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PubMed2003

[The history of Yunosawa village and the policy of leprosy of Japan III].

There was a village which was called Yunosawa, lots of leprosy patients lived, existed from 1887 to 1941, Kusatu town, Gunnma Prefecture, Japan. It was the only place continued securing self-government to the last as area was free from the isolation policy of State in prewar days there. The aim of this study will make clear the dynamism of "The protection from the tension of the society of leprosy patient currently persecuted" to "The defense of the society from the leprosy patient who is a source of infection". In this study, explained the history of the Yunosawa village and the shift of the policy of leprosy by State had relation to the village. In addition, showed worth of free medical-treatment area here.

Health Policy↗
PubMed2003

[The history of Yunosawa village and the policy of leprosy of Japan. II].

There was a village which was called Yunosawa, lots of leprosy patients lived, existed from 1887 to 1941, Kusatu town, Gunma Prefecture, Japan. It was the only place continued securing self-government to the last as area was free from the isolation policy of State in prewar days there. The aim of this study will make clear the dynamism of "The protection from the tension of the society of leprosy patient currently persecuted" to "The defense of the society from the leprosy patient who is a source of infection". In this study, explained the history of the Yunosawa village and the shift of the policy of leprosy by State had relation to the village. In addition, the effort of residents and Christianity persons' activity are drawn in this paper. Moreover also drew what is desired how it is going to live under adverse circumstances, and showed worth of free medical-treatment area here.

Charities↗
PubMed2003

[A case suspected multibacillary leprosy].

The presence of acid-fast bacilli in the lesion and its positive culture usually provide the diagnosis in cutaneous mycobacteriosis. But in diagnosis of leprosy, characteristic clinico-histopathological findings are so important as the demonstration of the organism, because of the failure to grow Mycobacterium leprae in vitro. It is classified in various forms along a spectrum of infectious and immunological symptoms supported by the pathogen-host relationship. The patient was a Japanese woman 69 years of age. She had been diagnosed as multibacillary leprosy with the positive results of slit-smear tests and the confirmation of the genomic sequence by PCR. Multidrug therapy had been started, but it was discontinued afterwards because an exact diagnosis of leprosy could not be determined by clinical, histological, and immunological assessment. As its diminishing prevalence in Japan, where ordinary physicians cannot have opportunities to see leprosy patients and they are unfamiliar with protean manifestations of the disease, it can be very difficult to make accurate diagnosis in those cases with atypical findings.

Aged↗
PubMed2005

[Current advances in leprosy research activities].

Due to the advent of multi-drug therapy (MDT) recommended by the WHO, for the treatment of leprosy, presently, leprosy is regarded as a "curable disease". The number of new cases in Japan is relatively very low, due to which the disease is likely to be neglected, but on scientific grounds, there is a necessity to perform in depth studies. Leprosy caused by M. leprae is still unclear on various aspects including transmission, immunology, nerve damage etc. Here we introduce the recent advances in the field of basic leprosy research.

Animals↗
PubMed2006

[Leprosy services following elimination in WPRO and SEARO regions].

The elimination of leprosy with the advent of multidrug therapy (MDT) is one of the success stories in public health. Elimination will be achieved in the regions of Western pacific and South-East Asia in near future. A biregional consultation between the WHO South-East Asia and Western Pacific regions was held in the end of 2004 in Manila, the Philippines. A strategy document was developed during the consultation, to sustain quality leprosy services in Asia and the Pacific beyond 2005, and to further reduce the leprosy burden. The main strategy involves timely detection of new cases, multidrug treatment, and the key element of integration of leprosy services into general health services.

Asia, Southeastern↗
PubMedDate not supplied

[Peripheral nerve lesions of experimental leprosy in monkeys. VII. Intrafascicular-edema and small blood vessels].

