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PubMed1986

Use of synthetic glycoconjugates containing the Mycobacterium leprae specific and immunodominant epitope of phenolic glycolipid I in the serology of leprosy.

The high specificity of phenolic glycolipid I (PG-I) in the identifying individuals with leprosy appears to be attributable to the species-specific trisaccharide region of the molecule. Synthetic glycoconjugates were produced by coupling the corresponding terminal mono- or disaccharide to bovine serum albumin by reductive amination. Conjugates which contained only the terminal sugar maintained in its pyranose form, the terminal disaccharide with only the terminal sugar in its pyranose form and the terminal disaccharide with both the 3,6,di-o-Me-glucose and 2,3,di-o-Me-rhamnose sugars in their pyranose forms, were all highly active in the enzyme-linked immunosorbent assay (ELISA) and showed good concordance with native PG-1 in analysis of sera from leprosy patients. The antibody levels to the glycoconjugates in tuberculosis patients and patients with other mycobacterial infections were not significantly different from the levels in normal healthy control subjects. A few of the leprosy sera showed much stronger binding to conjugates which contained the disaccharide with both sugars in the pyranose form than to conjugates with only the terminal sugar in its pyranose form. Therefore a synthetic conjugate which contains the intact disaccharide region of PG-I may provide the most sensitive antigen for the large scale serodiagnosis of leprosy.

Antibodies, Bacterial↗
PubMed1989

Demonstration of PGL I antigens in skin biopsies in indeterminate leprosy patients: comparison with serological anti PGL I levels.

The survey of histological findings in leprosy patients from 1985 to March 1988 has been carried out at the Pasteur Institute in Noumea. Histologically, according to Ridley Jopling criteria, 82 patients were classified, 14 as T.T., 12 as B.T., 2 as B.B., 7 as B.L., 4 as L.L.s., 24 as L.L.p. and 19 as Indeterminate leprosy. Histological examination of tissues sections, using a monoclonal anti-PGL I antibody showed PGL I antigen in histiocytic cells of the infiltrate and more rarely in Langerhans cells in 7 cases of indeterminate leprosy. The Ziehl staining method revealed the presence of alcoholo resistant bacilli in only one case. For 10 patients, histological findings were compared with serological results. In 3 cases, the diagnosis was confirmed by the 2 techniques (immunohistology and serology). In 2 cases by only immunohistology or by serology and in 3 cases the diagnosis was not confirmed by either methods. These results showed the interest of the immunohistological and serological methods in indeterminate leprosy, specially in children. A study of household contacts may be of interest.

Adolescent↗
PubMed1989

[Studies on the serological activity of ND-O-BSA and its application in serodiagnosis of leprosy].

In this article, optimum conditions of ND-O-BSA-ELISA were determined and comparisons made of the serologic activity of 3 different types of antigens (WML, PGI, ND-O-BSA) in leprosy (151) and tuberculosis (20) patients and normal controls (42). The results indicated that: 1) optimum conditions for ND-O-BSA-ELISA were ND-O-BSA and OPD concentration of 0.1 and 400 micrograms/ml respectively with HRP-IgM and test sera dilutions of 1:1000 and 1:200; and 2) serological activity showed highly significant positive correlations between 3 types of antigens (WML vs PGI: r = 0.88, P less than 0.0005; PGI vs ND-O-BSA: r = 0.86, P less than 0.0005), all of which were highly sensitive and specific for leprosy serodiagnosis with positive rates of 100% (PGI) and 97.4% (WML, ND-O-BSA) in leprosy patients. None were positive in normal controls, but crossreactivity of different degree were present in tuberculosis patients. The authors suggest that PGI-ELISA and ND-O-BSA-ELISA be used in combination in the evaluation of clinical therapeutic efficacy and determination of disease stages, as well as in epidemiologic survey of subclinical leprosy infection in "high-risk" areas.

Antigens, Bacterial↗
PubMed1989

Dermatological disorders resembling leprosy.

Three dermatological conditions - epidermolysis bullosa dystrophica (EBD), granuloma multiforme (GM) and mycosis fungoides (MF) were diagnosed elsewhere as leprosy either clinically or histologically. Although the morphology of the lesions were suspicious of leprosy there were few striking clinical findings which were unfavourable. Leprosy is still an important disease that should not be missed. However, the recognition of these skin disorders is highlighted so that unnecessary and prolonged treatment for leprosy can be avoided in endemic countries.

Child↗
PubMed1989

Short-course multi-drug therapy for leprosy patients.

