy cases occurred in those belonging to Uttar Pradesh 17.11%. Maximum number of cases were detected (88.55%) in age group 20-39 years. Incidence of leprosy increased with increased years of service. 11.82% patients were illiterate. 89.85% patients earned Rs. 200 to 499 per month. 56.08% patients had no landed property. Houses of 47.29% cases were located in congested areas. 68.23% patients had to support larger families. In 95.94% cases no family members were examined for leprosy. Diet, smoking and alcohol appear to have had no relation to disease in cases studied. Clinical presentation of cases was classical and typespecific. Skin eruption and loss of sensation were the commonest symptoms. Leprosy lesions were detected on almost all parts of body. Thermal sensation was the commonest modality lost. Ulnar, lateral popliteal and greater auricular were the frequently affected nerves. Amongst complications paralytic deformities were common (16.09%). 545 complications were detected in 1911 cases. While 84.29% patients had put in more than 4 years of service, the source of infection was known only in 0.57% positively (intrafamilial).

Adolescent↗
PubMed1985

Geographical variations in the occurrence of leprosy: possible roles played by nutrition and some other environmental factors.

The considerable variation in leprosy prevalence among 35 villages and field areas in South India was compared with variations in their socioeconomic and nutritional conditions. Using villages/field areas and aggregates thereof as observational units, leprosy prevalence rates were found to be significantly lower in field areas than in villages. Moreover, there was a significant correlation between the occurrence of malnutrition in children 1 to 4 years of age and the prevalence of leprosy. The possible association between the occurrence of malnutrition in childhood and leprosy is discussed in light of the present knowledge of leprosy, immunocompetence, and malnutrition. Strategies for further illumination of the hypothesized importance of malnutrition among children are discussed.

Body Height↗
PubMed1985

Serological survey of leprosy and control subjects by a monoclonal antibody-based immunoassay.

A serological antibody competition test (SACT) using a murine anti-Mycobacterium leprae-specific monoclonal antibody (ML04) has been evaluated in 96 untreated leprosy patients and 128 control subjects. The test is based on the competitive inhibition by antibodies from human test sera of the binding of the specific 125I-ML04 murine monoclonal antibody to M. leprae soluble antigen coated microtiter plates. Along the spectrum of the disease, SACT positivity was observed in 100% of LL-BL, 87.5% of BB, and 46.7% of the TT-BT groups of patients. Moreover, 46.4% of apparently healthy household family contacts of multibacillary leprosy cases were also antibody positive. Sera from 15 contacts of paucibacillary leprosy cases as well as from 85 various nonleprosy subjects (tuberculosis, autoimmune disease, cancer, and healthy) were all found to be negative. These results satisfy the requirements of a leprosy-specific serodiagnostic test. The striking increase of antibody titer in all of the LL/BL patients indicates a potential prognostic utility of this test for the lepromatous shift of the disease. The observed positivity in a fraction of healthy leprosy contacts still requires prospective evaluation of disease incidence in a larger test sample.

Antibodies, Bacterial↗
PubMed1985

In vivo responses to Mycobacterium leprae: antigen presentation, interleukin-2 production, and immune cell phenotypes in naturally occurring leprosy lesions.

To investigate the immune defect in lepromatous leprosy we studied immune cell phenotypes, lymphocyte activation states, and interleukin-2 (IL-2) production in naturally occurring leprosy skin lesions. Mouse hybridoma monoclonal antibodies reacting with the IL-2 receptor (anti-Tac), unbound IL-2 (DMS-1), antigen-presenting Langerhans' cells (OKT6) and the OKT4-Leu3 and OKT8 T-lymphocyte subpopulations were used with indirect horseradish peroxidase and alkaline phosphatase techniques on frozen biopsy sections. The percentage of Tac+ lymphocytes and the number of OKT6+ cells in the epidermis and dermal granuloma were significantly correlated in naturally occurring lesions (correlation coefficient 0.79) and were higher in tuberculoid than in lepromatous lesions. Leu3 antigen was expressed by 70-90% of Tac+ cells in tuberculoid lesions. Although the percentage of cells producing IL-2 was low in lesions of both lepromatous and tuberculoid patients, it was about 15 times greater in tuberculoid than in lepromatous lesions (0.032 +/- 0.037 tuberculoid vs 0.0019 +/- 0.023 lepromatous). There was an association between the number of OKT6+ cells and the percentage of IL-2-producing cells, but the association was weaker than that of OKT6+ cells and the percentage of IL-2 receptor-bearing cells (r = 0.2), implying that IL-2 production is not an intervening variable in the latter association. The absolute number of OKT4-Leu3+ lymphocytes was significantly different in different clinical leprosy groups and was positively correlated with host resistance (mean OKT4-Leu3+ cells/mm2 in 6 micron sections; 1412 +/- 288 tuberculoid, 400 +/- 93 borderline lepromatous, 200 +/- 100 polar lepromatous; r = 0.95). Absolute numbers of OKT8+ cells/mm2 in lesions were not significantly different. We conclude that there is a relative paucity of OKT4-Leu3+ cells as well as IL-2-producing cells at the local level in lepromatous leprosy lesions. Possible functional relationships between these findings and the failure of macrophage activation and destruction of Mycobacterium leprae in lepromatous leprosy are discussed.

