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PubMed2004

Analysis on the detection of new leprosy cases before, during and after the year of leprosy elimination campaigns.

To analyse the impact on of case finding of leprosy elimination campaigns (LECs), data on newly detected leprosy cases in a leprosy endemic area were collected before, during and after the year of LEC. The number of new leprosy cases detected during the year of LEC was significantly higher than previously. The number of newly detected cases after the year of LEC was similar to that of detected before the year of LEC in counties with persisting case finding activities. However, the number of newly detected cases after the year of LEC significantly decreased in counties without active case finding activities. The average distance from the homes of leprosy cases detected during LEC to the leprosy control unit at the count town was 62.8 km, which is farther than that of other leprosy cases detected before and after the year of LEC. The average time from disease onset to diagnosis of leprosy cases detected after the year of LEC shortened. The results also showed that carrying out LECs is unlikely to have a significant impact on the trend of case finding within a short time in local areas, but it may improve some indicators of leprosy patients and so promote leprosy control in local areas.

China↗

PubMed2005

Qualitative assessment of social, economic and medical needs for ex-leprosy patients living in leprosy villages in Shandong Province, The People's Republic of China.

After successful control of the endemic of leprosy in Shandong Province, China, how to deal with ex-leprosy patients living in the leprosy villages/leprosaria has become a hot topic among programme managers, medical staff and governmental officials at different levels. One of the possible solutions in dealing with the problem was proposed to combine small leprosy villages into a few larger, already existing, leprosaria/leprosy villages with better facilities, in order to provide better care for ex-leprosy patients and make better use of existing resources. With this assumption, social, economic and medical needs felt by ex-leprosy patients in three leprosy villages of Shandong province were assessed qualitatively, and the possibilities and obstacles regarding combination were explored. The results showed that the basic needs for living, such as food and clothes, were provided by state governments, although living standards remained at a low level. Medical care was not satisfactory, as many health problems related and unrelated to leprosy were increasing, and self-care needed to be addressed, as the dependents grew older and the disability status became worse. Although the majority of ex-leprosy patients, medical staff and government officials interviewed agreed with the idea of the adjustment of leprosy villages/leprosaria, some obstacles, including stigma, existed. Government commitment, ideally at top level, was needed in order to facilitate the process of combination.

Aged↗

PubMed1998

Cytokines in leprosy, I. Serum cytokine profile in leprosy.

BACKGROUND: Leprosy is a chronic infectious disease characterized by a broad spectrum of clinical forms depending on the patient's immune response, in particular cell-mediated immune response. METHODS: Cytokines can play a role in the cell-mediated immune response. Serum levels of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), interleukin-2 receptor (IL-2R), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta (IL-1beta) were measured by enzyme-linked immunosorbent assay (ELISA) in 55 untreated leprosy patients and 35 reactional leprosy patients, in addition to 20 age- and sex-matched healthy controls. RESULTS: Leprosy patients showed significantly higher serum levels of the studied cytokines (except IL-2) compared with healthy controls. When the two poles were compared, tuberculoid leprosy (TT) patients showed significantly higher levels of IFN-gamma and TNF-alpha with significant negative correlations with the bacterial index (BI), whereas lepromatous leprosy (LL) patients showed significantly higher serum levels of IL-2R, IL-10, and IL-1beta with significant positive correlations with the BI. Both type I and type II reactional patients showed significantly higher serum IFN-gamma, IL-2R, and IL-1beta, in addition to IL-10 in type II reactional patients, compared with nonreactional leprosy patients. When compared with each other, type I reactional patients showed increased levels of IFN-gamma, whereas type II reactional patients showed increased levels of IL-10. CONCLUSIONS: In leprosy patients, both IFN-gamma and TNF-alpha are immunoprotective, whereas IL-2R, IL-10, and IL-1beta are immunosuppressive. Our results indicate that type I reaction, with increased levels of IFN-gamma, is a cell-mediated immune response, whereas type II reaction, with increased levels of IL-10, is essentially an immune complex disease.

