HANSENÍASE: RESUMOS

HANSENIASIS ABSTRACTS

BACTERIOLOGIA E IMUNOLOGIA

BACTERIOLOGY AND IMMUNOLOGY

BAROCCI, S.; NOCERA, A.; CHIARLA, W. Studiodegli antigeni HLA in pazienti affetti da lebralepromatosa. G. Ital. Dermatol., 114(10) :501-504, 1979.

In its lepromatous variety, leprosy ischaracterized by marked depression in cell-mediated immunity. Recent studies of the HLAsystem have shown numerous disease situationsassociated with particular histocompatibilityantigens; as these antigens may play a part in thedevelopment of immune responses, it was decided toundertake a study of HLA antigens in patients withlepromatous leprosy. 27 patients, 18 male and 9female, all Italian Caucasians and suffering fromlepromatous leprosy, were typed for HLA antigensand compared with 165 healthy individuals; HLAantigens were measured by means of the Terasakimicrolymphocytotoxicity technique using 117 monoand polyspecific anti sera for the identification of 52HLA antigens belonging to A, B and C loci. Thefrequencies of three antigens, BW 38, BW 52 and B7proved to be significantly increased in patients withleprosy compared to the controls, values after Yatescorrection being respectively p < 0.005, p < 0.01' andp < 0.025.

Authors' summary

BECHELLI, L.M.; HADDAD, N.; PAGNANO, P.M.G.;MELCHIOR J.R.E.; FREGNAN, R.C. Reactivityof leprosy patients and unaffected persons todifferent concentrations of armadillo's leprominin comparison to human lepromin. Prelimisaryfindings of a double blind trial. Acta. Leprol..(75) :1-6, 1979.

Hansen. Int.. 5(2):136-160. 1980

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The object of the study is to compare theivity of leprosy patients and unaffectedns to armadillo's lepromin (160, 40 andillion bacilli/ml) and human lepromin (40n bacilli/ml). After this it should be

ible to indicate the concentration ofdillo's lepromin (A) most suitable forg unaffected persons, determining theification and prognosis of leprosy cases,for epidemiological studies and future

ine trials. Thus the present investigationgreat practical importance for leprosy

rol and for research purpose.Authors' abstract

LOCK, W.E. Immunology and thera-peutics of leprosy. Ann. Intern. Med., 91(3):482-484, 1979.

The rapidly accruing knowledge ofunoregulatory mechanisms and of im-opathology in leprosy provides confidencemajor advances will be made in the

unotherapy of this disease, which for sohas afflicted so many. The lessons

ed from this paradigm of chroniculomatous. infection will be valuable inoaching chronic infections caused byr facultative or obligate intracellularogens which, with leprosy, constitute aand exciting frontier for research.

From the editorial

Hansesíase: resumos/Hanseniasis abstracts 137

for the serodlagnosis of leprosy. Int. J. Lepr.,47(3) :477-483, 1979.

Acetone-killed Mycobacterium leprae separatedfrom infected armadillo liver tissue without the useof proteases were treated with 0.2 M lithium acetate,20 mM EDTA, pH 8.8 solution, and the concentratedantigen extract was analyzed by Ouchterlonyimmunodiffusion. The antigen extract gave a singleimmunoprecipitate when reacted with pooledlepromatous leprosy (LL) patients sera made highlyspecific for M. leprae by adsorption. Apparentlyidentical precipitates were produced by reacting theantigen extract with sera of each of 15 treated LLpatients, 5 of 7 patients with tuberculoid leprosy,and 3 of 4 M. leprae infected armadillos. Serum from1 of 16 persons immunized with BCG and from noneof 15 patients with chlamydial urethritis or bru-cellosis reacted with the antigen. Identically preparedextracts of M. smegmatis, M. phlei, M. vaccae, M.duvali and M. diernhoferi gave noimmunoprecipitates with sera from LL patients orinfected armadillos. Preliminary characterizationindicates the antigen is protein since antigenicitywas destroyed by pronase and/or heat treatment.The relative specificity of the protein antigen for M.leprae and the presence of antibody to this antigenin patients with leprosy suggest a possible role forthis antigen in the serodiagnosis of leprosy.

Authors' summary

CAUZZI, N.J.; CORONA, C.J.; LONDNER,M.V.; MORINI, J.C. Immunologic skin

titration in leprosy patients and contacts.Int. J. Lepr., 47(1) :13-17. 1979.

A method of studying delayed-typehypersensitivity was developed with specific antigenin leprosy patients and contacts, measuring thedose-response curve at different leprominconcentrations. This "immunologic tit*ation" ishighly efficient for discriminating the degree ofhypersensitivity reactions among the groups tested.With respect to the Fernandez reaction, the resultsobtained showed that there was a similar behavior inall groups studied, except in the tuberculoid groupwhich had a more intense response, four timeshigher than that yielded by contacts of lepromatouspatients. In the Mitsuda reaction, a similar behaviorwas also found among the different groups, exceptwith respect to the reactivity intensity of contacts oflepromatous patients. Here it was demonstrated thatthis group had a significant depression in responseto M. leprae antigen when compared with that fromthe other

groups, independent of the degree of consanguinityor closeness to bacilliferous cases. In order toexplain this immunosuppression in contacts oflepromatous patients, a hypothesis is proposed. It issuggested that changes could occur in M. lepraederived from lepromatous patients, diminishing theircapacity to produce an adequate immune response.

Authors' summary

CHIRON, J.P.; DENIS, F.; MAUPAS, Ph.;LANGUILLON, J. Infection par le virus del'hépatite B chez les hanséniens. I. Detection deI'antigéne et de l'anticorps de surface du virusde l'hépatite B par radio-immunologie. Bull. Soc.Med. Afr. Noire Lang. Fr., 22(2) :174-182, 1978.

The frequence of surface antigen of hepatitis Bvirus (HBs Ag) and the corresponding antibody (anti-HBs) has been researched in 553 patients withleprosy and 100 Senegalese blood donors. Thisstudy has been carried out by radio-immunoassay.HBs Ag has been found in the serum of 25.5 % ofthe hansenians as against 12 % of the controlswhereas the presence of antibodies (anti-HBs) hasbeen shown to be 44.1 % and 38 % respectively.HBs Ag and/or anti-HBs markers have beenrevealed in 67.1 % of the leprosy patients sera. Thelepromatous forms more frequently possess HBs Agand/or anti-HBs (74.6 %) than the tuberculoidforms (62.9 %). No significant statistical differenceswith regard to sex, ethnic groups or mode of life havebeen discovered.

Authors' summary

COHEN, S.S. Comparative biochemistry and drugdesign for infectious disease: protein should betargets for chemotherapeutic agents. Science,205(4410) :964-971, 1979.

Little is known of the biochemistry ofMycobacterium leprae, whose growth is best achievedat present in the armadillo. In the followingdiscussion it will be assumed that the organismpossesses many biochemical features characteristicof other Mycobacterium'. In concentrating on the cellwall polysaccharide, I shall consider a pentose sugarwhose presence should be easily identifiable in thebacterial fractions obtainable from the infectedarmadillo.

It was noted earlier that the cell walls ofprokaryotic organisms are very different from thoseof eukaryotes, and provide sites for selectivechemotherapy. For example, these structures inprokaryotic organisms frequently contain polymerssuch as teichoic

Hansen. Int., 5(2):136-160, 1980

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138 Hansesíase: resumos/Hansenlasls abstracts

cid and peptidoglycan, as well as simpleubstances, such as muramic acid and diami-opimelic acid, which have not been found in thealls of eukaryotic cells. Among the latter in manyacteria is also found 2-ketodeoxyoctonate (KDO),hich is synthesized from another strictlyrokaryotic metabolite, D-arabinose 5-phosphate. D-rabinose 5-phosphate in produced from ribulose 5-hosphate by the action ofhosphoarabinoisomerase, an enzyme which has noteen detected in mouse fibroblasts or in yeast.acteria blocked specifically in the synthesis of KDOre killed during growth.

Mycobacterium, as well as Corynebacterium andocardia, lack KDO but synthesize a cell wallolysaccharide, about half of which consists of D-rabinose. This prokaryotic pentose is therefore noterminal but occurs within the chain, and by analogyo known mechanisms of polysaccharide synthesis,s derived from a nucleoside diphospho-D-arabinose.he origin of such a compound probably requires theonversion of D-arabinose 5-phosphate to D-rabinose 1-phosphate, which after reaction with aucleoside triphosphate will preside the immediaterecursor for polysaccharide synthesis. Thus theynthesis of the cell wall polysaccharide of organismsf three important genera would appear to requireour enzymes specific to these bacteria. If it isupposed that the cell wall polysaccharides of theserganisms are important in the development of theirathogenic properties, we might well have fourroteins to consider as possible targets for a specifichemotherapy, if the hypotheses described above areonfirmed.

From the article

ONVIT, J. Development of an active vaccine againsthanseniosis as an immediate high priorityobjective. Star, 38(4):5-6, 16, 1979.

The impact of the development of a vaccinegainst Hanseniosis would influence not only areaelated to this disease, but would also affect that ofther parasitosis. Malaria, trypanosomiasis,eishmaniasis, would be the new and importantroblems to solve. Finally, we would like to mentionhe social and human aspects involved in the devel-pment of a vac ine against Hanseniosis. Present-dayociet, should understand the importance of anction which would imply the development of anffective control measure that might serve as basisor the hope that in a few decades one of the mostncient diseases which have afflicted humanity wille placed under control.

From the article

ESTEVEZ, M.E.; SEN. L.; VADEZ, R.; BALII3A, L.M.Defective blood mononuclear phagocytefunction in patients with leprosy. het. J. Lepr.,47(4) :575579, 1979.

Patients with lepromatous leprosy possess adefective lymphocyte function in vivo and in vitro thatis less evident in the tuberculoid form. Dataconcerning their macrophage ability to digestMycobacterium leprae are controversial. The purposeof this study was to determine whether monocytesfrom patients with either tuberculoid or lepromatousleprosy were altered in their enzyme systems, that ismyeloperoxidase-dependent and myeloperoxidase-independent systems. The ability of adherent bloodmonocytes to ingest and kill Candidapseudotropicalis after 30 and 60 min of incubationwith yeast cells was tested. Mononuclear phagocyticcells from patients with either principal form ofleprosy functioned similarly to normal monocytes inphagocytosis while their fungicidal activity for C.pseudotropicalis was statistically significantly alteredand was more evident in the lepromatous than in thetuberculoid type.. The results indicate thatperipheral blood monocytes from patients withleprosy possess an impaired enzymatic candidacidalactivity.

Authors' summary

FABER, W.R.; LEIKER, D.L.; CORMANE, R.H.Immunofluorescence studies in reactionalleprosy with relevance to treatment. Arch.Dermatol. Res., 261 (3) : 323-330, 1978.

Twenty-three biopsies of skin lesions of patientswith various types of leprosy, showing a recentreaction, were examined by means ofimmunofluorescence (IF) methods. The patients weredivided into two groups according to the number ofinflammatory cells, staining with various FTC-labelled anti-immunoglobulin antisera, inrepresentative areas of the biopsies. It was foundthat the represence of these cells was correlated witha good response to thalidomide treatment.

Authors' summary

FABER, W.R. & LEIKER, D.L. Immunofluorescencestudies across the leprosy spectrum. Arch.Dermatol. Res., 262(1): 45-53, 1978.

Forty biopsies from skin lesions of untreated(24) and treated (16) leprosy patients, representingthe whole leprosy spectrum, were examined bymeans of

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Hansesíase: resumos/Hanseniasis abstracts 139

immunofluorescence (IF) methods. Only few orno cells staining with FTC-labelled antihumanimmunoglobulin antisera were found in thelesional skin of all patients examined. SparseIgM-deposits along the basement membrane ofthe epidermis were observed in a few borderlinelepromatous and lepromatous patients.Complement deposits along the basementmembrane of the epidermis and in the vesselwalls were found in tuberculoid as well as inlepromatous patients. Complement and in alesser number IgGdeposits were observed aroundsweat glands and sometimes around sweat glandducts and other skin appendages.Autofluorescing macrophages were noted inpatients at the lepromatous side of the leprosyspectrum; approximately half of these patientsshowed complement deposits in an around thesecells.

Authors' summary

GIRDHAR, B.K. & DESIKAN, K.V. Results of ;kintests with five different mycobacteria. Lepr.India, 50(4) :555-559, 1978.

