76
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Valentini A, Nery JA, Salles AM, Vieira LM, Sarno EN. [Edema in leprosy: the clinical and therapeutic aspects]. Rev Soc Bras Med Trop 1999; 32:131-8. [PMID: 10228362 DOI: 10.1590/s0037-86821999000200003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Edema, which is commonly described as a symptom of reactional states, may occur during the course of leprosy. Both diagnosis and adequate treatment measures are often difficult to achieve and failure to do so may result in permanent damage to the lower limbs. In a one-year follow-up study of leprosy patients--ten multibacillary and one paucibacillary--who had been submitted to a clinical protocol for diagnosis and pathological classification, a clinical pattern of localized and/or systemic edema was observed. Among these patients, five simultaneously presented other symptoms related to reactional states, 4 were diagnosed as Type I, and one as Type II. On the other hand, while three of the patients did not present reaction at the time when edema was diagnosed, they did develop some aspects of reactional disease later on (two had neuritis e one had Type I reaction). The edemas that preceded or were associated with reactional episodes showed clinical regression as a result of specific treatment against reactions (corticosteroids and/or pentoxifylline and/or thalidomide) in the absence of another treatment normally used for edemas. Although these data need to be confirmed by controlled studies, they strongly suggest that immunological mechanisms are involved in the physiopathology of edema in leprosy.
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77
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Munk ME, Anding P, Schettini AP, Cunha MG, Kaufmann SH. Soluble tumor necrosis factor alpha receptors in sera from leprosy patients. Infect Immun 1999; 67:423-5. [PMID: 9864247 PMCID: PMC96328 DOI: 10.1128/iai.67.1.423-425.1999] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Serum levels of soluble tumor necrosis factor alpha receptor I (sTNF-RI) were elevated in patients with lepromatous (LL) reactional-state type II leprosy, and sTNF-RII levels were increased in patients with full tuberculoid (TT) or LL type II leprosy. The sTNF-R in sera from patients with type II leprosy, but not other forms of leprosy, inhibited recombinant TNF cytolytic activities in vitro. This suggests that sTNF-R regulatory activities are partially impaired in patients with leprosy.
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MESH Headings
- Adult
- Animals
- Antigens, CD/blood
- Antigens, CD/physiology
- Cytotoxicity Tests, Immunologic
- Female
- Humans
- Leprosy/blood
- Leprosy/drug therapy
- Leprosy/immunology
- Leprosy, Tuberculoid/blood
- Leprosy, Tuberculoid/drug therapy
- Leprosy, Tuberculoid/immunology
- Male
- Mice
- Receptors, Tumor Necrosis Factor/blood
- Receptors, Tumor Necrosis Factor/physiology
- Receptors, Tumor Necrosis Factor, Type I
- Receptors, Tumor Necrosis Factor, Type II
- Solubility
- Tumor Cells, Cultured
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
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78
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Mahé A. [How should leprosy be treated?]. Ann Dermatol Venereol 1998; 125:881-3. [PMID: 9922859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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79
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Abstract
A case of fixed drug eruption due to rifampin in a leprosy patient is described. Fixed drug eruption due to rifampin with the classical residual hyperpigmentation has not been described before.
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80
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Singh G, Dash K, Grover S, Sangolli P. Skin patches heralding relapse in a treated case of neuritic leprosy. LEPROSY REV 1998; 69:400-1. [PMID: 9927814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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81
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Moubasher AD, Kamel NA, Zedan H, Raheem DD. Cytokines in leprosy, II. Effect of treatment on serum cytokines in leprosy. Int J Dermatol 1998; 37:741-6. [PMID: 9802683 DOI: 10.1046/j.1365-4362.1998.00382.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Multidrug therapy (MDT) causes a decrease in the bacterial burden in leprosy patients. Does the decrease in the antigenic stimulation of the immune system have an effect on cytokine production? METHODS The effect of treatment on serum cytokines was evaluated in 36 leprosy patients and 35 reactional leprosy patients and compared with that in 20 age- and sex-matched healthy individuals. The enzyme-linked immunosorbent assay (ELISA) technique was used to measure serum levels of interleukin-2 receptor (IL-2R), interleukin-10 (IL-10), and interleukin-1beta (IL-1beta) before and after treatment. These cytokines represent T-helper 1 (TH1), T-helper 2 (TH2), and macrophage cytokines, respectively. RESULTS The studied serum cytokines were significantly reduced after 1 year of treatment in leprosy patients. The degrees of reduction were significantly positively correlated with a reduction in the bacterial index (BI) and morphologic index (MI). After 1 year of MDT (but not 6 months), paucibacillary (PB) patients showed a significant reduction in all the studied serum cytokines to levels comparable with those of healthy controls. Multibacillary (MB) patients also showed a significant reduction in all the studied serum cytokines, but the levels were still significantly higher than those of healthy controls. Leprosy patients with high levels of serum IL-1beta were more susceptible to the development of reactions after the initiation of treatment. Corticosteroid therapy of reactional patients resulted in a significant reduction in the studied serum cytokines to levels similar or lower than those of nonreactional leprosy patients. The dose of steroids showed a significant positive correlation with the amount of decrease in IL-1beta. CONCLUSIONS MDT caused a reduction in serum cytokines correlated with a reduction in the bacterial burden. It is advisable to continue MDT for PB patients for 1 year. Serum IL-1beta levels may have a prognostic value for the susceptibility of leprosy patients to the development of reactions.
