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PubMed1983

Leprosy--a case for mental health care.

One hundred twenty institutionalized cases of leprosy were tested for anxiety and depression on standard scales before and after psychiatric treatment. The latter seems to be effective in reducing both anxiety and depression after a course of treatment of three months. This appears to be a sound justification to advocate mental health care in institutions of leprosy in conjunction with physical care. Leprosy is a chronic and disabling disease entity. With the social stigma associated to the disease the psychiatric hazards of the disease are as bad as its physical manifestations. However, usually, only the latter attract attention. Ignorance about the disease and social values about the disease can at once land a person in depression on utterance of the diagnosis. Further, anxiety about the outcome of the disease in particular and future in general are known to exist in sufferers of leprosy.

Anxiety↗
PubMed1983

Leprosy in wild armadillos (Dasypus novemcinctus) on the Texas Gulf Coast: anatomic pathology.

Recent studies of the "naturally occurring leprosy-like disease of wild armadillos" establish that the causative bacillus is genetically identical to M. leprae from human sources, and thus the disease is a zoonosis, sylvatic leprosy. A recent survey of 451 wild armadillos from the Texas Gulf Coast demonstrated sylvatic leprosy in 4.66%. This companion study reports the anatomic pathologic changes seen in the 17 leprous and 17 nonleprous armadillos necropsied in that survey. Findings support previous studies on the histopathology and pathogenesis of sylvatic leprosy, but a broader spectrum of histologic changes are noted.

Animal Population Groups↗
PubMed1983

Haptoglobulin phenotypes in leprosy.

Haptoglobulin phenotyping was carried out in fifty controls and in thirty five leprosy patients. In controls the incidence Hp phenotypes 2-2, 2-1 and 2-1 (Mod) is 76%, 16% and 8% respectively. In leprosy patients, the incidence of phenotypes 2-2, 2-1, 1-1 and 0-0 is 77%, 11%, 3% and 9% respectively. The incidence of phenotype 2-2, 1-1 and 0-0 is more in leprosy patients than in controls and is significant (p less than 0.05). In none of the leprosy patients phenotype 2-1 (Mod) was recorded.

Haptoglobins↗
PubMed1983

Ocular leprosy - a new perspective.

The classification of ocular lesions in leprosy into academic and PST lesions clears away much of the confusion engendered by the wide disparity in the reported incidences. It also enables to project confidently the level of ocular morbidity in a given leprosy population with more precision. Based on the observation in the study approximately 1.5 million leprosy patients are expected to be affected with potentially sight threatening lesions. Measures to be undertaken to prevent this morbidity and visual impairment in this vulnerable group can be better worked up. The incidence of blindness on account of leprosy is reported to be 2.6 percent.

Blindness↗
PubMed1978

Sequential biochemical investigations in lepromatous leprosy.

Sequential biochemical investigations were conducted in cases of lepromatous leprosy in the reactive as well as subsided phases. Low levels of blood sugar and serum cholesterol were indicated in the reactive phase of lepromatous leprosy. Significant increase in thymol turbidity and decrease in A/G ratio were noted in most of the cases of lepromatous leprosy. Enhancement of serum levels of transaminases was observed in the reactive phase of lepromatous leprosy. Serum protein electrophoresis indicated increases in alpha2--globulin and r--globulin and decrease in albumin in the reactive as well as subsided phases. The results are discussed in this paper.

Aspartate Aminotransferases↗
PubMed1982

Aberrant immunoregulatory control of B lymphocyte function in lepromatous leprosy.