A comparison of intradermal response toinjection of Dharmendra type of coded antigens,prepared from different species of Mycobacteriaby Prof. G.P. Talwar has been made over 3 weeksperiod. The results are reported.

Authors' abstract

GOIHMAN-YAHR, M.; R O D R I G U E ZOCHOA,G.; ARANZAZU, N.; PINAR- DI, M.E.;GOMEZ, M.E.; OCANTO, A.; CONVIT, J. Invitro activation of neutrophils bysuspensions of Mycobacterium leprae. Int. J.Lepr., 47(4) :570574, 1979.

Activation, defined as an increase in theproportion of cells that reduce nitrobluete-trazolium in vitro, is present in neutrophils frompatients with reactional lepromatous leprosy butnot in neutrophils from patients with non-reactional lepromatous leprosy. Neutrophils frompatients with all forms of leprosy are equally wellactivated by endotoxin in vitro. We have nowshown that in vitro activation induced byMycobacterium leprae suspensions is ofcomparable magnitude in neutrophils frompatients with all forms of leprosy (includinglepromatous and reactional lepromatousleprosy). There is no intrinsic neutrophil energyin patients with lepromatous leprosy vis-à-vis M.leprae as pertains to activation. Spontaneousactivation in reactional lepromatous leprosy islikely due to an indirect mechanism, probably ofimmunologic nature, and not simply to the

Hansen. Int., 5(2):136-160, 1980

presence of circulating Mycobacterium leprae inthe blood.

Authors' summary

GOIRENA DE GANDARIAS, F.J.; MONGEJODRA, V.; PÉREZ PÉREZ, B. Presencià delHBsAg en una poblácion de enfermosleprosos. Rev. San. Hig. Pub., 52(11-12):1467-1478, 1978.

The presence of Hb,Ag in 206 sera fromleprous patients (173 inpatients and 33outpatients) has been studied. The frequency ofpositive in the first group was higher inlepromatous patients of both sexes in 8,27% andin tuberculoid patients the frequency descendedto 2.63%, figure very close to that found inhealthy population (1.66 %). In outpatients theinly case occurred among the lepromatouspatients with a frequency of 6.25%. These factsseem to show that these is a series of factorsfavoring the appearance of the disease: bloodtransfusions more frequent in lepromatous,more contacts in hospitalized patients andprobably the higher persistance of, Hb,Ag inlepromatous patients due to the higher incidenceamong them of hepatic troubles.

Authors' abstract

GOVIL, D.C. & BHUTANI, L.K. Delayedhypersensitivity skin reactions to leprominand antigens prepared from four othermycobacteria. Lepr. India, 50(4) : 550-554,1978.

Antigens prepared from five mycobacteriaviz. M. leprae, M. vaccae, M. phlei, M.W. and ICRCbacillus were used for assessing cross reactivitybetween different antigens on sixteen patientswith different forms of leprosy. ICRC bacillus andM.W. gave the best correlation with M. leprae.

Authors' abstract

HORGERZEIL, L.M. & PRABHUDASS, N.Delayed hypersensitivity skin reactions tolepromins prepared from M. leprae andselected cultivable mycobacteria. Lepr.India., 50(4) :560-565, 1978.

Lepromins prepared from M. lepras andfrom selected cultivable mycobacteria weretested in 50 leprosy patients. Preparation M.W.showed the best correlation with true lepromin,especially in the group of TT patients.

Authors' abstract

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140 Hansesíase: resumos/Hanseniesis abstracts

KATO, L. Cholesterol dynamics in macro-phages implication for the bacteriologyand pathology of leprosy. Acta Leprol.,

(76):36-47, 1979.

M. leprae in the host multiplies abundantlyn macrophages rich in cholesterol. Host-growneprosy bacilli have an extremely high cholesterolontent and in this respect they occupy a uniquelace among procariotic cells. M. leprae takes upholesterol from the environment and it is notlear whether it can synthesize cholesterol and ifo from which precursors. Mycobacteria can berown from leprous tissues in primary culturesnly in the presence of cholesterol. These strainsuickly adapt to in vitro substrates and are ableo synthesize cholesterol from still-unknownhemical entities, which are also sources ofarbon and energy. These still unknownubstrates will probably have to be discoveredefore cultivation of these elusive microorgan-sms is achieved and we approach a betternderstanding of the chemical mediators in theellular defence and/or pathology of

eprosy.Authors' summary

ATO, L. & KIM, C.H. Mycobacterium leprae:atypical and unclassified. Acta Leprol., (75):49-54, 1979.

Once M. leprae is grown on artificial median the test tube, it might prove to have a greatariety of characteristics quite different to thosexpected from our knowledge of M. lepraesolated from the susceptible host. The cultures

ight be slow or fast growing, pigmented orolorless, pathogenic for the armadillo, or not;hey might produce limited disease in the footad of mice, or the contrary. The in vitro M.

eprae culture might or might not provoke aepromin reaction; the culture might grow at aower or higher temperature. It is wellocumented that mycobacteria show greatifferences in elasticity and adaptability toultivation conditions. It is absolutely certainhat once grown in a test tube, M. leprae willehave as an atypical species. However, eachndividual culture of M. leprae obtained in vitroill have the same drug sensitivity pattern as in

he lepromatous leprosy patient from whom itas cultivated.

Authors' summary

AI A FAT, R.F.M.; CHAN PIN JIN, J.; VANFURTHER, R.; HARBOE, M. In vitrosynthesis of anti-mycobacterial antibodies inbiopsies from skin lesions of leprosypatients. Infect. Immun., 27(2) : 297-301,1980.

ansen, Int., 5(2):136160, 1980

To demonstrate local synthesis of anti-Mycobacterium leprae antibodies, biopsies fromskin lesions of leprosy patients were cultured invitro in a medium containing 'C-labeled lysineand isoleucine, and the culture fluids wereanalyzed by crossed immunoelectrophoreefs withintermediate gel and autoradiography. Theresults show that anti-M. lepral. antibodies weresynthesized in vitro in tl a biopsies from the skinlesions of leprosy p ,- tients and that thespecificity of the locally produced antibodiesvaried from patient to patient.

Authors' abstract

MARTÍNEZ-PALACIOS, B.N. Chemotaxis inleprosy. Dermatologia, 22(1):26-36, 1978.

Plasmatic factors of chemotaxis were lookedfor in 25 leprosy patients and in 25 nonleperpersons by a modified Boyden's technique.Stimulation was done by S. albus, M. leprae andM. lepraemurium. The results of this work havenot confirmed the observations of Ward about

the existence of an inhibitor of chemotaxis in leprosy patients. M. leprae and M. lepraemuriumwere not able to stimulate liberation ofchemotaxis factors into the plasma of thesepatients nor in healthy persons. This perhapsexplains the persistence of this infection inhuman beings.

Author's summary

McCORMICK, G.T. & SANCHEZ, R.M. Pyridineextractability of acid-fastness fromMycobacterium leprae. Int. J. Lepr.,47(3):496-499, 1979.

Various mycobacteria were tested for theirability to retain acid-fastness after treatmentwith pyridine: a) Mycobacterium leprae separatedfrom organs of 20 experimentally infectedarmadillos (which were sacrificed); b) M. lepraeseparated from a biopsy of a lepromatouspatient; c) direct smears of lepromatous tissuesfrom armadillos; d) eighteen cultivablemycobacteria obtained from the American TypeCulture Collection (ATCC) ; e) cultivablemycobacteria separated from the lymph nodes ofa wild-caught armadillo and also the sameorganism grown in culture and Skinsnes allegedM. leprae culture. A loss of acid- -fastness wasobserved microscopically from M. lepraeseparated from experimentally infected armadillotissues, M. leprae separated from a lepromatouspatient biopsy, and

Hansesíase: resumos/Hanseniasis abstracts 141

M. leprae found in direct smears prepared frominfected armadillo tissues. The eighteencultivatable mycobacteria from ATCC, culti-vatable mycobacteria separated from the tissueof a wild-caught armadillo (and also grown inculture) and Skinsnes' alleged M. leprae cultureretained their acid-fastness. Testing of pyridineextractability of acid- fastness combined withthose of D-DOPA oxidase testing proved to beextremely reliable in our laboratory indifferentiating M. leprae from other mycobacteria.

Authors' summary

MOHAGHEGHPOUR, N.; TABATABAI, II.;MOHAMMAD, K.; RAMANUJAM, K.;MODABBER, F.Z. Histocompatibilityantigens in patients with leprosy fromAzarbaijan, Iran. Int. J. Lepr., 47(4) :597-600, 1979.

The distribution of 24 histocompatibilityantigens in 88 Azerbaijani patients with leprosywas determined and compared with those of 125normal, ethnically matched individuals. HLA-BW% was increased in frequency among theKurdish patients as compared to the controls;HLA-A„ however, displayed decreased frequencyin patients with the lepromatous form of thedisease. Among the Turks, diminished frequencyof HLA-BW,s was noted in the total patientpopulation. None of these comparisons, however,reached statistical significance when correctedfor the number of antigens tested. Across the twoethnic groups, differences in the frequencies ofHLA antigens between the patients and thecontrols were only marginal.

Authors' summary

MUSTAFA, A.S. & TALWAR, G.P. Early and latereations in tuberculoid and lepromatousleprosy patients with lepromins fromMycobacterium leprae and five selectedcultivable mycobacteria. Lepr. India,50(4):566-578, 1978.

Skin reactions have been measured intuberculoid and lepromatous leprosy patients withDharmendra and Mitsuda type of leprominsprepared from M. leprae, Mycobacterium w, ICRCbacillus, M. phlei, M. vaccae and M. gordonae. Intuberculoid patients Mycobacterium w gave theclosest response to M. leprae, however, inlepromatous and borderline lepromatous cases, thisbacteria produced greater response than M. leprae.

Authors' summary

MUSTAFA, A.S. & TALWAR, G.P. Five cultivablemycobacterial strains giving blasttransformation and leukocyte migrationinhibition of leukocytes analogous toMycobacterium leprae. Lepr. India, 50(4):498-508, 1978.

Fifteen cultivable mycobacteria and BCGhave been screened for antigens resemblingthose of M. leprae in two cell mediated immunitytests, namely the antigen driven blasttransformation of peripheral leukocytes andleukocyte migration inhibition assays carried outwith cells from a panel of tuberculoid leprosypatients. Five strains of mycobacteria weresingled out for their ability to give reactionsanalogous to M. leprae in these test systems.Three of these are previouly known strainsnamely M. vaccae, M. phlei and M. gordonae. Thefourth was the strain cultivated at the IndianCancer Research Centre Bombay from lepromanodules, and the fifth, a hitherto undescribedstrain of fast growing mycobacteria coded inthese studies as Mycobacterium w.

Authors' abstract

NUTI, M.; TARABINI, G.; PALERMO, P.;TARABINI, G.L.; THAMER, G. Leprosy andhepatitis B virus markers: incidence ofHBsAg and HBeAg in Somalian patients. Int.J. Lepr., 47(4) :580-584, 1979.

Serum samples from 222 Somalian patients,135 with the lepromatous form of leprosy and 87with the tuberculoid form of the disease, wereexamined for the presence of the surface antigen(HB.Ag), the "e" antigen (HB.Ag), and theircorresponding antibodies (anti-HB and' anti-e).HB.Ag was present in 24.4% of the LL cases andin 11.5% of the TT patients while anti-HB. wasfound respectively in 46.6% and 58.6%. The e-antigen was not found in any case of leprosy;anti-e was detected in 8.1% of the LL patientsand in 3.5% of the TT cases. The rate of HBVseropositivity (HB.Ag plus anti-HB.) was thesame in the LL patients (71.1%) and in the TTpatients (70.1%) and that could reflect theconditions of life in their closed community. Theanalysis of results obtained in Somalia hasshown the presence of a difference in thedistribution of HB.Ag among leprosy patients,with an increased antigenemia in thelepromatous form which was statisticallysignificant (p < 0.05). No differences, however,were found between the leprosy patients andhealthy controls.

These observations seem to indicate thatpatients with lepromatous leprosy do not have

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142 Hansesíase: resumos/Hanseniasis abstracts

Authors' abstract

an increased susceptibility to infection byhepatitis B virus.

Authors' summary

NGUYEN, H.T.; TRACH, D.D.; MAN, N.U.;NGOAN, T.H.; DUNIA, I.; LUDOSKY-DIAWARA, M.A.; BENEDETTI, E.L.Comparative ultrastructure of Mycobac-terium leprae and Mycobacterium cellenvelopes. J. Bacteriol., 138(2) :552-558,1979.

