The intervention treatment with the immuno-adjuvant levamisole was given in 14 persistently bacteriologically positive lepromatous cases who had had adequate chemotherapy for over 5 years. There was a temporary conversion of the early lepromin reaction in a majority of the patients with a corresponding improvement in clinical and bacteriological status. However, the lepromin response was short lived. Most patients had become bacteriologically negative at the end of 1 year. No adverse effects due to levamisole therapy were encountered.
Oral zinc sulfate was tried in Eight cases of recurrent Erythema Nodosum Leprosum. To control ENL, they required high dosage of clofazimine and steroids for prolonged periods. After instituting oral zinc, the dose of clofazimine could be reduced to 100 mg twice a week and steroids could be withdrawn completely. Four out of five patients who were not tolerating dapsone earlier, started tolerating dapsone. Incidence and severity of subsequent ENL was also reduced.
The in-patient treatment of 107 complicated forefoot plantar ulcers occurring in the anaesthetic foot by the operation of dorsal incision is presented. The operative technique of dorsal incision and subsequent wound dressing is described. 69 ulcers healed prior to discharge and all but 3 ulcers healed in an average of 27.2 days. In-patient stay averaged 31.4 days. The complications of the procedure are presented. Emphasis is placed on health education of the patient regarding care of the anaesthetic foot. Further follow up is suggested to see if dorsal incision reduces the recurrence of plantar ulceration.
Sensory and mixed nerve conduction studies were performed on the distal segments of the radial, sural, median and ulnar nerves of leprosy patients from the entire spectrum of the disease. The values obtained were compared with those of age matched normal controls. All the clinically involved nerves, and about 30% of the clinically normal patient nerves showed a delayed conduction velocity. The conduction velocity difference was most significant (P less than 0.001) for the cutaneous branch of the radial, and sural nerves as compared to the ulnar and median. Five patients nerves that were clinically normal and showed a normal conduction velocity when tested in vivo, were biopsies and studied in vitro to determine the type of early nerve damage. C and A delta fibre involvement was found in all these nerves. It is concluded that leprosy is a diffuse neuropathy and there is early detectable nerve involvement even in clinically normal nerves of leprosy patients.
Ultrastructural observations made on the blood vessels of nerves in CBA/J mice with experimentally produced M. leprae infection revealed cytoplasmic filamentous structures along with large sized vacuoles in the endothelial cells and reduplication of peripericytal basement membranes in the 6-9 months of infection. In animals with late infection of 9-15 months duration, the endothelial cells presented foamy appearance caused by an increase in the number of vacuoles. These findings are suggestive of degenerative changes in the endothelial cells probably due to circulation of noxious substance in the blood stream.
A study of regional lymph nodes in 44 cases of proved tuberculoid leprosy (BT & TT) is presented. Out of 26 cases of tuberculoid polar (TT) leprosy, 76.92% showed presence of paracortical lymphocytes, 61.52% showed presence of granuloma and 11.54% showed presence of acid fast bacilli in lymph nodes. In the borderline tuberculoid (BT) group, 61.1% showed granuloma, 72.22% showed presence of paracortical infiltration by lymphocytes and 11.11% showed presence of A.F.B. in lymph nodes. Lesions of tuberculoid leprosy have been conclusively demonstrated in the low resistant tuberculoid (BT) leprosy and polar tuberculoid leprosy (TT). The presence of paracortical lymphocytes in large numbers in the lymph nodes could indicate high cell mediated immunity (CMI) and possibly a tuberculoid end of the spectrum. The skin lesions and lymph nodes had comparative histopathology.
One hundred and five leprosy patients including 37 cases of LL and LI, 22 cases of BL, 3 cases of BB, 17 cases of BT, 23 cases of TT and 3 cases of indeterminate type during the period of 1980-81 have been examined clinically. All the patients of LL, LI, BL and BB types, 94% of BT, 70% of TT and 66.6% of indeterminate type have showed clinical enlargement of lymph nodes. In order of frequency the enlarged nodes are inguinal (76.2%) cervical (69.5%), axillary (69.5%), epitrochlear (64.7%) and lastly pre-auricular (9.5%). Although both regional and distant groups of lymph node enlargement have been observed in all cases of LL, LI and BL, in majority of the non-lepromatous cases there is only involvement of regional lymph nodes. Biopsies of lymph nodes are made from 51 leprosy patients, 22 from LL and LI cases, 11 from BL cases, 2 from BB cases, 8 from BT cases, 6 from TT cases and 2 from indeterminate leprosy cases. Major histopathological changes have been studied in different types of leprosy. The humoral antibody response and the cellular immune response are well reflected on the histopathological finding of the lymph nodes belonging to different immunological spectrum of leprosy patients. The examination of lymph nodes is recommended as a useful adjunct for the diagnosis and classification of leprosy.
