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PubMed1962

Serological studies on leprosy. A comparison of complement-fixation tests using antigens prepared from tubercle bacilli and beef-heart lipids with other serological reactions.

Sera from lepromatous leprosy patients were subjected to a battery of serological tests, including flocculation, agglutination and complement fixation. A correlation was found between the antileprous antibody content and the reactivity with "cardchol" antigen, but not with Trypanosoma cruzi antigen, cardiolipin or Rubino antigen. The reactivity of leprous sera with tubercle bacilli antigen in the quantitative complement-fixation test decreased in three patients with lepromatous leprosy during sulfone treatment. When syphilis was present in a lepromatous leprosy case, it was possible to follow the effect of specific treatment of the two infections, with sulfone and with penicillin, by the drawing of two serological curves-one for leprosy and one for syphilis.

Animals↗

PubMed1992

Estimated number of leprosy cases in the world.

Planning for leprosy control requires estimates of the number of leprosy patients at different levels. During the period between the mid-1960s and the mid-1980s, global estimates had remained constant at between 10 and 12 million. The introduction of multidrug therapy (MDT) in many countries and the consequent reduction of the disease's prevalence has necessitated a reassessment of this. Based on available information and its interpretation, the number of leprosy cases in the world for 1991 has been estimated at 5.5 million. The number of individuals deformed by leprosy, including those cured of the disease, has been estimated at between 2 and 3 million.

Humans↗

PubMed2003

Assessment of disability, social and economic situations of people affected by leprosy in Shandong Province, People's Republic of China.

With the decline in prevalence of leprosy, social and economic rehabilitation (SER) has become a major priority in leprosy control programme in Shandong Province. In the preparative phase of an SER programme, a province-wide survey was conducted with a semi-structured questionnaire in order to provide policy makers and programme managers with some basic information on the disability, and social and economic situation of the people affected by leprosy. This paper presents the results of a study in the people affected by leprosy living in the communities.

Activities of Daily Living↗

PubMed2003

Comprehensive treatment of complicated plantar ulcers in leprosy.

OBJECTIVE: To investigate feasible treatment methods for plantar ulcers in leprosy patients according to the agreement between the Ministry of Health (MOH) of China and the Leprosy Mission International (LMI). METHODS: A total of 2599 complicated foot ulcers in 1804 leprosy cases underwent surgic treatment. Plastic fixation and supports were used, dressings were changed regularly, and protective footwear and modified insoles were provided. RESULTS: Of the 2599 foot ulcers 1446 (55.64%) healed. The cure rate of the patients treated in leprosy hospitals was 71.31%, with 219 (15.15%) recurrences of foot ulcers. The recurrence rate of those who lived at home was 18.35%. CONCLUSIONS: Comprehensive treatment of foot ulcers has a high cure rate and a low recurrence rate. Reduction of workload, avoidance of long distance walking, intensification of education on foot self-care and provision of financial support are the main measures for preventing a recurrence of foot ulcers.

Foot Ulcer↗

PubMed2003

Treatment with corticosteroids of long-standing nerve function impairment in leprosy: a randomized controlled trial (TRIPOD 3).

Some leprosy patients with long-standing nerve function impairment (NFI) appear to have responded favourably to treatment with corticosteroids. This study investigated whether patients with untreated NFI between 6 and 24 months duration and who are given standard regimen corticosteroid therapy, will have a better treatment outcome than a placebo group. A multicentre, randomized, double-blind placebo-controlled trial was conducted in Nepal and Bangladesh. Subjects were randomised to either prednisolone treatment starting at 40 mg/day, tapered by 5 mg every 2 weeks, and completed after 16 weeks, or placebo. Outcome assessments were at 4, 6, 9, and 12 months from the start of treatment. 92 MB patients on MDT were recruited, of whom 40 (45%) received prednisolone and 52 (55%) placebo treatment. No demonstrable additional improvement in nerve function, or in preventing further leprosy reaction events was seen in the prednisolone group. Overall, improvement of nerve function at 12 months was seen in about 50% of patients in both groups. Analysis of subgroups according to nerve (ulnar and posterior tibial), duration of NFI, and sensory and motor function, also did not reveal any differences between the treatment and placebo groups. There was however, indication of less deterioration of nerve function in the prednisolone group. Finally, there was no difference in the occurrence of adverse events between both groups. The trial confirms current practice not to treat long-standing NFI with prednisolone. Spontaneous recovery of nerve function appears to be a common phenomenon in leprosy. Leprosy reactions and new NFI occurred in a third of the study group, emphasizing the need to keep patients under regular surveillance during MDT, and, where possible, after completion of MDT.

Adolescent↗

PubMed1992

[Leprosy and heredity. Reflections of a district physician in 1884].