The structural properties of the cell en-velopes of Mycobacterium leprae and Mycoba-cterium lepraemurium were investigated by freeze-fracture, freeze-etching, and negative- stainingtechniques. Freeze-fracture split the cell wall andexposed the internal features of thepeptidoglycolipid mycosidic filamentous network.The cell membrane was also split into twoasymmetric faces. The external fracture face wascharacterized by linear arrays of in-tramembranous particles, whereas the proto-plasmic fracture face showed randomly dis-tributed clusters of particulate entities.Comparative analysis of the ultrastructuralfeatures observed in M. leprae and M. leprae-murium indicated that the organization of the cellenvelope in these two species differedparticularly with respect to the amount andcomplexity of the superficial peptidoglycolipidand mycosidic integument, which is poorlydeveloped in the mycobacterium responsible forhuman disease.

Authors' abstract

PRABHAKARAN, K.; HARRIS, E.B.; KIR-CHHEIMER, W.F. Metabolic inhibitors ofhost-tissue origin in Mycobacterium leprae.Lepr. India,-51 (3) :348-357, 1979.

It is not clear why host-derived bacteria aremetabolically inert, compared to organismsgrown in vitro. o-Diphenoloxidase is the onlymetabolic property proven to be present inMycobacterium leprae separated from infectedhuman as well as animal (mouse and armadillo)tissues. However, highly concentrated sus-pensions of M. leprae obtained from the organs ofexperimentally infected armadillos showed littleor extremely low o-diphenoloxidase, while theorganisms bound "C-labeled dopa. When thesepreparations were diluted, they readily oxidized D-dopa to pigment. The activity remained unaltered bywashing the suspensions with dilute alkali oracetone and ether, indicating that it is an intrinsicproperty of the bacilli. Treatment with differentproteases relieved the inhibition, and resulted in a100% stimulation of O-diphenoloxidase in the bacilli.

Evidently, the M. leprae sus-

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pensions obtained from infected tissues containan inhibitory material which is protein in nature,and the metabolic inertness sometimes observedin host-grown bacteria may not be due to loss ofenzymes or metabolites from the organisms.

Authors' abstract

PRASAD, H.K.; SINGH, A.K.; TALWAR, G.P.Ability of M. leprae, Mycobacterium W, andICRC bacillus to produce macrophageactivating factors from lymphocytes ofleprosy patients. Lepr. India, 50(4):539-549,1978.

Lymphocytes from tuberculoid and lepro-matous leprosy patients were cultured for 24hours with M. leprae, Mycobacterium w or ICRCbacillus. The supernatants from these cultureswere tested for activation of human peripheralblood monocyte derived macrophage lysosomalacid phosphatase and betaglucuronidase (insome cases). 11 experiments were performedusing different combinations of macrophages anddonor lymphocytes. In 7 cases both M. leprae andMycobacterium w generated mediators fromlymphocytes which activated macrophageenzyme to similar extent. The results with ICRCbacillus were concordant with M. leprae in 3cases but discordant in 3 cases.

Authors' abstract

PRICE, J.; DAVIS, M.; RAMU, G. Comparison ofthe reaction to Dharmendra antigen in thenormal skin and in the lesion of leprosypatients. Lepr. India, 51(1):87-95, 1979.

In this study, 0.1 ml of Dharmendra antigenwas injected intradermally into the normal skinand lesions of 35 leprosy patients. The responsewas measured at 24 hrs., 48 hrs. and 21 days. Itwas found that the maximum response toDharmendra antigen occurred at the end of 24hrs. and started wanning by 48 hrs. Intuberculoid leprosy, there was significantlygreater response in the lesion as compared withthe nearby normal skin. It has been suggestedthat this could reflect an increasedimmunological activity at the site of the lesion. Inthe borderline tuberculoid cases with annularlesions, Dharmendra antigen was injected intothe peripheral infiltrated area and into theapparently normal centre of the lesion, and agreater response was found at the centre. Thismight be the site of a previous lesion. The latereaction at the end of 21days did not show much significant difference.

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ansesíase: resumos/Hanseniasis abstracts 143

AHA, K. & AGARWAL, S.K. Immune deficit inpatients with lepromatous leprosy: its natureand relation to genetic factors, spectrum, andduration of the illness. Int. J. Lepr., 47(1): 1-6,1979.

Cell-mediated immunity or hypersensitivity toM. leprae and other unrelated antigens, such astuberculin and dinitrochlorobenzene, was studied in73 leprosy patients of different histopathologic types.It was found that specific as well as nonspecificanergy intensified as the disease spectrum shiftedfrom the tuberculoid toward the lepromatousimmunologic pole. Within the lepromatous group, theimpairment of cellular immunity became morepronounced as the bacillary load increased. It wasfound that the impairment of the cell-mediatedimmunity towards antigens other than M. lepraebecame more severe as the duration of the illnessincreased.

Late lepromin responsiveness, which is thehallmark of resistance of an individual to M. leprae,may be absent even before the onset of clinicalillness. Its deficit seems to be primary and has agenetic predisposition.

Authors' summary

AXENA, V.K.; SINGH, U.S.; SINGH, A.K.Bacteriological study of a rapidly growing strainof Mycobacterium. Lepr. India, 50(4) :588-596,1978.

Morphological, colonial and biochemicalharacteristics of a strain of mycobacteria, whichxhibited antigenic cross reactivity with M. leprae asndicated by antigen driven blast transformation ofeukocytes, leukocyte migration inhibition test initro, and delayed hypersensitivity skin test in leprosyatients, are described. It belongs to Runyon's groupV and can be distinguished from other knownpecies of rapidly growing mycobacteria. It is non-athogenic in mice. The strain has been tentativelyamed as M. w.

Authors' abstract

ENGUPTA, U.; RAMU, G.; DESIKAN, K.V.Assessment of Dhamendra antigen. Lepr. India,50(4) :599-609, 1978.

Dharmendra antigen has certain advantagesver Mitsuda antigen and these have beennumerated. Consequently, a reappraisal ofharmendra antigen has been done. A variation in

he degree of lepromin reaction was noted when theests were performed with different batches ofharmendra antigen. This was found to be due toariation in the

ansen. Int., 5(2):136-160, 1980

bacillary content which was further confirmed bydilution experiments. Standardization of the antigenby bacillary count has been found to give betterresults. Dharmendra antigen prepared with aconcentration of 160 million bacilli per. ml was foundto give not only early lepromin reaction but also latereaction comparable to Mitsuda antigen. It was alsofound that with a concentration of 16 million bacilliper ml (one tenth the concentration of Mitsudaantigen), the results were consistent andreproducible.

Authors' abstract

SENGUPTA, U.; RAMU, G.; DESIKAN, K.V.Assessment of Dharmendra antigen. II.Standardization of the antigen. Lepr. India,51(3) :316-322, 1979.

Dharmendra antigen with different bacterialcounts (16, 12.5, 10, 7.5, 5 and 2.5 million/ml) havebeen utilized for determination of skin delayedhypersensitivity in leprosy patients. It has been notedthat antigen with 10 million acid fast bacilli (AFB)/mlmounts a standard early (24 hrs) as well as late (3weeks) reaction in patients. Lepromatous patients donot show any skin reaction with this dilution. Thus, astandard Dharmendra antigen has been preparedusing a considerably smaller number of organisms ascompared to the International standards for Mitsudaantigen.

Authors' abstract

SENGUPTA, U.; SUDHIR SINHA; RAMU, G.Immunological assessment of sera of leprosypatients. Lepr. India, 51(1) :4348, 1979.

IgG levels were significantly high in sera of alltypes of leprosy. House-hold contacts of lepromatousleprosy (LL) cases also showed significantly highervalues for IgG when compared to that of control.Except polar tuberculoid (TT) cases and house-holdcontacts other types of leprosy revealed a significantrise in IgA levels in their sera. IgM was only raised inborderline tuberculoid (BT) cases. C-reactive protein(CRP) was present in the sera of all types of leprosy.Highest positivity (97%) was shown by sera fromerythema nodosum leprosum (ENL) cases. Rose-Waaler antibody (RA) was noted in BT, borderlineleprosy (BL), LL and ENL cases. Significance of thesefindings is discussed.

Authors' abstract

144

SINHA, S.; SENGUPTA, U.; RAMU, G.; DESIKAN, K.V.Assessment of Dharmendra antigen. III.Comparative study with Mitauda antigen. Lepr.India, 61(3) :323-329, 1979.

Four fractions each from Dharmendra and Mitsudaantigen have been obtained by step-wise centifugationand sonication of the antigen. These fractions have beenassessed for their capacity of inducing skin delayedhypersensitivity response. While, it has been noted thatall fractions of both types of antigens can induce a goodearly reaction, the late skin reaction is only mounted byintact bacilli of both types of antigen. When compared ata constant bacillary concentration, Dharmendra antigenhas produced better early skin reaction than Mitsudaantigen, whereas the intensity of late skin reaction isalmost equal with both the antigens. The hypothesis hasbeen put forward that the early, as well as the latereaction are produced by the same antigen and thisantigen is located in the protoplasm of M. leprae.

Authors' abstract

SYED MAROOF SAHIB, H. & VELLUT, C. Someobservations on skin reactions induced bylepromin and four other mycobacterial antigens.Lepr. India, 50(4):579-587, 1978.

A study on skin reactions induced byMycobacterium leprae, lepromin and four

Hansesíase: resumos/Hanseniasis abstracts

other mycobacterial antigens was done on 47 leprosypatients of Hemerijekx Leprosy Centre, Polambakkam,as a first stage towards a vaccine approach. This paperdeals with certain observations noted during the trial.

Authors' abstract

VELIATH, A.J.; BEDI, B.M.S.; BALASUBRAHMANYAN,M. Behaviour of macrophages to Mycobacteriumleprae: a tissue culture study. Lepr. India, 51(3):330-335, 1979.

Macrophage culture was performed on 45 healthyadults who were initially categorised on the basis oftheir Lepromin reactivity using Dharmendra antigen.There were 25 individuals in the Lepromin positivegroup and 20 in the Lepromin negative group. Thecultures were challenged with M. leprae and themacrophages studied at varying time intervals ofculture. No difference was evident in the behaviour ofcultured macrophages to M. leprae in both the groups.The Lepra bacilli were phagocytosed by themacrophages and retained essentially intact till thetermination of culture. The Lepromin reactivity of ahealthy individual was not reflected on the macrophagefunction in vitro. The observations suggested against thepossibility of an intrinsic genetically determinedmacrophage defect in dealing with M. leprae.

Authors' abstract

PATOLOGIA, FISIOPATOLOGIA, BIOQUÍMICA

PATHOLOGY, PHYSIOPATHOLOGY, BIOCHEMISTRY

BATESON, E.M. & HARGRAVE, J.C. Nervecalcification caused by leprosy in NorthernTerritory aboriginals. Med. J. Australia, 2(9):497-499, 1979.

Three cases of nerve calcification caused byleprosy (Hansen's disease) in Aboriginal patientsfrom the Northern Territory of Australia arereported. This is a rare manifestation of thedisease and is the result of direct involvement ofperipheral nerves with abscess formation and isusually seen in tuberculoid or borderline types ofleprosy.

Authors' abstract

Hansen. Int., 5(2):136-160, 1980

BEDI, T.R.; KUMAR, B.; KAUR, S. Histo-pathologic study of clinically normalappearing skin in lepromatous leprosy. Lepr.India, 51 (1) :78-80, 1979.

Skin biopsies from clinically normal skin ofthe scalp, axillary and groin regions in 20lepromatous leprosy patients revealed significanthistopathological findings in up to 25 percent ofthe patients. The positive findings could,perhaps, be eshaneed by studying larger skinmaterials from these body areas. Indeed, no skinarea appears to be immune from invasion byMyco. leprae.

Authors' abstract

Hansestase: resumos/Hanseniasis abstracts 145

CHACKO, C.J.G.; BHANU, T.; VICTOR, V.;ALEXANDER, R.; TAYLOR, P.M.; JOB, C.K.The significance of changes in the nasalmucosa in indeterminate, tuberculoid andborderline leprosy. Lepr. India, 51(1) :8-22,1979.

