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PubMed2001

Experiences from a collaborative project on the prevention of disability in leprosy patients in Shandong Province, the People's Republic of China.

Shandong Province (present population 89 million) in the People's Republic of China established a leprosy control programme in 1955. Between that year and the end of 1999, allowing for death and migration, the cumulative number of cases registered was 53,618, including 120 cases on multiple drug therapy (MDT) and 18,248 who had completed satisfactory courses of dapsone monotherapy and/or MDT. Of this latter group, 9500 cases (52%) suffered from visible disabilities (grade 2 of the WHO classification). Prevalence and incidence rates of leprosy have decreased dramatically since 1955 and, on average, only 50-70 new cases are now being detected annually in the entire province. Leprosy is thus no longer a public health problem, but the existence of such a large number of patients with grade 2 disabilities is clearly a matter of serious concern. This paper describes a pilot project to investigate the potential of health personnel in the leprosy programme and the dermatology and sexually transmitted diseases services to (a) prevent deterioration of existing disabilities in ex-patients through self-care and (b) prevent new neuritis in patients on MDT through early detection and the use of steroids.

Adult↗
PubMed2001

Leprosy bacillus--possibly the first chemoautotrophic human pathogen cultivated in vitro and characterised.

Leprosy bacillus (LB) and leprosy derived in vitro culture forms, the chemoautotrophic nocardioform (CAN) bacteria, showed an extremely close homology and identity with each other as regards a chemoautotrophic nutritional pattern, a nocardioform morphology, a weak acid-fastness coupled with Gram and Gomori's stain positivity, an exclusive mycolate and lipid profile, a phenolic glycolipid (PGL-I) and a highly sequestrated DNA characteristic, namely, a unique small size, a low G+C % mole, an exceptionally high gamma and UV radiation resistance, and a high thermal resistance. LB/CAN bacteria (CANb) gave positive signals for 36 kDa protein PCR, as well as, for 65 kDa epitope, and hybridisation with two or more probes and also by RFLP-analysis. Both LB/and CAN bacteria exhibited bacillary multiplication in the mouse footpads (MFP), nerve infiltration and evidences for local pathogenicity associated with pronounced systemic invasion. A highly reproducible mutilation model could be established which enabled a successful application of the postulates of Koch. The proof of their total identity was their anergic reactions in LL cases counterpoised against Mitsuda type strong nodular responses, mirroring the reactions of leprosy bacilli in TT cases, in accordance with the dictum of XIth International Leprosy Congress (1978). Thus, the chemoautotrophic nutritional requirements of LB, entirely unsuspected for a medically important pathogenic bacterium, having dimorphic (both bacillary and mycelial) characters with spores, mycelia and granules and unique pathogenicity of multilation manifested through the virulence factor, the enzyme collagenase, made LB or M leprae the highly enigmatic bacterium for so long.

Animals↗
PubMed2001

Protein profile in leprosy.

Serum proteins and plasma fibrinogen were estimated in 103 patients in various groups of leprosy and 52 patients of reactional leprosy. Total proteins, serum globulin and fibrinogen showed significant rise while serum albumin showed fall over the immunological spectrum from TT to LL. Type II reactional leprosy similarly revealed significant rise in globulin and fibrinogen. The comparison of these parameters between most of the comparable groups of leprosy was statistically significant. ENL patients after complete subsidence of reaction and after steroid treatment showed significant decrease in these protein fractions, thus conferring some prognostic implication on these tests.

Blood Proteins↗
PubMed2002

[Neuritic leprosy disclosed by reversal reaction].

We report a case of neuritic borderline tuberculoid leprosy with lingering insidious growth disclosed by a brutal reversal reaction. Inflammatory polyarthralgia and sensory and motor loss in the median and ulnar territories, without skin lesions, suggested vasculitis. A few weeks later, inflammatory skin lesions developed leading to the diagnosis of biopsy proven leprosy. Leprosy should be considered as a possible diagnosis in patients with multineuritis, especially when associated with rheumatic or cutaneous manifestations. Early skin biopsy in neuritic leprosy is discussed.

Adult↗
PubMed2002

[The discovery of the leprosy bacillus].

Gerhard Henrik Armauer Hansen (1841-1912) worked on leprosy throughout his career. Following his discovery of the leprosy bacillus in 1873, he proposed legislation that, when enacted in 1877 and 1885, established preventive measures aimed at isolating infectious patients. Around 1920, leprosy was more or less eradicated in Norway after a period of decline starting in 1850. Over this period, more than 8,000 cases were registered. Armauer Hansen's unique research achievement was based on a scientific and medical infrastructure in place long before he started his work. This context had several implications, though the discovery of the leprosy bacillus holds a particular fascination, with bearings on the interaction between medicine and the community even today.