Adolescent↗
PubMed1985

[Leprosy--observations, experiences, problems].

From the field of view of own observative and experiences was tried to outline the present situation in leprosy. It is referred to the results of the modern epidemiological, bacteriological, immunological and medicamentous leprosy research which was particularly stimulated under the impression of the increasing DDS-resistance of the leprosy bacteria. At present ambulatory polychemotherapy, sometimes combined with a vaccination technique, is in the centre of the world-wide combat programme against leprosy. In no other infectious disease, however, social-economical points of view are so important as in leprosy and in the opinion of the author they are finally also decisive for an actually successful and permanent combat.

Diagnosis, Differential↗
PubMed1973

Immunological problems in leprosy research. 1.

This Memorandum reviews the present status of knowledge of the immunology of leprosy, with particular attention to developments since the publication of a similar review in 1970. The different types of lepromin reaction and their significance in healthy contacts and in patients with tuberculoid and lepromatous leprosy are discussed. The immunological responsiveness of patients with leprosy is also considered, with special attention to in vitro methods for evaluating this response. Part 2 of the Memorandum will cover possible mechanisms of altered immune response in leprosy (including a tentative scheme to explain the possible genesis of the lepromatous lesion); genetic, nutritional, and hormonal factors; the possibility of vaccination; attempts at immunotherapy; and areas in which further research is needed. A detailed protocol for evaluating the effect of transfer factor in leprosy will be included as an annex.

Antibodies, Bacterial↗
PubMed1979

Immunological assessment of sera of leprosy patients.

IgG levels were significantly high in sera of all types of leprosy. House-hold contacts of lepromatous leprosy (LL) cases also showed significantly higher values for IgG when compared to that of control. Except polar tuberculoid (TT) cases and house-hold contacts other types of leprosy revealed a significant rise in IgA levels in their sera. IgM was only raised in borderline tuberculoid (BT) cases. C-reactive protein (CRP) was present in the sera of all types of leprosy. Highest positivity (97%) was shown by sera from erythema nodosum leprosum (ENL) cases. Rose-Waaler antibody (RA) was noted in BT, borderline leprosy (BL), LL and ENL cases. Significance of these findings is discussed.

C-Reactive Protein↗
PubMed1979

The association of leprosy and pulmonary tuberculosis.

The association of leprosy with pulmonary tuberculosis was seen in 20 cases during January 1972 to October 1977. Of these 20 cases, 15 were of lepromatous, 3 of dimorphous and 2 of tuberculoid leprosy. Maximum number of cases were from 3rd decade of life with male to female ratio of 3 : 1. Patients were suffering from the disease for a very long time (8 cases of lepromatous leprosy with duration of illness 10-15 years). The symptoms of leprosy seemed to have preceded to the symptoms of pulmonary tuberculosis. Duration of tuberculosis in most of them was within 6 months (55%). The predominent presenting symptom was cough with expectoration (100%) and fever (80%). Anaemia (75%) and crepitations (60%) were the presenting physical sign mainly. Radiologically bilateral extensive pulmonary lessons were seen in 14 cases (70%). Sputum for acid fast bacilli was positive in 80% of cases. The general condition and nutritional status was poor and death was resulted in 4 cases (3 of lepromatous and 1 of dimorphous leprosy).

Adolescent↗
PubMed1972

Some aspects of the pathogenesis and pathomorphology of leprosy.