A study of nasal biopsies from 137 leprosypatients classified on the basis of clinical,microbiological and skin biopsy as Indeter-minate, Tuberculoid, Borderline-tuberculoid andBorderline-leproma was undertaken. Changessuggestive of leprosy viz., nerve and smoothmuscle inflammation with a few acid fast bacilliin a proportion of the biopsies were seen in allgroups of patients examined. This suggests, thateven in Indeterminate and Tuberculoid leprosythe disease becomes gen- eralised by the timeclinical manifestations appear in skin.Tuberculoid granuloma was seen in two nasalbiopsies from Borderline- tuberculoid leprosypatients, one of which was located in the wall ofa vein, suggesting the possibility ofintravascular dissemination of the disease evenin non-lepromatous leprosy. 33 of the patientswere children 15 years and below and they alsoshowed changes such as nerve and smoothmuscle inflammation but bacilli were seen onlyin the Borderline group. These findings suggestinvolvement of the nasal mrcosa early in thecourse of the dis- ease as 70% of the childrenhad the skin lesion for less than one year. Thenasal mucosa offers favourable conditions forthe growth of the organisms and is readilyaccessible to infection by droplets, andtherefore, it could be one of the primary sites ofinvolvement in leprosy.

Authors' abstract

CHEHATA, M. L' atteinte du nerf auditif dans la16pre. Ann. Oto-Laryng., 95(10-11) :685-689, 1978.

A study of 260 male patients in theAlexandria leper colony showed that 15% ofthem had uni- or bilateral perception deafness.The lesion was of the retro-cochlear type andhas to be related to lesions of the peripheralnerves.

Author's summary

ÇOLOGLU, A.S. Immune complex glomeru-lonephritis in leprosy. Lepr. Rev., 50(3):213-222, 1979.

Twenty patients with lepromatous orborderline leprosy selected at random wereinvestigated for evidence of immune complexglomerulonephritis. Light, immunofluorescen-ce and electron microscopy findings suggested

Hansen. Int., 8(2):136-160, 1980

that glomerulonephritis in leprosy results fromthe accumulation of immune complexes inglomeruli. Pluorencence and electron micro-scopy findings may be attributed to the fact thatthe deposits are less soluble immune com-plexes. A comparison was made betweenglomerulonephritis in the BSA-rabbit system andleprosy.

Author's abstract

CORUH, G. & McDOUGALL, A.C. Untreatedlepromatous leprosy: histopathologicalfindings in cutaneous blood vessels. NC J.Lepr., 47(3) :500-511, 1979.

Skin biopsies from 100 patients withuntreated lepromatous leprosy from Malay- sia,India, Africa, and South America were examinedwith particular regard to patho- logical changesin intima, media, or adven- titia of blood vesselsand to the presence of leprosy bacilli in theselayers. Bacilli were found in capillaries, venules,or arterioles in all cases, and in many instancesthey were present in endothelial lining cells orsmooth muscle in large masses (globi). In severalcases, solid-staining bacilli in endothelial liningcells were especially prominent. The findings arediscussed in relation to a) the continuousbacteremia of lepromatous leprosy, b) the role ofendothelial cells in phagoc3rto- sis, c) smoothmuscle cells of the media as a site in whichbacilli may persist, and d) the transmission ofhuman leprosy by biting arthropods.

Authors' summary

DEVI, S. & STEWART-TULL, D.E.S. De- tection ofmycolic acid in leprous tissue. bd. .1. Lepr.,47(3) :484-486, 1979.

A method is described for the extraction ofmycolic acid from lepromatous leprosy tissuesand from tuberculous tissues and itsidentification by thin layer chromatography.Verification of the mycolic acid extracted andseparated by thin layer chromotography wasaccomplished by infrared spectroscopy. Althoughthe presence of mycolic acid in tissues is not, initself, diagnostic for leprosy, its demonstration inbiopsy tissues might be a useful additionalqualitative test if used in conjunction withclinical evidence of the disease.

Authors' summary

IBRAHIEM, A.A.; AWAD, ILA.; METAWI, B.A.;RAMADA; T.A.Y. Pathologic changes in testisand epididymis of infertile leprotic males.Int. J. Lepr., 47 (1) :44-49, 1979.

H

146 Hansesíase: resumos/Hanseniasis abstracts

Thirty-two cases of male infertility inpatients having leprosy were studied. One casewas oligospermic and the remaining 31 caseswere azoospermic. Pathologic changes in thetestis and epididymis are described andillustrated. An important observation was thepresence of obstruction in the tail of theepididymis in five cases and this obstructionwas undoubtedly the cause of sterility in thesefive cases as the head of the epididymis was fullof sperm and testicular biopsy was more or lessnormal. In the remaining 27 cases, the cause ofsterility was testicular affection with fibrosis andhyalinization of the seminiferous tubules inmost of the cases.

Authors' summary

JARIWALA, H.J. & KELKAR, S.S. Fluorescencemicroscopy for detection of M. lepras intissue sections. Int. J. Lepr., 47(1):33-36,1979.

The fluorescence method was comparedwith the Fite-Faraco method for detecting acid-fast microorganisms in paraffin sections of casesof leprosy. Biopsies were obtained from 50 casesof leprosy covering all varieties and ad varyingstages of treatment. The fluorescence methodwas better than the FiteFaraco method; 22biopsies showing acidfast organisms influorescence microscopy and 20 in the Fite-Faraco method. Its superiority was evidenced intwo cases in which the organisms were veryscanty. Fluorescence microscopy can also beused to determine the Bacterial Index and theMorphologic Index of organisms. TheMorphologic Index, however, was one and a halftimes higher than that obtained by the Fite-Faraco technic. The ease and speed offluorescence microscopy appear to be a greatadvantage.

Authors' summary

KAPUR, T.R. & BHALE RAO, S.M. Post- -traumatic tuberculoid leprosy. Lepr. India,61(1):112-114, 1979.

Inoculation Tuberculoid Leprosy has beendescribed by various leprologists off and on andthis mode of onset has been established. A caseof tuberculoid leprosy over thumb, appearingafter trauma in an Army recruit is describedwith the review of the literature.

ansen. Int., 5(2):136-160, 1980

MARKS JR., S.C. The cellular basis for extremitybone loss in leprosy. Int. J. Lepr., 47(1) :26-32, 1979.

Osteoclasts and osteolytic osteocytes havebeen observed in the majority of 60 samples ofbone taken from five patients with lepromatousor tuberculoid leprosy. These results areinterpreted to mean that bone loss in patientswith leprosy is an acceleration of a normalcellular process and not the result of avascularnecrosis. The acceleration of bone resorptioncould be due to local release of products from M.leprae or host cells, a hypothesis testable byorgan culture methods. The presence oflymphocytes and mononuclear cells in bonesamples in this and previous studies is discussedwith respect to recent evidence of a role forlymphoid cells in bone resorption.

Author's summary

PARVEZ, M.; SHARDA, D.P.; JAIN, A.K.;BHARGAVA, N.C.; MISRA, S.N. A study ofplatelet adhesiveness in leprosy. Lepr. India,51 (3) :363-368, 1979.

Platelet adhesiveness was studied in fiftypatients of leprosy and fifteen healthy individualswho served as control group. Plateletadhesiveness as determined by glass beadapparatus,'showed a trend towards elevation inpatients of leprosy, being maximum in reactionalphase, statistically also the increase being highlysignificant (p value less than 0.001). Theobserved increase in platelet adhesiveness maybe due to marked tissue destruction andvasculitis seen in leprosy patients.

Authors' abstract

RAMU, G. & DESIKAN, K.V. A study of scrotalbiopsy in subsided cases of lepromatousleprosy. Lepr. India, 51(3):341347, 1979.

Scrotal biopsies were obtained from 38 casesof lepromatous leprosy who were clinicallysubsided and had negative skin smears. Twentysix (68.4%) of these cases revealed bacilli in thedartos muscle None except one showed a specificlesion in the dartos. Bacilli obtained from 2 outof 7 cases multiplied in the mouse foot-pad.Bacilli were found to be persisting in the dartosmuscle despite prolonged treatment before aswell as after clinical subsidence of the disease.The persisting bacilli in this situation could be acause of relapses.

Authors' abstract

Hanseaiase: resumos/Hanseniasis abstracts 147

VARMA, S.C.; KUMAR, R.; BHARGAVA, N.C.Histopathologicaj study of liver in leprosy.Indian J. Dermatol. Venereol. Leprol.,44(2):108-109, 1978.

Fifty patients with lepromatous leprosy

were studied. Involvement of liver was observedin 90 per cent of the cases. Fatty degenerationwas seen in two cases only. Amyloid deposit wasnot seen in any of them.

Authors' summary

HANSENÍASE EXPERIMENTAL, LEPRA ANIMAL

EXPERIMENTAL HANSENIASIS, ANIMAL LEPROSY

ALEXANDER, J. & CURTIS, J. Development ofdelayed hypersensitivity responses inMycobacterium lepraemurium infections inresistant and susceptible strains of mice.Immunology, 36:563-567, 1979.

C57B1 mice are relatively resistant to amoderate subcutaneous infection with Myco-bacterium lepraemurium while BALB/c mice aremuch more susceptible. Cutaneous delayedhypersensitivity reactions which develop in thefirst 3 weeks of infection were compared in thesetwo strains of mice. Both strains gave a peak ofdelayed hypersensitivity between 6 and 10 daysafter infection which was followed by a period oflow reactivity before the - deve'opment, in thethird week, of a stable persistent delayedhypersensitivity reaction. There was no differencebetween the strains in the size at 24 h of thedelayed hypersensitivity reaction but thereactions differed in their kinetics. The lowresistance strain, BALB/c, gave a JonesMote-type of response while the high resistance straingave a response which could be described as atuberculin-type reaction.

Authors' summary

BIRDI, T.J.; SALGAME, P.R.; ANTIA, N.H. Therole of macrophages in leprosy as studied bprotein synthesis of macrophages fromresistant and susceptible hosts — a mouseand human study. Lepr. India, 51(1) :23-42,1979.

3H-leucine uptake by macrophages fromSwiss white and C57BL mice before and after M.leprae infection was studied. A depression in 3H-leucine uptake after infection was observed onlyin Swiss white mice. 3H-leucine uptake was alsostudied in blood derived macrophages fromnormals, and LL and TT patients. A depressionwas obtained in 311-Ieucine uptake after M.leprae infection in macrophages from LL patients.

Authors' abstract

Hansen. Int., 5(2)136-160, 1980

BULLOCK, W.E.; CARLSON, E.M.;: GERSHON,R.K. The evolution of immunosuppressivecell populations in experimentalmycobacterial infection. J. Immunol., 120(5):1709-1716, 1978.

Immunosuppressor activity of considerablepotency and complexity was generated during thecourse of chronic, progressive infection ofC3H/Anf mice by Mycobacterium lepraemurium.From the 5th through 10th week afterinoculation, spleen cells from infected micemildly but reproducibly suppressed the directplaqueforming cell response of normal spleen cellcultures to sheep erythrocytes. Suppression atthis stage of infection was mediated by cells withmacrophage- -like characteristics. A markedincrease in splenic suppressor activity at 10 to11 weeks was associated with the appearance ofa second suppressor cell subpopulationcomposed of T lymphocytes. The appearance ofthese cells was closely related in time to theonset of rapid splenic enlargement and a loss ofcutaneous delayed type hypersensitivity toantigens of M. lepraemurium in mice at 10 to 11weeks of infection. Suppressor cells were notpresent in peripheral lymph nodes until terminalinfection at 22 to 25 weeks. Suppressor spleencells depressed the T-dependent antibodyresponse most severely, but there was also adirect effect upon B cells as shown by moderatesuppression of responses to TNP-LPS and DNP-Ficoll. Spleen cells from 14-week-infected micegenerated a soluble suppressor factors(s) thatinduces depression of moderate severity,however, the immunosuppression by intact cellswas far greater.

Authors’ abstract

CALDWELL, H.D. & BUCHANAN, T.M.Immunochemical and structural integrity ofsurface protein antigens of mycobacteriaduring separation from armadillo liver tissue.Int. J. Lepr., 47(3) :469-476, 1979.