History, 19th Century↗
PubMed2001

Helicobacter pylori and associated histopathological changes in gastric biopsies of patients with leprosy.

Two antral biopsies each from 104 patients of leprosy and 100 controls were studied to find out the prevalence of H. pylori and associated histopathological changes. Sections were stained with hematoxylene and eosin, AB/PAS (Ph 2.5) and Loeffler's methylene blue stains. Infection by H. pylori, inflammation and atrophy were found to be significantly more in leprosy patients as compared to controls (p < 0.01, < 0.005 and < 0.02 respectively). On comparing the histopathological changes in various subgroups of leprosy, H. pylori, inflammation and activity showed a statistically decreasing trend from tuberculoid to lepromatous subgroups (p < 0.05, < 0.001, < 0.01 respectively). Atrophy showed a significant increasing trend from tuberculoid to lepromatous group (< 0.001), it is concluded that despite a low prevalence of H. pylori and associated gastritis in patients with lepromatous leprosy, gastric epithelial damage is more marked due to altered immune response.

Adolescent↗
PubMed2001

Evaluation of leprosy lesions by skin smear cytology in comparison to histopathology.

Cytological evaluation of leprosy skin lesion was done to evaluate cytohistological correlation. Twenty five clinically suspected patients of leprosy were evaluated by performing fine needle aspiration (FNA) in nodular lesions and slit skin smear technique in flat lesions to classify across R-J scale. May-Grunwald-Giemsa (MGG) and Ziehl-Neelsen stain were employed on slit skin smears and fine needle aspiration material. Histopathological assessment of slides from same lesion was done. The overall diagnostic accuracy of fine needle aspiration was 76.1% and that of slit skin smear 50%. However, on adequate material diagnostic accuracy of slit skin smear was high, 100% as compared to 81.8% of fine needle aspiration smears. In cases of polar leprosy cytological findings paralleled histopathological diagnosis. Within the constraints of cytological interpretation the cases in borderline unstable spectrum of leprosy can be classified broadly.

Adolescent↗
PubMed1975

Polymorphonuclear activation in leprosy. I. Spontaneous and endotoxin-stimulated reduction of nitroblue tetrazolium: effects of serum and plasma on endotoxin-induced activation.

Spontaneous nitroblue tetrazolium (NBT) reduction was evaluated in neutrophils from patients with the different types and forms of leprosy, and compared with reduction obtained form cells from normal controls. Leucocytes from the same subjects were stimulated in vitro by endotoxin, and the rise in percentage of cells reducing NBT was determined. Patients of all groups, with the exception of those with reactional lepromatous leprosy (RLL) had an essentially normal proportion of reducing cells. Neutrophils were normally activated by endotoxin. This indicates that while Mycobacterium leprae does not by itself stimulate leucocytes from leprosy patients, there is no overall anergy of neutrophils in lepromatous or other forms of leprosy. In RLL the proportion of reducing cells was significantly raised. Stimulation with endotoxin was able further to enhance this proportion, but not above levels reached by stimulation of normal cells. Neutrophil activation could not be reproduced by mixing serum from highly activated RLL patients with normal leucocytes. An inhibitory effect of serum and plasma over in vitro endotoxin activation of neutrophils was found.

Endotoxins↗
PubMed2002

The leprosy elimination campaign in Jigawa, Nigeria: an opportunity for integration.

Integration of leprosy control into the general health services is regarded as an important condition for increasing the accessibility and sustainability of leprosy services. However, it is often difficult to embark on such an integration process. In Jigawa State in Northern Nigeria, the leprosy elimination campaign was used as the initiator and catalyst for the integration process. In this article, this challenging process is described and analysed. Available information is used to identify the constraints that emerged and to assess the consequences of integration for important aspects of leprosy control, such as case detection and case-holding and the accessibility and quality of the provided services. Some lessons from this experience are drawn that can be helpful for integration in other States or countries.

Delivery of Health Care, Integrated↗
PubMed2002

Processes and challenges: how the Sri Lankan health system managed the integration of leprosy services.

