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PubMedDate not supplied

HLA antigen and susceptibility to leprosy.

Fifty-nine leprosy patients (31 tuberculoid, 28 lepromatous) have been HLA typed and compared to 125 healthy individuals who have had no known contact with leprosy patients in the past. HLA antigens were determined by the microdroplet lymphocyte toxicity method developed by Prof. Terasaki of UCLA. In order to detect 31 HLA antigens, a total of 58 antisera were used in a No. T-7 research tray. AW24 antigen showed the most remarkable deviation. The frequency of this antigen in leprosy patients was 25.4% and that in normal subjects of the control group was 63.2%. The difference in frequency between the two groups was statistically significant when the p value was corrected for the number of antigens being tested. Uncorrected p values of the BW39, A9, and B8 antigens were also statistically significant. Frequencies of the majority of HLA antigens in tuberculoid leprosy patients were similar to those of corresponding HLA antigens in lepromatous leprosy patients.

HLA Antigens↗
PubMedDate not supplied

The prevalence and pattern of leprosy in a school survey.

The prevalence of leprosy in a school survey conducted in Panaji, India was found to be 5.3 per 1,000 with males predominating. The majority of patients had a single lesion on exposed parts of the body showing the clinical characteristics of tuberculoid leprosy. However, clinical features of indeterminate leprosy were seen in two patients and borderline tuberculoid in a single case. On the other hand, histopathologically, the majority of the patients were classified as having borderline tuberculoid or indeterminate leprosy. A disparity between the clinical and histopathologic diagnosis was evident. This observation emphasizes the importance of studying both the clinical and histopathologic features in deciding the precise status of a patient in the leprosy spectrum.

Adolescent↗
PubMedDate not supplied

A leprosy health education project.

Results of a survey of knowledge and attitudes of the general public towards leprosy and knowledge, attitudes and practices of leprosy patients are reported. This survey is the base line for a health education project, based on social psychological theories of behavior, which is described. The results of the survey show that the general public has very little knowledge about leprosy; patients have more knowledge. Attitudes measured with a Likert scale are negative for the general public and only slightly positive for the patients. Allopathic treatment for leprosy is preferred by most, but many do not relate the "patch" to leprosy and therefore do not seek early treatment. In addition, many patients do not complete the treatment. There is much need for health education.

Attitude to Health↗
PubMed1977

[The "e" antigen (HBeAg) in leprosy].

Sixty-six sera from leprosy patients, 42 with lepromatous leprosy (l.l.) and 24 with tuberculoid leprosy (t.l.) were examinated for the presence of e-antigen and e-antibody by immunodiffusion. The test for e-antigen was negative in all leprosy patients; e-antibodies were found in only three patients (4.5%) with l.l., all carriers of hepatitis B antigen. The HBsAg test was positive in 23.8% of the l.l. cases and in 12.5% of the t.l. cases; the anti-HBs was present in 38.1% of the l.l. cases and in 41.6% of the t.l. cases. The results suggest the possibility that the leprosy patients positive for the surface B antigen represent a very low risk and can be considered as chronic asymptomatic carriers of HBsAg.

Adolescent↗
PubMed1983

Effect of treatment on antibody activity against Mycobacterium leprae antigen 7 in tuberculoid leprosy.

Anti-Mycobacterium leprae antigen 7 antibody activity was determined by radioimmunoassay during treatment in a longtime study of individual patients with newly diagnosed borderline tuberculoid (BT) leprosy and in BT leprosy patients who were suspected from their case histories to have dapsone (DDS) resistant leprosy. There was a strong correlation between clinical and antibody activity, and clinical improvement following treatment led to a marked decrease in antibody activity in most cases. A characteristic pattern of rapid and marked increase in antibody activity shortly after the initiation of treatment was observed in patients with newly diagnosed BT leprosy. This pattern may become of practical importance in the evaluation of patients with BT leprosy as an indicator that the therapy is effective, even though this pattern was associated with a transient increase in inflammatory activity in the skin lesions. The association of inflammatory activity with increased antibody activity strongly indicates that the underlying processes are associated with the stimulation of both humoral and cellular immune responses.

Antibodies, Bacterial↗
PubMed1984

Free subepidermal grenz zone (band of Unna) in lepromatous leprosy. Histological and ultrastructural findings.

Although the grenz zone is indeed free of typical leprosy cells with giant lysosomes, it is not free from leprosy bacilli--these are found in slightly infested macrophages and fibroblasts. For that reason, it would be much clearer if we simply called this region the subepidermal grenz zone of lepromatous leprosy. The subepidermal grenz zone is not pathognomonic of leprosy since grenz zones can be found in other diseases as well. Whereas the grenz zone is typical in lepromatous leprosy, it is not necessarily characteristic of the borderline or the tuberculoid form of the disease. The light and electron microscopical structure of the grenz zone shows that the formation of the subepidermal grenz zone cannot be explained by any particular pathogenetic principle on which therapy can be based.

