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PubMed1987

Factors influencing corneal involvement in leprosy.

Corneal involvement in leprosy is known to be influenced by factors such as lagophthalmos, ectropion, and corneal anesthesia. In the present study conducted on 400 eyes of leprosy patients, observations were made on tear film abnormalities, and their relation to the above-mentioned factors was analyzed. The abnormality of tear film breakup time (BKUT) was found to be clinically more significant (47.2%) than a Schirmer's test alone (24.5%), and this finding was of greater significance in the lepromatous form of leprosy. An abnormal BKUT reflects a decreased mucin secretion by the conjunctival goblet cells. Tear film abnormalities in association with lagophthalmos, corneal anesthesia, concomitant ocular diseases, and environmental factors such as high relative humidity have been identified as factors contributing to corneal involvement in leprosy in India. It is not surprising that with so many mechanisms of corneal involvement the clinical manifestations are diverse, and all forms of pathological changes may contribute to corneal morbidity.

Cornea↗
PubMedDate not supplied

Subpolar tuberculoid leprosy.

Existence of subpolar tuberculoid leprosy was postulated by a few leprologists to explain clinical variations near the tuberculoid pole but failed to precisely identify the same. An attempt has been made to describe the clinical and histological features of subpolar tuberculoid leprosy. 76 cases of the TT-BT range according to Ridley-Jopling classification were examined by detailed clinical, histological and immunological methods. Definite clinical and histological discrepancies from either BT or TTp were seen in 30 (39.4%) cases, confirming the existence of subpolar tuberculoid leprosy (TTs) and thus clarifying the immunological spectrum of leprosy.

Humans↗
PubMedDate not supplied

The associated diseases with leprosy.

The prevalence of cutaneous, medical and surgical disorders was studied in 846 leprosy patients. Common cutaneous disorders among leprosy patients were pityriasis versicolor, tinea, pyodermas, warts, acquired ichthyosis, scabies, pediculosis and callosities. Only pityriasis versicolor had higher incidence when compared to general population. Common medical diseases were tuberculosis, infective hepatitis and diabetes mellitus. The epidemiological importance of their co-existence with leprosy is discussed and relevant literature of other diseases found to be frequently associated with leprosy is reviewed.

Adult↗
PubMed1986

In situ characterization of T lymphocyte subpopulations in leprosy in the mangabey monkey.

Leprosy in the mangabey monkey is an experimental model which is similar both clinically and histologically to human lepromatous leprosy. The immunopathology of these diseases was compared using monoclonal antibodies against T lymphocyte subpopulations in frozen tissue sections with an immunoperoxidase technique. In both mangabey and human lepromatous granulomas OKT4 (or Leu 3a) and Leu 2a cells were scattered among macrophages with greater numbers of Leu 2a as compared with OKT4 (or Leu 3a) cells. The results suggest that from an immunopathological standpoint experimental leprosy in mangabeys will provide a suitable model for the investigation of the pathogenesis of human lepromatous leprosy and for the evaluation of new antileprosy vaccines.

Animals↗
PubMed1986

The immunobiology of leprosy.

Leprosy, a chronic infectious disease of man, is caused by the obligate intracellular bacterium M. leprae. Infection with M. leprae affects the peripheral nerves and the dermis, causing an accumulation of macrophages and other immune cells at the infected sites. Host resistance to the bacterium determines the extent of local inflammatory reactions and its resulting damage to the affected tissues. In lepromatous disease little if any cellular immunity develops. Bacterial multiplication is uncontrolled and M. leprae disseminate throughout most of the dermis. In tuberculoid disease, marked cellular immunity is observed and bacterial growth and dissemination are controlled. The depression of cellular immunity in lepromatous patients is not fully understood. Since M. leprae cannot be grown in vitro, and a suitable animal model has not yet been developed, the study of host immunity to the pathogen is limited primarily to investigations of the cutaneous lesions of patients and to in vitro responses of the peripheral blood leukocytes to M. leprae. While the blood monocytes of leprosy patients appear to be activated normally by lymphokines, T cell proliferation and production of lymphokines in response to M. leprae are impaired in lepromatous patients. Attempts to restore responsiveness in cells from these patients have been unsuccessful in our hands. The addition of exogenous IL-2 to leukocyte cultures does not appear to restore responsiveness to M. leprae in cells from nonresponsive patients. Rather, some enhancement, often not antigen specific, is observed in cells from patients with a preexisting response. Similarly, depletion of monocytes does not restore responsiveness to M. leprae in nonresponder patients, but a nonspecific enhancement of proliferation is observed in monocyte-free cultures from patients that do respond to M. leprae. Thus, the defect in lepromatous nonresponder patients does not result from a simple lack of IL-2 production or suppression by monocytes and/or their products. Possibly, there is a low level or lack of M. leprae-responsive T cells in the circulation of these patients. Attempts to overcome the defect in immunity of patients with lepromatous leprosy by immunoprophylaxis and immunotherapy are being investigated. This approach has become of major importance since the development of widespread drug resistance to Dapsone as well as to the other chemotherapeutic agents used to control leprosy.

