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PubMed1983

[Articular manifestations in leprosy].

Articular manifestations occur in approximately 1% of cases of leprosy, sometimes at onset. They consist in a highly inflammatory polyarthritis, fairly similar to that seen in rheumatoid polyarthritis. They often herald a reactive leprous exacerbation and are dependent upon immunologic disturbances in brittle leprosy (mainly lepromatous). Joint pain should be differentiated from neurologic pain resulting from peripheral neuropathy which is often concomitant. Leprosy should be considered among the causes of polyarthritis, especially in immigrants, but also in residents who have travelled to areas where leprosy is endemic.

Adult↗
PubMed1984

In situ identification of cells in human leprosy granulomas with monoclonal antibodies to interleukin 2 and its receptor.

Leprosy is a chronic granulomatous disease with an immunologic spectrum in which lepromatous leprosy patients have defective cell-mediated immune responses, in comparison to tuberculoid leprosy patients. Immunoregulatory aspects of this spectrum were investigated by using monoclonal antibodies to interleukin 2 (IL 2), IL 2 receptors (Tac), and T lymphocyte subpopulations with immunoperoxidase techniques on frozen sections of skin biopsy specimens from 10 tuberculoid and 10 lepromatous patients. A comparison of IL 2+ cells revealed markedly fewer IL 2+ cells in lepromatous specimens (lep. 0.028% +/- 0.02 vs tub. 0.46% +/- 0.28, p less than 0.001). These IL 2+ cells were large, exhibited cytoplasmic staining, and on double immunostaining were Leu-4+, Leu-3a+, Leu-2a-, Tac-, and OKT6-, consistent with the fact they are IL 2 producers. Equivalent numbers of Tac+ cells were observed in both lepromatous and tuberculoid granulomas (lep. 1.5% +/- 0.5 vs tub. 2.1% +/- 0.7, p, NS), suggesting that the responder cells are present in both conditions. The tuberculoid granuloma was highly organized, composed of a central core of mature macrophages, Leu-3a+ and Tac+ cells with a surrounding mantle of Leu-2a+, Leu-3a+, IL 2+, Tac+, and OKT6+ cells. In lepromatous granulomas, Leu-2a+, Leu-3a+, Tac+, and rare IL 2+ cells were randomly admixed with bacilli-laden macrophages. The defective cell-mediated immune responses in lepromatous leprosy appears to be associated with diminished IL 2 production and disorganization of the granuloma.

Antibodies, Monoclonal↗
PubMed1983

Leprosy in wild armadillos (Dasypus novemcinctus) on the Texas Gulf Coast. Ultrastructure of the liver and spleen.

Recent studies have established that the "naturally-occurring leprosy-like disease of wild armadillos" is, indeed, caused by Mycobacterium leprae indistinguishable from M. leprae from human lepromatous leprosy. The present study reports the ultrastructure of the mycobacteria and host response in deep viscera, liver and spleen, in Texas armadillos with sylvatic leprosy. Evidence for acid-fast bacillary proliferation in these organs and penetration of hepatocytes is given. Acid-fast bacilli concentrated in activated macrophages in Billroth cords and sheaths of Schweigger-Seidel of the spleen and in Kupffer cells of the liver. Both mycobacteria and host response seen in lepromata of sylvatic leprosy, lepromatous lesions produced by injection of inocula from human lepromata and human lepromata, are compared.

Animal Diseases↗
PubMed1983

Relation between anti-Mycobacterium leprae antibody activity and clinical features in borderline tuberculoid (BT) leprosy.

Antibody activity against Mycobacterium leprae antigen 7 was determined by radioimmunoassay and IgG antibodies against various antigens present in an M. leprae sonicate by a solid phase radioimmunoassay in 77 patients with borderline tuberculoid (BT) leprosy. In both assays there was a wide variation in antibody activity in individual patients although all were diagnosed as having BT leprosy. The median antibody activity was lower in newly diagnosed cases than in patients appearing with active skin lesions or new skin lesions despite dapsone (DDS) treatment of long duration. Further comparison of patients with high and low antibody activity revealed that high antibody activity was significantly correlated statistically with active skin lesions, new skin lesions and neuritis despite DDS treatment of long duration. The reason for variation in antibody activity in newly diagnosed BT leprosy remains unclear, and this patient group is of particular interest for further characterization of the basis for variation in antibody activity in tuberculoid leprosy.