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82
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Ng PP, Goh CL. Sparing of tuberculoid leprosy patch in a patient with dapsone hypersensitivity syndrome. J Am Acad Dermatol 1998; 39:646-8. [PMID: 9777777 DOI: 10.1016/s0190-9622(98)70019-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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83
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Arunthathi S, Ebenezer L, Kumuda C. Reversal reaction, nerve damage and steroid therapy in three multibacillary HIV positive patients. LEPROSY REV 1998; 69:173-7. [PMID: 9715603 DOI: 10.5935/0305-7518.19980020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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84
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Abstract
Although its overall prevalence is decreasing, leprosy continues to be a major cause of neuropathy worldwide. In the United States, it is a relatively rare condition. As a result, physicians may lack familiarity with the disease, which can delay diagnosis and treatment. Leprous neuropathy is characterized by involvement of dermal nerves and superficial peripheral nerve trunks in cooler body regions. A continuing pattern of immigration from endemic areas may allow practicing neurologists in any region of the country to become involved in the care of patients with leprosy. The diagnosis should be considered in patients from endemic regions presenting with peripheral neuropathy with or without skin lesions. Readily available diagnostic testing, access to subspecialists, and modern transportation and information systems through the satellite clinics of the Hansen's Disease center serve as major advantages for the management of leprosy patients in the United States.
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85
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Partida-Sanchez S, Favila-Castillo L, Pedraza-Sanchez S, Gomez-Melgar M, Saul A, Estrada-Parra S, Estrada-Garcia I. IgG antibody subclasses, tumor necrosis factor and IFN-gamma levels in patients with type II lepra reaction on thalidomide treatment. Int Arch Allergy Immunol 1998; 116:60-6. [PMID: 9623511 DOI: 10.1159/000023926] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A group of 9 Mexican lepromatous leprosy patients was studied at the beginning of a type II reaction (erythema nodosum leprosum, ENL) and after 1 or 2 months of thalidomide treatment. ENL patients at the onset of the reaction had slightly higher amounts of anti-Mycobacterium leprae IgG1 and IgG2 antibodies, compared to similar lepromatous patients that did not develop ENL. Neither these antibody levels nor IgM and the other IgG subclasses were importantly modified after thalidomide treatment. Serum TNF was significantly higher in the patients that developed ENL compared to those that did not develop the reaction. TNF levels were slightly decreased after 1 month of thalidomide treatment and significantly decreased after 2 months of treatment. Serum IFN-gamma was significantly lower in patients at the onset of ENL and was increased after 1 and 2 months of thalidomide treatment.
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86
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Ramanathan VD, Thyagi P, Ramanathan U, Katoch K, Ramu G. A sequential study of circulating immune complexes, complement and immunoglobulins in borderline tuberculoid leprosy patients with and without reactions. INDIAN JOURNAL OF LEPROSY 1998; 70:153-60. [PMID: 9724850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sequential estimates of the levels of circulating immune complexes (CIC), complement catabolic fragment C3d, complement-mediated immune complex solubilization (CMS) and immunoglobulins were made in 24 newly diagnosed with borderline tuberculoid leprosy over a 20 month period after initiation of chemotherapy. Fourteen of these patients had not suffered from reversal reactions either at the time of presentation or during the follow-up. The levels of CIC were evaluated in them from the third to the eleventh month after starting chemotherapy and immunoglobulin G (IgG) levels were evaluated up to eight months. The concentrations of C3d and immunoglobulins A (IgA) and M (IgM) were normal in these patients. The other ten patients had reversal reaction at the time of diagnosis which subsided by the third month after starting treatment. They did not have reversal reactions later. The levels of CIC and IgG were elevated and those of CMS were depressed throughout the study period. Serum C3d level was initially elevated but came down to normal by the third month while IgA and IgM levels were within normal limits. The relevance of these findings to the genesis of reversal reaction is discussed in this communication.
