Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “LEPROSY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,495 records · Page 83Linked to original sources
PubMed1994

Evaluation of chemiluminescence, procoagulant activity and antigen presentation by monocytes from lepromatous leprosy patients with or without reactional episodes.

In this study, we evaluated the activity of peripheral blood mononuclear cells (PBMC), isolated from treated and untreated lepromatous leprosy patients, from lepromatous leprosy patients during and after reactional episodes (erythema nodosum leprosum (ENL) and reversal reaction (RR)), and from normal healthy individuals. We determined reactive oxygen intermediate (ROI) production, procoagulant activity (PCA) and HLA-DR antigen expression of monocytes, besides lymphoproliferation, both in the presence and absence of various stimulatory agents. Phorbol myristate acetate (PMA) stimulated ROI production by monocytes from all the groups studied, with patients during reactional episodes (ENL and RR) showing a significantly higher response (p < 0.009 and p < 0.00001). Irradiated Mycobacterium leprae, although having little effect when added alone, strongly suppressed PMA-stimulated ROI production. Muramyl dipeptide (MDP) had no influence on either basal or on PMA-induced ROI production. Basal monocyte PCA, as well as M. leprae or concanavalin A (ConA)-induced monocyte PCA was comparable in monocytes from all the groups studied. ConA was able to induce mitogenic activity in mononuclear cells isolated from all the groups studied. M. leprae, although stimulatory for normal individuals, did not induce lymphoproliferation in lepromatous leprosy patients, except for cells from patients during RR, which responded equally to M. leprae and to ConA. The absence of M. leprae-induced lymphoproliferation in lepromatous leprosy patients is not caused by the lack of basal HLA-DR expression, as PBMC from all individuals studied showed the same level of this antigen. Our results suggest an increase of spontaneous or PMA-induced monocyte activity, as detected by ROI production, during the reactional episode; addition of M. leprae suppressed this response. The increase in monocyte activity could be correlated with the increase of lymphoproliferation response to M. leprae during RR, but not during ENL. The importance of a possible immune suppressive action of M. leprae is discussed.

Blood Coagulation Factors↗
PubMed1994

Evaluation of a multidrug therapy programme of leprosy control.

MDT programmes for leprosy control have two objectives, controlling leprosy in populations and controlling leprosy in individuals. Evaluation of such programmes needs to address both objectives and this can be done by a review of the trends in key indicators and by site visits. Site visits are more expensive and should be done less frequently, but they can reveal issues not apparent in routinely produced statistics. Evaluation on an annual basis is the responsibility of programme managers and programme funders. Evaluation by programme staff themselves should be encouraged and supported. Evaluation of an MDT programme's effectiveness in controlling leprosy in a population should be by analysis of case detection as a proxy for incidence. Prevalence rates will continue to be monitored because of the WHO elimination goal, but these do not reflect disease transmission. Case detection is a proxy measure of incidence and depends on consistency in case detection activities. Case detection data by age, gender, mode of detection, disability ratio and lepromatous (MB) rate need to be analysed over at least 5 years and preferably 10 years to give an indication of trends in incidence. Caution is needed, however, as the pattern seen when case detection deteriorates may resemble the pattern expected when transmission is reduced. The site visit is important in this situation in allowing examination of the case detection activities, as well as in looking for new, undetected cases in the population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Immunoreactive antigens of a candidate leprosy vaccine: Mycobacterium habana.

Mycobacterium habana (M. simiae serovar-1) is a candidate vaccine for mycobacterial infections on the basis of the protection shown by this strain. We prepared 3 fractions of M. habana, i.e. the cell wall (CW), the cell membrane (CM) and the cytosol (CS). Protein antigens of these fractions were resolved by SDS-PAGE and subsequently probed with the sera of leprosy and tuberculosis patients and also antiBCG antibodies. We saw 3 major protein bands at congruent to 33 kD in the CW, congruent to 38 kD in the CM and congruent to 22 kD in the cytosol (CS) after coomassie blue staining of the gels. Pool leprosy patients' serum had identified proteins of congruent to 26 kD in CW, congruent to 35 and congruent to 18 kD in CM and congruent to 24 kD in the CS which have not been seen by the TB patient's serum pool. Pool serum of tuberculosis patients has identified 1 protein at congruent to 10 kD in the CW and a broad band between 20 and 24 kD and 1 at congruent to 4 kD in the CM which have not been visualized in the pool leprosy patient's serum lane. The proteins of M. habana which are recognized only by leprosy antisera or only by tuberculosis antisera could be exploited for developing diagnostic agents against these infections.