During the 19th century leprosy was a serious health problem in Norway, especially in some western, rural districts. In 1856 it was decided that all leprous patients should be examined by the local doctor (District Health Officer), and registered in a national leprosy register. The patients' family relationships received special attention. Some patients tried to avoid registration, fearing that the data might be misused. After Armauer Hansen (1841-1912) discovered in 1873 that leprosy was an infectious disease, isolation of leprous patients was enforced. In 1884 Thomas Collett (1835-1898), the local doctor in a rural district of western Norway, carried out a survey of all leprous patients registered in his district, a total of 164 patients. The data from his survey provide convincing support for the view that hereditary factors play an important role in the development of the disease. Modern research has confirmed that an important gene controls the susceptibility to leprosy.

History, 19th Century↗

PubMed2003

Antibodies to diverse lipids in the serum of patients with clinically cured leprosy and tuberculosis.

In this study we looked for the presence of antibodies to cardiolipin, cerebrosides, and whole lipids extracted from M. leprae, M. tuberculosis and M. habana, in the serum of patients with clinically cured lepromatous leprosy (sixteen) or tuberculosis (sixteen), 8 to 12 months after arresting the corresponding multi-drug therapy (MDT). Compared to healthy controls (sixteen), both leprosy and tuberculosis ex-patients had still significant levels of antibodies to the three mycobacterial lipids but no detectable levels of antibodies to cardiolipin or cerebroside lipids. Although leprosy and tuberculosis sera recognized the homologous mycobacterial lipids in a preferential fashion, all of them, on the average, reacted more strongly with the lipids of M. habana. This observation backs up, in a certain way, the proposition of using M. habana as a prospective vaccine for leprosy and tuberculosis.

Adult↗

PubMed2004

Trends in leprosy case detection worldwide since 1985.

Trends in case detection and case detection rate (CDR) since 1985 are described at regional and national levels. Annual case detection by WHO Region was available for 1994-2000. Using different sources, complete time series for case detection were constructed for 1985-1998 for a group of 33 endemic countries cumulatively (top 33), and for 14 individual countries (top 14). Population statistics were used to derive CDRs. India contributed 79% to global case detection in 1998. Africa, the Americas and South-East Asia each contributed about 30% when India is excluded. During 1994-2000, case detection did not decrease in these three WHO Regions. The 33 countries contributed 99% and 98% to global case detection in 1994 and 1998, respectively. Cumulative case detection for the top 33 minus India gradually increased, overall almost doubling. The contribution of the top 14 to case detection of the top 33 hardly changed over time, equalling 96% in 1998 (81% when India is excluded). In terms of annual case detection, Brazil was always ranked second after India; it accounted for 27% of 1998 case detection in the top 33 except India. In 1998, seven of the top 14 countries--including India and Brazil--had CDRs above 2 per 10,000. The CDR did not exceed 1 per 10,000 for the other half. Decreasing tendencies in CDR, either for the whole period or in the 1990s, are observed for four of the top 14 countries (Guinea and three Western Pacific countries: China, Vietnam and the Philippines). In conclusion, there is no general decline in case detection to date, and several important countries still have high CDRs. Prevalence is an irrelevant indicator for monitoring epidemiological changes in leprosy. Trends in the transmission and incidence of leprosy are still completely unclear, necessitating further research. The target to eliminate leprosy as a public health problem, defined as a prevalence of less than 1 per 10,000, is therefore also an inadequate yardstick for decision making on leprosy control.

Africa↗

PubMed1976

An evaluation of the immune state in leprosy.

An evaluation of the immune state in leprosy was done by the application of a system of graft-versus-host reaction. Peripheral blood lymphocytes obtained from patients with different forms of leprosy and from normal healthy individuals were injected intravenously into the irradiated mice. The rate of blast transformation of the donor cells was measured by the radio-active thymidine uptake. The number of cells labelled with tritiated-thymidine was much higher in the normal individuals and patients with tuberculoid leprosy than in the patients with lepromatous leprosy with the borderline group placed in between the two. However, following successful treatment with DDS, an increased responsiveness and active DNA synthesis could be observed in the previously less responsive lepromatous lymphocytes.

Adult↗

PubMedDate not supplied

Modular teaching programme on leprosy.

Though repeated attention has been drawn to a lack of proper teaching-learning modules in leprosy endemic countries, no satisfactory module exists. Keeping in view this fact, we attempted to draft a suitable module on leprosy that could be used to teach leprosy to undergraduate medical students in a simple and comprehensive manner. We used two different modules, Module A and Module B, to teach two different batches of students of the pre-final year (VI and VII semesters) of the MBBS course. Both these modules were conducted by the Department of Dermatology and STD, with participation by the Departments of Microbiology, Pathology and Preventive and Social Medicine. The drafts of the modules were discussed before hand in the Department, keeping in mind the number of days allotted to us. Both the modules were different in certain aspects, but the basic concept was the same. Because Module A had more time, certain practical aspects were also discussed. It was interesting to note that the percentage of increase in the post-test score was 17 for Module A and 15 for Module B, thus proving that both the modules were effective in conveying the core message about leprosy.