Short-course multi-drug therapy for leprosy patients was evaluated in terms of effectiveness, recurrence rate and side effects. Of the 108 patients studied, 48.1 per cent defaulted. This MDT appeared to be quite effective in controlling leprosy. The medication could be stopped at 6 months in 83 per cent of the paucibacillary patients. The medication was continued further in 17 per cent of paucibacillary patients because of persistent skin lesions clinically and histopathologically. Recurrence occurred in 2.3 per cent of the paucibacillary patients. The effect of this regimen for multibacillary patient is difficult to evaluate because of the small number of patients studied. Side effects of this regimen occurred in 5.4 per cent of the patients. Leprosy reaction occurred in two patients with borderline lepromatous leprosy.

Adolescent↗
PubMed1989

Implementation of chemoprophylaxis of leprosy in the Southern Marquesas with a single dose of 25 mg per kg rifampin.

Between 1967 and 1987 in the Southern Marquesas, a remote archipelago in French Polynesia, the detection rate of leprosy was 48.9 per 100,000 when it was 8.6 per 100,000 for French Polynesia as a whole. In 1988, a program of chemoprophylaxis of leprosy with a single dose of 25 mg/kg rifampin was implemented, and 2751 persons (98.7% of the population) were treated in the Southern Marquesas. In addition, 678 South Marquesans and 2466 members of their families living in the Northern Marquesas and in the Society Archipelago, received the same chemoprophylaxis. Among 2676 persons studied in the Southern Marquesas (97.4% of the treated population), 130 had elevated IgM anti-phenolic glycolipid-I antibodies by ELISA without any evidence of leprosy. The onset of a skin lesion of borderline leprosy in a boy 3 months after chemoprophylaxis raises the question of the nature of such a skin lesion and, indirectly, of the effectiveness of the chemoprophylaxis.

Antibodies, Bacterial↗
PubMed1988

Diagnostic value of cardinal signs/symptoms in paucibacillary leprosy.

With the help of sensitivity and specificity criteria, an attempt is made to quantify the gain in certainty in diagnosis with the use of various cardinal signs/symptoms (S/s) of leprosy in order to study their predictive value in correct diagnosis of paucibacillary leprosy (PB) by the Paramedical Workers. The study was based on the findings in 326 new cases of paucibacillary leprosy detected by 10 paramedical workers during a recent field survey. Observations in the present study confirm the scientific basis of presently used combinations of cardinal S/s for correct diagnosis of leprosy especially the combination of (skin) patch with loss/impairment of sensation. The detailed observations made in the study are discussed in this communication.

Adult↗
PubMed1986

Suppressor T lymphocytes from lepromatous leprosy skin lesions.

The immune response in leprosy forms a spectrum with lepromatous leprosy patients exhibiting specific unresponsiveness to antigens of Mycobacterium leprae. This unresponsiveness is thought to be related to the prevalence of T8-positive lymphocyte in these lepromatous lesions. To analyze the immunoregulatory function of these T8 cells, we developed simple procedures to extract lymphocytes from skin biopsy specimens of patients with leprosy. These lymphocytes were sorted for T8 and T4 positive cells, and cell lines were established by expansion with interleukin 2 (IL 2) and irradiated feeder cells. All T8 positive lines tested were positive for IL 2 receptors and HLA-DR determinants. These lines were additionally assayed for lepromin-induced suppression of the normal peripheral blood lymphocyte Con A proliferative response. Thirteen of 32 lines from six lepromatous patients showed significant suppressor activity, whereas nine lines from six tuberculoid patients and one line from normal peripheral blood failed to show suppression (p less than 0.001). Taken together, the finding of M. leprae-triggered suppressor cells within lepromatous skin lesions may in part explain the M. leprae unresponsiveness of lepromatous leprosy patients.

Antigens↗
PubMed1985

Hydrogen peroxide and superoxide production by peripheral blood monocytes in leprosy.

Susceptibility to infection with Mycobacterium leprae, the causative organism of leprosy, is the result of a defect in cell-mediated immunity (CMI). The co-operation of macrophages and T lymphocytes is known to be essential for competent CMI response. In this study we have examined peripheral blood monocytes from a range of leprosy patients in an attempt to identify a possible defect in macrophage function. The ability of these cells to produce hydrogen peroxide and superoxide, two bactericidal metabolites of the monocyte/macrophage, has been measured. Monocytes from leprosy patients were found to be capable of producing normal amounts of hydrogen peroxide and superoxide, and no differences in production were found between tuberculoid, lepromatous and control monocytes. These results suggest that macrophages in leprosy are competent, and that probably a T lymphocyte defect contributes to susceptibility to this disease.