Histopathological findings of intrafascicular-edema found in n. ulnaris running at forearm, palmside of hand and fingers of rhesus monkey 8664 and african green monkey 8175 were studied by semithin section method. These two monkeys were inoculated with leprosy bacilli from lepromata of mangabey monkey A022. The mangabey monkey A022 had been experimental leprosy after inoculum of the leprosy bacilli from lepromata of the mangabey monkey A015-natural infection. Period between date of inoculum and sacrifice of the rhesus monkey 8664 was about 2 years, and the african green monkey 8175 was about 5 years. Results found were: 1. Intrafascicular-edema found in n. ulnaris running at forearm, palmside of hand and fingers was remarkable at some of peculiar anatomical areas where were put on mechanical pressure. 2. The intrafascicular-edema inside many fascicles was remarkable around the small blood vessels. 3. Obsruction of the small blood vessels and congestion of blood stream at surrounded of the intrafascicular-edema with fibrous elements and cellular elements were observed inside some of fascicles. 4. Bundles of peripheral nerve fibers inside some of fascicles were pressed by the intrafascicular-edema, and the fibrous elements, especially collagen fibers, were increased around the pressed bundles of nerve fibers and each nerve fiber inside the fascicles. 5. Vacuolar degeneration and swelling of axon were observed at some of myelinated nerve fibers. 6. Not only the intrafascicular-edema but also a large amount of intracytoplasmic foamy structures with solid leprosy bacilli were observed inside many fascicles.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Immunopathological stain of lipoarabinomannan-B (LAM-B) for diagnosis of leprosy.

We developed an immunopathological staining of LAM-B antigen in formalin-fixed paraffin-embedded tissues, and compared it with, PGL-I immunostaining, Fite Faraco's stain and periodic acid carbol pararosaniline (PACPR) stain. Out of the total 28 leprosy cases, 27 were positive to LAM-B immunostaining while 23 were positive to PGL-I stain. Fite's stain was positive in 21 cases while PACPR stain was positive in 24 cases. In scrofuloderma, LAM-B antigen was observed only in the granuloma while no other positive findings were noted with other stains. Normal skin did not give any positive findings with any of the stains. Other dermatoses showed no positive findings to any of the stains tested. LAM-B staining was observed in the nerve even in the absence of bacilli in leprosy tissues. Presence of LAM-B in the cutaneous nerves is helpful in discriminating leprosy from other mycobacterioses. Considering the high sensitivity of LAM-B and the predilection of M. leprae for the nerves, we concluded that LAM-B staining can be a useful new tool in the prompt diagnosis of leprosy, especially in suspected or early cases.

Diagnosis, Differential↗
PubMed1989

Eye lesions in leprosy.

Out of 742 out-patients screened for ocular disease, 177 (24%) had eye lesions due to leprosy. These were more in the lepromatous spectrum of the disease and showed increasing trend with age of patient and duration of the disease. Madarosis was the commonest lesion (76%). The serious and sight threatening lesions like lagophthalmos, corneal anaesthesia, corneal opacities and ulcers, iritis and complicated cataracts constituted 8.22% of the lesions. Blindness due to corneal opacity and complicated cataract developed in 6 patients, constituting 3.4% of eye lesions with a prevalence rate of 0.8% among all the leprosy patients. Although the blinding lesions occurred in a very small percentage of patients, most of these are preventable through early recognition and institution of appropriate treatment. The simple techniques of examination to detect potentially sight threatening lesions should be taught to all leprosy workers to prevent blindness among leprosy patients.

Eye Diseases↗
PubMed1990

The role of intrahousehold contact in the transmission of leprosy.

This study examines the role of intrahousehold contact in the transmission of leprosy using the case control methodology. The study was done in the leprosy control area of the Community Health and Development (CHAD) Programme of the Christian Medical College. Three age, sex and village matched controls were selected for each case. This study shows that persons with intrahousehold contact with leprosy have a higher risk of acquiring leprosy compared with those who did not (RR 2.509; 95% confidence limits 1.23-5.109).

Adolescent↗
PubMed1990

Epidemiological pattern of leprosy in Ethiopia: a review of the control programmes.

Leprosy control started in a limited area of Ethiopia in 1956. Extended coverage of the country was achieved in the early seventies. Review of the data from the control projects since 1976 revealed that leprosy is a disease of the Ethiopian highlands where prevalence rates as high as 7 per thousand have been recorded in some provinces, while the cumulative national average for the last 13 years was 2.6 per thousand. The paucibacillary form was predominant. However, unlike other African countries, a relatively high proportion of multibacillary leprosy was found in Ethiopia. The male-to-female ratio was 2:1 with the highest prevalence in the 15-44 years age bracket. Detection rates for new cases have shown a gradual decline since 1982, a year before multiple drug therapy (MDT) was introduced into the country. For the last 5 years the number of new cases has stabilized at 4700/year. These trends probably reflect a general reduction in the prevalence of leprosy in the country, while the conspicuous decline in 1982 is most likely related to discharge of cases during screening before MDT. The new villagization policy of Ethiopia with its effective reorganization of the populations is believed to make control programmes and supervision of MDT easier and presumably more effective. Similarly, more reliable prevalence and incidence studies could be undertaken with success.

