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PubMed2000

A scholarship project for the children of leprosy patients in Turkey.

Most of the leprosy patients in Turkey live in the rural areas of Eastern and South-Eastern Anatolia. Those living in the suburbs of the big cities of the Western parts of the country have come there by immigration. Nearly all patients are very poor; they have no land, or only a small amount of soil for cultivation. The incidence of deformities in our patients is high, excluding them from regular employment and a source of income. In Turkey, it is obligatory to attend primary school, but after that education has to be paid for, and the poor families of leprosy patients find it difficult to continue the education of their children. As the 'Society for the Struggle Against Leprosy', based in the Istanbul Leprosy Hospital at Bakirköy, we have developed a project to enable patients to continue sending their children to school, whilst at the same time asking the mothers to seek advice and guidance on family planning. The outset objective of this project was to enable children and young people, who otherwise have almost no chance of continuing education, to pursue education at secondary, high school and university levels. It was envisaged that in the long term educated children would be able to find a job and provide effective care and support for parents and other members of the family. This paper describes the administrative and other measures adopted and the results of the project from 1995 to 1998, during which a total of 545 children have been supported at an overall cost of US$107,378. The scholarship project has so far been remarkably successful in Turkey and it is hoped that it may provide a model for similar approaches in other countries. An unexpected and extremely encouraging finding has been that females now exceed males in this project and are increasing at all levels, including university entrance.

Adolescent↗
PubMed2000

Pathogenesis of nerve damage in leprosy: genetic polymorphism regulates the production of TNF alpha.

Studies carried out over the last decade have strongly suggested that TNF alpha both overtly participates in the cell-mediated immune response against Mycobacterium leprae, and is overproduced during reaction. In addition, reactions are intimately related to the onset of nerve damage. Finally, TNF alpha has been implicated in the pathogenesis of many human and experimental autoimmune peripheral neuropathies that, as in leprosy, result in demyelination and axonal lesions. Because of recent findings associating human TNF alpha mutant alleles at the -308 position with increased production of TNF alpha in many immunological and infectious diseases, an investigation of the role of TNF2 in predisposing leprosy patients to reaction has been undertaken. Analysis of 300 patients with leprosy--210 multibacillary and 90 paucibacillary--has shown that the percentage of reactional patients was similar among both carriers and non-carriers of the TNF2 allele. However, a separate analysis of 57 carriers of TNF2 found that reactions occurred much more frequently among heterozygous than among homozygous patients. Moreover, the frequency of neuritis was somewhat greater among the heterozygous patients than among the non-carriers. Enhanced serum levels of TNF alpha have been noted in both TNF-1 and TNF-2 mutant patients in the course of leprosy reaction. Our observations to date suggest that other factors not related to the presence of the mutant gene may lead to the TNF alpha hyper-responsiveness observed during reaction.

Alleles↗
PubMed2001

Involvement of male genitalia in leprosy.

Four hundred and sixty-seven male patients with leprosy were screened for genital involvement. Genital lesions were observed in 6.6% of all male cases of leprosy. They were seen most frequently in lepromatous leprosy (25.8%), followed by borderline lepromatous (13.3%) and borderline tuberculoid (1.4%) leprosy.

Genitalia, Male↗
PubMed2001

Treatment outcome and impact of leprosy elimination campaign in Sokoto and Zamfara states, Nigeria.

A Leprosy Elimination Campaign (LEC) was implemented in 37 districts of Sokoto and Zamfara states, Nigeria from 13 August to 30 November 1998. The campaign utilized intensive community mobilization and training of local health personnel to detect hidden leprosy cases. During 8 weeks of case finding, 160,127 persons were screened; 353 new cases of leprosy were detected and placed on MDT; 236 (67%) of new cases detected were classified as MB, 64 cases (18%) suffered visible deformities and 24 patients (6.8%) were children. Follow-up in December 1999 of patients placed on MDT revealed 97% PB and 96% MB cure rates, respectively. Detection of cases in communities led some community leaders to ask for repeat surveys in their communities. Repeat surveys continue to yield new cases. The authors recommend that LECs be maintained for 3 years to accelerate leprosy elimination in the region. The cost effectiveness and impact of LEC in Sokoto-Zamfara are discussed.