Antigens, Bacterial↗
PubMed1995

Assessment of the methods available for testing sensation in leprosy patients in a rural setting.

The aim of this study was to assess the efficacy, practicality and patient understanding of 5 methods used for testing sensation in leprosy patients, in a rural setting. The tests used were the WHO test, cottonwool, pin-prick, monofilaments and the biothesiometer. We concentrated on testing sensation in the hands, and the various tests were carried out on 75 patients and 32 controls, all taken from villagers living at Kindwitwi Leprosy Village, Tanzania. Our results showed that although the WHO test, cottonwool and pin-prick were all easy to use, cheap and well accepted they were not sensitive enough to be of any practical value. We found that the monofilaments, as well as being cheap and easy to use, had great potential value, as the 2-g monofilament could be used as a threshold value (indicative of leprosy, but not diagnostic) for protective sensation with a combined false-positive and false-negative value of only 4%. Finally, the biothesiometer was found to be a precise test that can accurately identify leprosy patients from controls and identify patients at risk of ulceration. It was, however, associated with its own problems, chiefly those of expense and its need of electricity, although we found this latter problem could be easily and relatively cheaply solved by the use of a solar powered recharger (Appendix).

Humans↗
PubMed1995

Classification of leprosy cases under field conditions in Bangladesh. II. Reliability of clinical criteria.

In 2 non-governmental organization projects 244 new leprosy patients in Bangladesh were classified in the field according to clinical criteria i.e. number of skin lesions and number of enlarged nerves. Comparison of these classification results with the results of skin smears and biopsies yielded a sensitivity (for detection of a MB case) of 92.1%, but the 'unconfirmed MB rate' amounted to 52.6%. In order to improve the reliability of the operational classification, several additional clinical criteria were investigated. It was found that neither the presence of anaesthesia in the skin lesions nor the presence of grade 2 disabilities or peripheral anaesthesia or voluntary muscle testing (VMT) impairment contributed to an improved classification. Counting the number of body areas showing signs of leprosy, which had proven very useful in other programmes, did not result in a more reliable classification in the 2 projects in Bangladesh. The presence of clinical signs of lepromatous leprosy, more specifically nodules or diffuse infiltration, could be a useful addition to the classification criteria. If the sensitivity must remain higher than 90%, the lowest 'unconfirmed MB rate' obtainable in Bangladesh, using clinical criteria only, is 46.4%, for a sensitivity of 91.0%. However, the inclusion of skin-smear results in the classification criteria could improve the sensitivity to 96.6% and lower the 'unconfirmed MB rate' to 40.3%. A reduction in MB overclassification will result in more efficient and more cost-effective leprosy control programmes.

Bacteriological Techniques↗
PubMed1995

Estimating the size of the leprosy problem: the Bangladesh experience.

Assessing the size of the leprosy problem in a country is an important but difficult issue for the purpose of programme planning. Different methods have been proposed but often estimates have proved to be very different from reality. We have attempted to address this issue in Bangladesh, a country where official estimates are more than 5 times greater than the registered number of leprosy cases. A combination of methods, including surveys, data from leprosy control programmes and local knowledge based on the Delphi techniques have been combined to construct an estimate of the total number of cases in Bangladesh. This figure (173,196) is only 10% greater than the official estimate (136,000). It will be possible over the next few years to see how close this figure is to reality through data obtained from the National Leprosy Control Programme which is now rapidly developing to cover the whole country.

Bangladesh↗
PubMed1996

Active surveillance in leprosy: how useful is it?

In this paper, active surveillance is compared with self-reporting as a method of detecting new nerve function loss in leprosy patients who have completed multidrug therapy (MDT). Five hundred and three patients were selected according to new surveillance guidelines in one part of the Danish-Bangladesh Leprosy Mission leprosy control project working area. Surveillance coverage of 71% was achieved in a 7-month period. During this time, 10 released-from-treatment (RFT) patients from among the study group were found to have acute nerve damage requiring prednisolone treatment. Out of the 10, only 2 were detected actively; the remaining 8 self-reported. It is concluded that health education given at RFT time is effective in motivating patients to self-report with acute nerve damage, and that the time spent on active surveillance could have been better used in other activities, i.e., case detection. As a result of these findings, active surveillance has been abandoned in the leprosy control project.

