Japanese Journal of Leprosy最新文献

The authors reported a conjugal leprosy infection observed in Japan. The husband, index case, first noticed sensory disturbance at the lower right leg in his forties. He developed edematous swelling with redness of the right hand and forearm at the age of 72 (1989), and then developed multiple erythema and hypesthesia at the extremities. He was diagnosed as BL type leprosy (reactional stage) and treated with multi-drug therapy. His 71-year-old wife developed a few erythema at the right forearm in 1993. She was classified as BT type. The duration of their marriage life was over forty years. The couple did not have consanguinity. No other leprosy patients were found in their lineage. From their clinical courses the authors concluded that the husband infected his wife. According to Japanese literatures, the frequency of conjugal leprosy among new patients in Japan was approximately 1%. There were worldwide observations that the husband often infected the wife, and mostly the index case was multibacillary and the secondary case paucibacillary. The authors reviewed definition and frequency of conjugal leprosy, factors in conjugal infection and leprosy infection among the adults.

Leprosy Research Center is engaged in the international collaborative research project since 1989. The project was consists of two parts. One part is the JICA training course which has been practiced since 1989. Another part is the international collaborative research which was started in Indonesia in the year 1991. Author has participated in this project since 1998. Then, we started collaboration with various organizations including Pakistan, Vietnam, and Myanmar. The contents of the collaborative research were mainly technical assistances for leprosy diagnosis and we have trained young doctors, staff to conduct serological diagnosis and molecular biological diagnosis of leprosy. The projects between the countries were succesful. Throughout the collaboration with foreign countries, author felt strongly that one of most important things in such collaboration was better communication and relation between people having different cultural background.

Human immunology and relationship between immune mechanism and infection were explained. Humoral immunity and cellular immunity collaborate properly and eliminate microorganisms. In immunocompromised host these mechanisms are broken. For prevention of healthcare associated infections, standard precausion is important basically. Additionary, according to the status of the patient, contact precaution, droplet precaution or airborne precaution should be applied.

Sentinel surveillance for drug resistance in leprosy by global leprosy programme has launched in 2006. Possible contribution of Japanese researchers to global leprosy control in the future were discussed on the base of circumstances of the project and our assignment in the sueveillance.

Until the Japanese Leprosy Prevention Law was abolished in 1996, leprosy patients, regardless of their severity, had to be treated by accredited doctors. The majority of them had to be confined in a sanatorium to be treated, since only few hospitals/sanatoria had outpatient clinics for leprosy patients. This de facto confinement limited their occupational, social, financial, and family options, but no clear criteria/guidelines allowing discharge existed. The importance of leprosy outpatient clinics was almost never debated until 1962, when Tofu Association (a foundation established in 1952 to support the confined patients) and the National Suruga Sanatorium planned the opening of the clinic. This clinic looked after total of 4,977 patients until the abolishment of the Law. Since 1996, 349 persons consulted the clinic as of 2010. The importance of the continuation of these clinics is beyond dispute, even in low-endemic countries. However, the diminishing number of patients and demands in this country makes the management difficult. Thus, coordination with the local clinics and dermatologists is inevitable.

We report the results of an examination of gross images of two patients with Buruli ulcer and a histopathological evaluation of surgically removed skin from two other cases at the non-ulcerated and ulcerated stages, respectively. Histopathologically, dermal nodes were found in the non-ulcerated specimen; while wide necrosis of skin and fibrin deposition, as well as Langhans giant cell, epitheloid cells, and vasculitis, were observed in the ulcerated specimen, with granuloma in the lymph nodes. M. ulcerans was positive in a Fite stain and in a PGL-1 immunohistological stain. Based on these cases, we discuss the histological characteristics of Buruli ulcer.