Adolescent↗
PubMed1991

The protective effects of methyl cellulose and conoid shields for lagophthalmos and corneal hypaesthesia in leprosy.

Lagophthalmos and corneal hypaesthesia are amongst the most frequently encountered lesions in leprosy and they can easily give rise to blindness. Many measures (such as eye drops, protective conoid shields, muscle exercises, surgical treatment etc.) have been used to protect the eyes under such circumstances and this paper examines the protective role of methyl cellulose and conoid shields in 41 patients. All of them had lagophthalmos (5 mm or more) and corneal hypaesthesia. They were divided into three groups. Group one had 15 leprosy control patients (27 eyes) who did not use methyl cellulose or eye shields. Group two had 16 leprosy patients (28 eyes) and they used methyl cellulose and eye shields when they felt discomfort in their eyes. Group three had 10 leprosy patients (17 eyes) and they used methyl cellulose and eye shields regularly. Statistically significant improvement was seen in group three. Further studies on larger groups of patients including the effects of different concentrations of methyl cellulose, on Schirmer test and tear break up time, may be of value.

Adult↗
PubMed1991

ALERT-India 1981-89: nine years' experience of leprosy control in the slums of Bombay.

Bombay has a population of about 8 million people, one-half of whom live in slums. In 1981, ALERT-India started its first leprosy control project in N, S and T Wards of Greater Bombay Municipal Corporation covering an area of 122 sq km in the north-eastern suburbs of Vidhyavihar, Ghatkopar, Vikhroli, Kanjurmarg, Bhandup and Mulund, with a total population of 1,100,000 according to the 1981 census. In the 9 years of operation, over 12,000 patients have been registered and treated and of these 7425 have been released from treatment, having satisfactorily completed courses of chemotherapy. However, over 1000 cases are still identified every year by house-to-house or school surveys, or by self-reporting, including a considerable percentage in children. The origin, development, staff structure, operational procedure, administration and recording system of ALERT-India are described in detail, with emphasis on what has been accomplished with purely outpatient facilities, using paramedical workers, all of whom have received inservice training from Government recognized training centres for their specific tasks. The account includes a brief description of an expansion of the organization's work into townships in New Bombay, where preliminary surveys in 1988 confirmed the presence of leprosy cases and the need for treatment facilities. The discussion addresses: 1, the better use of the large volume of statistical information which has been collected by ALERT-India during the past 9 years, with emphasis on its value in assessing the impact on the control programme and modifying future policy; 2, the need to radically examine the present policy of survey, versus an 'education campaign approach' with regard to increasing early case-detection and self-reporting; 3, the establishment of a central coordinating body for leprosy control in Bombay to exchange information, coordinate efforts and formulate a future plan of action, the latter in association with the National Leprosy Eradication Programme; and 4, the development of a health education resource centre in association with the Bombay Municipal Corporation.

Health Services↗
PubMed1992

Considerations in the integration of eye care into leprosy care services.

Little attention has been directed to the development, management and evaluation of eye care programmes for leprosy patients. This paper examines when an eye care programme for leprosy patients is needed, methods for integrating eye care into leprosy control programmes and lists of available ocular leprosy teaching materials.

Eye Diseases↗
PubMed1992

Leprosy in French Polynesia. The possible impact of multidrug therapy on epidemiological trends.

In 1982, following the recommendations of a WHO study group, multidrug therapy (MDT) was introduced into French Polynesia to treat all patients suffering from active leprosy, and--only on request--those still on dapsone monotherapy. After 5 years, a clear-cut decrease of prevalence and mean annual detection rates for leprosy (except for detection rates among children aged less than 15 years, many of such cases being detected early by increased household contact training) has been observed. There was also a decrease in the proportion of newly detected cases with disabilities. During the 21-year period preceding the introduction of MDT into the control programme, mean annual detection rates for leprosy had remained stable, and this led to the consideration that such a decrease was due neither to the natural decline of the disease nor to the economic improvement of the country. Our results, together with the fact that, to date, the relapse rate was nil in the Polynesian patients put on MDT, strongly suggest that the implementation of MDT has resulted in a decrease of detection rates for leprosy which may be a consequence of a decrease in the transmission of the disease.

Clofazimine↗
PubMed1993

Distinguishing post-kala-azar dermal leishmaniasis from leprosy: experience in the Sudan.