Epidermis↗
PubMed1984

A study of blood ascorbic acid in leprosy.

The basal level of blood ascorbic acid was studied in 70 cases of polar leprosy. The level was found to be significantly reduced in both polar types, more so in tuberculoid. In untreated cases of these two polar forms, the differences were highly significant. No significant differences were found between untreated and treated cases of either form of leprosy, indicating that dapsone (DDS) has no effect on the ascorbic acid level. In lepromatous leprosy, the level was not affected by erythema nodosum leprosum (ENL). The deficiency of ascorbic acid in leprosy might be due to the disease per se and/or associated with nutritional factors. In trophic ulcers after supplement therapy for 60 days, the low level of ascorbic acid became close to the control group with marked improvement in the healing of the ulcers clinically. In addition, lactic and pyruvic acids were also measured and found to be significantly raised. After ascorbic acid supplement, the levels fell to near the control values, indicating that ascorbic acid played a role in controlling the infection as well as possible thiamine deficiency and also checked the disturbance caused by DDS on lactate and pyruvate metabolism. The present study suggested that supplementing DDS therapy with ascorbic acid might provide a beneficial effect on the general condition of the leprosy patients and the early healing of trophic ulcers.

Ascorbic Acid↗
PubMedDate not supplied

An approach to leprosy work in south Bombay--a preliminary communication.

The city of Bombay with its teeming eight million citizens is characterised by varied types of living pattern in its different parts and the approach to leprosy control work should be flexible to suit these facets of living conditions. Earlier reports (Ganapati and Girija 1979) have indicated the possibility of the successful application of techniques based on mass surveys in North Bombay where people belonging to low socio-economic strata live in somewhat organised slums or shanty towns. However, extreme South Bombay is marked by the paucity of such vast slums and one is struck by the more permanent multistoreyed housing structures. Living in commercial establishments as well as footpath dwelling are common. This presentation consists of an attempt to gauge the leprosy problems in this part of the city taking advantage of 425 patients registered at a leprosy clinic run in conjunction with the dermatology out patient department of a big general hospital over a period of 40 months. 212 cases (50%) hailing from South Bombay proper were the subject matter for analysis. 66% (140) belonged to progressive types of leprosy classifiable as BT through LL and of the Ridley-Jopling classification and 30.7% were bacteriologically positive. 42.9% of the patients had some degree of deformity. Males formed 80% of the sample and 76% were above 15 years of age. Analysis of duration of residence revealed that 68% were living in Bombay for over six years and 53.5% were residing in the city for 11 years or more. This finding is contrary to the expectation of leprosy patients in Bombay belonging to a "floating population". Attempts at field work revealed the following findings: Slum pockets being few (only four), patients were expected to live in residential buildings; but it was found that 25% of population were staying in work places. 17% were footpath dwellers and 18.9% shared their accommodation with people other than family members. 10.4% were domestic servants staying in the residences of their employees. The labour class constituted 50.5% the unemployed housewives group formed 21.7% and beggers 0.9%. 4.2% only were slum dwellers. Locating and examining contacts of patients was difficult as 42.9% could not be traced owing to faulty addresses or patients having changed residences or shifted to native places. Of the 111 patients (52.3%) contacted, 26.4% were living with families and 26.1% were staying alone or with others.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Treatment compliance by leprosy out-patients and its monitoring under field condition.

The widely experienced poor treatment compliance by leprosy out-patients has interfered with effective leprosy control and contributed to the problem of drug (dapsone) resistance. This paper summarises (1) the pattern of treatment compliance by rural and urban patients in a leprosy hyperendemic area, and (2) various methods to monitor the treatment compliance, especially under field conditions. Two simple methods of monitoring the dapsone intake by patients viz. "Physical verification of DDS tablets with patients" and "paper spot test", when applied together, by a field worker in the field, were found to be operationally very feasible, economical and acceptable; and had good correlation with each other. Thus these methods are recommended to be used on large scale in leprosy control programme. The paper spot test was found to be 98% reliable, when compared with DDS/Cr. ratio estimation. In addition, communities and patients be continuously educated about leprosy and its control; and for the optimal utilization of medical care services by patients, they should be organized in background of the consumers.

Aged↗
PubMedDate not supplied

Field follow-up of leprosy cases in an urban area.