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87
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Jaswal R, Thami GP, Kanwar AJ. Dapsone syndrome: an incomplete form. INDIAN JOURNAL OF LEPROSY 1998; 70:229-30. [PMID: 9724867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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88
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Padełskaya EN. [Ofloxacin in mycobacteriosis therapy]. ANTIBIOTIKI I KHIMIOTERAPIIA = ANTIBIOTICS AND CHEMOTERAPY [SIC] 1998; 42:26-31. [PMID: 9463298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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89
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Beuria MK, Parkash O, Joshi B, Mohanty KK, Katoch K, Sengupta U. Levels of IgG subclasses in active and inactive cases in the disease spectrum of leprosy. Int Arch Allergy Immunol 1998; 115:61-6. [PMID: 9430497 DOI: 10.1159/000023831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The present study was carried out to establish the role of IgG subclasses in leprosy. IgG subclasses to Mycobacterium leprae sonicated antigens (MLSA) and phenolic glycolipid-I (PGL-I) were determined in 124 patients with active leprosy across the disease spectrum and in 76 cases with inactive disease after completion of chemotherapy. IgG2 antibodies were found to be the predominant subclass across the disease spectrum. Lepromatous patients showed elevated levels of IgGI. IgG3 antibody levels were higher in lepromatous than that in tuberculoid patients. Patients with erythema nodosum leprosum showed a significant fall in IgG3 antibody to MLSA. While chemotherapy induced a reduction in IgG1, IgG2 and IgG3 to PGL-I in almost all types of leprous patients, for MLSA the reduction was noticed for these subclasses only in lepromatous patients. IgG4 responses to these antigens were low through out the disease spectrum and did not alter with chemotherapy.
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MESH Headings
- Antibodies, Bacterial/analysis
- Antibodies, Bacterial/blood
- Antibodies, Bacterial/physiology
- Antigens, Bacterial/immunology
- Enzyme-Linked Immunosorbent Assay
- Erythema Nodosum/blood
- Erythema Nodosum/drug therapy
- Erythema Nodosum/immunology
- Glycolipids/immunology
- Humans
- Immunoglobulin G/analysis
- Immunoglobulin G/blood
- Immunoglobulin G/physiology
- Leprostatic Agents/therapeutic use
- Leprosy, Borderline/blood
- Leprosy, Borderline/drug therapy
- Leprosy, Borderline/immunology
- Leprosy, Lepromatous/blood
- Leprosy, Lepromatous/drug therapy
- Leprosy, Lepromatous/immunology
- Leprosy, Tuberculoid/blood
- Leprosy, Tuberculoid/drug therapy
- Leprosy, Tuberculoid/immunology
- Mycobacterium leprae/immunology
- Severity of Illness Index
- Sonication
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90
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Sehgal VN, Kumar S, Jain S, Bhattacharya SN. Relapse (reactivation) in borderline tuberculoid (BT) leprosy. J Dermatol 1998; 25:63-5. [PMID: 9519615 DOI: 10.1111/j.1346-8138.1998.tb02350.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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91
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Butlin CR, Soares D, Neupane KD, Failbus SS, Roche PW. IgM anti-phenolic glycolipid-I antibody measurements from skin-smear sites: correlation with venous antibody levels and the bacterial index. INTERNATIONAL JOURNAL OF LEPROSY AND OTHER MYCOBACTERIAL DISEASES : OFFICIAL ORGAN OF THE INTERNATIONAL LEPROSY ASSOCIATION 1997; 65:465-468. [PMID: 9465156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Measurements of anti-phenolic glycolipid-I antibodies were made in 200 matched samples of capillary blood from the skin-smear site, venous blood collected on filter paper, and sera. A close correlation among the three samples was observed and a weaker correlation among the antibody levels and the average and skin-smear bacterial index. Capillary blood from the skin-smear site had a consistently higher level of antibodies in each sample than did the sera. The collection of capillary blood from skin-smear sites is a convenient and economical method of obtaining samples for serology and for measuring local antibody levels, and it may be more sensitive than measurements of antibodies in sera.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antibodies, Bacterial/analysis