Animals↗
PubMedDate not supplied

[A survey for school screening in Senegal: considerations on the usefulness of this screening method and on the importance of endemicity among the youthful population of leprosy villages].

A mass case-finding survey has been carried out among the pupils as a test measure: in an ordinary rural village: 2204 examined children; prevalence rate of leprosy: 0.90 per 1000; in two leper villages: 333 examined children; prevalence rate of leprosy: 125 per 1000. The authors have emphasized: the difficulty of school survey and the necessity to entrust a skilled staff with this job. The general low prevalence of leprosy cases with children in Senegal: 0.96 per 1000, inferior to the threshold of 4 per 1000 above which school survey is advised to be carried out. The high prevalence rate of leprosy with the children of the leper villages (140 times as much as general prevalence rate). This situation could be the result of: the inefficiency of the chemoprophylaxis by DDS; the existence of primary resistance cases to DDS (some of them clinically proved), consequence of the numerous secondary resistance cases which have already been witnessed in these villages.

Adolescent↗
PubMedDate not supplied

A dot enzyme immunoassay for detection of IgM antibodies against phenolic glycolipid-I in sera from leprosy patients.

A visual dipstick dot enzyme immunoassay (EIA) for diagnosis of leprosy is described. The assay is based on detection of IgM antibodies against phenolic glycolipid (PGL-I) in sera from leprosy patients. The antigen (PGL-I or synthetic disaccharide of PGL-I) was dotted on a nitrocellulose pad stuck on a plastic strip (dipstick). Sera were used at a dilution of 1:200. Peroxidase coupled mouse anti-human IgM monoclonal antibodies were used as the conjugate. A positive test gave a blue dot against a white background. The test was highly specific for leprosy, and was quite sensitive for detection of bacilliferous (BL/LL) leprosy. The antigen dotted and preblocked dipsticks stored at room temperature upto 4 months of observation period, were unable in the assay.

Animals↗
PubMed1986

Knowledge, beliefs and attitudes on leprosy in Iloilo City Proper, Philippines.

This study attempts to find out the prevailing knowledge and beliefs in Iloilo City, Philippines regarding leprosy, its causation, mode of transmission, and care. Attitudes of people towards Hansenites and their offsprings are also looked into. Qualitative data are obtained from seven keypersons in the locality who were interviewed in-depth using the unstructured interview guide. Quantitative data are furnished by 100 household heads who were randomly chosen and by 70 senior student-nurses enrolled in the six colleges of nursing in the same city using an interview schedule and questionnaire respectively. Results reveal that 90% of the household heads and 45% of the students have inadequate knowledge on leprosy. None of the household heads and only two students have highly adequate knowledge pertaining to this disease. Leprosy is believed by both the household heads and students to be brought about by as well as supernatural causes. A great majority of the household heads (94%) and students (79%) attribute the cause of leprosy to germs. Blood predilection has been cited by the next highest proportion of both groups of respondents. The third highest proportion of the households heads attribute the cause of the illness to God's will, while among the students, the cause of this disease is believed to be spontaneous. The majority of household heads (94%) and students (95%) believe that skin to skin contact is the most possible mode of transmitting the disease.

Attitude to Health↗
PubMedDate not supplied

Leprosy in eastern region of Rajasthan.

Total population survey covering 28055 persons living in 34 villages of eastern Rajasthan was carried out. Out of 28055 persons 20276 (72.27%) were actually examined and 218 cases of leprosy were detected. Prevalence of leprosy was found to be 10.75/1000, which is very high and contrary to earlier observations regarding leprosy prevalence in Rajasthan. Leprosy problem in Rajasthan has been discussed.

Adolescent↗
PubMed1987

Ultracytochemical studies of lysosomal function in the macrophages of human leprosy--I.