To achieve effective case holding in SET programme "treatment reminder" through home visits by field personnel is of much importance as drug compliance of leprosy cases is known to be very poor in general. A field study was undertaken to followup (A) school detected 158 leprosy cases (B) patients residing within project area especially 350 infectious cases as well as those 329 patients taking treatment elsewhere (C) 28 infectious patients from outside control area. (A) 70% Children diagnosed as leprosy through earlier surveys were available. 14% were believed to be regular for treatment 78% patients did not go for treatment. From this untreated group 73% showed features ranging from marked improvement to total regression of lesions. (B) 22% smear positive leprosy cases registered for treatment who dropped out from treatment over a period of 5 years were followed up. 21% dropped out cases had left the control area and their whereabouts were not known. From a group of 329 patients living in the control area of the same project who were believed to be taking treatment elsewhere only 48% could be contacted. The rest of them could not be contacted for various reasons. (C) During home visits to 28 infectious leprosy cases coming from far away places 21% said that they were taking treatment elsewhere. The figures in this study indicate the need for planning priority oriented home visit programme according to local situations to maintain at least infectious cases under regular treatment in view of the multiplicity of drugs as per the recent recommendations from experts.

Child↗
PubMed1983

Utilization of medical agencies and treatment compliance by urban (Madras) leprosy patients.

The utilization of medical agencies and treatment compliance by 3880 leprosy patients registered with Govt. Leprosy Control Unit, Saidapet, Madras were studied. It was observed that 39% patients waited for 1.32 (+/- 1.75) years before medical consultation, for their negligence and unawareness of disease. About 16% and 4% patients consulted Gen. Hospitals and Private Practitioners, respectively. The leprosy clinics were most popular, 35% patients changed medical agencies. On an average, one patient had consulted 1.47 (+/- 0.51) medical agencies and 1.23 (+/- 0.52) leprosy clinics, for treatment of leprosy. Only 45% patient attended clinic regularly, others attended irregularly (22.5%) or discontinued (32.4%). The unsuitable clinic timing (morning) was an important factor for defaulting the clinics. Of the 2625 (67.66%) patients who attended last clinic, one patient had missed an average of 5.5 (+/- 8.3) DDS tablets in a month. The implications of findings and suggestions to improve the service utilization with good compliance by patients, are discussed in this communication.

Adolescent↗
PubMed1983

Field application of combined therapy for infectious leprosy cases. A feasibility study in Bombay.

The practical problems related to dapsone monotherapy for a prolonged period to infectious leprosy patients are well known to the scientific community and combined treatment of dapsone with clofazimine, rifampicin or prothionamide has been successfully carried out by several workers in hospitalised leprosy patients. The application of polytherapy in field condition was hindered by the cost of the drugs and fear of side effects. 42 infectious leprosy patients attending 5 field leprosy clinics in the slums of Bombay city were put on combined drug schedule. The drug compliance of these patients was judged along with their regularity in attendance at clinics by the persons in charge and periodic and frequent check up of urines. 27 (65%) were regular in treatment from the beginning, 8(19%) who were initially irregular after motivation and 7(17%) remained irregular through out the period. The urine samples collected from leprosy patients on monotherapy and attending the same centres revealed 31% irregularity in drug consumption. The study indicates that advocating combined therapy in field conditions by paramedical workers is quite feasible. The patients on multiple drugs are more regular in drug consumption as compared to monotherapy group. The frequent check up of urine for drug content and advice to patients who are irregular in treatment improve their regularity in drug consumption.

Adolescent↗
PubMed1983

Regional lymph node involvement in tuberculoid leprosy.

A study of regional lymph nodes in 44 cases of proved tuberculoid leprosy (BT & TT) is presented. Out of 26 cases of tuberculoid polar (TT) leprosy, 76.92% showed presence of paracortical lymphocytes, 61.52% showed presence of granuloma and 11.54% showed presence of acid fast bacilli in lymph nodes. In the borderline tuberculoid (BT) group, 61.1% showed granuloma, 72.22% showed presence of paracortical infiltration by lymphocytes and 11.11% showed presence of A.F.B. in lymph nodes. Lesions of tuberculoid leprosy have been conclusively demonstrated in the low resistant tuberculoid (BT) leprosy and polar tuberculoid leprosy (TT). The presence of paracortical lymphocytes in large numbers in the lymph nodes could indicate high cell mediated immunity (CMI) and possibly a tuberculoid end of the spectrum. The skin lesions and lymph nodes had comparative histopathology.

Adolescent↗
PubMed1982

IgA, IgM and IgG anti-M. leprae antibodies in babies of leprosy mothers during the first 2 years of life.