Serum haptoglobin phenotypes were studied in 80 patients with leprosy classified according to the criteria of Ridley and Jopling. The distribution of phenotypes was: 2-2, 65%; 2-1, 27.5%; 1-1, 1.25%; and 0-0, 6.25%. This distribution was not significantly different from the controls except for the phenotype 0-0 (p less than 0.02). Thus, although this genetic marker did not correlate with the occurrence of the variety of disease, it is possible that leprosy caused inhibition of haptoglobin synthesis and therefore an apparent increased frequency of the 0-0 phenotype. Evidence for such a secondary anhaptoglobinemia was available in one case.
Serological tests for the detection of C-reactive protein (CRP), Rheumatoid factor (RE) and Anti Streptolysin 'O' (ASLO) antibodies employing latex test were carried out in 120 cases of active lepromatous leprosy, 14 LL cases with ENL during active and subsided phases and 25 controls. Out of 120 LL cases 25.8% gave a positive reaction to CRP and ASLO. Only 4.2% of the cases with LL were positive for Rheumatoid factor. None of the controls showed positive reaction in these tests. During ENL, 100% of the sera showed positive test for CRP as against 35.7% during subsidence of reaction. Tests for RF were positive in 28.5% of the cases ENL as compared to none during subsided ENL. Raised ASLO titers were noticed in 38.2% cases with active ENL as against 21.4% during subsided phase of ENL.
Serum total cholesterol and the lipoprotein fractions were studied in forty subjects of lepromatous leprosy and age matched controls. The study revealed a significant decrease in serum cholesterol in the disease group as compared to control group. The decrease in cholesterol was 28.76% An alteration in serum lipoprotein fractions was observed in disease group. The beta-lipoprotein fraction showed a significant decrease along with a rise in alpha-lipoprotein fraction. A positive correlation was also observed between total cholesterol and beta-lipoproteins. The significance of the above findings are discussed.
A preliminary study in which a sample of 25 patients registered with SLR and TC, Karigiri, with proved secondary DDS-resistant leprosy were compared, with 25 patients not suspected to be DDS-resistant, for social and personality factors, which could have lead to non-compliance in treatment. A structured interview schedule enquiring into factors leading to irregular treatment and the psycho-social background of the patient was used. The Eysank's Personality Inventory (EPI) and Personality traits assessment on a linear analogue was also administered to them. Statistical analysis showed that DDS-resistant leprosy patients were as a group more irregular for treatment, showed personality traits of being casual and uncontrolled and scored high on the neuroticism scale of the EPI.
Available reports both from rural and urban leprosy centres prove beyond any doubt that dapsone is not being consumed regularly by all those who show regular clinic attendance. No reports are available from urban field projects where SET programme is being operated. In this study surprise urine samples of 294 patients of all types (smear positive 53%) mainly on dapsone monotherapy attending (1) leprosy treatment centres in slum clinics situated in the field areas adopted for SET work by Bombay Leprosy Project and (2) general hospital clinics situated predominantly outside the project area were analysed for dapsone/creatinine ratio to judge the extent of drug compliance. 201 out of 294 (68%) were regular and 82 out of 294 (28%) were irregular in consuming DDS as judged by urine examination. 67% of smear positive cases were regular. No difference was found in regularity between patients living within the project area (intensive follow up is done in this group to remind about treatment) and outside project area patients (no reminder followup is done). Similarly no difference was observed in regularity amongst the patients attending slum clinics and general hospital clinics. It could be stated that facilities for treatment offered at general hospitals or dispensaries and encouraging voluntary reporting could be quite fruitful and economical for obtaining better drug compliance in urban areas.
Fibrinolytic activity was studied in 31 patients of leprosy and 10 healthy controls. Fibrinolytic activity was found to be significantly decreased in patients with erythema nodosum leprosum, compared to those with uncomplicated lepromatous leprosy, who in turn showed lowered activity compared to patients with tuberculoid form of leprosy and controls. The severity of ENL correlated very well with decrease in fibrinolytic activity. Fibrinolytic activity was improved to levels obtained in uncomplicated lepromatous leprosy after the subsidence of reaction. So it would seem reasonable to suggest that estimation of fibrinolytic activity provides a reliable criteria to quantitate the severity of erythema nodosum leprosum.
Langerhans cell population was counted in 44 patients of different types of leprosy and compared with 12 normal volunteers. Significant reduction in LC count was observed in cases of LL (253.44 +/- 136.83/mm2) and BL (349.36 +/- 121.67/mm2). Whereas in TT (854.60 +/- 332.01/mm2) and BT (715.76 +/- 235.33/mm2) there was no significant difference, as compared to Normal (927.43 +/- 103.87/mm2). Treatment had no influence on LC population in both the polar types of leprosy. Role of these immunocompetent dendritic cells in the pathogenesis of leprosy is discussed.