At the end of 1999, the Ministry of Health in Sri Lanka took the bold decision to integrate its Leprosy Services within the country's general health system. The integration was completed in February 2001 and is already starting to bear fruit, but implementing the necessary changes has been a challenging task. Many new procedures had to be established, logistics improved, attitudes changed and health workers trained. A broad bridge between curative and preventative health services needed to be built. Integration efforts were supported by an advertising campaign to inform people that leprosy, like any other illness, can be treated at all health facilities. Contrary to the expectation that quality of service would drop following integration, more cases are now detected and an extensive network of government doctors is able to diagnose, treat and manage leprosy patients more efficiently. Prevalence has increased by 36% and the new case load by 41%. A few areas still need more attention, such as integrating MDT supplies within existing systems and improving the flow of information, but nonetheless the ownership of leprosy is shifting rapidly to local health services.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

[Immunological examination of patients with undetermined leprosy].

The immunological competence of eleven patients with undetermined leprosy was compared with that of ten normal volunteers of the same age and sex distribution; these controls have not had previous contact with leprosy. The following parameters were studied in peripheral blood cells: 1) percentage of lymphocyte bearing surface immunoglobulins, as revealed by immunofluorescence; 2) percentage of lymphocyte bearing complement receptors, as studied by antibody and complement coated erithrocyte rosetting; 3) percentage of T cells, as revealed by spontaneous sheep erithrocyte rosettes; 4) blastogenic and mytogenic response of cultured lymphocytes to PHA and 5) cell migration inhibition test using lepromine (80 x 10(6) bacilli/ml) as antigen. Skin reactions to lepromine were also assayed. In the six lepromine-positive patients with undetermined leprosy, no major immunological alterations could be detected. On the contrary, the five lepromine-negative patients showed important alterations which could well be considered as precursors of lepromatous leprosy.

Adult↗
PubMed2003

Estimating the relative recurrence risk ratio for leprosy in Karonga District, Malawi.

Leprosy is a chronic disease caused by infection with Mycobacterium leprae. Susceptibility to leprosy is influenced by both genetic and non-genetic factors and the disease is known to cluster in families. One measure of genetic effect is the relative recurrence risk ratio, lambdaR. Estimates of this parameter can be inflated if environmental risk factors which also cluster in families, such as household contact, are not properly accounted for. We present the results of fitting a cross ratio model that allows estimation of the odds ratio of disease conditional on disease or no disease in a given relative, given measured covariates. From this model we can predict fitted values for lambdaR that represent the familial risk not accounted for by other covariates including observed household contact. If all covariates could be measured, this would be the 'genetic relative risk ratio'. We find lambdaR > 1 for all relative pairs except grandparent-grandchild, and lambdaR > 2 for siblings. Though not in itself evidence for a strong genetic susceptibility to leprosy, this result is consistent with much other evidence which suggests susceptibility to leprosy is under the control of many factors, the strongest of which may be non-genetic, with host genetics playing a small but significant role.

Adolescent↗
PubMed2003

A survey of blindness and poor vision in leprosy patients.

OBJECTIVE: To determine the prevalence, cause and distributions of blindness and poor vision in patients with leprosy. METHODS: An epidemiological survey of blindness and poor vision among 1045 cases of leprosy was carried out in Taixing City of Jiangsu Province, China. RESULTS: The prevalence of bilateral blindness was 7.67%, unilateral blindness 4.4%, bilateral poor vision of various degrees 9.28% and unilateral poor vision 5.84%. The prevalence of eye complications varied significantly among different groups of patients; females had a higher prevalence than males, multibacillary patients higher than paucibacillary patients, and in-patients higher than out-patients. Corneal disease was the most common cause of blindness in study groups, followed by iritic disease and cataract; while the main cause of poor vision was cataract, then corneal and iritic diseases. Treatable blindness accounted for 62.7% of the cases and treatable poor vision for 88.6% of the patients studied. 56.62% of cases with eye complications expressed their willingness to be treated. CONCLUSIONS: Although prevention and treatment of low vision and blindness in leprosy patients is very hard, it is necessary for doctors and medical workers to make clear of the factors to cause low vision and blindness, especially those in leprosy patients so that some measures for prevention and treatment of the disease could be taken accordingly.

Adult↗
PubMed1992

[Leprosy survey conducted in the Central African Republic from 1982 to 1985 among the Ba-Benzele Pygmies].

A leprosy survey was conducted from 1982 to 1985 among 2650 semi-sedentarized Pygmies in two camp-villages in the Central African Republic. Leprosy is endemic there, with an estimated prevalence rate of 1.05% and an annual detection rate of 0.2%. In view of its close relations with other neighbouring ethnic groups this Pygmy community can be considered as a target population the study of which provides indications on the transmission and typical course of leprosy in the region and also as a potential focus of contamination. However, the concurrent presence of endemic tuberculosis made it necessary during the survey to look for clinical associations of leprosy and tuberculosis in patients so that the standard multidrug treatment schedules comprising rifampicin could be adjusted accordingly.