IgA, IgM and IgG anti-M. leprae antibody activity was estimated by solid phase radioimmunoassay in repeated serum samples from cord sera to sera taken 2 years after birth from 29 babies of mothers with lepromatous leprosy (Group 1) and 16 babies of mothers with tuberculoid leprosy and non-leprosy control mothers (Group 2). IgA anti-M. leprae antibody activity could be detected in 30% and IgM anti-M. leprae antibody activity in 50% of cord sera from Group 1, but not in any of the cord sera from Group 2. After birth, there was a significantly higher increase of IgA and IgM anti-M. leprae antibody activity in sera taken 3-6 months after birth from babies of Group 1 compared to Group 2, but the IgA and IgM activity in sera taken after 6 months of age showed the same increase in the two groups. IgG anti-M. leprae antibody activity showed a marked decrease in sera from both Groups 1 and 2 taken 3-6 and 6-9 months after birth compared to the activity in the cord sera. No increase of the IgG activity could be demonstrated even in sera taken 15-24 months after birth in any of the two groups. These findings are discussed in relation to possible transfer of M. leprae bacilli across the placenta, the influence of M. leprae and other mycobacteria exposure on the antibody activity, the poor IgG anti-M. leprae antibody response and subclinical leprosy infection in babies exposed to leprosy below 2 years of age.

Age Factors↗
PubMedDate not supplied

[Morphologic and biologic properties of diphtherroid organisms (LDC) isolated in leprosy].

Acid-alcohol-fast bacteria are not always detectable in all leprosy lesions. Non acid-fast microorganisms may be associated with acid-fast bacteria. The most frequently isolated strains from leprosy lesions are non acid-fast bacteria, morphologically related to C. diptheirae. Hence their designation as diphtheroïds or LDC (leprosy derived corynebacteria). Their antigenic structure is more closely related to M. leprae and other mycobacteria than to classical corynebacteria. This leads to the hypothesis of a potential role in the pathogenesis of leprosy and their use as an antigen for skin tests by leprosy patients.

Animals↗
PubMed1982

Pregnancy and leprosy: the consequences of alterations of cell-mediated and humoral immunity during pregnancy and lactation.

One hundred fourteen Ethiopian women with leprosy and 33 healthy women without leprosy were studied prospectively throughout 119 and 37 pregnancies, respectively, and followed up during lactation. Fifty-five women showed worsening of their leprosy status; in 31 (56%) this was observed during the third trimester of pregnancy. Forty women were diagnosed as having Type 1 lepra reaction; in 20 (50%) the first occurrence was during the first six months of lactation. Twenty-eight women had Type 2 lepra reaction, which in 19 (68%) first occurred during the third trimester of pregnancy or the first six months of lactation. These adverse effects of pregnancy on leprosy are thought to be associated with suppression of maternal cell-mediated immunity during gestation and recovery postpartum. Implications for the obstetrician, physician and leprosy health worker are discussed.

Antibody Formation↗
PubMedDate not supplied

Immunologic aspects of leprosy with special reference to the circulating antispermatozoal antibodies.

Macroscopic sperm agglutination in gelatin, sperm immobilization and tanned red cell hemagglutination tests could detect antispermatozoal antibodies respectively in 41%, 37%, and 23% sera of 35 leprosy patients, including 5 female cases. Interestingly, all of the above tests were positive in one serum from a female patient with borderline leprosy. Sperm antibodies were detected in both lepromatous and tuberculoid forms of leprosy by the above three technics and no significant difference was observed in their incidences among the two groups of patients. A three dimensional correlation was observed in 57% of 42 tests performed with 14 sera. Head-to head type of agglutination was the predominant feature of spermagglutination observed in the sera of these patients. In the control group, only 1 of 50 normal fertile male showed a positive spermagglutination test. Not one in this group showed positive sperm immobilization and tanned red cell hemagglutination tests. Antihuman globulin consumption test, presumably a very sensitive test, was also employed to demonstrate sperm-specific antibodies in the sera of these leprosy patients. These antibodies were adsorbed on the surface of the normal donor's spermatozoa when the latter were incubated with the patients sera. Antispermatozoal antibody could be demonstrated by this sensitive technic in the sera of two female patients. Moreover, antihuman globulin was consumed more intensely by the antispermatozoal antibodies present in the sera in the lepromatous than in the tuberculoid and borderline leprosy groups.

Adult↗
PubMed1980

Status of circulating "T" lymphocyte population in leprosy.

'T' lymphocyte population was estimated in 40 cases of various types of leprosy by E-rosette formation. The mean percentage value of T-lymphocyte was significantly low in lepromatous group as compared to tuberculoid and borderline leprosy. The mean percentage population of 'T' lymphocyte was also compared with 24 normal healthy control cases and significantly low levels were observed in all types of leprosy. The population of 'T' lymphocytes was also co-related with tuberculin tests in leprosy patients and healthy control cases. Lowest count of 'T; lymphocyte population and smallest diameter of erythema was observed in lepromatous leprosy, suggesting impaired cell mediated immunity in this group.

Female↗