Adolescent↗
PubMedDate not supplied

Histomorphometric study of the superficial peroneal nerve in leprosy.

A histomorphometric analysis of the superficial peroneal nerve was made in 15 cases of leprosy. Thirteen patients presented clinical signs of leprous neuropathy, while the other two showed only cutaneous signs of leprosy. The presence of M. leprae in all the nerves sampled, and the appearance of the histologic lesions, made it possible to confirm the diagnosis of leprosy and to specify the type of leprosy in each case, even in the absence of clinical signs of leprous neuropathy. Correlation of the histomorphometric results with the duration of development of the disease and with the time elapsing before treatment showed, in the beginning stage, a considerable reduction in myelinated and unmyelinated never fibres and a proliferation of Schwann cells, as well as segmental demyelination and axonal degeneration of the teased fibres. When treated early, the evolution of the lepromatous type (LL) appears favourable, with apparent regeneration of the nerve fibres. When treatment is not instituted early, gradual loss of nerve fibres, axonal degeneration of all the teased fibres, proliferation of the Schwann cell processes devoid of axons, and increase in endoneural connective tissue lead to a severe degeneration of the nerve. This unfavorable development appears to progress faster in the absence of treatment or when treatment is irregular. In the borderline lepromatous (BL) and borderline tuberculoid (BT) types, nerve degeneration appears to be more rapid than in the type LL.

Adolescent↗
PubMed1977

Leprosy--a clinico-epidemiological study in a rural population of Bundelkhand.

The present study was carried out in the three villages viz. Kochha Bhanwar, Kargawan and Pichhore, situated within 3 kms radius from M.L.B. Medical College, Jhansi, U.P. About 91 per cent (91.17%) of population was surveyed. Out of the 3,362 individuals studied, 18 cases of leprosy could be detected giving a prevalence rate of 5.41/1000 population. No association between the size of village and prevalence of leprosy cases was observed. The highest prevalence rate (7.40/1000) was seen in age group 15-49 years with male to female ratio of 2.6: 1. The disease was not prevalent in preschool age-group. Poor class of people contributed comparatively to a greater extent (6.37/1000). Size of the family did also not seem to be associated with the prevalence of disease. More than one case of leprosy in a family was observed in 30.7 per cent of the families. Early cases of leprosy remained acceptable in rural society whereas advanced cases were not acceptable. The disease seemed to manifest at all ages except pre-school age group. Majority of the cases (55.56%) were of early stage with a duration of the disease of less than 2 years. Possibilities to arrest the disease by early diagnosis, and prompt and proper treatment have been emphasized.

Adolescent↗
PubMed1988

Seroepidemiological studies of leprosy in northern Malawi based on an enzyme-linked immunosorbent assay using synthetic glycoconjugate antigen.

A total of 6002 blood samples from total population samples in four separate areas within Karonga District, Northern Malawi, were tested for anti-Mycobacterium leprae antibody using an ELISA based on synthetic glycoconjugate antigen. Results are presented using different criteria for seropositivity. Regardless of the criterion used, the proportion of individuals classified as "positive" rose to a peak at 20-30 years of age and then fell, and it was higher at all ages in females than in males. There was no difference in seropositivity levels between individuals with or without BCG scars. Although leprosy cases, in particular those with positive smears, had higher antibody levels than nonleprosy cases, analysis of age-standardized data revealed only weak evidence for a correlation between the prevalence rates of clinical leprosy and of seropositivity within the four areas. There was no evidence for higher seropositivity levels in household contacts of leprosy cases compared to noncontacts. The implications of these results for the epidemiology of leprosy in this population are discussed.

Age Factors↗
PubMed1988

Use of non-conventional antigen: M. habana in detecting M. leprae antibodies from leprosy patients and contacts in FLA-ABS test.

An indirect immunofluorescent (FLA-ABS) test has been developed to detect M. leprae specific antibodies in the active and subclinical cases of leprosy. An antigenically related mycobacterium, M. habana, was used as an antigen to detect M. leprae specific antibodies in the sera samples of leprosy patients. A comparison was made with M. leprae antigen using same set of sera samples. M. habana is capable of detecting anti-M. leprae antibodies in the serum samples of leprosy patients, previously absorbed with various mycobacterial antigens, cardiolipin and lecithin, almost to the same percentage as M. leprae. Possible use of M. habana antigen as an alternative to M. leprae, in the serodiagnosis of leprosy, has been discussed.