Cytokines↗

PubMed2003

Segregation of HLA/TNF region is linked to leprosy clinical spectrum in families displaying mixed leprosy subtypes.

Each year an estimated 600000 new leprosy cases are diagnosed worldwide. The spectrum of the disease varies widely from limited tuberculoid forms to extensive lepromatous forms. A measure of the risk to develop lepromatous forms of leprosy is provided by the extent of skin reactivity to lepromin (Mitsuda reaction). To address a postulated oligogenic control of leprosy pathogenesis, we investigated in the present study linkage of leprosy susceptibility, leprosy clinical subtypes, and extent of the Mitsuda reaction to six chromosomal regions carrying known or suspected leprosy susceptibility loci. The only significant result obtained was linkage of leprosy clinical subtype to the HLA/TNF region on human chromosome 6p21 (P(corrected)=0.00126). In addition, we established that within the same family different HLA/TNF haplotypes segregate into patients with different leprosy subtypes directly demonstrating the importance of this genome region for the control of clinical leprosy presentation.

Chromosomes, Human, Pair 6↗

PubMed2005

Current status of leprosy and leprosy control in Bangladesh: an ongoing collaboration.

Elimination of leprosy as a public health problem, defined by a registered prevalence of less than one case per 10,000 population, was achieved by Bangladesh in 1998, and steady reduction in prevalence is ongoing. It is less certain whether a sustained reduction in case detection is occurring, with little overall change in some longstanding programme areas, though the overall annual new case detection rate has fallen by over one-third between 1996 and 2004, from 9.8 to 6.1 per 100,000. Concerns about 'hidden' cases have been raised in Bangladesh as elsewhere, though the National Leprosy Elimination Campaign of 1999 detected relatively fewer new cases than in other countries, and mainly in low endemic areas. Investigation into the correct diagnosis of leprosy and recording and reporting practices has not suggested high levels of over-diagnosis or 'over-registration'. Both before and since achievement of the elimination target at national level, the collaboration of Non-Governmental Organizations with the national Leprosy Elimination Program has been considerable. NGOs now support ongoing leprosy control efforts in rural and urban populations, moderate to high endemic for leprosy, amounting to 50% of the entire population, and NGO staff look after 75% of all new cases in Bangladesh. This close collaboration has highlighted the potential for large-scale partnership in disease control, and has expanded to extensive partnership in tuberculosis control, which will hopefully enhance cost-effectiveness and quality of both programmes. Further challenges remain in the area of urban leprosy control, where leprosy case finding represents 30% of the whole country, but public health infrastructure and community organization is weakest. Sustaining of leprosy services in the long term is a significant concern, and new modes of collaboration, with a more technical, supportive role for NGOs in some areas is being piloted.

Bangladesh↗

PubMedDate not supplied

[Epidemiological immunological studies on leprosy in Okinawa. 6. Lepromin, lymphocyte transformation, FLA-ABS and leproagglutination tests in the in-and out-patients with leprosy and the relationships among these tests and personal or family history or clinical findings of the patients].