148 Hanseslase: resumos/Hansenlesls abstracts

Surface proteins of Mycobacterium smeg-matis were iodinated using the lactoperoxidasemethod. Sodium dodecyl sulfate polyacrylamidegel electrophoresis demonstrated two majorsurface proteins in the radiolabelled M.smegmatis. Both surface proteins were releasedfrom M. smegmatis using the nonionic detergentTriton X-100. The major surface component wassensitive to pronase digestion and contained nodetectable carbohydrate. The secondradiolabelled component was found to be of lowmolecular weight, resistant to pronase digestionand stained positive for carbohydrate by theperiodic acid/Schiff method. Triton X-100solubilized radiolabelled surface proteins wereantigenic as assessed by a radioimmuneprecipitation test. When surface labelled M.smegmatis was mixed with armadillo liver tissueand separated from tissue using a methodformerly employed by the World HealthOrganization Immunology of Leprosy Programfor the purification of M. leprae, as much as 50%of the surface proteins of M. smegmatis waseither released or destroyed. In addition,another twenty distinct proteins were releasedfrom M. smegmatis after treatment with TritonX-100. Similar losses of proteins from M. lepraemay also occur using this procedure for M.leprae purification. Separation techniquesemploying surfactants and enzymatic treatmentshould be carefully evaluated since proteins lostduring these procedures may prove relevant tohuman immune responses to M. leprae.

Authors' summary

DAWSON, P.J.; RINGUS, J.C.; FIELDSTEEL,A.H. Neoratally thymectomized Lewis ratsinfected with Mycobacterium leprae. 2.Histopathologic and electron microscopicobservations. Int. J. Lepr., 47(4) :561-569,1979.

We report the histologic and electronmicroscopic findings following intravenousinoculation of M. leprae into neonatally thy-mectomized Lewis rats, which were killed one totwo years later. All organs appeared normalgrossly. Histologic changes were confined to thefootpads, snout, ears, tail, and testes, all ofwhich were involved in every rat. The tissueswere edematous and infiltrated by varyingnumbers of foamy macrophages. In the footpadsmuscle fibers were vacuolated, and small nervesshowed degenerative changes. Lange numbersof M. leprae were present in macrophages andstriated muscle cells and smaller numbers inperineural cells and pericytes, as well as lyingfree in the tissues. Occasional intracellularbacilli were found throughout the reticulo-

Hansen. Int., 5(2):136-160, 1980

endothelial system. Electron microscopy con-firmed that the majority of organisms werewithin activated macrophages. Both intact andfragmented bacilli were contained withindouble-membrane bound vacuoles. NumerousM. leprae were lying free within the sarcoplasmof striated muscle cells. Virtually all of theentracellular organisms were degenerating.

Authors' summary

FOTEDAR, A.: MEHRA, N.B.; MUSTAFA, A.S.;TALWAR, G.P. Local reactions to intradermalinstillation of Mycobacterium w and ICRCbacilli in mice. Lepr. India, 50(4) :520-533,1978.

Local reactions have been recorded in themouse, after intradermal administration ofMycobacterium w and ICRC bacilli in the mousefoot pad. The response obtained with liveMycobacterium w was higher than with ICRCbacillus employed in the same dose and form.Live Mycobacterium w given at 2x10° bacilliproduced a transient thickness of the foot padat 48 hours, a dip on day 8 and a notable riseagain on day 12. which persisted up to 26th dayof the observation period. Live bacilli produced abetter reaction than autoclaved bacilli. Histologyshowed principally the infiltration ofmononuclear cells at the injection site. Doseresponse studies indicate a low sensitization at2x10° bacilli and a good response at 2x10bacilli. 2x10° bacilli produced a pronouncedthickness of the foot pad from day 1 onwardswith no inflexion seen in the foot pad responsearound days 8 and 12. Mycobacterium w givenintradermally in the thigh evoked a positiverecall reaction to Mycobacterium w sonicatesinjected in the foot pad. The time kinetic patternof this response resembled that given by non-pathogenic mycobacteria.

Authors' abstract

HIRATA, T. Electron microscopic observations ofintracytoplasmic membrane systems andcell division in Mycobacterium lepraemurium.Int. J. Lepr., 47(4):585- 596, 1979.

The fine structures and the interconnectionsbetween the intracytoplasmic membranesystems and' cell division of murine leprosybacilli in liver tissue from mice infectedintraperitoneally with Mycobacterium, leprae-murium, Hawaiian strain, were studied inultrathin serial sections at the electron micro-scopic level. Intracellular membranousorganelles (mesosomes) were seen as vesi-

Hansesíase: resumos/Hanseniasis abstracts 149

cular, tubular and/or lamellar structures. Theformation of mesosomes appeared to be initiatedby invagination and/or folding of thecytoplasmic membrane. A few dividing bacilliwere observed. The lateral extension and thecentripetal growth of the septal wall seemed toresult from the original development ofcytoplasmic membrane occurring at or nearthe leading edge of the nascent septum.After the septum formation was completelyaccomplished, the separation of two newdaughter cells is assumed to occur. Themesosome was associated with the newly formedcytoplasmic membrane (septal wall). It wasshown that both the cytoplasmic membrane andthe mesosome played an important part inseptum formation.

Author's summary

KIRCHHEIMER, W.F. Examination ofNorth American armadillos for mycobac-teriosis — a further report. Lepr. India,51(1):60-64, 1979.

The assumption of the Gulf South Re-search-Armed Forces Institute of Pathologycollaborators that armadillo became infectedfrom patients does not account for the observationthat this allegedly had occurred in an areawhere according to Enna et al., no new cases ofhuman leprosy were reported in the last 10years. It also seems in conflict with the failureof South American investigators to discover'natural' leprosy in 679 armadillos underconditions which make man to armadillotransmission far more likely than in the UnitedStates. The possibility also needs to beinvestigated that infection of wildlife mighthave originated from conditions which permittedexperimentally infected armadillos and/orcontaminated materials to reach the outside.Dharmendra's plea for a proper investigation byworkers who have not been associated with oneview or the other should be supported.

From the article

LEVY , L . & ANANDAN, J.A . Fur the rstudies of the action of antithyroid drugs onMycobacterium leprae. Proc. Soc. Exp. Biol.Med., 158:582-585, 1978.

Methimazole, an antithyroid drug, andthiambutosine, an antimicrobial active against M.leprae in the mouse, were both found toinhibit multiplication of M. leprae in themouse foot pad when administered in concen-trations too small to inhibit thyroid function ofthe mice. Moreover, methimazole inhibitedmultiplication in vitro of a number of culti-

Hansen. Int., 5(2):136.160, 1980

vable Mycobacteria. Although the antimicrobialand the antithyroid effects may be exertedthrough a common mechanism, it appearsthat methimazole nevertheless possesses directantimicrobial properties.

Authors' summary

MUSTAFA, A.S. & TALWAR, G.P. Delayedhypersensitivity skin reactions to homologousand heterologous antigens in guinea--pigs immunized with Mycobacteriumleprae and four selected cultivable myco-bacterial strains. Lepr. India, 50(4):509519,1978.

Guinea-pigs were immunized with Myco-bacterium leprae in saline and with autoclavedpreparations of Mycobacterium w, ICRCbacillus, Mycobacterium phlei and Mycobac-terium vaccae. A group of animals were alsoimmunized with live Mycobacterium w. Allanimals were challenged after one month ofinjection with Dharmendra and Mitsudalepromins from M. leprae and other mycobac-teria. Induration produced in response to thechallenge antigens have been recorded ondifferent days. All bacteria produced delayedhypersensitivity response in guinea-pigs tochallenge with homologous mycobacterialpreparations and M. leprae. In most cases,the early reaction was higher with homologousantigens as compared to M. leprae antigens.The late reactions to homologous and M.leprae antigens were however ofcomparable order especially in animals im-munized with Mycobacterium w, and ICRCbacillus. Animals immunized with M. lepraegave low late reactions with preparationsfrom Mycobacterium phlei and Mycobacteriumvaccae.

Authors' abstract

MUSTAFA, A.S. & TALWAR, G.P. Enlargementof draining lymph nodes in mice by fourselected cultivable strains of mycobacteria.Lepr. India, 50(4) :534-538, 1978.

Mycobacterium phlei, Mycobacteriumvaccae, ICRC bacillus and Mycobacterium wwere injected intradermally in thigh of swissstrain of mice and the enlargement of thedraining lymphnode vis-a-vis the contralateralglands was recorded at 4 weeks. Myco-bacter ium w was the most ef fective incausing the enlargement of lymph nodes with analmost hundred per cent positivity index. Thebacteria produced the enlargement in bothlive and killed state.

Authors' abstract

1

A

H

50 Hansesíase: resumos/Hanseniasis abstracts

RANI KUMAR; VAIDYA, M.C.; KESHWANI, N.H.In vivo response of mast cells tolepromatous serum. Lepr. India, 51(1) :49-53, 1979.

Adult heathly mice of pure line Institutestrain were given, into the foot pad, anintradermal injection of normal human serum ingroup A and lepromatous serum in group B. Inboth groups, the animals were killed at varyingtime intervals. Serial paraffin sections of the footpad skin 5-7µ thick, were cut and stained withhaematoxylin and eosin, toludine blue, acridineorange and para-bromaniline. On comparing thetwo groups, in group B the response of mastcells was more prompt, pronounced andpersistant. The increase in the number of cellswas accompanied by explosive degranulationaround nerves, blood vessels and muscles. Thisresponse became less by 15 days but did notdisappear completely. There were still few intactcells in the dermis. Histamine, heparin and 5-Htshowed a corresponding rise. The importance ofthe findings is discussed.

Authors' abstract

TANAKA, Y. Partial inhibition of the growth ofMycobacterium lepraemurium in C3H miceimunized with cell wall skeletons. Int..1.Lepr., 47(3) :487-494, 1979.

C3H mice stimulated with M. lepraemuriumcell wall skeletons (LM-CWS) were challengedwith viable M. lepraemurium, and delayed-typehypersensitivity (DTH) to picryl chloride wasmeasured. In one type of experiment the micewere challenged at the time when stimulation ofcell-mediated resistance by means of LM-CWSwas undertaken. The major purpose was toinvestigate principles pertaining toimmunotherapy. In contrast to the loss of adetectable DTH response to picryl chloride,development of murine leprosy was partiallysuppressed. In the second type of experiment

weeks before challenge with M. lepraemurium.Findings were: a) that nonspecific DTH asmeasured by sensitization and challenged withpicryl chloride was activated before the infectionwith M. lepraemurium and b) that the DTH whichdeveloped was associated with partial protectionagainst the growth of lepromata. The murineleprosy which developed in C3H mice stimulatedwith LM-CWS was progressive after some delay.

Authors' summary

WATERS, M.F.R.; BAKRI, I.; REES, R.J. W.;McDOUGALL, A.C. Experimentallepromatous leprosy in the white-handedgibbon (Hylobatus lar): successful in-oculation with leprosy bacilli of humanorigin. Br. J. Exp. Pathol., 59(6):551557,1978.

Leprosy bacilli of human origin wereinoculated into a white-handed gibbon by the i.v.and i.p. routes, and also locally into ears, testisand around an ulnar nerve. The animal wasobserved closely during a period of nearly 15years and did not exhibit any clinical evidence ofcutaneous or neurological disease. At death, awide range of tissues was taken for bacterialcounts and histological examination, and adisseminated and progressive infection wasdemonstrated. Acid-fast bacilli were found inmany sites; their morphological appearance,distribution in nerves, and pattern ofmultiplication in mouse foot-pads, and also thepresence of anti-mycobacterial antibody in theserum and, the absence of specific lymphocytetransformation were all in keeping with aninfection by Mycobacterium leprae, at an earlylepromatous stage. This is probably the first fullydocumented report of experimental lepromatousinfection in a primate. The findings are discussedin relation to the long incubation period oflepromatous leprosy and the difficulties ofdiagnosing the disease at an early stage in man.

Authors' summary

CLÍNICA, DIAGNÓSTICO

CLINICAL ASPECTS, DIAGNOSIS

BDUL LATHEEF, K.; MOHANDAS, P. P.; JOY,M.I. Pseudoxanthoma elasticum: report of 3cases with review of literature. Indian J.Derm. Venereol. Leprol., 44(3) :162-165,1978.

Three cases of pseudoxanthoma elasticum

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are described. One case has features of GronbladStrandberg syndrome with lepromatous leprosy.The other two cases are reported in siblings. Ashort review of literature is given.

Authors' summary

Hansesíase: resumos/Hanseniasis abstracts 151

BOOPALRAJ, J.M. & MUTHUSAMI, T.C.Squamous cell carcinoma arising fromtrophic ulcers. Lepr. India, 51(1) :74-77,1979.