Adolescent↗
PubMedDate not supplied

Comparative leprosy vaccine trial in south India.

This report provides results from a controlled, double blind, randomized, prophylactic leprosy vaccine trial conducted in South India. Four vaccines, viz BCG, BCG+ killed M. leprae, M.w and ICRC were studied in this trial in comparison with normal saline placebo. From about 3,00,000 people, 2,16,000 were found eligible for vaccination and among them, 1,71,400 volunteered to participate in the study. Intake for the study was completed in two and a half years from January 1991. There was no instance of serious toxicity or side effects subsequent to vaccination for which premature decoding was required. All the vaccine candidates were safe for human use. Decoding was done after the completion of the second resurvey in December 1998. Results for vaccine efficacy are based on examination of more than 70% of the original "vaccinated" cohort population, in both the first and the second resurveys. It was possible to assess the overall protective efficacy of the candidate vaccines against leprosy as such. Observed incidence rates were not sufficiently high to ascertain the protective efficacy of the candidate vaccines against progressive and serious forms of leprosy. BCG+ killed M. leprae provided 64% protection (CI 50.4-73.9), ICRC provided 65.5% protection (CI 48.0-77.0), M.w gave 25.7% protection (CI 1.9-43.8) and BCG gave 34.1% protection (CI 13.5-49.8). Protection observed with the ICRC vaccine and the combination vaccine (BCG+ killed M. leprae) meets the requirement of public health utility and these vaccines deserve further consideration for their ultimate applicability in leprosy prevention.

Adolescent↗
PubMed1976

Classification of leprosy from the clinical point of view.

While, according to some, classification of leprosy is primarily clinical, there should be no objection to the application of the advances made in the last decade in understanding the immunological and histopathological aspects of the disease, provided thereby the clinical classification can be made with more accuracy. Unlike most other diseases, the bulk of the process of attempts at diagnosis and classification of this disease is still in the hands of para-medical personnel in the field, and hence it is important that at the same time, an easily understood, uniformly accepted clinical classification should be recommended for field workers. While tuberculoid and lepromatous leprosy of the polar types can be diagnosed with accuracy even under field conditions, confusion generally arises with reference to the diagnosis or indeterminate maculoanaesthetic and borderline forms, and to identify some reacting lesions. Certain terminologies in vogue add further to the confusion. Reacting lesions are confused with active lesions. The importance of recognition of varieties of reacting lesions is stressed since the therapeutic management in such cases is entirely different. It is suggested that the early forms of leprosy characterised by paucity of cardinal features of the disease should be separated from the more established types and grouped under the term indeterminate leprosy. The diagnostic points to be taken into consideration in these lesions are discussed. The importance of investigating thoroughly before classifying patients who report rarely with neuritic symptoms without any evidence of skin lesion is stressed.

Adult↗
PubMed1999

Role of S-100 staining in differentiating leprosy from other granulomatous diseases of the skin.

Since Mycobacterium leprae are rarely demonstrable in the tuberculoid spectrum of leprosy, a confirmatory diagnosis of leprosy can be made on the basis of finding active destruction of cutaneous nerves by granulomatous inflammation in a skin biopsy. Immunoperoxidase staining for S-100 protein, which is a marker for Schwann cells, was used to delineate nerves in lesional skin biopsies of 25 patients with tuberculoid and borderline tuberculoid leprosy as well as 15 controls with nonleprous granulomatous inflammation. Four different patterns of nerve damage were observed: infiltrated, fragmented, absent, and intact. All of the nonleprous granulomatous dermatoses showed only intact nerves, either inside or outside the granuloma, and so S-100 staining can be used to rule out leprosy.

Diagnosis, Differential↗
PubMed1999

Dermal extracellular matrix in cutaneous leprosy lesions.