The present study was undertaken to understand the lysosomal status and function in macrophages across the leprosy spectrum, including the reactional states. Acid phosphatase was used as the marker enzyme to demonstrate lysosomes at the electron microscopic level. It was observed that lysosomal morphology was well maintained in the macrophages of tuberculoid, borderline tuberculoid, and borderline tuberculoid leprosy in reaction, while they lost their cellular morphology and cell membrane integrity in lepromatous leprosy and lepromatous leprosy in reaction. The importance of these findings is discussed.

Humans↗
PubMedDate not supplied

Bedside urinalysis in untreated leprosy patients.

The study included 53 patients of untreated leprosy attending University Hospital, Banaras Hindu University during study period of 1 1/2 years. The various types of leprosy included 9,14,16 and 14 cases of tuberculoid, borderline, lepromatous and leprosy with type II reaction respectively. Majority of the patients were below the age of 49 years with male preponderance. 66.04% of patients came from the rural area. Painful micturation (dysuria) (13.20%) was the commonest urinary complaint recorded on enquiry. Specific gravity of urine did not show any change. Abnormal proteinuria was noted in 16.98%, 11.32%, 7.54% and 3.77% of patients of leprosy with reaction, lepromatous, borderline and tuberculoid group respectively. Significant haematuria, pyuria and epithelial cells were noted in all the groups. Haematuria was recorded in focal segmental Glomerulonephritis (GN), mesangioproliferative and diffuse endocapillary Glomerulonephritis (GN) incidence of which was 7.89%, 7.89% and 5.26% respectively in the biopsy tissue. Significant pyuria was noticed in all the groups except minimal change GN.

Adult↗
PubMedDate not supplied

Antispermatozoal antibodies in leprosy with special reference to their morphological patterns.

Sixty two male patients with polar leprosy--38 lepromatous and 24 tuberculoid types were investigated for the presence of antispermatozoal antibodies with special reference to their morphological patterns. Antibodies were detected by three different immunological techniques. Sperm agglutination was found to be the most sensitive. The incidence of antibodies was higher in patients with lepromatous leprosy and was directly proportional to the duration of the disease in both types of leprosy. Morphologically, head-to-head type of agglutination was observed in 50 percent of the patients, mixed in 41.7 percent and tail-to-tail type in 8.3 percent. There was no correlation between the number of ENL attacks and the incidence of anti-bodies. In polar tuberculoid leprosy patients the histological findings of testicular biopsy indicated cell mediated tissue damage occurring in a non-infective form.

Antibodies↗
PubMed1986

Natural killer (NK) cell activity and reversal reaction in leprosy.

Two studies were conducted to assess natural killer (NK) cell activity in leprosy patients and healthy Ethiopian controls. The first study tested 26 untreated leprosy patients across the spectrum of the disease. It was found that lepromatous leprosy and all untreated, nonreactional patients had lower NK activity than healthy controls. However, patients presenting with reversal reaction (RR) had NK activity within the normal range. Heterogeneity was particularly marked in the NK activity of borderline patients. In the second study, NK cell activity was assessed in treated borderline tuberculoid leprosy (BT) patients. There were 30 patients with a history of RR and 27 BT patients without such a history (NR). All patients had had at least 3 years of dapsone treatment and 6 months of multidrug therapy. There were 26 control subjects. NK activity was higher in controls than in patients only at one effector:target (E:T) ratio tested, but NK cells from the BT patient group appeared to be more "aggressive" in that there was significantly (p less than 0.001) less reduction of activity with dilution of effector cells. There were no significant differences in NK activity between RR and NR patients. The NK activity of NR patients was positively correlated with the size of induration of the lepromin response. We conclude that higher NK activity in acute RR would appear to be a consequence rather than a cause of reversal reactions.

Cytotoxicity, Immunologic↗
PubMed1986

Studies of cell death (apoptosis) and cell division in leprosy granulomas.

We have studied the histological changes across leprosy lesions by taking biopsies from the center and edge of the lesions and from the clinically uninvolved skin outside the lesions. A comparison of the granuloma fraction (GF) between biopsies from the center and edge of lesions and the adjacent unremarkable skin shows that the greatest GF is found at the edge of lesions, except in early tuberculoid (BT) cases when biopsies from the center have the greatest GF. Central healing of leprosy lesions occurs without tissue necrosis or appreciable fibrosis. Apoptosis, a form of individual cell death in living tissues, is known to be the mechanism of cell loss in a variety of situations, and we have found it to occur in leprosy lesions. Apoptotic activity is greatest at the edge of established tuberculoid lesions, but can be found in the center of the lesion in early cases. We, therefore, suggest that apoptosis is the mechanism by which epithelioid cells are lost during central healing in tuberculoid leprosy lesions. In the small number of multibacillary cases studied, apoptosis were found in biopsies from both the center and edge of the lesions. Mitoses can be found in biopsies from both lepromatous and tuberculoid lesions. However, the degree of mitotic activity does not appear to be related to the position of the biopsy within the lesion, and immigration of monocytes into the granulomas may be of greater importance than cell division in maintaining the numbers of epithelioid cells or macrophages present.