Antibodies, Bacterial↗
PubMedDate not supplied

[Advances in the chemotherapy of leprosy].

The chemotherapy of multibacillary leprosy with dapsone alone has resulted after 15-20 years in the selection and the diffusion of dapsone resistant Mycobacterium leprae. To overcome dapsone resistance, to prevent the selection of organisms resistant to other drugs and to kill the largest proportion of sensitive M. leprae, the chemotherapy of leprosy must rely, as chemotherapy of tuberculosis, upon the combination of several drugs. Rifampicin is included in all drug combinations recommended by WHO. The drug combinations have to be given for at least six months in patients with paucibacillary leprosy and two years in patients with multibacillary leprosy.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Epidemiologic surveillance in leprosy control programs].

Epidemiological surveillance of leprosy has to be very particular. As a matter of fact, leprosy is a long lasting disease which occurs for preference in developing countries where means of surveillance are said to be rudimentary and of poor reliability. Moreover initial stage of the disease is always undeterminated and its mean duration depends on clinical forms. Epidemiological and operational constraints are closely related together and must be included in an original surveillance program. The incidence rate is infered from the detection rate ratified by rates of: new monomacular cases, new cases with deformities and ratio multibacillary forms/pancibacillary forms. Prevalence rate is a very important operational indicator. Leprosy must be constantly registered and notified by every people in charge of collecting epidemiological data whether this epidemiological collection is exhaustive or selective. (Selectivity based on morbidity or on health centers in charge of surveillance). It is necessary to repeat transversal domiciliary surveys, in order to obtain necessary information for the knowledge of incidence and prevalence rate determinator. This gives also the possibility to correct the incidence and detection rates outside of the area of influence of health centers. Methodology of surveillance depends not only on epidemiological but also on clinical and operational informations (case holding problems). Feedback of results must be decentralized. In this respect, epidemiological surveillance of leprosy appears to be more interesting than its own purpose.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMedDate not supplied

Occurrence of antigen BCG 60 in leprosy derived corynebacteria and other coryneforms.

Previous studies have shown that anti BCG 60 monoclonal antibody could recognize major antigen A 7 of M. leprae. In the present investigation we attempted to search the presence of the same antigen from the strains of Leprosy Derived Corynebacteria (LDC+), which were isolated from leprosy lesions and were supposed to be the cultivable form of the leprosy bacillus. A comparative study was equally performed on 7 strains of Corynebacteria which were isolated in France and had no relation with leprosy patients (LDC-). Utilizing the ELISA technique with an anti BCG 60 monoclonal antibody, it was found that all the three LDC+ strains contained an antigenic determinant common to M. leprae, however no LDC+ specificity was found as this antigenic determinant was also revealed on two LDC- strains.

Antibodies, Monoclonal↗
PubMed1983

Serological activity of a characteristic phenolic glycolipid from Mycobacterium leprae in sera from patients with leprosy and tuberculosis.

Serological activity against a purified phenolic glycolipid from Mycobacterium leprae, which may be obtained in large amounts from M. leprae infected armadillo liver, was investigated using immunodiffusion and an enzyme linked immunosorbent assay (ELISA). Generally a good correlation was obtained between these techniques, but the ELISA was more sensitive and convenient. Relatively high IgG and IgM anti-glycolipid antibody levels were found in lepromatous leprosy patients. The antibody titres to the glycolipid were, however, low when compared with antibody titres to crude sonicates. Since the glycolipid is present in large quantities, this suggests that it is not very immunogenic. Antibody against the glycolipid especially of the IgM class, was demonstrable in some tuberculoid leprosy patients, although at much lower titres than in the lepromatous leprosy sera. In lepromatous leprosy patients that were skin smear negative after more than 5 years of treatment the IgG anti-M. leprae derived glycolipid activity had decreased markedly. The anti-IgG and IgM glycolipid antibody levels in tuberculosis patients did not differ significantly from the levels in appropriate normal healthy subjects. The glycolipid antibody levels in patients infected with M. kansasii, M. avium or M. intracellulare also fell within the range of normal healthy individuals.

