Japanese Journal of Leprosy最新文献

Treatment of erythema nodosum leprosum (ENL, type 2 reaction) using thalidomide provides effective alternative choice to steroid therapy. Yet, the Japanese National Health Insurance approves thalidomide prescription only for the treatment of multiple myeloma under the Thalidomide Education and Risk Management System (TERMS). Benefit of thalidomide therapy for patients with ENL is already an established fact based on various reports from other countries, but limited experiences and standards in Japan have hindered application of the medication to our patients. This led us to compose a local guideline. Based on and following the TERMS, we suggest starting thalidomide from 50-100 mg/day and then onwards adjusting the dose according to the symptoms of each patient, not to exceed the maximum recommended dose of 300 mg/day, for the treatment of ENL.

Hansen's disease sufferers had been visiting the hot spring, Kusatsu-Spa, in Gunma, Japan, for Toji (which means 'hot springs treatment' in Japanese) since the middle ages, as it was known reportedly for a long time to be effective in curing the disease. In 1869, Kusatsu-Spa was hit by a massive fire. The innkeepers, who suffered devastating damages, were trying to reconstruct the economy quickly by promoting the medical benefits of the hot spring. This made many Hansen's disease patients to visit and of which many stayed on a long term bases. They would use the hot spring with ordinary visitors. And, they had received the treatment of the spotted moxa cautery with the hot-spring treatment. Later on, Kusatsu- Spa became well known throughout Japan and as the numbers of ordinary visitors increased, they voiced their concerns in sharing the hot spring with the Hansen's disease patients. Therefore, the innkeepers decided to move the patients to another district called Yunosawa and suggested to make a special village of just the patients. In 1887, the representative of the patients came to an agreement with the mayor of Yunosawa to establish a treatment centre there. Yunosawa became part of an administrative area of Kusatsu Town. The area seemed to become a local-governing area mainly shaped by Hansen's disease sufferers and the first legal residential area where Hansen's disease sufferers were given citizenships and may convalesce freely. However, in 1931, leprosy prevention law was passed, and the Japanese government built a new medical treatment centre of Hansen's disease, 4km away from Kusatsu- Spa, which is called National Sanatorium Kuryu Rakusen-en. After deliberations with the representative of the Hansen's disease patients living in the Yunosawa area and the governor of Gunma Prefecture, who received the order from the Japanese government to move them, had agreed to the mass relocation in 1941. This is how Yunosawa had closed its 55 years history and many Hansen's disease patients had moved to the National Sanatorium Kuryu Rakusen-en. The 'Freely recuperate Zone' within the centre houses affluent patients who had enough funds to build their own houses. I was able to hear from many residential People who have historical knowledge of the above and would like to report it here.

Buruli ulcer is a skin disease caused by Mycobacterium ulcerans (M. ulcerans). In this review, we introduce our recent studies and other important works. Lesions of Buruli ulcer are usually painless, despite the extensive tissue necrosis. We have reported that mice inoculated with M ulcerans show nerve degeneration and absence of pain, but the mechanism evoking the nerve damage have not been clarified. In order to define whether mycolactone, a toxic lipid produced by M. ulcerans, can induce nerve damages, we have injected mycolactone A/B to BALB/c mouse footpads. Mycolactone induced footpad swelling, and sensory test showed hyperesthesia on day 7 and 14, recovery on day 21, and hypoesthesia on days 28 and 42. Histologically, nerve bundles showed hemorrhage, neutrophilic infiltration, and loss of Schwann cell nuclei on days 7 and 14. Semithin section studies revealed vacuolar change of Schwann cells started on day 14, which subsided by day 42, but myelinated fiber density remained low. This study suggests that mycolactone directly damages nerves and is responsible for the absence of pain characteristic of Buruli ulcer. In the human lesions, presence of neuritis is reported (Rondini S, 2006), and murine studies showed "autoamputation" (Addo P, 2005). In order to prevent the serious deformities evoked by Buruli ulcer, further studies are necessary.

We aimed to elucidate the patterns and trends of autochthonous leprosy in Japan from 1964 to 2009, to compare them with the findings from other studies of leprosy in decline. Data on registered leprosy cases in Japan in the period 1964-2009 were analysed with reference to trends in case detection, geographical distribution, age at diagnosis, sex, classification and family history. A consistent decline in leprosy case detection was observed in all areas of the country over the period 1964-2009. Highest incidence was consistently in Okinawa. Autochthonous leprosy has not been reported in anyone born in Japan since 1980. Increasing average age and a shift towards lower latitudes were demonstrated throughout the period. Analyses of data on autochthonous cases revealed patterns similar to those reported in other countries with declining leprosy. Okinawa has had the highest incidence of leprosy in all of Japan since the first national survey in 1900. Several possible explanations include the difference of leprosy control history between Okinawa and the rest of Japan, Okinawa's unique geographical condition, large-scale problem of stigma and discrimination against leprosy patients and delayed improvement of socio-economic conditions.

Leprosy is suspected to develop after a long period of latency following infection with Mycobacterium leprae (M. leprae) during infancy, but definitive proof has been lacking. We found a rare case of leprosy in a chimpanzee (Pan troglodytes) born in West Africa (Sierra Leone) and brought to Japan around 2 years of age. At 31, the ape started exhibiting pathognomic signs of leprosy. Pathological diagnosis, skin smear, serum anti-phenolic glycolipid-I (PGL-I) antibody, and by PCR analysis demonstrated lepromatous leprosy. Single-nucleotide polymorphism (SNP) analysis verified the West African origin of the bacilli. This occurrence suggests the possibility of leprosy being endemic among wild chimpanzees in West Africa, potentially posing a zoonotic risk.

Drugs included in new-quinolone are used for the treatment of leprosy with single lesion. These drugs are also known to be effective drugs for the treatment of multi-drug resistant M. tuberculosis. Recent emergence of new-quinolone resistant M. leprae and M. tuberculosis enforced the urgent elucidation of the mode of emergence of new-quinolone resistant strains. In this review, new-quinolone drugs, their mode of action and mechanism of acquisition of resistance by M. leprae and M. tuberculosis were explained. And rapid differentiation methods for resistant bacilli were also introduced.