Cell Division↗
PubMed1985

Successful kidney transplantation in leprosy and transitory recurrence of the disease.

A 40-year-old woman on chronic hemodialysis had been diagnosed as having lepromatous leprosy at the age of 17 and treated for 15 years with sulfones. She remained clinically free of leprosy during 19 months of hemodialysis and then underwent successful renal transplantation. Fourteen months after surgery, recurrence of leprosy was observed. In spite of immunosuppression, the skin lesions healed with sulfone treatment. Renal transplantation is a useful treatment in patients with leprosy and chronic renal failure.

Adult↗
PubMedDate not supplied

[Leprosy and hepatitis B].

In 1966, B. S. Blumberg, investigating for carriers of the "Australia" antigen which he had discovered two years before, finds that the percentage is significantly more elevated in a group of leprous patients than in controls. In this initial work, realized at Cebu, Philippines, he mentions a higher percentage of this antigen carriers among the lepromatous than among the tuberculoid patients. He explains his findings by a genetic hypothesis and by the fact that lepromatous patients are more often hospitalized than the tuberculoid ones, thus narrowest contacts could favour the antigen transmission. Later, the established relation between Australia antigen and hepatitis B incites the authors to disregard the very deceiving genetic hypothesis and to build up the most important characteristic of lepromatous leprosy--cell immunity--as opposed to the tuberculoid form where cell immunity is normal. Investigation for seric markers of hepatitis B virus in patients with tuberculoid or lepromatous leprosy provides a model for the study on "cell immunity and hepatitis B". The juxtaposition of geographic areas with high prevalence of leprosy patients and of HBs Ag carriers is a supplementary argument for the study of their connection. Up to now, about fifty works have been published on this subject. Most of them investigate detection of HBs Ag and a few of HBe Ag and HBs Ac. This bibliographical study, including a personal study, reviews markers of hepatitis B virus replication in leprosy patients, incidence of hospitalization and age of these patients, as well as the methodology used.

Adolescent↗
PubMed1985

A study of the immunological effects of cimetidine in patients with lepromatous leprosy.

To test the capacity of cimetidine to enhance cellular immunity in patients with lepromatous leprosy (LL), cimetidine was given for one month to 29 inactive LL patients and 3 active LL patients. Immune function was monitored with skin tests (lepromin, PPD, candida, and trichopytin), lymphocyte transformation tests (phytohemagglutinin, BCG, and Dharmendra lepromin), and quantitation of peripheral blood lymphocyte subpopulations. A small but significant "booster" response to PPD was the only change observed in the study of patients with inactive disease, and leprosy-related reactions did not occur. In the few active LL patients studied, neither immune enhancement nor leprosy-related reactions were observed. The results of this investigation suggest that cimetidine can be used safely in patients with inactive lepromatous leprosy.

Adjuvants, Immunologic↗
PubMed1985

Determination of antibodies in dried blood from earlobes of leprosy patients by enzyme-linked immunosorbent assay--a preliminary report.

An enzyme-linked immunosorbent assay (ELISA) was used with soluble antigens of Mycobacterium leprae. All blood samples collected from the earlobes of 109 leprosy patients and 100 healthy controls (from a non-endemic area of leprosy) were absorbed with M. vaccae, BCG, cardiolipin, and lecithin according to the technology of the FLA-ABS test before being tested in the ELISA. The results (at a 1:200 blood dilution) showed that antibody activity gradually increased from TT to LL (mean OD values: TT = 0.43, BT = 0.62, BB = 0.72, BL = 0.84, LL = 0.89), and the rates of positive reactions were 100% in all classifications of patients except TT (66.6%). Antibody activity in the controls was less pronounced than in leprosy patients, their mean OD value being only 0.15. We suggest that the ELISA is highly sensitive and specific for the determination of anti-M. leprae antibodies, and is useful for clinical serodiagnosis and for the study of subclinical infections in leprosy.

Antibodies, Bacterial↗