Thirty-eight biopsies of cutaneous lesions from leprosy patients [borderline tuberculoid (BT) 14, borderline lepromatous (BL) 18, lepromatous (LL) 6] were processed for staining of some extracellular matrix (ECM) components (collagen, proteoglycans, elastic fibers and fibronectin). Specific histological staining and the indirect immunofluorescence method with antibodies to collagen and fibronectin were utilized. The ECM of the normal dermis was strikingly modified in the inflammatory infiltrate. By Gomori's reticulin and anti-fibronectin immunostaining, replacement of the dense interlaced collagen fibers with a reticular mesh was observed in the infiltrate. The immunoreactivity obtained with anti-type I and anti-type III collagens showed positive fibrils and a lumpy pattern in the lepromatous and tuberculoid lesions with a higher amount in the lepromatous lesions. The lack of clear-cut boundaries between the normal dermis and the inflammatory infiltrate in the lepromatous (BL, LL) lesions was correlated with the blurred limits of the clinical lesions of this pole of the leprosy spectrum. Absence of elastic fibers in the infiltrate was a constant finding, and fuchsin-positive microfibrils were found in some infiltrates. The clear zone of lepromatous lesions was devoid of oxytalan fibers. Elaunin fiber rings around sweat gland acini were present even when the leprosy infiltrate was seen enveloping them. The original ECM is replaced by a newly assembled one, which is suited for the dynamic nature of the inflammatory process. The trophic effects of the ECM upon the cutaneous epithelial structures are modified so that atrophy and late degeneration ensues. These ECM modifications contribute, therefore, to the biological alterations of the skin functions in leprosy.

Biopsy↗
PubMed1998

IgG response to some mycobacterial antigens in selected leprosy patients.

Serum samples from selected leprosy patients with putative tuberculosis were tested by indirect ELISA to determine the level of IgG antibody against six mycobacterial antigen preparations. PCR-positive leprosy patients were confirmed with PGL-I ELISA. A ratio of antibodies to antigens of tuberculosis and leprosy was found to be a valuable serological marker for tuberculosis in long-treated leprosy patients.

Adult↗
PubMed1999

Histology and immuno-histology of lesions clinically suspicious of leprosy.

Forty-six patients presenting with lesions clinically suspicious of leprosy were selected among patients attending the outpatient department (OPD) of our Institute. The lesions were biopsied deeply for histological analysis. The cases chosen commonly belonged to the 20-35 years age group, were predominantly males, with rare cases of leprosy within the family (2/46, 4.35%). The clinical presentation in most of the cases was that of a solitary lesion, (44/46, 95.65%) located in one of the extremities (40/46, 86.95%). A positive Mitsuda reaction could be elicited in 40% of the cases. Routine histopathologic analysis using defined criteriae, has established the diagnosis of leprosy in 16/46 (34.78%) cases with positivity for acid-fast bacilli in 4 cases. The remaining cases (25/46, 54.35%) exhibited a non-specific histopathology with a perivascular/periadnexal mononuclear cell infiltrate, few (5/46, 10.86%) exhibited minimal or no histopathological features. The sections with nonspecific or minimal pathology when immunostained for the presence of mycobacterial antigen exhibited positivity in 11/30 (36.6%) cases. Presuming the features observed to be consequent to the presence of antigens nearby, the diagnosis of leprosy was significantly enhanced compared to the diagnosis achieved with routine histopathology alone.

Adolescent↗
PubMed1999

Recognition of phenolic glycolipid-I (Mycobacterium leprae) and sulfolipid-I (M. tuberculosis) by serum from Mexican patients with leprosy or tuberculosis.