- Antibodies, Bacterial/blood
- Antibodies, Bacterial/immunology
- Antigens, Bacterial
- Child
- Disease Progression
- Drug Monitoring/methods
- Female
- Glycolipids/blood
- Glycolipids/immunology
- Humans
- Immunoglobulin M/analysis
- Immunoglobulin M/blood
- Immunoglobulin M/immunology
- Leprosy/diagnosis
- Leprosy/drug therapy
- Leprosy/immunology
- Leprosy, Borderline/diagnosis
- Leprosy, Borderline/drug therapy
- Leprosy, Borderline/immunology
- Leprosy, Lepromatous/diagnosis
- Leprosy, Lepromatous/drug therapy
- Leprosy, Lepromatous/immunology
- Leprosy, Tuberculoid/diagnosis
- Leprosy, Tuberculoid/drug therapy
- Leprosy, Tuberculoid/immunology
- Male
- Middle Aged
- Sensitivity and Specificity
- Skin/blood supply
- Skin/immunology
- Skin/microbiology
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92
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Ebenezer GJ, Suneetha S, Arunthathi S. Clinical and histopathological activity in paucibacillary leprosy patients after fixed-duration multidrug therapy. LEPROSY REV 1997; 68:218-24. [PMID: 9364822 DOI: 10.5935/0305-7518.19970030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In 37 clinically-diagnosed borderline-tuberculoid (BT) leprosy patients skin biopsies were done prior to starting multidrug therapy (MDT) and at the end of 6 months therapy. Clinical and histopathological activity, graded as active, resolving and inactive, were studied at the end of 6 months of MDT. Of the 37 clinically-diagnosed BT patients 24 could be confirmed by histopathology as having BT leprosy, while the other 13 biopsies showed features of indeterminate (I) leprosy. After 6 months of MDT, out of the 24 histopathologically-confirmed BT patients, 4 (17%) showed clinical activity and 8 (33%) showed histopathological activity. Of the 13 histopathologically-diagnosed indeterminate cases all were clinically inactive but histological activity persisted in 3 cases (23%). Out of the 37 clinically-diagnosed BT patients 3 showed both clinical and histopathological activity at the end of MDT. This study emphasizes the importance of performing histopathological examinations on leprosy patients undergoing research studies for the confirmation of diagnosis and for proper classification of the disease. The histopathological activity that outlasts the MDT may be due to the bacillary fragments that persist but clinical activity coupled with histopathological activity seen in 3 patients at the end of 6 months may foreshadow a relapse and these patients and others like them need to be followed up for longer durations.
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93
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Velázquez de Castro y Sagarra A, López Bueno R, Gómez Jiménez G. [Suspected leprosy]. Aten Primaria 1997; 20:107-8. [PMID: 9296648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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94
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Shetty VP, Antia NH. Relapse in a borderline-tuberculoid case of leprosy 5 years after the release from rifampicin monotherapy. LEPROSY REV 1997; 68:162-6. [PMID: 9217356 DOI: 10.5935/0305-7518.19970022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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95
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Darius EJ, Selvasekar A, Mani MN, Jesudasan K. Ulnar abscess: 4 months after release from control with paucibacillary-multidrug therapy. LEPROSY REV 1997; 68:173-4. [PMID: 9217358 DOI: 10.5935/0305-7518.19970024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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96
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Abstract
About 95% of individuals who come in contact with M. leprae do not develop overt disease. The clinical form of the disease correlates with the T-cell mediated immune response of the host rather the direct damage caused by bacilli. We review the current aspects of epidemiology, transmission, bacteriology, clinical features, reactions, diagnosis, chemotherapy and treatment of reactions.