Animals↗
PubMed1978

Serum iron and total iron binding capacity in leprosy patients.

Serum Iron and Total Iron Binding capacity were estimated on the sera collected from 45 leprosy patients attending the out-patient department of the Central JALMA Institute for Leprosy, Agra. The Sera from 15 healthy subjects were included in the study as controls. Hypoferraemia was observed in lepromatous leprosy and was particularly marked during the reactive phase. Further investigations to elucidate the pathogenesis of anaemia in leprosy are being planned.

Anemia, Hypochromic↗
PubMed1978

Persistence of Australia antigen in leprosy--a frustrating puzzle in immunology.

This paper deals with the relationship of Australia antigen (Au) to various sub-groups of leprosy, in a total of 200 cases. Au was found to be present up to 4% in lepromatous leprosy, 2% in tuberculoid leprosy and lepra reaction, and 3% of antibody in lepromatous leprosy. Presence of antibody denotes past antigenemia. The quantitation of the antigen is done using the new technique of Electro-immuno-diffusion (EID) of Laurell, synonymous with rocket technique. The persistence of the antigen is explained in the light of deranged immunological mechanisms.

Adolescent↗
PubMedDate not supplied

Gynaecomastia in leprosy in three districts of Tamil Nadu.

The prevalence of Gynaecomastia (GM), a well known complication of leprosy in adult male patients was studied in 790 cases of whom 641 were the inmates of five leprosy hospitals and the remaining 149 mostly from the clinics of field area attached to the Central Leprosy Teaching and Research Institute, Chengalpattu during 1982-83. The overall prevalence rate was found to be 19.24%. Among the hospitalised patients, it was 22.15% against 6.71% among the patients attending the clinics in the field area. The youngest and the oldest patient in this study was 16 years and 83 years respectively. The highest rate of 32.89% was in the 36-45 age group. Only 152 GM cases were detected; the rates in the lepromatous, borderline lepromatous, borderline tuberculoid were 29.21%, 9.64% and 3.68% respectively. Those who gave a history of frequent ENL reactions had a higher rate of GM i.e. 34.55 as against 21.52 without or with very infrequent ENL reaction. Early treatment had a remarkable effect in the reduction of GM. Only 14% developed GM when the treatment was started within 2 years after the onset of leprosy as against 46.9% when the same was started after 16 years. In the latter group, the longer duration of the disease could also play a contributory role. Sterility rate was more than double in those with GM i.e. 34.14% against 14% without it.

Adolescent↗
PubMedDate not supplied

Leprosy detection through non-survey techniques.

Most practical and cheap techniques other than mass surveys to detect leprosy in urban slums are still not known. The population inhabiting a large somewhat isolated slum in North Bombay was exposed to intensive health education programmes over a period of two years. Leprosy cases reporting as a result of these measures as well as those detected by trained workers casually or through contact examination were registered at two weekly clinics conducted within the slum. A total of 184 patients out of whom 27 were smear +ve, were identifiable by these means. The population of the slum was found to be 18228. Total prevalence rate of leprosy after examining 14723 subjects in the colony was revealed to be 24 per 1000 (smear +ve cases: 2.2. per 1000) out of which a prevalence of 12.4 per 1000 (smear +ve cases: 1.8 per 1000) had actually come to our knowledge even before instituting mass surveys. The results of this study indicate that in comparable urban situation it should be possible to identify 54% of total leprosy cases by techniques other than surveys. More significantly a striking feature of this study is that 82% of cases of true public health significance namely smear +ve patients could be unearthed by these means.

Health Education↗
PubMedDate not supplied

A study of knowledge, attitude and practice of leprosy among doctors of Bhopal, India.