The capacity of peripheral blood mononuclear (PBM) cells from patients with leprosy to generate immunoglobulin-secreting cells in response to pokeweed mitogen (PWM) was evaluated by a reverse haemolytic plaque forming cell (PFC) assay. The PFC responses of PBM cells from patients with lepromatous (Lpr) leprosy were significantly higher (P less than 0.01) than those of PBM cells from normal controls and patients with tuberculoid leprosy. Co-culture of T lymphocytes from normal donors with PBM cells from Lpr patients reduced the PFC response of these cells to the normal range. T4+-helper lymphocytes from Lpr donors did not induce supranormal responses to PWM by normal PBM cells enriched for B lymphocytes. T8+-suppressor lymphocytes from normal donors greatly reduced the response of cultures containing normal allogeneic B cells plus T4+ cells. Conversely, when T8+ cells from Lpr donors were cocultured with normal B cells plus T4+ cells, they failed to suppress the response to PWM. In summary, these studies have demonstrated abnormally high PWM-stimulated PFC responses by B lymphocytes from patients with Lpr leprosy. This aberration, in turn, is associated with a loss of regulatory function by T8+-suppressor cells in Lpr patients.

Adult↗
PubMed1982

Radiolabelled M. leprae resident in human macrophage cultures as an in vitro indicator of effective immunity in human leprosy.

Twelve strains of human derived, freshly extracted M. leprae maintained within human macrophages showed a 2.1-13.2-fold increase in the incorporation of 3H-thymidine compared to parallel cultures containing heat-killed bacilli of the same strain. The addition of antigen stimulated lymphokines from five paucibacillary, tuberculoid leprosy patients resulted in the inhibition of the uptake of the radiolabel by 49-87%. Minimal, or no, inhibition was noted in the presence of similar culture supernatants from five bacilliferous lepromatous leprosy individuals. The results indicate that in contrast to lepromatous leprosy, tuberculoid patients possess antigen reactive lymphocytes which modulate macrophage function through soluble products. Attention is drawn to a rapid and sensitive in vitro method with potential for studying the immunological mechanisms leading to bacterial killing in human leprosy.

Cells, Cultured↗
PubMed1982

In vitro lymphocyte stimulation in patients with lepromatous and borderline tuberculoid leprosy. The effect of dapsone treatment on the response to Mycobacterium leprae antigens, tuberculin purified protein derivative and non-mycobacterial stimulants.

Lymphocytes from peripheral blood were isolated from leprosy patients and healthy contacts (HC) of leprosy patients and stimulated in vitro with: Mycobacterium leprae and a M. leprae cell wall antigen, MLW 1; tuberculin purified protein derivative (PPD); antigens prepared from Candida albicans, Entamoeba histolytica, Leishmania aethiopica, and parotitis virus; the non-specific mitogens phytohemagglutinin (PHA) and concanavalin A (Con-A). Lymphocytes from patients with untreated lepromatous leprosy failed to respond to the M. leprae antigens, and the median response to PPD was also significantly (p less than 0.005) lower than in the HC group. They responded almost as well as the other groups to non-mycobacterial antigens, PHA, and Con-A. In LL patients who had been treated with dapsone for several (median 10) years, the failure to respond to M. leprae antigens remained, but the depression of the PPD response and the slight non-specific depression of the lymphocyte stimulation test (LST) responsiveness had been reversed. Our results confirm that the major defect in the cell-mediated immune response of LL patients is M. leprae-specific and permanent. The possibility that the defect may be due to a continuous, antigen-induced suppression of the immune response is discussed. That the defect also affected the response to PPD is important since it points to a clear antigenic relationship between M. leprae and BCG/M. tuberculosis. Evidence is presented suggesting that an antigen induced suppressor mechanism may be operating in vitro with cells from patients with borderline tuberculoid leprosy.

Adolescent↗
PubMed1981

Incidence of Australia antigen in leprosy.

Ninety seven male patients attending the Leprosy clinic of the Dermatology Out-patients' Department were studied for the detection of Australia antigen. There was a 20% antigen positivity in patients suffering from Lepromatous Leprosy and 5.7% in the cases with Tuberculoid Leprosy. SGPT level was found to be significant in patients with Lepromatous Leprosy having Australia antigen as compared to other groups.

Alanine Transaminase↗
PubMed1981

Immunogenetics of susceptibility to leprosy, tuberculosis, and leishmaniasis. An epidemiological perspective.