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97
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Grover S, Singh G, Dash K. Primary hyperpigmented palmar lesion: a rare presentation of borderline tuberculoid leprosy. INDIAN JOURNAL OF LEPROSY 1997; 69:191-3. [PMID: 9290973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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98
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de Carsalade GY, Wallach D, Spindler E, Pennec J, Cottenot F, Flageul B. Daily multidrug therapy for leprosy; results of a fourteen-year experience. INTERNATIONAL JOURNAL OF LEPROSY AND OTHER MYCOBACTERIAL DISEASES : OFFICIAL ORGAN OF THE INTERNATIONAL LEPROSY ASSOCIATION 1997; 65:37-44. [PMID: 9207752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Between 1980 and 1994, 67 new or relapsing leprosy patients were treated by daily administered multidrug regimens. Tuberculoid patients (23 TT/BT) received either bitherapy [rifampin + dapsone or clofazimine (RMP + DDS or CLO)] or tritherapy [RMP + DDS and/or CLO and/or ethionamide (ETH)] until clinical cure. Lepromatous patients (44 BB/BL/LL) received tritherapy (RMP + DDS and/or CLO and/or ETH) at least until bacteriological negativity. Of the 23 tuberculoid patients only one patient (5%) was cured at 6 months and about 70% needed between 6 and 24 months of treatment to obtain clinical cure (mean 19.5 months). In the 44 lepromatous patients, the achievement of bacteriological negativity was significantly linked to the initial bacterial index (BI), and it occurred after 2 to 7 years (mean 66.5 months) of multidrug therapy (MDT). The average BI decrease per year was 1.1+ during the first year, 0.9+ the second year, and then < 0.5+ per year. Reactional states significantly (p < 0.01) influenced the BI course: reversal reactions (RR) accelerated while erythema nodosum leprosum (ENL) delayed the BI decrease. Three of the 23 (13%) tuberculoid and 19 of the 44 (43%) lepromatous patients (p < 0.02) exhibited a RR and 18 of 44 (41%) lepromatous patients had ENL during MDT. A late RR (LRR) was observed in 1 (5%) and 6 (17%) of our tuberculoid and lepromatous patients, respectively, and 3 (8%) of our lepromatous patients suffered post-MDT ENL. No confirmed relapse has been observed within a follow-up period of 6 months to 7 years and 3 months [59 person-years at risk (PYR)] for TT/BT patients and of 4 months to 5 years and 10 months (100 PYR) for BB/BL/LL patients. When compared to the recommended WHO/MDT, it appears that daily MDT does not increase the clinical or the bacteriological cure rates either at 6 months in paucibacillary tuberculoid patients or at 2d years in multibacillary lepromatous patients. Moreover, as does the WHO/MDT, our regimens show a high frequency of reactional states both during and after treatment. This fact constitutes the main new problem of the actual treatment of leprosy.
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99
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Vijayakumaran P, Manimozhi N, Jesudasan K, Arunthathi S, Jacob M, Samuel P. Leucocytopenia after rifampicin and ofloxacin therapy in leprosy. LEPROSY REV 1997; 68:10-5. [PMID: 9121326 DOI: 10.5935/0305-7518.19970003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
New antimycobacterial agents and combined treatment regimens are being introduced for the treatment of leprosy. Ofloxacin is one such broad spectrum antimicrobial agent. In this study rifampicin plus ofloxacin were administered daily for 4 weeks (daily supervised dose). Two patients (and possibly a third patient who refused all investigations) out of 125 patients developed leucocytopenia during the third week of therapy. It was associated with fever, malaise, nausea and loss of appetite. They recovered after cessation of drug treatment. Patients receiving ofloxacin should be monitored for constitutional symptoms suggestive of this complication even though the risk of such complication may be minimal.
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100
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Job CK, Baskaran B, Jayakumar J, Aschhoff M. Pathologic changes in a tibial nerve with surviving M. leprae in a healed tuberculoid leprosy patient. INTERNATIONAL JOURNAL OF LEPROSY AND OTHER MYCOBACTERIAL DISEASES : OFFICIAL ORGAN OF THE INTERNATIONAL LEPROSY ASSOCIATION 1997; 65:90-4. [PMID: 9207758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A tibial nerve from a disease-arrested borderline tuberculoid (BT) leprosy patient was dissected out and examined almost in its entirety using hematoxylin and eosin staining, a modified Fite's stain for acid-fast bacilli (AFB), solochrome cyanin stain for myelin, and van Gieson's stain for fibrous tissue. Fibrosis of the perineurium and epineurium and fibrous replacement of the nerve parenchyma, which was maximum at the ankle joint area, were seen. In focal areas inflammation was present, especially in the epineurium around blood and lymph vessels. Even 21 years after adequate antileprosy therapy, AFB were present in the endoneurium in all except 2 of the 10 segments of the nerve, evoking hardly an inflammatory reaction or other ill effects. It is pointed out that BT leprosy should also be considered a generalized disease, especially when there is peripheral nerve trunk involvement and, in such cases, a longer duration of currently available antileprosy therapy is advisable. Trauma to nerve trunk plays a major role in producing nerve destruction and paralysis.
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