Adolescent↗
PubMedDate not supplied

Study of leprosy among slum dwellers in Pune. Part II--Disabilities.

While conducting a leprosy survey in an urban slum in Pune 45 cases of leprosy were detected in a population of 4915 and only 7 of these cases had some disability. Disability rate in the leprosy cases was 15.56 percent, and maximum number had Grade 2 disability of hands or feet. Disability was higher in the higher age groups, males, Hindus, widower/widows, unemployed and lower socio-economic classes. Majority of the cases had a very low Disability Index DI (2) between 0.10 to 0.69 which is heartening and proves the successful implementation of the National Leprosy Eradication Programme.

Persons with Disabilities↗
PubMed1992

An epidemiological survey of deformities and disabilities among 14257 leprosy patients in 11 counties.

This study was planned and conducted in 11 counties in Yangzhou Prefecture, which had formerly had a high prevalence of leprosy. Out of 14257 leprosy patients, 8122 (56.97%) with permanent deformities and disabilities were found. The disability rate was much higher among patients with multibacillary (MB) leprosy (81.15%) than among those with paucibacillary (PB) leprosy (53.04%). The statistical data involving the patients and the types of deformities and disabilities are presented in this paper, and the influences of various host factors and disease factors are discussed.

Adolescent↗
PubMed1992

A preliminary study of correlation of immuno-histological and ultrastructural characteristics of neural granuloma in leprosy patients.

With an aim to better understand the pathogenesis of nerve damage in leprosy, peripheral nerve biopsies from six untreated leprosy cases (3 BT/TT and 3 BL/LL) were studied by electronmicroscopy and immuno-histology. In addition to routine histopathology for diagnosis, infiltrating cells of granuloma were characterized after preparation of single cell suspension. The lymphocytes in the lesion were characterized by E and EAC rosetting and macrophage phagocytic system (MPS) cells were studied using histochemical markers like esterase and peroxidase. The results indicate that the lymphocyte content was significantly greater in tuberculoid neural granuloma compared to lepromatous nerves and these formed rosettes with sheep erythrocytes (E) and expressed HLA-DR antigen suggesting that they are activated T cells. Infiltrating macrophages in both the tuberculoid and lepromatous neural granuloma were esterase positive, peroxidase negative and did not form rosettes with sheep erythrocytes or EAC. Ultrathin sections of tuberculoid granuloma showed lymphocytes clearly associated to epithelioid macrophages having well developed Golgi apparatus and rough endoplasmic reticulum. Correlation of these immunological and ultrastructural characters suggests that hypersensitivity mechanisms are possibly responsible for nerve damage in tuberculoid leprosy. Ultrastructural examination of lepromatous nerves, on the other hand, showed the predominance of macrophages with large nucleus, heavily bacillated Schwann cells, and a few lymphocytes. The correlation of immuno-histological and ultrastructural characters indicates that the mechanism(s) of nerve damage in lepromatous leprosy are basically different wherein hypersensitivity appears to play a very limited role.

Academies and Institutes↗
PubMedDate not supplied

[Leprosy in Guadeloupe (French West Indies): declining disease, increasing diagnosis delay].

INTRODUCTION: Endemic for nearly three centuries, leprosy is declining in Guadeloupe: its prevalence has decreased by 75 p. 100 over the last decade. Because it has become rare, it may well be overlooked. PATIENTS AND METHODS: Retrospective study of all the new cases of leprosy diagnosed in Guadeloupe from May 1996 to May 2001. RESULTS: In 10 cases of the 41 reported in this study, diagnosis had been delayed by more than 6 months. Nine of these 10 cases presented with classical clinical signs. The mean delay before diagnosis in these 10 cases was of 22 months (range: 7-36 months); the mean number of consultations with a physician before the final diagnosis was of 3.2 (range: 2-8). The mean age at the time of diagnosis in patients in whom diagnosis was delayed was significantly greater than those in whom diagnosis was confirmed rapidly (55 vs. 37 years). DISCUSSION: In Guadeloupe, one patient out of 4 presenting with leprosy is diagnosed with a delay of more than 6 months, despite a classical clinical presentation. This is deleterious to the patients and health economics. The patients in whom diagnosis was delayed were older. This epidemiological tendency appears inherent to this form of "residual leprosy". The present rareness of the disease is responsible for a lack of knowledge of the disease by the physicians through lack of experience. This phenomenon is also observed for syphilis and measles. There is a real risk of underestimation or erroneous diagnosis.

Adolescent↗