The literature on the genetic regulation of susceptibility in leprosy, tuberculosis, amd leishmaniasis is critically reviewed. Of the three groups of diseases, leprosy has received the most attention from the standpoint of human genetics. There is now evidence that genetic factors, some of them HLA-linked, play a role in tuberculoid leprosy. However, the evidence leaves considerable room for environmental determinants in addition to genetic background. Several twin studies of tuberculosis have favored some genetic factors in clinical tuberculosis, but their evidence is mitigated by the many biases underlying such studies. Though very little work has been done on the genetics of leishmaniasis in man, experimental studies in mice have begun to unravel mechanisms controlling successive steps in the course of both L. donovani and L. torpica infections. It is suggested that future work should concentrate on moving from genetics to biochemical genetics in the mouse, should extend family studies in conjunction with markers in man, and should place high priority on confirmation of reported leprosy type discordance among monozygous twins.

Animals↗
PubMed1982

Effect of dapsone on blood lactic and pyruvic acids in leprosy.

The effect of leprosy and dapsone (DDS) on the basal levels of blood lactic and pyruvic acids has been studied. In untreated tuberculoid and lepromatous leprosy patients both of the acids were found to be significantly raised. The rise in lactic acid was relatively more in tuberculoid patients; whereas pyruvic was relatively more elevated in lepromatous cases. Both the acids showed a tendency to increase with the duration of the disease in lepromatous leprosy. Statistically no significant differences were observed in lactic acid levels between untreated and treated cases of both forms of leprosy, suggesting that DDS was not effective in controlling the conditions responsible for the increased lactic acid. On the other hand, pyruvic acid showed a further increase in cases who were on DDS therapy, particularly in lepromatous cases. This indicated that DDS affects pyruvic acid metabolism. Whether DDS disturbs the normal degradative pathway of pyruvic acid or affects pathways of pyruvic acid production is not clear.

Dapsone↗
PubMed1980

[Content of T- and B-lymphocytes in the blood of patients with polar types of leprosy].

The content of T and B lymphocytes in the peripheral blood of patients with polar types of leprosy and healthy adults was determined. The lepromatous (severe) form of leprosy was found to be accompanied by a sharp decrease in the percentage of T lymphocytes, while the percentage of B lymphocytes perceptibly increased. In patients with the tuberculoid type of leprosy only an insignificant decrease in the percentage of T lymphocytes was observed, while the level of B lymphocytes remained normal. These data indicate that in the severe form of leprosy cellular immunity is deeply suppressed, and the nonspecific stimulation of humoral immunity occurs.

B-Lymphocytes↗
PubMed1982

Illness and service utilization behaviours of leprosy patients.

225 adult leprosy patients attending the CLTRI, were interviewed to study their illness and medical agency utilization behaviours. Almost all patients perceived their disease as leprosy but 71.50% did not know how they got it. 10-11% did not reveal the disease to their family for fear of rejection. The time-lag between first suspicion and medical consultation was 1 year or more in 48% of cases. For treatment of leprosy, 36-38% of patients consulted Private Practitioners and General Hospitals, at one or the other time. 42.6% of patients changed 3 or more medical agencies for treatment. On an average patient had taken 62.39% of expected treatment. 41% of patients were not aware of the name of drug (DDS) they were taking. 44% of patients had tried home remedies. Most of the patients preferred to take treatment at leprosy referral hospitals.

Cross-Sectional Studies↗
PubMed1980

The transmission of leprosy in man.

Existing clinical, scientific, and epidemiological knowledge on the mode of transmission of human leprosy is reviewed under the following headings: a. The release of viable organisms from the host into the environment. b. The presence of viable organisms so released into the environment. c. Entry into the new human host and distribution within the body. d. Production of clinical illness. It is concluded that much of the published evidence deals with one, or rather few, parameters, whose relationship to the overall scheme of transmission is uncertain. Although it is beyond doubt that most leprosy bacilli emerge from the nose and nasal secretions, probably entering the environment in droplets, little is known of their mode of survival in the environment or their entry into the new host. Existing data certainly does not provide a full "model" of leprosy transmission, and it is suggested that further work attempting to clarify the relative importance of the component events in transmission may have to rely increasingly on epidemiological methods. It also emerges that consideration of the immunological factors bearing on whether or not infections causes clinical illness is important in elucidating the mechanism of leprosy transmission. Thus even the most "applied" and practical of problems must eventually turn to the realm of "pure" research for a definitive solution.