Antibodies, Bacterial↗
PubMed1988

Serological activity of natural disaccharide octyl bovine serum albumin (ND-O-BSA) in sera from patients with leprosy, tuberculosis, and normal controls.

We studied the natural disaccharide-octyl-bovine serum albumin (ND-O-BSA) enzyme-linked immunosorbent assay (ELISA) in sera from 151 leprosy patients, 20 tuberculosis patients, and 42 normal persons from a nonendemic area. The three ELISAs, whole Mycobacterium leprae (WML), phenolic glycolipid-I (PGL-I), and ND-O-BSA, are all highly sensitive for detecting antibodies against M. leprae. The results indicate that the serological activity has highly significant, positive correlations among the three types of antigens used. Their positivity rates are 100% with PGL-I and 97.4% with WML and ND-O-BSA in leprosy patients, and 0% with any antigen used in normal persons at NV-a (a supposed theoretical normal value). However, all three antigens show crossreactivity with tuberculosis patients at different levels. At NV-c (a supposed practical normal value, PNV), this crossreaction significantly decreased in the WML ELISA (PNV = 0.28) and the PGL-I ELISA (PNV = 0.16), and disappeared in the ND-O-BSA ELISA (PNV = 0.20). Under the same conditions, the positivity rates did not decrease significantly in leprosy patients, especially in multibacillary patients. Therefore, we suggest that the PGL-I ELISA in combination with the ND-O-BSA ELISA may be very useful for clinical applications, serodiagnosis, and for the study of subclinical infection in leprosy.

Antibodies, Bacterial↗
PubMed1979

T and B lymphocytes and blastogenesis in leprosy.

T and B cell percentages and their blastogenic response to PPD and lepromin have been studied in 107 patients of various types of leprosy. T cell counts and their blastogenic response were found to be considerably lower in all types of leprosy as compared to the normal. The counts and stimulation were the lowest for lepromatous leprosy. B cell counts were unaltered in all types of leprosy.

Adult↗
PubMed1988

Epistaxis and leprosy.

Forty-four leprosy patients with epistaxis were analysed. Aetiopathogenesis of epistaxis in leprosy is discussed in the light of available literature. It has been suggested that epistaxis is more frequent and severe in leprosy patients and more liable to have complications. Epistaxis in leprosy with nasal lesions may alarm the physician that patient has some systemic disorder.

Epistaxis↗
PubMed1988

Adreno-cortical function in leprosy.

Adreno cortical function was carried out in 43 cases of leprosy. These cases were further divided into tuberculoid, borderline, lepromatous and Lepra reaction. Serum and urinary electrolyte, urinary 17-Ketosteroid and 17-Ketogenic steroid and plasma cortisol levels were measured to assess the adrenocortical status in these different forms of leprosy. It was observed that these parameters were within normal limit in tuberculoid leprosy except low value of urinary 17-Ketogenic steroid. The borderline and Lepromatous leprosy cases revealed low values of urinary sodium, potassium and 17-Ketogenic steroid and high level of serum potassium. However, the cases of lepra reaction revealed low value of serum and urinary sodium and potassium, urinary 17-Ketogenic steroid. The basal plasma cortisol level was high in this group but it was statistically insignificant.

17-Ketosteroids↗
PubMed1987

A component of Mycobacterium leprae as immunomodulating agent for immune deficient cells of leprosy patients.

The delipidified component of the insoluble portion which presumably is the cell wall of Mycobacterium leprae (DCW) was able to induce lymphocyte proliferation in the leucocyte culture from the peripheral blood of lepromatous leprosy patients. Normally these cells show no lymphocyte proliferation in response to M. leprae or their sonicated extract. The delipidified component (DCW) appears to be proteinaceous and able to induce antibodies in rabbit. The DCW has affinity to the sera from lepromatous leprosy patients but not sera from normal healthy individuals or tuberculoid leprosy patients. The ability to induce lymphocyte proliferation is blocked by agglutination of DCW with patient sera, heat treatment of DCW or protease treatment of the component. Along with lymphocyte proliferation, DCW also induces ability in the macrophages to render phagocytosed M. leprae non viable. Thus it is proposed that DCW of M. leprae could be a potent immunomodulator for immunedeficient cells of leprosy patients. The efficacy of DCW as a probable immunoprotector for M. leprae infection in mice has already been demonstrated earlier.

Adjuvants, Immunologic↗