Education, Medical↗

PubMedDate not supplied

Answering the rehabilitation needs of leprosy-affected persons in integrated setting through primary health care services and community-based rehabilitation.

This article aims to discuss the strategies for answering the rehabilitation needs of persons with leprosy-related disabilities in integrated settings through primary health care (PHC) services and community-based rehabilitation (CBR). While the provision of rehabilitation services through the PHC system remains problematic in most developing countries, the article concludes that CBR programmes have the potential for rehabilitation of leprosy-affected persons in integrated settings. However, the limited coverage of CBR programmes may pose an obstacle to such an approach. The author suggests the use of existing specific rehabilitation infrastructures meant only for leprosy-affected persons for initiating, sustaining and extending the CBR coverage to the surrounding communities. At the same time, the author asks for support and strengthening of organizations of leprosy-affected persons, promoting their active involvement in all rehabilitation processes.

Community Networks↗

PubMedDate not supplied

Knowledge and management of disabling conditions in South Asian histories: implications for leprosy futures.

Elimination of leprosy as a public health problem appears feasible in South Asia in the present decade through multi-drug therapy, but management of disability in cured leprosy patients will continue through the 21st century, probably with some ongoing stigma. This paper provides new perspectives on leprosy-related disabilities by reviewing the historical careers of four disabling conditions sharing some features with leprosy: lathyrism, iodine deficiency disorders (IDD), cataract and poliomyelitis. All are targeted for eradication or serious reduction using affordable surgery or preventive measures, yet they have proved unexpectedly resilient. Technical solutions alone bring only partial success. There is a need also for community-based delivery methods, individual and family self-help, and some redeployment of professional expertise.

Asia, Southeastern↗

PubMed2004

Nerve thickening in leprosy patients and risk of paralytic deformities: a field based study in Agra, India.

This paper examines the extent of nerve thickening among leprosy patients detected in the field in Agra district. All the clinically diagnosed leprosy patients were examined in detailed for thickening of local cutaneous nerves and peripheral nerve trunks. In each case all the major nerve trunks in both upper and lower extremities, forehead and neck were examined for thickening. Nerve thickening was found in 94% of multibacillary (MB) patients and among 52% paucibacillary (PB) patients. Nerve thickening was found to be more in males, in prevalent cases than in new (untreated) cases and increased significantly with age and delay in diagnosis (P<0.001). Visible deformities of grade > or =2 were found in 10% (58/573) of the leprosy patients; paralytic deformity accounted for 78% (45/58). Claw hand alone or in combination was seen in 82% (37/45) of patients with paralytic deformities. Risk (odd ratio) for deformities was observed to be high (15-18 times) with increasing number of nerves among patients with neuritic leprosy but correlated with delay in diagnosis of over 5 years. Likewise, deformities were more often seen in those with skin lesions, provided they had > or =3 thickened nerves. Findings suggest that early detection and treatment is useful in preventing deformities.

Chi-Square Distribution↗

PubMed2004

Large-scale candidate gene study of leprosy susceptibility in the Karonga district of northern Malawi.

We present a large case-control candidate gene study of leprosy susceptibility. Thirty-eight polymorphic sites from 13 genes were investigated for their role in susceptibility to leprosy by comparing 270 cases with 452 controls in Karonga district, northern Malawi. Homozygotes for a silent T-->C change in codon 352 of the vitamin D receptor gene appeared to be at high risk (odds ratio [OR] = 4.3, 95% confidence interval [CI] = 1.6-11.4, P = 0.004), while homozygotes for the McCoy b blood group defining variant K1590E in exon 29 of the complement receptor 1 (formerly CD35) gene appeared to be protected (OR = 0.3, 95% CI = 0.1-0.8, P = 0.02). Borderline evidence for association with leprosy susceptibility was found for seven polymorphic sites in an additional six genes. Some of these apparent associations may be false-positive results from multiple comparisons, and several associations suggested by studies in other populations were not replicated here. These data provide evidence of inter-population heterogeneity in leprosy susceptibility.

Adolescent↗

PubMed2004

Utility of serodiagnostic tests for leprosy: a study in an endemic population in South India.