Bangladesh↗
PubMed1996

Health information systems for leprosy control programmes: a case for quality assessment.

A qualitative study was carried out aimed at checking the level of understanding and the actual use of the indicators recommended in leprosy control programmes by either the World Health Organization or the International Federation of Anti-Leprosy Associations. Two successive questionnaires were sent to 268 leprosy control programme managers. The first one concerned information about the main characteristics of the programme, the information system in operation, and the data regarded as indispensable or useful for programme monitoring. The respondents to the first questionnaire (n = 64) proposed an extraordinarily wide range of indicators, mainly ill-defined. The respondents to the second questionnaire (n = 37) to whom a limited list of precisely defined indicators was submitted did not succeed in reaching a complete agreement on any of these indicators. Although the question of programme monitoring has been dealt with at an international level for years, there is an urgent need for a real agreement of international agencies and managers of leprosy control programmes on the indicators to be used. Programme managers in the field are obviously open to the idea of greater intervention by international organizations to improve data collection and to encourage standardization of computerized information systems.

Communicable Disease Control↗
PubMed1996

Nerve function impairment in leprosy at diagnosis and at completion of MDT: a retrospective cohort study of 786 patients in Bangladesh.

This retrospective cohort study includes all new leprosy patients registered for multidrug therapy (MDT) in 1990 at the Danish-Bangladesh Leprosy Mission project in Bangladesh. The main objective was to determine the extent of nerve-function impairment (NFI) at diagnosis and at completion of MDT, and to identify opportunities for intervention and their relative impact on the prevention of disabilities (POD). A total of 786 patients were included; 486 males and 300 females. There were 315 PB, and 471 MB patients. In terms of the WHO leprosy disability grading system, at the time of diagnosis 31/315 (9.8%) had grade 1 or grade 2 disability in the PB group, and 177/471 (37.6%) in the MB group. The incidence rate of NFI during MDT was 3.5 per 100 person years at risk (PYR) in the PB group, and 7.5 per 100 PYR in the MB group. In the MB group 37 (7.9%) previously normal patients sustained NFI during MDT, whilst 19 (4.0%) with NFI at diagnosis showed complete recovery at completion of MDT. The most commonly involved nerves were the ulnar (motor function) and the posterior tibial nerves (sensibility). Reversal reactions were observed in 0.6% of the PB patients during MDT, giving an incidence rate of 1 per 100 PYR. The percentage of MB patients diagnosed with reversal during MDT was 14.2%, giving an incidence rate of 6 per 100 PYR. The percentage of MB patients diagnosed with ENL during MDT was 2.1%, with an incidence rate of 1 per 100 PYR. It was concluded that early detection of new cases of leprosy would prevent disabilities in more than 30% of all patients, thus having the highest impact in the quest for the prevention of disabilities. POD activities during and after MDT will prevent disabilities in approximately 10% of all cases. This study also indicates that treatment with prednisolone is effective and should be available at field level for all patients with recent NFI.

Adolescent↗
PubMed1997

Women and leprosy: a review.

Gender inequalities in health have a significant impact on women's health. In leprosy gender inequalities could be even more serious, as it is a highly stigmatized disease. A review has been made of the most recent literature dealing with gender and leprosy. First some data are presented on gender inequalities in rates of case detection, deformities and reversal reactions among leprosy patients. Then the major factors contributing to those differences are discussed. The paper ends with some recommendations for further research on gender and leprosy.

Female↗
PubMed1997

Study on the detection of leprosy reactions and the effect of prednisone on various nerves, Indonesia.

This paper presents a retrospective study on the detection of the treatment of leprosy reactions in a field situation, and the effect of prednisone on the various affected nerves. Two patient cohorts were analysed. The leprosy control programme in the testing area is not backed up by a specialized referral leprosy hospital, but patients are treated on an ambulatory basis at peripheral health centres by trained multipurpose health workers supervised by the health centre doctors. For operational purposes the guidelines and procedures for reaction management in the field were adjusted and partially simplified. In both studies it appeared that the time of the occurrence of severe reactions was the same: 80% or more of the severe reactions occurred in the first year of treatment, the majority in the first few months after the start of the multidrug (MDT) treatment. One third of all reaction patients suffered from a silent neuritis. Well-instructed fieldworkers proved to be competent in detecting and treating leprosy reactions. Treatment of severe reactions with prednisone in the field situation can preserve or considerably improve the functions of the affected nerves. It is interesting that often the motor function of a nerve was found to be impaired without any loss in sensibility, which was tested using the ballpoint pen method.