Animals↗
PubMed1980

The granulomatous response of leprosy patients to lepromin and killed BCG.

The volunteers studied included 6 tuberculoid and 11 lepromatous leprosy patients (Ridley and Jopling). Each received intradermally 0.1 ml of lepromin (Wade method) and 0.1 ml of autoclaved BCG (grown on Dubos medium) at 2 separate sites on the left upper arm. Observations were made at weekly intervals, and biopsy specimens were taken at the fourth wk. Within 3 to 4 wk all 6 tuberculoid patients responded to lepromin with typical granulomas (5 of which measured 5 mm or more in diameter) composed of epithelioid cells, lymphocytes and giant cells. In contrast, 8 of the 11 lepromatous patients remained negative; the other 3 developed tiny papules less than 3 mm in diameter which disappeared after 2 wk. Biopsy specimens taken from injection sities at the fourth wk showed essentially normal histology. All 1 patients developed typical granulomas to heat-killed BCG (non were less than 5 mm in diameter and most were larger) consisting of epithelioid cells, many lymphocytes and a few giant cells. The reaction in tuberculoid leprosy was stronger than that in lepromatous leprosy and the reaction to BCG in tuberculoid leprosy was stronger than that to lepromin, but the differences were not very remarkable.

Adult↗
PubMed1982

Indirect assay of beta hydroxy beta methyl glutaryl CoA reductase in the sera of leprosy patients--a further probe into cholesterol metabolism.

With an aim to study the cholesterol biosynthetic capacity of the leprosy patients, the enzyme Beta hydroxy methyl glutaryl CoA reductase (HMG CoA) has been indirectly determined in the sera of leprosy patients and their family members by assaying the circulating levels of HMG CoA and mevalonate and finding out the ratio between two. The ratio was around 1 in leprosy patients indicating a normal HMG CoA reductase activity and approximately the same values were obtained in cases of healthy controls. The results suggest that cholesterol biosynthetic capacity of leprosy patients is normal. Whether cholesterol, the final product or intermediates like mevalonate are utilised by the invading M. leprae, thereby causing a lowered cholesterol level remains to be seen.

Cholesterol↗
PubMed1982

A sociological study of leprosy cases in the Gandhi Kusth Ashram, Jodhpur (Rajasthan).

A Sociological study was carried out in respondents of a Lepers Colony (Gandhi Kusth Ashram), Jodhpur. An attempt was made to study the knowledge about causation of Leprosy, age at onset, and treatment. The reason for leaving their original place of origin (South India) was enquired. A majority (95.2%) of patients were Hindus, had onset of leprosy in the age group of below 20 years to 30 years (80.94%) had a literacy rate of 6.3% only. A history of contact with a case of leprosy could be traced in 38% but within the family only in 11.9%. The infection as a cause of leprosy was recognised only by 3.57% patients but a majority had no idea about aetiology (70.24%) or thought it to be due to punishment for past sins (3.57%) or due to supernatural causation (1.19%). Most of them (70.2%) left home for fear of losing family prestige and to hide the disease (25.00%) or hatred of other family members (4.76%).

Adolescent↗
PubMed1980

Psychiatric disturbances among leprosy patients. An epidemiological study.

An epidemiological study was done to determine the prevalence of psychiatric disturbances among leprosy patients. Using a stratified random sampling technique, 540 subjects with leprosy were selected from a total population of 5745 leprosy patients. A mental health evaluation was conducted on 494 of these subjects. Forty-nine of these patients were found to have a psychiatric disturbance, giving a prevalence rate of about 99 per 1000. Depressive reaction was the most common disturbance seen. Those patients who were sick for a longer time and those who developed physical deformities were found to be more prone to get psychiatric disturbances. It is emphasized that supportive psychotherapy is important in the management and rehabilitation of leprosy patients.

Adult↗