In order to evaluate the usefulness of natural disaccharide (PGL1) and 35 kDa antigens based serology in diagnosis of leprosy and in detecting high risk groups for leprosy, this study was conducted in an endemic population in South India. Out of 3346 cases and their households and neighbouring household contacts, serum samples from 2994 and 2875 individuals were screened for antibodies against PGL1 and 35kDa antigens respectively. While the overall positivity for contacts and leprosy cases was 3.3% for PGL1 antibody, the positivity for 35 kDa antibody was 6.3%. The positivity for contact population was 2.7% and 5.4% for PGL1 and 35 kDa antibodies, respectively. Lepromatous and borderline lepromatous patients showed positivity of 35.1% for PGL1 antibody and 45.7% for 35 kDa antibody. Follow-up of contacts showed that the majority (>90%) remained seronegative for both the antibodies and most of the new cases emerged from the seronegative group. The study clearly indicates that specific serological assays are not sensitive enough for application, both for diagnosis and for identifying any individual at risk for leprosy in the south Indian endemic population.

Adult↗

PubMed2004

Serial measurement of serum cytokines, cytokine receptors and neopterin in leprosy patients with reversal reactions.

Serum levels of cytokines (IL-4, IL-5, IFN-gamma, TNF-alpha), cytokine receptors (TNFR I and II) and one monokine (neopterin) were estimated in seven leprosy patients to establish disease associated markers for reversal reactions (RR). Sera were collected at diagnosis of leprosy, at the onset of reversal reaction and at different time points during and at the end of prednisone treatment of reactions. It was expected that the serum cytokine and monokine profile before and at different time points during reactions would provide guidelines for the diagnosis and monitoring of reversal reactions in leprosy. The cytokines and cytokine receptors were measured by ELISA, whereas a radioimmunoassay was used for neopterin measurement. Six of the seven patients showed increased levels of neopterin either at the onset of RR or 1 month thereafter, and levels declined on prednisone treatment to that seen at the time of diagnosis without reactions. No consistent disease associated cytokine profile was observed in these patients. Interestingly, serum TNF-alpha levels were increased in the same patients even after completion of prednisone treatment, indicating ongoing immune activity. In conclusion, this study demonstrates that despite cytokines levels in leprosy serum being inconsistent in relation to reversal reactions, serum neopterin measurement appears to be an useful biomarker in monitoring RR patients during corticosteroid therapy.

Adult↗

PubMed2004

Comparison of multidrug therapy treatment results between multibacillary leprosy patients in hyperendemic and hypoendemic areas in Gowa Regency, South Sulawesi, Indonesia.

We studied 88 multibacillary (MB) leprosy patients, who received multidrug therapy (MDT) treatment in hyperendemic (44 persons) and hypoendemic (44 persons) areas in Gowa Regency, South Sulawesi, Indonesia. Bacteriological examinations were carried out (bacteria index and morphology index), immunological examinations (MLPA and TNF-alpha) and genetic variation in blood and ear lobe slit skin smears of MB leprosy patients, which had been treated by MDT, were performed. The collected data were analyzed with the chi-square test and discriminant analysis. Eight persons (9.1%) had a positive bacteria index and 2 persons (2.4%) had a morphology index. All patients (100%) increased their TNF-alpha concentration. All the samples (100%) showed an increase in the TNF-alpha concentration, compared to controls. MLPA positive conversion was found in 4 persons (47.7% samples) and TNF-alpha gene genetic variation at the position of -308, occurred in 12 persons (13.6% samples). Statistic test results showed a significant difference (p<0.01) in the TNF-alpha concentration between hyperendemic and hypoendemic areas. On the basis of a positive conversion by bacteriological results and its association with immunological results, it can be concluded that multibacillary leprosy patients with MDT treatment did not become a source of leprosy transmission.

Adult↗

PubMedDate not supplied

The BCG controversy: a reappraisal of the protective effect against tuberculosis and leprosy.

BCG (Bacillus Calmette Guerin) vaccine remains a highly controversial method of preventing tuberculosis and leprosy despite more than eighty years of use. The protective effect against tuberculosis observed in various studies ranged from -56% to 98%. Case-control studies carried out at Nagpur reported moderate effectiveness of BCG vaccination in prevention of tuberculosis. Its effectiveness was higher against extra-pulmonary tuberculosis. The summary protective effects obtained from meta-analysis of trials, cohort studies and case-control studies of BCG vaccination and tuberculosis were 51 (33-64), 76 (63-85), and 65 (57-72) percent respectively. The case-control studies carried out at Nagpur also demonstrated a significant protective association between BCG vaccination and leprosy. The summary protective effects obtained from meta-analysis of trials, cohort studies and case-control studies of BCG vaccination and leprosy were 43 (27-55), 62 (53-69), and 59 (46-68) percent respectively. The results of the current study and systematic review thus supported arguments favoring use of BCG vaccine for prevention of tuberculosis and leprosy.

BCG Vaccine↗