Anti-Inflammatory Agents↗
PubMed1997

Transmission and protection in leprosy: indications of the role of mucosal immunity.

Recent advances in treatment have achieved a large drop in the prevalence of active leprosy cases, but the incidence is at best decreasing slowly. Most people within leprosy-endemic populations have been exposed to Mycobacterium leprae, but few develop disease and it seems likely that the majority of the population develops protective immunity. If the site of initial infection is in the nose, dissemination of bacilli around the body to skin and nerve implies that the initial infection is bacilliferous and it has been shown that nasal M. leprae are detectable by polymerase chain reaction (PCR) of nasal swabs. Since salivary anti-M. leprae IgA (sMLIgA) levels are correlated with protection, we have surveyed groups of leprosy patients, contacts and the general population for both their sMLIgA and nasal PCR positivity. A total of 304 subjects were enrolled in the study: PCR and mucosal challenge tests were performed in 204 of these individuals. sMLIgA was present in 66% of treated patients, 76% of leprosy workers and 72% of healthy contacts. However, only 33% of indigenous subjects were sMLIgA+, in contrast to the earlier studies showing 74% positivity. PCR for M. leprae was present in both household contacts (2%) and indigenous controls (5%). In a subsequent follow-up study, nasal swabs were taken from 97 of those studied in the first series: three PCR+ individuals followed up after one year became negative, while of the remaining 94 PCR- individuals retested, 2 became positive. Of 112 subjects retested with the mucosal challenge test for sMLIgA: 22 converted from positive to negative and 12 from negative to positive. These results suggest that there is widespread subclinical transmission of M. leprae with transient infection of the nose resulting in the development of a mucosal immune response, despite the fact that few individuals will develop clinical disease. This may explain the current lack of effect of multidrug therapy (MDT) control programmes on incidence, although the reduction in general population immunity is consistent with some effect of MDT on transmission.

Adolescent↗
PubMed1998

Leprosy and renal transplantation.

Nine cases of leprosy in patients treated at a large renal transplant centre in South Asia are described. Three had leprosy diagnosed before transplantation and had either completed or were continuing chemotherapy at the time of transplantation. One showed exacerbation of undisclosed leprosy after transplantation. Five patients developed the disease for the first time 22 months to 12 years after transplantation. Immunosuppression did not adversely affect the treatment of leprosy in any of the patients though concurrent liver disease required cessation of rifampicin in one patient.

Adult↗
PubMed1998

The National Leprosy Control Programme of Zimbabwe a data analysis, 1983-1992.

Prevalence and detection rates of leprosy in Zimbabwe as well as patient characteristics were reported by the National Leprosy Control Programme over the 10-year period 1983-1992. The control programme made a new start in 1983 when multidrug therapy was introduced. Prevalence per 10,000 population declined steeply from 3.78 in 1983 to 0.52 in 1987. Prevalence continued to decline to 0.22 in 1992 and was highest in the north-eastern provinces. After an initial increase, the detection rate per 10,000 had declined from 0.19 in 1985 to 0.08 in 1992. The proportion of refugees among new cases had gradually increased since 1988 and amounted to one third in 1991 and 1992. An analysis of records of 802 cases who were newly detected from 1983 to 1992 showed that 51% were of the multibacillary (MB) type, 33% had visible disabilities at detection, 5% were under 15 years of age while the average delay time was 2.6 years. Patients with disabilities reported a longer delay time, were more often men and had more often the MB type of leprosy. The data suggest that transmission of leprosy is low but that cases are not diagnosed early enough to prevent transmission altogether.

Adolescent↗
PubMed1999

Knowledge, attitude and practice regarding leprosy and tuberculosis in Bangladesh.