In- and out-patients with leprosy in Okinawa were surveyed by using the following immunological tests: cutaneous reaction to Mitsuda's lepromin (40 million bacilli/ml) (LPR), lymphocyte transformation test with Dharmendara's antigen (DL-LTT), that with phytohemagglutinin (PHA-LTT), fluorescent leprosy antibody absorption test (FLA-ABS) and Leproagglutination test with cardiolipin-lecithin antigen (LAT). A correlation between two tests and a relationship between the test and personal or family history or clinical finding of the patients were evaluated by non-parametric statistics. Spearman's rank correlation coefficient was significant between LPR and DL-LTT, while a reverse correlation was found between LPR and FLA-ABS, DL-LTT and FLA-ABS, and DL-LTT and LAT, respectively. High reactivity in PHA-LTT was found in almost all of patients, irrespective of type and stage of leprosy, suggesting general immune responsiveness of leprosy patients in Okinawa. The other tests showed a significant difference in the mean rank of reaction values according to clinical findings such as type and stage of leprosy, property of skin lesion, loss of eyebrow, and bacteriological test. The use of LPR and DL-LTT for the study of cell-mediated immunity in leprosy was therefore confirmed. FLA-ABS was found useful for early serodiagnosis, while LAT for the study of autoimmunity in leprosy. None of these immunological tests showed significant difference among the subgroups of patients classified by the following items: presence or absence of consanguineous patient with leprosy, living place, place of onset, presence or absence of neural symptoms such as the enlargement of peripheral nerve, claw hand and facial palsy, ocular and nasal involvement, ENL in lepromatous and borderline leprosy and conditions in the treatment. On the other hand, LPR showed higher reactivity in female than in male, in the patients at home than those discharged, and in the patients with drop foot than those without. Higher reactivity of DL-LTT was also found in male than in female and in the patients with plantar ulcer than those without. FLA-ABS reactivity was significantly higher in the discharged patients than the inpatients, in the period of 5 to 9 years after onset than that of 20 or more years, but the reactivity was lower in the patients with drop foot than those without. LAT reactivity was significantly higher in the 30-39 years old patients than 0-19 years old, and in the patients with physical work than those with mental.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1983

Community awareness about leprosy and participation in National Leprosy Control Programme.

To evaluate the health education component of our National Leprosy Control Programme (NLCP), 955 adult community members and 225 adult leprosy patients were interviewed with a view to assess their awareness about leprosy and participation in NLCP. The early signs/symptoms of leprosy were poorly perceived by the community. Majority of the community (81%) and patients (75%) were unaware or held superstitious ideas about causation of leprosy. The spread of disease through close contact with patient(s) was better known to the community (65%) than the patients (45%); but the role of open cases in spread was stressed by more patients (17%) than community (5.5%). About 31% community and 23% patients had no idea about the ways to prevent leprosy spread. As against 89% patients, only 62% community believed in curability of leprosy with early and regular treatment; but 20% of the community members did not know where to refer patients for treatment. The causation and prevention of deformities were poorly perceived by 71% patients, and likewise 62% of the patients did not take precaution(s) to prevent the deformities. About 32% respondents were unaware of the efforts being made to control leprosy; and their (79-84% respondents) participation in NLCP was very vague. About 44% community members showed prejudice towards leprosy. The NLCP infra-structure and mass media could not educate community effectively. The implications of the findings are discussed in this paper.

Adult↗

PubMed1983

A clinical and immunological study of four babies of mothers with lepromatous leprosy, two of whom developed leprosy in infancy.

One hundred thirteen women and 27 healthy controls were studied throughout pregnancy, at delivery, and followed up with their babies during lactation. Thirty-eight of the mothers with lepromatous leprosy were found to have solid-staining bacilli in skin smears or biopsies, and hence were considered potentially highly infectious to their unborn children by hematogenous spread via the placenta. Two babies of mothers within this group were diagnosed as having leprosy on clinical and histological grounds. A third baby could well have had leprosy, but the case was not proven. The fourth baby did not have leprosy and, although it did have ringworm, was thus deemed to be a reasonable control. The leprosy skin lesions were first observed at a special followup clinic when the children were between the aged of 9 and 17 months. The demonstration of IgA and IgM anti-M. leprae antibodies in cord sera was taken as an indication of intrauterine immunologic stimulation, and hence transplacental transmission of M. leprae. The two babies with proven leprosy showed an early and significant increase in serum IgA and in particular serum IgM anti-M. leprae antibody activity. A third baby, suspected of having leprosy but in whom the diagnosis was not proven, showed a similar but less marked increase in serum IgA and IgM activity. The fourth baby showed no such rise in anti-M. leprae activity. A decrease in serum IgG anti-M. leprae antibody activity could be demonstrated in one of the babies with leprosy after healing of the leprosy lesions, but not in the second baby.

Antibodies, Bacterial↗

PubMed1981

Fluorescent leprosy antibody absorption (FLA-ABS) test for early serodiagnosis of leprosy.