In this study 4 patients were post-kala-azar dermal leishmaniasis (PKDL), whose lesions were similar to those of lepromatous and borderline leprosy, are described. In 2 patients there was no previous history of kala-azar but they were residents of an area of known endemic kala-azar. Lack of proper clinical and laboratory assessment was behind the failure to diagnose PKDL. Consequently the patients were treated with antileprosy drugs without proof of leprosy. The 3rd and 4th patients, though suspected clinically of leprosy, were correctly diagnosed as PKDL with adequate history, clinical assessment and appropriate laboratory investigations. The salient points in distinguishing PKDL from leprosy are described and discussed.

Adult↗
PubMed1993

Human immunodeficiency virus and leprosy.

In summary, clinical leprosy does not appear to be more frequent in HIV-positive than in HIV-negative people in areas where both infections are endemic. There is no evidence that the paucibacillary to multibacillary distribution of patients is altered by HIV infection. There are reports that neuritis is more severe in co-infected people, and that reversal reactions (or, at least, new lesions) may be more frequent after therapy; but these reports are either poorly documented or poorly controlled. In several ways, this lack of expected leprosy is similar to the patterns of other low-virulent infections in HIV-positive patients in the tropics, such as MAC infection, Pneumocystis carinii and cytomegalovirus infection. Despite the presence of the agents in the environment and/or in the human host, they are infrequently encountered clinicopathologically. This is in marked contrast to their importance in industrialized countries. One explanation, as yet unproven, is that HIV-positive patients in the tropics do not live long enough in states of severe immunosuppression to develop these infections. Perhaps the same applies to M. leprae infection, whose incubation period can be measured in decades and whose clinical course may evolve over years, in contrast to the common reactivation of latent, virulent M. tuberculosis infection with its high morbidity. There may also be an analogy between leprosy and infection with Plasmodium falciparum, Strongyloides stercoralis and Entamoeba histolytica: these infections are controlled (or at least influenced) by cell-mediated immunity and, theoretically, should be more frequent in HIV-positive people than HIV-negatives. In fact they are not, and leprosy may be regarded as another 'missing infection in AIDS'.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV Infections↗
PubMed1993

In leprosy the presence of mycobacteria in the nerve is an essential factor in the cycle and spectrum of Mycobacterium leprae infection.

A total of 220 untreated leprosy patients who underwent parallel skin and nerve biopsies are included in this study, which is intended to evaluate the extent of previously reported differences in bacillary load between skin and nerve lesions in leprosy and to describe the response of peripheral blood lymphocytes to Mycobacterium leprae antigens in such patients. In 161 patients out of the 220, the skin and nerve biopsies were diagnostic for leprosy. When patients were grouped according their skin and nerve lesions, the 3 groups observed were (1) paucibacillary skin and nerve lesions; (2) multibacillary skin and nerve lesions, and (3) paucibacillary skin and multibacillary nerve lesions. There was no observation of a group of patients with multibacillary skin and paucibacillary nerve lesions. In all patients with multibacillary nerve lesions, regardless of the type of skin lesions, a low response of peripheral blood lymphocytes to M. leprae was consistently noted. These results suggest that the bacillary load in the nerve is certainly one of the factors determining the immunological spectrum observed in leprosy.

Humans↗
PubMed1993

The effects of World Health Organization chemotherapy on imported leprosy in Auckland, New Zealand, 1983-90.

Between January 1983 and December 1990 in Auckland, New Zealand, 87 patients (28 paucibacillary disease (PBD) and 59 multibacillary disease (MBD)) commenced WHO multidrug therapy (MDT). All were immigrants from the Pacific Islands (65) or Asia (22). A total of 57 patients had already received non-WHO regimens, some continuously, but often intermittently, for many years; 30 patients received WHO MDT only. By December 1990, 50 had completed treatment, with 1 relapse and 1 late reaction, both in patients with PBD treated with WHO MDT only. There have been no relapses in those treated with WHO MDT after prior leprosy treatment. In those with MBD, type II leprosy reactions were less common (16%) in those treated only with WHO MDT than in those treated continuously before 1983 with older regimens (64%). Type I leprosy reactions occurred in about 20% of both these groups. The bacterial index fell faster in those who had had a prolonged prior treatment beginning WHO MDT than in those starting WHO MDT as their initial leprosy chemotherapy. Overall we found WHO MDT was well accepted and the compliance good, but 13 patients (15%) left Auckland before treatment was completed and 6 (7%) during follow up.

Asia↗