Squamous cell cancers arising from trophiculcers in Leprosy is not so uncommon as it hadbeen earlier thought of. It is probable thattrophic ulcers by themselves are not likely tobecome carcinomatous unless there are certainother associated or complicating factors whichmake them more vulnerable to it such asunderlying osteomyelitis or a calcaneal spur.Among trophic ulcers, heel ulcers appear moreprone to malignant transformation.

Authors' conclusions

KAPUR, T.R. Study of non-lepromatous leprosyamong Indian Armed Forces personel. Lepr.India, 51(1) :81-86, 1979.

Clinico-histopathological study of 50 casesof Non-lepromatous leprosy among Indian ArmedForces personnel is presented Maximum caseswere of Tuberculoid (TT) type. Thirty fourindividuals were having single lesions. Posterioraspect of elbow and medial aspect of forearmwere the favourite sites. Both Indian and Ridleyand Jopling classification was studied whileclassifying the lesions. The individuals belongedto almost all the states of India. All of themdenied the history of contact with a known caseof leprosy. The highest prevalent age group wasbetween 20 to 30 years. Two cases of Tuberculoidand 3 of Maculo-anaesthetic leprosy werewithout involvement of nerves.

Author's abstract

KAUR, S.; MALIK, S.K.; KUMAR, B.; SINGH, M.P.;CHAKRAVARTY, R.N. Respiratory systeminvolvement in leprosy. Int. J. Lepr., 47(1):18-25, 1979.

Respiratory system involvement wasstudied in 25 leprosy patients, irrespective ofage, sex, duration of disease and treatment.Nasal bleeding, cough, expectoration and nasalobstruction were present in 64%, 60%, 48%,and 48% of patients respectively. Sixty percentof the patients were cigarette smokers. Twoviews of chest skiagrams were taken whichshowed nodular shadows in upper andmidzones in two LL patients. Nasal involvementwas present in 88%, chiefly LL and BL patients.Nasal smears taken from four sites were positivefor leprosy bacilli in

Hansen. Int., 5(2):136-160, 1980

70.5% of the patients, again LL and BL variety.Anterior and posterior rhino- and laryngoscopieexaminations were carried out under generalanesthesia and biopsies were taken from theepiglottis, false vocal cords, and the right upperand lower bronchi. Laryngeal involvement wasseen in 33% of the patients, chiefly of the LL andBL type. The vocal cords were the most commonlesion site. Bronchial smears were positive forleprosy bacilli in three LL (25%) patients. Twoepiglottic and one vocal cord biopsy showed foamcell and tuberculoid granuloma. Leprousgranuloma was not seen in any bronchial biopsy.Acidfast bacilli were present in one right upperand lower bronchial biopsy but were absent inlaryngeal biopsies. Coexistent pulmonarytuberculosis was present in two LL (8%) patients.No correlation was found between clinical, radio-logic, sputum and bronchial smear positivity foracid-fast bacilli and histopathology of bronchialmucosa.

Authors' summary

MANZI, R.; MARZETTI, A.; GANOPOL, J.;SIMONOVICH, I.; ANTOLA, M. Lesionesulcerosas en los pies de los hansenianos.Tem. Leprol., (65/66) :1-44, 1978.

Prólogo, Definición y concepto. Antecedenteshistóricos. Sinonímia. Etiopatogenia. Diagnósticoy classificación. Classificación de las acropatiasulceromutilantes. Classificación anátomo clínica.Semiologia y clínica del pié ulcerado. Exploraciónclínica. Tratamientos de las úlceras de piésneuropáticos anestésicos. Bibliografia.

MICHELSON, J.B.; ROTH, A.M.; RARING, G.O.Lepromatous iridocyclitis diagnosed byanterior chamber paracentesis. Amer. J.Ophthalmol., 88(4) :674-679, 1979.

A 34-year-old man with a three-monthhistory of intraocular inflammation after oculartrauma with a fir branch, had an acute unilateralfulminant iridocyclitis. The iris had a thick, gray,cheesk membrane composed of nodularlepromata. The patient denied a history ofHansen's disease, despite the dermatologic andfacial features that suggested the diagnosis.Anterior chamber paracentesis and scleralnodule biopsy demonstrated Mycobacteriumlepra. The iridocyclitis resolved after treatmentwith dapsone, corticosteroids, and rifampin.

Authors' summary

152 Hansesíase: resumos/Hanseniasis abstracts

NIGAM, P.; DUBEY, A.L.; DAYAL, S.G.; GOYAL,B.M.; SAXENA, H.N.; SAMUEL, K.C. Theassociation of leprosy and pulmonarytuberculosis. Lepr. India, 51(1) :65-73, 1979.

The association of leprosy with pulmonarytuberculosis was seen 20 cases during January1972 to October 1977. Of these 20 cases, 15were of lepromatous, 3 of dimorphous and 2 oftuberculoid leprosy. Maximum number of caseswere from 3rd decade of life with dale to femaleratio of 3 : 1. Patients were suffering from thedisease for a very long time (8 cases oflepromatous leprosy with duration of illness 10-15 years). The symptoms of leprosy seemed tohave preceded to the symptoms of pulmonarytuberculosis. Duration of tuberculosis in most ofthem was within 6 months (55%). Thepredominant presenting symptom was coughwith expectoration (100%) and fever (80%).Anaemia (75%) and crepitations (60%) were thepresenting physical sign mainly. Radiologicallybilateral extensive pulmonarâ lesions were seenin 14 cases (70%). Sputum for acid fast bacilliwas positive in 80% of cases. The general con-dition and nutritional status was poor anddeath was resulted in 4 cases (3 of lepromatousand 1 of dimorphous leprosy).

Authors' abstract

REA, T.H. & LEVAN, N.E. Lucio's phenomenonand diffuse nonnodular lepromatousleprosy. Arch Derm., 114(7) :10231028,1978.

The records of ten patients with Lucio'sphenomenon showed clinical and histopath

ological changes similar to those described byothers. Lucio's phenomenon is a syndromedistinct from erythema nodosum leprosum asindicated by an absence of fever, leukocytosisand tenderness, a failure to respond to thali-domide, and a restriction to patients withdiffuse nonnodular lepromatous leprosy.Lymphopenia associated with splenomegaly inthree patients and glomerulonephritis in onepatient were unexpected findings of unknownrelevance.

Authors' abstract

WESHLER, Z.; LEVIATAN, A.; GORDON, R.;KOPOLOVIC, J. Development of Hodgkin'sdisease in a patient with leprosy. Oncology,35:281-284, 1978.

We present a patient with leprosy whodeveloped Hodgkin's disease of the nodularsclerosing type. There are two previous reportsdescribing the combination of leprosy andHodgkin's disease in a single patient. Hodgkin'sdisease was diagnosed 14 months after thecomplete disappearance of Mycobacterium lepraefrom the skin lesions, under treatment withDDS (diamino-diphenyl-sulfone). Hodgkin'sdisease was treated by irradiation andchemotherapy. Obstructive jaundice developedwhich resolved under treatment by irradiation ofthe hilar area of the liver, chemotherapy andhormones. During two years of immuno-suppressive therapy, without DDS, noexacerbation of the leprosy occurred.

Authors' abstract

TERAPÊUTICA

THERAPY

ANAND, L.C. & RATHORE, B.S. Activity andeffective serum level of repository sulphones(DADDS) in lepromatous leprosy. Lpr. India,61(3):358-362, 1979.

35 cases of lepromatous leprosy werestudied to evaluate the effective blood level andlong depot action of acedapsone (DADDS). It wasrevealed that serum level of this drug

Hansen. Int., 5(2):136-160. 1980

is maintained well above the minimum inhibitoryconcentration upto 60 days following singleintramuscular injection. No significant untowardeffects of the drug were encountered except onecase of Erythema Nodosum Leprosum and sixpatients with mild reactional symptoms in theform of fever and arthralgia.

Authors' abstract

Hansesíase: resumos/Hanseniasis abstracts 153

BALAKRISHNAN, S. & SHESHADRI, P.S.Influence of rifampicin on DDS excretion inurine. Lepr. India, 51(1) :54-59, 1979.

The plasma half-lives and urinary excretionlevels of DDS were compared before and duringconcurrent administration of rifampicin in 23cases of active lepromatous leprosy. The plasmahalf-life of DDS was found to be slightly lessduring rifampicin administration. The urinaryexcretion of DDS was found to be consistentlyenhanced in all the cases, particularly duringthe earlier phase of the therapy. This had norelation to the dose or the total duration ofrifampicin therapy. The findings are discussed.

Authors' abstract

CHAUDHURI, S.; GHOSH, S.; CHAKRABORTY,T.; KUNDU, S.; HAZRA, S.K. Use of acommom Indian herb "mandukaparni" in thetreatment of leprosy. J. Indian Med. Ass.,70(8) :177180, 1978.

From this short trial for one year it isobserved that "Mandukaparni" (Thankuni) seemsto be an effective drug in the treatment ofleprosy. Clinical improvement is quicker with"Mandukaparni" in comparison with dapsone.Bacteriological improvement is comparable withdapsone. The drug is well tolerated by patientswhereas with dapsone there is a possibility ofreaction which apneared in 3 out of 10 cases.Further observations with these drugs willsubstantiate the findings in this series.

Authors' summary and conclusion

CHOWDHURY, S. & GHOSH, S. "Mandu-kaparni" in the treatment of leprosy: apreliminary report. Lepr. India, 51(1) : 103-105, 1979.

It appears that with Mandukaparni there isboth clinical and bacteriological improvement,comparable with or better than that of D.D.S.

From authors' conclusion

HAGAN, K.J.; SMITH, S.E.; KIN MA GYI;MAUNG MAUNG LWIN; YI YI MYAING;KHIN MAW 00; TIN SHWE; KHIN MAUNGTIN; KHIN NYUNT THAN; THIDA HLA; WINWIN KYWE. The reliability of selfadministration of dapsone by leprosypatients in Burma. Lepr. Rev., 50(3) : 201-211, 1979.

A study of urinary dapsone/creatinine(D/C) concentration ratios has been per-

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formed on 852 leprosy patients in the Rangoonand Mandalay regions of Burma. The resultsshow that, by comparison with in-patients whoare assumed to be compliant with their therapy,hospital out-patients and urban and rural clinicpatients had overall compliance rates of only74% and 24% respectively. In each group,substantial numbers of patients were identifiedwho had taken no dapsone (DDS) tabletswhatsoever. The findings are in line with similarstudies performed in other countries and theyindicate an urgent need to reassess the existingprogramme of treatment supervisionparticularly in the urban and rural clinicenvironments.

Authors' abstract

LANGUILLON, J.; YAWALKAR, S.J.; Mc-DOUGALL, A.C. Therapeutic effects ofadding rimactane R (rifampicin) 450 mil-ligrams ,daily or 1200 milligrams oncemonthly in a single dose to dapsone 50milligrams daily in patients with lepro-matous leprosy. Int. J. Lepr., 47(1) :3743,1979.

The clinical, bacteriologic and histopath-ologic effects of adding Rimactane 450 mg dailyor 1200 mg once-monthly to a standarddapsone regimen were practically identical in 30lepromatous leprosy patients. Rimactane 1200mg once-monthly in a single dose for six monthscould, on the basis of this trial, betherapeutically and economically an ideal andeasily supervisable component of combinationregimens for large scale, initial and intensivetreatment of multibacillary (LL, LI and BL) typesof leprosy. This trial has to a great extent solvedthe problems of rifampicin therapy in leprosywith regard to dosage, dose intervals andduration of the treatment, which have baffledleprologists for so many years. This has beenthe first controlled clinical trial to demonstratethe practicability and utility of a once-monthlysingle dose rifampicin schedule in the initialtreatment of multibacillary forms of leprosy. It issuggested that a combination regimen com-prising dapsone 50-100 mg daily (1.5-2 mg/ kgbody weight), Lamprene a 100 mg on alternatedays, and rifampicin 1200 mg once- -monthly ina single dose for six months using long-termfollow-up merits further investigation. Thistriple-drug regimen might prove optimallyeffective, reasonably safe and fairly economicalfor the initial treatment of patients with LL, LIand BL leprosy. Furthermore, this combinationregimen could result in faster arrest oftransmission, and may prevent the emergence ofdrug resistance.

Authors' summary

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154 Hansesíase: resumos/Hanseniasis abstracts

MOULDING, T.S. The potential uses of themedication monitor in the treatment ofleprosy. Int. J. Lepr., 47(4) :601-606, 1979.

