International journal of leprosy and other mycobacterial diseases : official organ of the International Leprosy Association最新文献

In Iran, there have been a few cases of leprosy in several provinces, however, native physicians believe that leprosy is not present primarily in an Isfahan endemic area. We performed an investigation either to approve or rule out this idea. We found 25 lepra patients who were registered and followed in Isfahan Leprosy Health Registeration Center, all of whom were infected in other regions and migrated to Isfahan city at a later time. Final analysis proved that there are not any cases of leprosy by itself in Isfahan as an endemic region at the time of this study (1975 to 2002).

This study compares the results of HIV seroprevalence, which was carried out in two phases, i.e., 1989 to 1993 and 1999 to 2004. Although the number of leprosy patients screened for HIV infection in the second phase is less (2125) as compared to those screened during the first phase (4025), a rise in HIV infection from 0.12% to 0.37% is certainly disturbing since this area appears to be endemic for both the infections. During the study period, the Out Patient department attendance of a few types of leprosy patients like borderline and borderline lepromatous have risen, whereas others like borderline tuberculoid and polar tuberculoid have declined in the second phase as compared to that of the first phase. The trend over a decade suggests that HIV infection is low among the leprosy patients when compared with other risk groups. Follow-up of these patients at an interval of six months, revealed that none of them downgraded into a severe form of leprosy nor developed ARC or AIDS. In this study, it appears that neither infection precipitated the other. The occurrence of downgradation as well as reversal reactions and neuritis (both chronic and acute) was not observed among the leprosy patients. None of them developed erythema nodosum leprosum reactions. Similarly, the HIV-positive leprosy cases did not develop either AIDS related complex (ARC) or full blown case of AIDS.

Erythema nodosum leprosum necroticans is an uncommon manifestation of type 2 lepra reaction, encountered in lepromatous and borderline lepromatous cases of leprosy. We report an unusual clinical presentation of necrotic erythema nodosum leprosum in a 9-year-old boy with no pre-existing evidence of leprosy. The lesions resolved completely following multi-bacilliary multi-drug therapy for 12 months, non-steroidal anti-inflammatory drugs and corticosteroids.

Background: Even after 12 months of multi-drug therapy (M.D.T.) multibacillary (MB) therapy patients with high bacterial index (B.I.) continue to harbor dead bacilli and viable persisters, which lead to immunological complications such as recurrent reactions and late relapses, respectively. To achieve faster killing of viable bacilli and clearance of dead bacilli, various immunotherapeutic agents (vaccines and cytokines) are being evaluated as an adjunct to M.D.T. Aims and objectives. To evaluate the role of BCG and Mw vaccines in the immunotherapy of leprosy.

Materials and methods: Sixty untreated leprosy patients with a BI = 2 were randomly allocated to three treatment groups of twenty patients each. Group A patients received World Health Organization (W.H.O.) (12 months M.D.T.-MBR) and BCG intradermally (105 live bacilli/per dose). Group B patients were administered 12 months M.D.T.-MBR and Mycobacterium w (1 x 108) killed bacilli as first dose and 0.5 x 108 /dose in subsequent doses. Group C received 12 months M.D.T. MBR with 0.1 ml of normal saline as placebo. All the groups received 4 doses of vaccine or normal saline repeated at three monthly intervals. The patients were periodically monitored by clinical (Ramu's score), bacteriological (slit skin smear), and histopathological (skin biopsy) parameters, six monthly during and one year after completion of M.D.T.

Results: The mean reduction in clinical scores in BCG and Mw groups was significantly more when compared to controls. At 12 and 24 months, the patients in BCG group had significantly greater reduction in Ramu's score as compared to those in the Mw group. BI declined by 2.40 units/year in patients receiving BCG, 2.05 units/year in the Mw group and 0.85 units/year in the control group. Although the incidence of type 1 reactions was apparently more in the BCG and Mw vaccinated groups, the incidence of type 2 reactions, neuritis and development of new deformities was less as compared to the controls.

Conclusions: In our study, BCG exhibited slightly better and faster effect on bacteriological clearance and clinical improvement as compared to Mw vaccine in borderline lepromatous (BL)/ polar lepromatous (LL) patients with a high initial B.I., however, their effect on histopathological (decrease in GF) improvement was comparable. Both the vaccines were well tolerated. Immunotherapy can be a useful adjunct to the shortened (12 months) M.D.T. MB regimen to decrease the risk of reactions and relapses in highly bacilliferous BL/LL patients.

Leprosy prevalence has reportedly declined all over the world, but six countries, including India, are still endemic for the disease. India alone contributes about 60% to the world's leprosy case load, with the major share from its northern states. The present study done in Agra district was based on a randomly-selected sample of over 10% of the population, spread across 300 villages and 16 urban units of the district. A house-to-house survey was conducted from July 2001 to July 2003 in all the 26 selected panchayats (300 villages), all the 11 block headquarters which have an urban component, and 5 (out of 20) localities in Agra city. A population of 361,321 persons was examined for leprosy. A total of 592 leprosy cases [new and cases yet to complete a full course of multi-drug therapy (M.D.T.)] were found, giving a prevalence rate of 16.4/10,000 population. Although the overall prevalence was found to be similar in both rural and urban areas, there were pockets with high prevalence. More cases were detected in the eastern side of Agra (31.4/10,000 in Fatehabad and 28.5/10,000 in Bah Tahsils). Overall, the multibacillary (MB) leprosy rate was 22.3% and the child leprosy rate 8.4%. Of the 592 cases, 523 (88.3%) were new untreated cases, giving a new case detection rate of 14.5/10,000. The MB rate was 17% (89/523), and the child leprosy rate was 8.4% (44/523) among the new patients. The grade 2 deformity rate was found to be 4.8% (25/523) among these cases. The duration of disease among new cases was 32.3 months as compared to 48.1 months among prevalent (registered) cases (i.e., patients who had been diagnosed earlier and had yet to complete a full course of M.D.T.). The large number of undetected cases found in this survey suggests the need for continued intensive health education campaigns and case detection activities. This study highlights the fact that a large number of leprosy cases go undetected in the present integrated system which is mainly based on voluntary reporting of cases.