The results of bacteriological and histological examinations of the organs of mice infected in the footpad with human leprosy bacilli by the Shepard method are summarized. The periods of observation ranged from a few days to 2 years. The disease developed in mice as a chronic infection with a lengthy "incubation" period of 3-4 months or more without symptoms. Usually about 2 years after inoculation, or in some cases after a shorter interval, the disease became generalized. Different types of tissue reaction occurred: simple inflammatory infiltration, tuberculoid granuloma, and leproma-like granuloma, similar to the clinical types of leprosy in man. When the infection became general, cells resembling lepra cells formed in the internal organs and at the site of infection. These cells contained massive intracellular aggregations of mycobacteria and compact globi with lipids and a vacuolized protoplasm, similar in origin and morphology to the lepra cells in human lesions. Changes were found in the neuroreceptor apparatus of the skin of the mice, with groups of leprosy bacilli in the endoneurium, the Schwann cells, and the perineural spaces. The length of the experiments and the histological examination of material from the sacrificed mice at different stages of the infective process revealed biological parallels with human leprosy and threw light on a number of aspects of the pathogenesis of leprosy.

Animals↗
PubMed1979

A study of serum fibrinolytic activity in leprosy.

Fibrinolytic activity was studied in 50 patients of leprosy and 30 healthy individuals who served as control. Fibrinolytic activity was determined by measuring euglobulin lysis. No significant alteration in fibrinolytic activity was observed in patients with non-lepromatous leprosy, the levels being approximately similar to control group. However, fibrinolytic activity was found to be significantly decreased in patients of lepromatous leprosy and lepra reaction group. The observed decrease in fibrinolytic activity can be explained on the basis of presence of tissue destruction and vasculitis seen in leprosy more so in patients with lepromatous leprosy and lepra reaction.

Adult↗
PubMed1969

Immunological aspects of leprosy with special reference to autoimmune diseases.

Leprosy, particularly lepromatous leprosy, is associated with a multitude of (auto) immune aberrations, and its clinical features also have much in common with the collagen diseases. Immunopathological studies of the 2 groups of diseases may thus elucidate the basic mechanisms of both.The reported evidence for a genetically determined hyporeactivity of cell-mediated (CM) immunity in lepromatous subjects is reviewed; most, but not all, of the findings fit such a hypothesis well. The possibility remains that the observed hyporeactivities may be secondary to direct effects of Mycobacterium leprae. Evidence for a general hyperreactivity of the antibody-mediated (AM) immunity in lepromatous leprosy is then reviewed and considered to be fragmentary.The concept and general criteria of autoimmunity are discussed briefly and the high incidence in lepromatous leprosy of various (auto)immune aberrations, resembling those in systemic lupus erythematosus (SLE) and in rheumatoid arthritis is reviewed. Although autoantibodies are not likely to be directly deleterious to the host, immune complexes containing autoantibodies may be pathogenic.Mixed cryoimmunoglobulins, consisting of 2 (IgG-IgM or IgG-IgA) or 3 immunoglobulins, and occasionally also containing measurable amounts of complement components, have recently been encountered in SLE and its variants and also in a number of microbial diseases with autoimmune features (syphilis, streptococcal nephritis and endocarditis, mononucleosis, Mycoplasma pneumoniae pneumonia). They may represent circulating immune complexes, analogous to the IgM (IgA) rheumatoid factors in combination with their IgG reactants. In leprosy also, the existence of pathogenic immune complexes is indirectly suggested by mixed cryoglobulinemia and further by a number of other features reviewed in this article.

Autoimmune Diseases↗
PubMed1979

Serum calcium and magnesium in leprosy.

Serum calcium and magnesium were studied in 70 leprosy patients and 25 normal healthy individuals. An attempt has been made in this study to find out if there is any correlation between the clinical and pathological status of the disease and serum calcium and magnesium levels in the blood. Serum calcium was found to be significantly decreased in lepromatous leprosy (Ca=8.42+/-0.7 mg%, P less than 0.001) and dimorphous leprosy (Ca=8.68+/-0.94 mg%, P less than 0.05) while it was normal in tuberculoid leprosy (Ca=9.14+/-2.12, P less than 0.05). The decrease in serum magnesium level was highly significant in all clinical types of leprosy (Mg=1.08+/-0.29, P less than 0.001).

Adolescent↗