A study of knowledge, attitude and practice of leprosy among doctors of Bhopal has found that junior doctors had more exposure to leprology compared to all other groups. Medical college doctors had better knowledge of leprology compared to non-medical college doctors. Knowledge and attitude about leprosy among doctors were influenced by qualification, age, cultural and environmental factors. A strong association was observed between knowledge and attitude about leprosy of doctors and their practice of treating leprosy cases.

Attitude of Health Personnel↗
PubMedDate not supplied

Socio-environmental factors in relation to leprosy at Jaipur.

In a house to house study of leprosy cases at Jaipur (148) a majority (91) had NL leprosy, 50 had LL leprosy and remaining 7 had indeterminate leprosy. More cases (84.5%) had a poor housing, overcrowding, low socioeconomic status. Out of 59 persons giving history of contact a majority had it at home and others at work places. The period of contact was more than five years in 74.6% cases. Most of the cases had lesions on exposed or easily accessible parts of the body.

Adolescent↗
PubMedDate not supplied

Fibronectin in leprosy lesions: observations using monoclonal antibodies to human fibronectin.

Croystat sections of dermal lesions from 33 untreated patients with leprosy were studied by indirect immunofluorescence using monoclonal antibodies to human fibronectin. Macrophages in borderline (BL) and lepromatous (LL) leprosy showed intense staining with antifibronectin antibodies. In the tuberculoid lesions cells of the mononuclear phagocyte series in an epithelioid cell granuloma stained for fibronectin. The lymphocytes surrounding these granulomas also showed the presence of fibronectin. These results suggest that the granuloma of leprosy consists of macrophages expressing fibronectin and the lymphocytes in the lesion also appear to express this protein. In six borderline cases, the sub epidermal collagen band showed intense staining with antifibronectin antibodies. In addition, the distribution of Ia-like antigens and fibronectin was studied on the plastic adherent cells obtained from peripheral blood of 11 untreated patients with leprosy. Results indicate that higher percentage of adherent cells from lepromatous patients express fibronectin in comparison to adherent cells from tuberculoid patients or controls. However, no difference was observed in the expression of the Ia-like antigens by the adherent cells, from these patients.

Antibodies, Monoclonal↗
PubMed1983

Social aspects of leprosy in Malaysia.

This paper attempts to explain both the persistence of traditional misconceptions about leprosy as well as the relative ineffectiveness of the Leprosy Control Programme. It has been pointed out that leprosy is a disease with tremendous social significance. To improve the Programme therefore, the human element which is of paramount importance must be identified and rectified. It is felt however, that we the providers should set our own house in order first. We need to find out the knowledge, attitudes and practices of the medical personnel and auxiliaries relating to leprosy, and identify the factors that contribute to their lack of motivation and undesirable attitudes which in turn deter patients from seeking and continuing treatment. Interventions based on the findings of such studies will contribute considerably towards the successful implementation of the Programme.

Attitude of Health Personnel↗
PubMedDate not supplied

Electrophoretic pattern of serum proteins in leprosy.

Sera collected from 65 patients having various types of leprosy and 20 healthy human beings were studied for the determination of total serum proteins, paper electrophoresis for protein types and albumin globulin ratios. Significant changes in protein equilibrium with the presence of hypoalbuminemia and increases in various globulin fractions (except beta globulin) were observed in patients having lepromatous and dimorphous leprosy. An abnormal protein band was also detected in 3 of 20 cases of lepromatous leprosy. The patients suffering from tuberculoid and polyneuritic leprosy did not show much protein disequilibrium except for mild rises in serum alpha-2 and reductions in serum beta globulins.

Alpha-Globulins↗
PubMed1983

Renal abnormality in leprosy.

Adequate kidney biopsy was studied in 54 cases of leprosy, of which 45 were of lepromatous leprosy, 4 of tuberculoid type and 5 belonged to borderline type of leprosy. Membranous glomerulonephritis (31.5%) was the commonest type of glomerular lesion followed by mesangioproliferative glomerulonephritis (11.1). It is concluded that renal lesions can occur in any type of leprosy. Reaction of renal tissues to M. leprae could be due to various local immunologic or physiological factors.

Adult↗