A small survey was carried out in two areas of northern Bangladesh to assess and compare the level of knowledge, attitude and practice towards leprosy and tuberculosis (TB) among two communities that differed widely in the amount of health education received about these diseases. The results indicate that without a health education programme, levels of knowledge about the cause and treatability of the diseases are poor, worse for leprosy than TB, with correspondingly negative attitudes. Only 16% of the respondents in the 'uninformed' area mentioned 'skin patch' in a question about what they knew about leprosy; and only 44% mentioned 'cough' as a symptom of TB. In the area that had received health education, 90% mentioned, respectively, 'skin patch' and 'cough'. Seventy-eight percent of the respondents would not buy goods from a shopkeeper known to have leprosy, 76% if he had TB in the uninformed area; but in the community who had received health education the proportions were reversed, with three-quarters agreeing to purchase from a diseased shopkeeper. The implications of these findings for the DBLM and National Health Education programmes are discussed.

Bangladesh↗
PubMed1999

Increased levels of nitric oxide metabolites in urine from leprosy patients in reversal reaction.

We measured the metabolites of NO [nitrite (NO2-) and nitrate (NO3-)] in urine from Ethiopian patients suffering from leprosy. The urinary level of NO2-/NO3- in a group of healthy Ethiopians was 1020 +/- 471 microM (n = 22). Leprosy patients in reversal reaction had significantly higher levels of NO2-/NO3- (1817 +/- 492 microM, p < 0.001, n = 12) than both the control group and leprosy patients who were not in reversal reaction (1079 +/- 446 microM, n = 12). We conclude that the reversal reaction in leprosy in associated with increased urinary levels of nitric oxide metabolites.

Adult↗
PubMed1999

Factors associated with impairments in new leprosy patients: the AMFES cohort.

Data on the importance of the delay between onset of symptoms and registration as a risk factor for impairment are sparse. This study investigates the quantitative relationship between this delay, other risk factors and the impairment status in new leprosy patients. It reports on 592 new leprosy patients enrolled in 1988-1992 in the prospective ALERT MDT Field Evaluation Study in central Ethiopia (AMFES). The influence of the risk factors sex, age, delay, PB/MB classification in relation to BI, and prior dapsone treatment on the impairment status at intake is analysed. Estimates for the delay are based on patient recall. For the risk factors, odds ratios on impairment and on severity of impairment were calculated using both univariate and multivariate logistic regression. The registration delay was 2 years or more for 44% of new patients. The prevalence of impairment (WHO impairment grades 1 and 2 combined) increased continuously from 36% for new patients with a delay of 0-1 year to 81% for new patients with delays of 4 years or more. This prevalence also increased continuously with age; it rose from 26% in children to 80% for the age group 60 and over. In the multivariate regression, the odds ratios for new patients to be impaired were statistically significant for all delay categories (baseline 1-2 years) and age groups (baseline 15-29 years). No statistically significant differences in odds ratios were observed with respect to sex and PB/MB classification in relation to BI. Overall, 31% of new patients presented with WHO impairment grade 1 and 23% with grade 2. The risk on grade 2 also increased with the registration delay amongst the impaired new patients. Relatively few impaired males and relatively few impaired MB patients with a BI value of 3 or higher had grade 2 impairment. Registration delay and age are the main risk factors for presentation with impairment. Reduction of delay in central Ethiopia requires re-thinking of control methodologies. The search for ways to reduce delays in diagnosis and treatment should receive high priority in leprosy research and in leprosy control programmes.

Adolescent↗
PubMed1999

The stapedial reflex as a topographical marker of proximal involvement of the facial nerve in leprosy. A pilot study.

This study aimed to determine the parameters necessary for a study of stapedial reflexes in leprosy patients to ascertain if the facial nerve is involved more proximally than the stylomastoid foramen. It involved leprosy patients with and without facial nerve involvement and non-leprosy controls. Clinical examination of the patients' ears, a tympanogram and audiogram to exclude conductive and sensorineural deafness, followed by the measurement of a stapedial reflex and the acoustic reflex threshold, were carried out. The number of absent reflexes and the acoustic reflex thresholds did not differ between the three groups of subjects. A definitive study would be logistically impossible. Suggestions are made as to more exact patient selection in order to demonstrate any stapedial reflex changes due to leprosy. The findings of this study do not suggest that facial nerve pathology extends proximally to the stylomastoid foramen, unless such proximal involvement is subclinical to the detection methods used.

Adolescent↗