Electron microscopic characteristics of actinomycetic agents having aetiological association with human leprosy and epizootic ulcerative syndrome of fish.

The transmission electron microscopic (TEM) studies of the human leprosy derived chemoautotrophic nocardio-form (CAN) bacteria and EUS derived CAN bacteria showed presence of double contoured cell-walls consisting of an electron transparent and a dense layer. The fibrillar structures on the surface of these CAN bacterial cells also suggested their similarity to the human tissue derived Mycobacterium leprae cells. These EM studies further revealed mycelial and coccoid bodies in all these bacteria as was observed originally.

Culture of nocardioform bacilli from leprosy patients & clinical evaluation of nocardioform bacilli derived antigen.

An antigen derived from cultured nocardioform bacilli was compared with Mitsuda lepromin in intradermal skin test reactions. Nocardioform bacilli were cultured in gelatin minimal medium from the tissue fluid of 85 lepromatous patients (56 M, 29 F). Of these, 65 samples showed uncontaminated growth of the organism, which were pooled for the manufacture of the test antigen. This antigen was intradermally tested in 50 untreated leprosy patients irrespective of the type, together with Mitsuda lepromin and sterile gelatin minimal media, which served as a control. No early reaction was observed at 72 h, while the late reaction at 28 days was positive in all patients in the Tuberculoid (TT) group with both antigens. Eighteen patients (81.8%) in the Borderline tuberculoid (BT) group reacted strongly to Mitsuda lepromin at 28 days, while 21 patients (95.5%) in this group showed a strong late reaction with the test antigen. The lepromatous (LL) group did not show any reaction with the two antigens. It is inferred that nocardioform bacilli are easy to cultivate, and that the test antigen compares well with Mitsuda lepromin.

Paucibacillary multidrug therapy in leprosy. 7 1/2 years experience.

Three hundred and twenty-three paucibacillary (PB) leprosy patients were treated with WHO-recommended multidrug therapy (MDT) and followed up for over 7 1/2 years. The paucibacillary MDT regimen (PBR) was well accepted and tolerated. Complete clinical regression was attained in 61.2% patients after 6 doses of PBR. Persistence of clinical activity after 6 months of therapy was associated with occurrence of type I upgrading reaction, presence of six or more patches and more than two thickened major nerve trunks. Reversal reactions were encountered in 15.9% patients, one third of which were accompanied by severe neuritis. Delayed upgrading reaction occurred in six patients, two patients had relapse one and two years after stopping of PBR. The WHO recommended MDT regimen for paucibacillary cases needs careful evaluation and it may be necessary to extend the treatment beyond six months in certain situations.