SETTING: Differential diagnosis of leprosy and tuberculosis in regions where both illnesses are endemic is a prerequisite for proper identification and treatment. OBJECTIVE: To evaluate the recognition of phenolic glycolipid-I (PGL-I) of Mycobacterium leprae and sulfolipid-I (SL-I) of M. tuberculosis by serum from patients with leprosy (LL) or pulmonary tuberculosis (PTB). DESIGN: Purified PGL-I and SL-I were used as antigens in an ELISA test set up to assess recognition of these lipids by serum from 43 LL patients, 44 PTB patients and 38 healthy individuals. RESULTS: Leprosy patients gave higher IgM than IgG responses to PGL-I and had comparable IgM and IgG responses to SL-I. A similar situation was observed with PTB serum. Some healthy individuals were found to contain significant levels of antibodies to both lipids. CONCLUSION: There is no specific recognition of either of the two lipid antigens tested by serum from both leprosy and tuberculosis patients; this rules out the possibility of using PGL-I and SL-I as tools for the differential diagnosis of these two mycobacterial diseases.

Adolescent↗
PubMedDate not supplied

Significance of histopathological classification in leprosy.

A retrospective blind study was carried out on 2640 patients of leprosy to correlate the histopathological and clinical classification of leprosy using the criteria laid down by Ridley and Jopling. There was complete agreement between histopathological and clinical classification in 81.8% of the cases, with one step deviation in 5.1% of the cases. Histopathological diagnosis of indeterminate leprosy in high percentage (15.9%) as against 3.3% of indeterminate leprosy clinically in our series was an interesting feature. Type-wise correlation between histopathological with clinical classification was very high, it being the highest in LL (98%) followed by TT (97%), BT, BB and BL (95%, 89% and 87% respectively).

Adolescent↗
PubMed1999

Studies on risk of leprosy relapses in China: relapses after treatment with multidrug therapy.

Based upon the data from the Chinese National System for Leprosy Surveillance, this paper reports on the relapses in 47,276 leprosy patients cured by or released from WHO-recommended multidrug therapy (WHO/MDT). The overall relapse rate was 0.73/1000 patient-years (PY). There was a statistically significant difference in the relapse rates of WHO/MDT-MB (0.61/1000 PY) and WHO/MDT-PB (1.04/1000 PY) (chi 2 = 15.7, p < 0.01) patients. For multibacillary (MB) patients, the relapse rate in patients treated with fixed-duration MDT (0.56/1000 PY) was comparable with that in patients treated with MDT until skin-smear negativity (0.73/1000 PY) (chi 2 = 2.20, p > 0.05). Our present study suggests that fixed-duration MDT is a cost-effective regimen for the treatment of leprosy in China. The present results also show that relapse of leprosy is acceptably low and has not yet become a serious clinical or public health problem but, based upon the incubation of relapse in MDT patients, it is necessary to encourage annual follow up for at least 5 years for paucibacillary (PB) and 10 years for MB patients after being released from WHO/MDT.

China↗
PubMedDate not supplied

Community participation in case detection of leprosy in Nagpur district of Maharashtra.

Involving special community groups for new case detection is of great importance for achieving the target of elimination of leprosy. During 1998-99, thirty village level Mahila mandals (women's groups), 6950 teachers and students and 34,548 heads of families were co-opted to participate in case detection. They examined 56,113 persons including 378,959 school students and 184,940 family members. Of the examined population, 275 were suspected to be cases of leprosy by mahila mandals, 411 by teachers and students and 747 by heads of families. Subsequent examination of the suspected cases by trained medical officers and paramedical workers confirmed 203 of them to be cases of leprosy. This exercise showed that when proper attempts were made to involve the community, case detection activity became easier, besides helping to disseminate knowledge about leprosy in the community.

Adolescent↗
PubMedDate not supplied

[Dissertations about leprosy in the Seville at the end of the Enlightenment Age].

INTRODUCTION: Leprosy is a well-known disease from ancient history. Society reacts violently due to the fear of infection, and the fact that it causes appalling physical mutilation. It is produced by Mycobacterium leprae, which only affects the nervous system of human beings. DEVELOPMENT: The norms and examinations that for many years were practiced upon those suspected of being infected by the leprosy organism are based almost always in a series of requirements that were in keeping with cases of verification, thus named the 'declaration of leprosy'. Doctors in the 18th Century, conscious of the consequences of the disease, established a diagnostic procedure for leprosy. But as a result of the medical limitations of the time, and the innate risk of examination of the sufferer in the early phases and their changing symptoms, they adopted a cautious stance and on occasion were overly prudent. These problems remained established in different dissertations presented in the Royal Society of Medicine and other Sciences of Seville during the last third of the 18th Century. A total of eight dissertations related to this disease are analyzed. Two presented by Doctor Bonifacio Ximénez de Lorite in 1765 and 1788 are noteworthy due to the contents and quality.