A medication monitor has been developedthat utilizes radioctive material andphotographic film to record the intervals atwhich patients take medication. In the author'sopinion, this equipment represents the mostefficient means that has so far become availablefor determining how regularly outpatients takemedication. A monitor for the tuberculosisregimen of isoniazid and thiacetazone has beenmade at a sufficiently low cost that it is practicalto use it in routine treatment programs. Aninexpensive system for immediate developmentof the film that can be used in the most remotelocations is also available. Undoubtedly, withappropriate engineering work, a monitor forleprosy regimens could be made. The device hasbeen used with tuberculosis patients andrevealed that many patients were grosslyirregular in taking their medication. It has beenused to oversee medication used by tuberculosispatients and to select those who require eitherextra attention to improve medication ingestionor completely supervised, directly administeredprograms. In the treatment of leprosy, it couldbe used to study new drug regimens, the causesof noncompliance, and for the routinesupervision of patients.

Author's summary

NAAFS, B.; PEARSON, J.M.H.; WHEATE, H.W.Reversal reaction: the prevention ofpermanent nerve damage comparison ofshort and long-term steroid treatment. Int.J. Lepr., 47(1) :7-12, 1979.

Borderline leprosy patients with a reversalreaction were studied and short-term steroidtreatment compared with prolonged steroidtreatment using voluntary muscle testing (VMT)to assess the results. Prolonged steroidtreatment was shown to be superior to short-term treatment and free of harmful effects. It isconcluded that with the described antireactiontreatment, permanent nerve damage can beprevented, provided that the reversal reactionsis detected in time (within 3-4 months).

Authors' summary

PEARSON, J.M.H.; HAILE, G.S.; BARNETSON,R.St.C.; REES, R.J.W. Dapsone-resistantleprosy in Ethiopia. Lepr. Rev., 50(3) :183-199, 1979.

During the 5 years 1973-1977, 254 pa-tients suspected of developing dapsone-resis-

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tant leprosy were seen in the Addis Abeba area.They were drawn from a pool of about 1500registered patients with lepromatous leprosy,giving an incidence of about 3% per annum(among patients at risk). Fifty-one were provedresistant by mouse foot-pad tests, and 57 more byclinical trial. The remainder, who continued intrial treatment, conformed to the clinical patternof those proved to be dapsone resistant. Only 2patients were proved to be sensitive to dapsone. Inaddition, among 106 suspected cases fromelsewhere in Ethiopia giving a "classical" history,28 were proved resistant by mouse foot-pad tests,and only one was dapsone sensitive. Eleven out of17 patients who relapsed having discontinueddapsone treatment were also found to havedeveloped dapsone-resistant leprosy (7 by mousefoot-pad tests, and 4 more by clinical trial) : 2were sensitive to dapsone. Mouse foot-pad testingfor primary dapsone-resistant leprosy wasperformed in 29 patients. Fourteen lived in theAddis Abeba area; 5 of them were resistant.Fifteen came from elsewhere in Ethiopia; 11 wereresistant. Dapsone-resistant leprosy has becomeso widespread in Ethiopia as to threaten thepractical possibility of leprosy control bychemotherapy alone.

Authors' abstract

REYS FLORES, O. Tratamiento de la lepra.Derm. Venez., 17(3/4) : 1-49, 1979.

Entre los medicamentos usados en el tra-tamiento de la Lepra consideramos que lasulfona base, diamino-difenil-sulfona (DDS) siguesiendo la droga de elección, por su efectividad,fácil manejo y bajo tosto. Por lo general es bientolerada y debe ser administrada por el tiemponecesario para lograr una negatividadbacteriológica y una regresión total y estable delas lesiones, prolongando el tratamiento, comomedida de consolidación, cinco (5) anos o más enlos casos Mitsuda-negativos y dos (2) ó tres (3)anos en los casos Mitsuda-positivos. Los efectostóxicos de la DDS son muchos, aunque pocofrecuentes; entre ellos destaca la anemia. Losmodelos experimentales de la pata del ratón y delarmadillo constituyen un importante avance parael ensayo de drogas titiles en el tratamiento de laenfermedad. La 'riminofenazina es una droga degran utilidad, empleada sola o combinada es unaalternativa, especialmente en los casosreaccionales o cuando se sospecha resistencia ala sulfona. La rifampicina es, entre losantibióticos, la droga de mayor efectividad, suacción contra la bacteria es más violenta eintensa que la DDS, pero su costa limita su uso.La reaeción

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eprosa es una etapa clínico-evolutiva de lanfermedad habitualmente, de difícil manejo. Laalidomida constituye la droga de elección, dena gran efectividad, provoca una rápidaegresión de los sintomas; sus efectoseratogénicos deben ser tomados muy en

cuenta cuando se trate de mujeres en actividadsexual. Los corticoesteroides, por tener menorefectividad y mayor número de efectos secun-darios indeseables, es la medicación de segundaelección.

Resumen del autor

CIRURGIA, FISIOTERAPIA, REABILITAÇÃO FÍSICA

SURGERY, PHYSIOTERAPY, PHYSICAL REHABILITATION

OURREL, P. Paralysie lèpreuse de l'oppositiondu pouce intérêt de la transplantation del'extenseur propre de l'index. Med. Trop.,39(1):57-90, 1979.

The transplantation of the extensor indiciso restore the opposition of thumb has beenealized by two techniques: transplantationhrough the 2nd interosseous space with suturen the abductor pollicis brevis but the result wasoor for the guide pulley resulting did not workell; transplantation with reflexion on the cubitalide of the wrist which in 5 cases proved to beatisfactory. In medico cubital paralysis oneust also cure the "cubital claw of the thumb".

he surgical procedure, using a dispensableendon, could be directly associated to the su-ures of the proximal injuries of the cubital nerves a temporary palliative.

Author's summary

OPAL, P.K. Rehabilitation of leprosy patients. J.Rehab. Asia, 20(3) :4-7, 1979.

The above said measures for the improve-ent of rehabilitation of leprosy patients shoulde considered seriously since there already existuite a large number of deha- bilitated patients.edicated services of personnel from variousisciplines are required to rehabilitate theatients. If the community is changed in favourf leprosy patients, the disease could beontrolled in the near future which would greatlyelp the rehabilitation of the affected persons.

Author's conclusion

ansen. Int., 5(2):136-160, 1980

KUPPUSAMY, P.; RICHARD, J.; SEL-VAPANDIAN, A.J. A study of causes ofunemployment among agriculturallabourers afflicted by leprosy. Lepr. India,51(3):369-375, 1979.

116 patients consisting of 54 males and 62females, all engaged in agriculture wereinterviewed to find ou the cause of theirunemployment. Deformity seemed to be themajor factor responsible for the loss of jobamong them, which was prevalent amongadvanced age group (Males — 50, Females —53.5). Since the measures to rehabilitate themare rather difficult, it is essential to educatethem on the methods of prevention ofdeformities and their importance. If not, theyinvariably loose their job at an age when theycannot train themselves for a suitablealternative job to earn their livelihood.

Authors' abstract

OOMMEN, P.K. Ulnar nerve decompression bymedial epicondylectomy of the humerus anda method of assessing muscle power statusby totalling the muscle grading. Lepr. India,51 (3) :336-340, 1979.

This paper advocates the principle of ulnarnerve decompression by medial epicondylectomyof the humerus in leprosy patients presentingwith ulnar nerve neuritis and early muscleweakness of ulnar nerve supplied muscles. 16medial epicondylectomies were done on 14patients and a follow up showed relief of nervetenderness and an improvement in the motorpower status of the muscles as shown by totalgrading.

156 Hansesíase: resumos/Hanseniasis abstracts

EPIDEMIOLOGIA, PREVENÇÃO

EPIDEMIOLOGY, CONTROL

DHARMENDRA. Development of an anti--leprosy vaccine — progress in. Lepr. India,50(4) :488-491, 1978.

At present there is a big lacuna in themethods of control and ultimate eradication ofleprosy. This consists of the absence of anymeans of primary prophylaxis against thedisease, as there is not available anyprophylactic vaccine against the disease. For thevaccination, to begin with, thought was given toBCG because of its having some commonantigenic fractions with the leprosy bacillus.This raised the hope that, in addition toprotecting against tuberculosis, it might protectagainst leprosy also. Some trials with BCGseemed to indicate its usefulness for thispurpose. However, the long term WHO trial withBCG for protection against leprosy proved that ithas a very limited protective value againstleprosy. Because of the importance of thematter, WHO has created a special projectknown as IMMLEP. In this connection, attentionis being paid mostly to the production of vaccinefrom the leprosy bacilli isolated from the tissuesof experimentally infected armadillos whichprovide a huge quantity of the leprosy bacilli.

From the editorial

EDELMAN, R. Malnutrition and leprosy — ananalytical review. Lepr. India, 51(3) : 376-388, 1979.

I agree with Skinsnes (1964) that the longincubation period of leprosy and its chronicity,once established, do enhance the possibilitythat acquired factors, such as malnutrition,could interpose and modulate the immuneresponse. However, with all facts assembled, noconvincing evidence exists for a strongmodulating effect of malnutrition in humanleprosy. A few observations show effects onmorbidity of leprosy only under the mostextreme condition of nutritional deprivation.Although careful nutrition assessments ofleprosy patients have not been done, mostleprosy patients seem not to be severelyclinically malnourished, and it is not at all clearif mild to moderate malnutrition, such asgrowth retardation in children, affects the risk ofinfection or the course of their disease. Myprejudice is that it either does not, or that thenutritional effect is overshadowed clinically byother and more force-

Hansen. Int., 5(2):136-160, 1980

ful risk factors. However, research will berequired to settle this issue more definitively.

Author's summary and conclusion

FERREIRA, N. & BARBOSA, A. Fontes decontágio na doença de Hansen. RoviscoPais: rev. port. doença Hansen, 15/16(2/único) :193-198, 1976/1977.

On.º de fontes de contágio conhecidas

extra-familiares é cerca de 3 a 4 vezes inferiorao número de fontes de contágio conhecidasfamiliares; considerando extra-familiares asfontes de contágio desconhecidas e juntando aoseu número, o de fontes de contágio extra-familiares conhecidas, e obtidas as médias das 2séries, o conjunto é superior em perto de 20%ao de fontes de contágio familiares conhecidas,(59,6/40,4). Poderá portanto inferir-se que ocontágio familiar é responsável em média por40% dos casos e o extra-familiar por 60%.

Do artigo

GIMENEZ, M.M. Epidemiologia de la lepra. ActaLeprol., (75) :7-19, 1979.

La lepra cuya real magnitud se desconocees, evidentemente, un problema prioritario desalud pública. La gran cantidad de casos activossin controlar indica que la endémia seencuentra en plena expansión. La discon-tinuidad de las acciones de control de la lepra,por falta de apoyo político y económico, ha sidoprincipal factor determinante del progreso de laendémia. El diagnóstico de Ia enfermedad en suetapa de comienzo y el tratamiento de los casosconocidos, en muchas regiones ha contribuído auna evidente disminusión de la lepra. Lasinvestigaciones epidemiológicas en áreas pilotos,posiblemente dilucidarán incógnitas de estecomplejo problema sanitario y contribuirán a unmejor conocimiento de los factores'determinantes de la endemia, motivo por el cualson fundamentales para el control de laenfermedad.

Conclusiones del autor

LOMBARDI, C. Situação da endemia dahanseniase no município de São Paulo,Brasil (1976-1977). Rev. Saúde Publ. S.Paulo, 13(4) :281-298, 1979.

Descreve-se e avalia-se a situação daendemia da hanseníase no município de São

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aulo no biênio 1976/1977, caracterizando-aomo problema de saúde pública, através dapresentação e discussão dos coeficientes derevalência e de incidência, por local de resi-ência nos diversos distritos e subdistritos e nasonas Central, Intermediária e Periférica dounicípio. Os recursos sanitários existentes são

escritos e avaliados segundo os mesmos critériose localização, tentando-se relacionar suaistribuição com a dos índices endêmicoserificados.

Resumo do autor

ORRU, A. La lepra in Sardegna. RassegnaMedics Sarda, 82(1):23-39, 1979.