The conventional parameters for the diagnosis of leprosy i.e. clinical symptoms aided by smear and histological examinations, have certain limitations. With the conventional parameters, it is difficult to diagnose new cases in the early stage of leprosy. Recently Abe et al (1976) and Abe and Yoshino (1978) suggested that Florescent Leprosy Antibody Absorption (FLA-ABS) test developed by one of the authors (Abe) might be useful for early serodiagnosis of leprosy. Following this, the FLA-ABS test was standardised at the Central Jalma Institute for Leprosy, Agra to study the usefulness of the test in early serodiagnosis and detection of sub-clinical infections. In the present study sera were collected from 136 cases of different types of leprosy which includes 11 cases with lesions suspected to be leprosy, 58 healthy contacts and 19 healthy controls. Using FLA-ABS test, anti M. leprae antibodies were detected in all types of leprosy irrespective of the type and duration of the disease. The test has shown significantly high positive results in very early cases of leprosy with a duration of 3-6 months and having very small lesions measuring below 2 cms.

Fluorescent Antibody Technique↗

PubMed2000

Mast cells in leprosy and leprosy reaction.

BACKGROUND: Mast cells can be visualized in routine, acid-fast-staining, paraffin tissue section as metachromatic staining cells, and can be activated to release inflammatory mediators which play a role in the cell-mediated immune response. METHODS: Skin biopsy tissues were taken from the most active skin lesion of each leprosy patient at the time of diagnosis (nonreactional group) and at the time of reaction (reactional group) during the years 1994-1997 in the leprosy clinic at the Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand. Mast cells were identified by metachromatic staining (purple) in Fite's stain sections and reported as the average number of cells per high power field in three compartments: at the center and periphery of the granuloma and in the interstitium. The data were analyzed in three groups: nonreactional group, type I, and type II leprosy reactions. The mast cell count of each group and each compartment of the section, expressed as the mean +/- standard error, was compared. RESULTS: A total of 95 persons were included in the study, but 108 tissue sections were obtained due to nine cases having more than one section. Of these patients, 63 cases (66.32%) had no reaction, 19 cases (20%) had type I reaction, and 13 cases had type II reaction. There was no difference in age and sex among these groups. The mast cell count in the interstitium was higher than that within the granuloma, both at the center and at the periphery, in every type, and the count in this area reduced significantly in leprosy reactions, both type I and type II, compared with the nonreactional group. CONCLUSIONS: The change in the average mast cell number in nonreactional leprosy and leprosy reactions may indicate the important role of mast cells in dynamic changes in the cell-mediated immune response in leprosy and leprosy reactions.

Adult↗

PubMed1996

Electrophysiological evaluation of peripheral autonomic function in leprosy patients, leprosy contacts and controls.

Since there is immunocytochemical evidence that the initial damage in leprosy is directed at distal, small, unmyelinated nerve fibers, we investigated several electrophysiological methods for their potential value in detecting peripheral autonomic dysfunction in leprosy contacts and leprosy patients. Fingertip blood flow velocity and its control by vasomotor reflexes (VMR) with a laser Doppler flowmeter, fingertip skin temperature, and the sympathetic skin response (SSR) to exosomatic stimuli were studied in 89 leprosy patients, 36 leprosy contacts and 47 normal subjects. Whereas there were no significant differences between the groups in fingertip skin temperature and resting blood flow velocity measurements, there were significant differences in the prevalence of impaired fingertip VMR and absent SSR. The prevalence of absent SSR in leprosy patients was 60.9%, in contacts 13.8%, in controls 6.3%. The prevalence of abnormal VMR in leprosy patients was 61.2%, in contacts 34.7% and in controls 10.6%. VMR testing is a more sensitive test method for autonomic dysfunction compared with the SSR. The implication of impairment in vasomotor and sudomotor function in leprosy contacts needs yet to be determined. However, we propose this to be a response to exposure to Mycobacterium leprae, which represents either ongoing nerve damage or nonprogressive residual autonomic nerve damage. We suggest that VMR testing and SSR are valuable methods to evaluate early leprous neuropathy.

Adolescent↗

PubMed2006