Academic Dissertations as Topic↗
PubMedDate not supplied

An overview of research on the history of leprosy. Part 1. From Celsus to Simpson, Circa. 1 A.D. Part 2. From Virchow to Møller-Christense, 1845-1973.

This overview attempts to evaluate, in general, the results of nearly 2,000 years of writings on the history of leprosy. The ancients, although prone to confuse other skin diseases with leprosy, laid the emotional foundation for later work in superstitution and lore. Their efforts were faithfully copied for hundreds of years and provided at least an accumulation of facts and a documentation of the state of the art. The dawn of scientific medicine in the mid-nineteenth century and the following 125 years has brought an increasing specialization of research in the history of leprosy that might be usefully divided into medical, political, Biblical, instutional, and medieval aspects. Some of the most productive efforts within each of these areas are considered. The challenge of the future is to develop models of analysis and evaluation based on the findings of analysis and evaluation based on the findings of social scientific research rather than relying totally on pure narration. This is the way in which to free the history of leprosy from much of the myth and error that surrounds it.

Denmark↗
PubMed2000

Leydig cell hyperplasia and the maintenance of bone volume: bone histomorphometry and testicular histopathology in 29 male leprosy autopsy cases.

This study was conducted to determine if osteoporosis in male leprosy patients is caused by testicular atrophy. Bone volume (BV/TV), trabecular number (TbN), trabecular thickness (TbTh), and trabecular separation (TbSp) were measured in two areas in decalcified paraffin sections of lumbar bones from 29 male leprosy and 6 male nonleprosy autopsy cases. We found significant differences in the average BV/TV measurements among the 7 patients with nodular Leydig cell hyperplasia (BV/TV 12.24%) and the 22 patients without hyperplasia (BV/TV 7.35%) and 6 patients without leprosy (BV/TV 12.98%). Bone volume was maintained in patients with nodular Leydig cell hyperplasia, and we determined no clinical factor other than the Leydig cell hyperplasia that reflected the bone volume. The osteoporosis of male leprosy patients was attributed to secondary gonadal dysfunction due to testicular atrophy, and Leydig cell hyperplasia appears to preserve bone volume.

Aged↗
PubMed2000

Immuno-histopathology in the diagnosis of early leprosy.

The present study of 45 early leprosy cases in an endemic area in China indicates: a) Sensitivity of acid-fast bacilli (AFB) detection can be significantly improved by examining approximately 30 serial sections. AFB and/or phenolic glycolipid-I (PGL-I) were mostly detected in the infiltrates in the subepidermal zone, intraneurium, perineurium and around blood vessels. b) PGL-I antigen was positive in 10 clinically suspected, single lesion leprosy cases and AFB positive in 7 patients, AFB and/or PGL-I in nerve in 6 patients. c) Nonspecific chronic inflammation in indeterminate leprosy presented as selective perineural and/or intraneural infiltration with lymphocytes predominating. In the infiltrating mass, fragments of neural tissue were demonstrated with anti-S-100 protein staining. d) Except for 3 cases with unknown numbers of lesions, the present positive immunohistopathological findings are in direct correlation with the number of lesions at first diagnosis, namely: 41.6% (10/24) for single lesion, 66.6% (6/9) for 2 lesions, and 88.8% (8/9) for patients with > or = 3 lesions. e) Typical epithelioid or macrophage granuloma formations were not seen in early leprosy with a single lesion. In testing the immunological inclination of these patients with CD68 or tumor necrosis factor-alpha (TNF-alpha) a positive test is likely to be of prognostic value since TNF-alpha is involved in granuloma formation and nerve damage.

Adolescent↗