Phoenician Leprosy was most likely broughtto Sardinia by the Phoenician population. Itspread prevalently through the area of Oristanoalong the south west side of the region andCarloforte Island. Since the beginning of thiscentury, 195 cases in 43 different places werereported. Most of them in Sardinia wererepresented by autochthonous infection. Also,there has been a small number of sporadiccases from immigrants. Leprosy over the yearshas been reduced. Today only 10 foci of leprosyare active;

30 disappeared. From author's summary

PICOTO, A.J.S. & GRAVANITA, M.M.R. Combateà lepra em Cabo Verde. An. Inst. Hig. Med.Trop., 5(1-4) :333-336, 1977/1978.

Os números atrás apontados não são deodo nenhum tranquilizadores. A elevada

ercentagem de casos lepromatosos e em tra-amento irregular no Fogo e em Santo Antão são

favor de um prognóstico reservado quanto àvolução futura da endemia se não se tomaremedidas. Por outro lado a grande percentagem de

nvalidez é clara quanto à repercussãoevastadora que a doença está tendo ao mesmoempo que histórias clínicas indicam queumerosos casos de reação leprosa passam semiagnóstico e tratamento adequados. No Fogo em Santo Antão em muitos pontos nãoncontramos os meios para o tratamentodequado destas situações. Também são muitoracas as possibilidades de promover aeabilitação dos doentes. O fato de a maioria dosasos ser de Lepra lepromatosa deixa poucassperanças quanto à possibilidade de utilizar oCG como medida profiláctica neste pais.ntendemos portanto que a campanha deveráfectuar-se em moldes clássicos — diagnóstico eratamento precoces prevenção da invalidez,eabilitação. Em conclusão pensamos que em Caboerde a Endemia Leprosa é grave no Fogo e Santo

ansen. Int., 5(2):136-160, 1980

Antão, que o controle funciona deficientementenestas Ilhas, deixou de ser feito em Santiago e éprecário em São Vicente.

Resumo dos autores

TALWAR, G.P. Towards development of avaccine against leprosy. Lepr. India, 50 (4):492-497, 1978.

What are the characteristics that oneshould look for in search of the desirableorganism? It should of course have antigenswhich cross-react with those of M. leprae. Theresembling antigens should be those involved incell mediated functions. The bacteria shouldhave a potent immunizing capacity. Merepossession of common or cross- -reactingantigens may not suffice. In view of theobservations that lepromatous leprosy patientsare negative to lepromin and do not have theability to recognize some M. leprae antigens, itcan be inferred that they are tolerant to theseconstituents. In the strategy to be envolved, itwill be mandatory to seek ways and means tobreak this tolerance. One of the approaches thatcan be employed for this purpose is to couplethe tolerant antigens to those against whichthere is no tolerance. The linking of 'se1F'proteins to "foreign" carriers or haptens canelicit an immune response to the tolerantantigens, as has been successfully achieved inour studies on anti-hCG, (Talwar et al., 1976a &1976b). Thus the requirement that we haveframed for our desirable organism is not onlythe possession of cross-reacting antigens toMycobacterium leprae, but also those which aredifferent, and to which lepromatous leprosypatients can respond. It is hoped that with theassociated immunogenic antigens, it may alsobe possible to generate immune responseagainst the tolerant antigens.

From the article

TERENCIO DE LAS AGUAS, J. La lepra regresa aEuropa. Editorial. Rev. Leprol. Fontilles,12(3):285-289, 1979.

Este aumento de la lepra en Europa por laimportación de casos del exterior debe tenerse encuenta por un posible incremento en el futuro delos casos de lepra secunda- rios a losimportados. Esto supone una nueva estrategia delucha que consistiria primero en los paíseseuropeos con endemia hanseniana, terminar conella y en los restantes países donde haycorrientes inmigratorias de paísestercermundiastas, considerar la necesidad delcontrol sanitario, la formación del

1

pde

58

ersonal médico en materia de lepra paraetectar los posibles casos, el tratamiento dellos y su rehabilitación y aspectos sociales

Hansesíase: resumos/Hanseniasis abstracts

del problema, pues la lepra viaja otra vez haciaEuropa.

Del editorial

PSICOLOGIA, EDUCAÇÃO,

PSYCHOLOGY, EDUCATION,

APPEL, G.E. Social aspects of HD in Para State— Amazon Valley. Star, 38(4) :2, 1979.

We prefer to call it — Hansen's disease. Twogenerations ago, the. HD patient called himself— in Portuguese — "leproso", "leper". Now, ournew patient who does not have to face thegauntlet of condemnation and segregation thathis grandfather and greatgrandfetherexperienced, never uses that pejorative term. Hemay not be able to pronounce "Hanseniase", orHansen's disease, but he will tell you quitesimply that he has "a skin disease".

From the article

BHAGOLIWAL, A.; CHANDRA, J.; MISH-

RA, R.S. Some observations on defaultamong leprosy patients. Leer. India, 51

(1) :96-102, 1979.

It can be concluded that the retarding effecton attendance of the majority of reasons viz,carelessness, illiteracy and ignorance, prolongedtreatment period, social stigma, whereby apatient tries to hide his illness from thecommunity, religious ceremonies, false feeling ofcomplete recovery and failure to accept thediagnosis can be minimised to a considerableextent through efective and constantinterpersonal motivation and adequate healtheducation.

From the article

BOUDREAUX, L. Appeal for terminology changerejected. Star, 38(4) :1-13, 1979.

Radiating the light of truth on Hansen'sdisease has been the primary objective of "TheStar" since its inception in 1941, and in thisendeavor we have achieved more than amodicum of success, thanks to an ever- growingnumber of friends and staunch supporters.However, until or unless "Hansen's disease" isaccepted throughout the medical world as theofficial term victims of the illness will remainsocial outcasts. It is quite

Hansen. Int., 5(2):136-160, 1980

REABILITAÇÃO SOCIAL

SOCIAL REHABILITATION

obvious that the International Leprosy Asso-ciation has no intention of replacing thedehumanizing term "leprosy" with one that wouldrestore dignity and social acceptance to theunfortunate victims of this illness. A significantstep in the right direction was made when theodious word "leprosy" and all other derogatoryreferences to the disease were removed from theU.S. Public Health Service Manual. We are stillpinnig our hopes on an announcement by theU.S. Department of Health, Education andWelfare in the November 1977 issue of "U.S.Medicine" HEW had planned to .introduce alegislative package into Congress in 1978 whichwould include "Modernizing the terminology usedin the Public Health Service Act to eliminate alluse of the words 'leper' and 'leprosy', replacingthem with 'Hansen's disease', which is themedically preferred term". If you share our viewson terminology and want to help you shouldwrite to the Department of HEW, to your Senatoror Congressman, or to all three, expressing yourstrong support for legislation such as thatproposed by HEW.

From the article

GOPAL, P.B. Rehabilitation of leprosy patients. J.Rehab. Asia, 20(3) :4-7, 1979.

The above said measure for the improvementof rehabilitation of leprosy patients should beconsidered seriously since there already existquite a large number of dehabilitated patients.Dedicated services of personnel from variousdisciplines are required to rehabilitate thepatients. If the community is changed in favourof leprosy patients, the disease could becontrolled in the near future which would greatlyhelp the rehabilitation of the affected persons.

Author's conclusion

GONZALEZ GALVAN, A. Aspectos sociales de lalepra. Prensa Mid. Mex., 43(9-10) : 261-263,1978.

Paco se ha hecho para modificar losconceptos y actitudes erróneos respecto a la

Hansesíase: resumos/Hanseniasis abstracts 159

lepra, por lo que debemos tratar de otorgar unarehabilitación psíquica y social a las personasque desafortunadamente contrajeron laenfermedad, para que vivan una vida másproductiva y feliz en este mundo.

De Ias conclusiones del autor

KANDIAH, N.; RIJI, H.M.; PALAN, V.T. Currentattitudes of the society towards leprosy andthe changing role of the national leprosycontrol centre, Sungai Buloh, Malaysia.Southeast Asian J. Trop. Med. Public. Health,9(1) :103-111, 1978.

The study revealed that most people hadheard about leprosy and a majority of them werenot prejudiced against the disease. However, theChinese showed a higher degree of prejudicethan the non-Chinese, and this could be due tothe incidence of leprosy being the highest amongthe Chinese and the majority with lepromatousleprosy are also Chinese (National LeprosyControl Centre, 1975-1976). On the basis of this,it could be expected that it would be moredifficult to reduce the fear of disease amongChinese than in the other races. It was alsofound that the educational status of therespondents did not have an effect on the degreeof prejudice. The degree of prejudice however diddepend on age, where the older respondentsseemed to be more prejudiced. The acceptance ofleprosy patients undergoing treatment, into thecommunity is low. This will hinder the modernmethod of treating leprosy on an out-patientbasis, after the initial period of inpatienttreatment in the leprosaria. A majority of therespondents knew about the existence of theNLCC but only a third knew that it catered to alltypes of illnesses in addition to leprosy. Asignificant number of people preferred to go toprivate clinics and hospitals rather than to NLCCfor medical treatment, the main reason beingfear of getting leprosy and the difficulty of accessto the centre.

From authors' summary

MASSEY, E.W. Leprosy: Biblical opprobrium?South Med. J., 71(10):1294-1295, 1978.

Leprosy is present in many parts of theworld today, especially the tropics and sub-tropics, with estimates of 10 to 20 million cases.Incidence rates of 20 per 1,000 or greater exist inAfrica and Southeast Asia, but rates in thePalestine vicinity are 0.1 to 1.9 per 1,000population.' Syphilis is a universal disease,especially since about 1500 AD. The

Hansen. Int., 5(2):136-160, 1980

stigma attached to leprosy is still present. Panicmay follow admission of such a patient to ageneral hospital, and even for the person witharrested disease, employment is difficult to find.Patients with leprosy justifiably abhor the term"leper," for they are painfully aware that it impliesmuch more than having a mycobacterial infection;many of them have suffered more from theravages of the stigma than from the disease itself.

From the article

RAMU, G. Psycho-social aspects of leprosyin India. Star. 38(5) :6-7, 11, 1979.

The psychological profile of leprosy patientshas not been properly studied. It could howeverbe indicated here that a particular type or types ofpersonality profiles are not obtained in leprosypatients. The behaviour patterns are modified bycircumstances-e.g., social and physicaldisabilities, deprivation of biological essentials,nutritional and emotional stress exceedingtolerance. The body, mind and the emotional stateare aspects of the same human personality. Animpairment of function of any one will adverselyaffeèt the harmony of the whole organism.

From the article

VARKEVISSER, C.M. Methodology of research intosocial aspects of leprosy control. Lepr. Rev.,50(3) :223-229, 1979.

Given the goal of optimal dapsone intake,social scientific research need to take intoconsideration both the socio-cultural and socio-medical settings in which dapsone is available.Various techniques can help reveal what factorsdetermine prompt self-reporting and regular clinicattendance, and what factors retard them. In ourproject (Western Province, Kenya and MwanzaRegion, Tranzania 1974-76) we combined a factoranalysis of data on patient registration cards(limited in value because of the low quality of thedata) with in-depth interviewing (patients,relatives, neighbours, false-alarmists, communityleaders, traditional doctors). With a set of "test"statements, we measured prevailing communityattitudes towards leprosy patients and thencompared the results with our observations. Atthe same time we interviewed health personnelintensively, and observed patient-staffinteractions. In-depth research is able to generatevaluable suggestions for strengthening the leprosyservices available, for training and retraininghealth personnel, and for educating patients andcommunities about leprosy control essentials.

Author's abstract

160 Hansesíase: resumos/Hanseniasis abstracts

GENERALIDADES, HISTÓRIA

GENERAL, HISTORY

GUSSOW, Z. Notes on the history of leprosy inLouisiana. South. Med. J., 72(6):600604, 1979.

In the late 1880s it became apparent inLouisiana that leprosy was endemic in the southernpart of the state. Initially, the intention wasto establish a leprosy hospital in the city ofNew Orleans, close to medical facilities, and wherethe bulk of the patients were to be found.The establishment, instead, of an isolated lepercolony at the run-down plantation at Carville,85 miles up-river, was

the result of community indifference, misun-derstanding of the nature of the disease, andexpected depreciation of property values. Fear ofthe disease was a secondary matter. The practiceof locating residential facilities for the chronicallyill at long distances from the centers of physicianpractice and medical research continues to thisday. Interestingly, the arguments that permit thisto happen have not changed appreciably fromthose of a century ago.

Author's abstract

Hansen. Int., 5(2):136-160, 1980