Lepra dimorfa lepromatosa conyugal / Lepromatous dimorphic leprosy in spouses

Leprosy is a contagious, chronic infectious disease caused by Mycobacterium leprae. The immune response of the host to this bacillus is variable, determining different clinical forms of the same disease. Between the Lepromatous and Tuberculoid spectra, both stable clinical forms, the Dimorfo type can be presented, with great immunological instability, determining clinical characteristics, according to the pole to which most approaches. Leproatous dimorphic leprosy is characterized by brwn and violet macules, large number of lesions and less definition at its edges, variable sizes and alteration of sensitivity. Conjugal leprosy occurs in very few cases, knowing that intimate contaqct for a long time is an important factor, but has also demonstrated the fundamental role of immunity and genetics to acquire and develop the disease. We present two cases of lepromatous dimorphic leprosy in spouses, with 20 years of cohabitation, in which the same clinical presentation was found. Ths is an infrequent fact, given the low infectivity of the pathogen and the multiple varieties that could occur.

Leprosy and American cutaneous leishmaniasis coinfection

Abstract: Brazil is a country with a high prevalence of infectious diseases such as leprosy and leishmaniasis. However, coinfection of these diseases is still poorly understood. We report a case of a patient who presented with lepromatous leprosy and cutaneous-mucosal leishmaniasis at the same period. After clinical, laboratory, and histopathological diagnosis, the treatment was introduced and the patient showed important clinical improvement. He was followed in our outpatient clinic. Both pathologies play an important role in the immune system. Depending on the immune response profile of the host, diseases may present themselves in different ways. In this case, the patient showed a divergent immune response for each disease. We hypothesized that this response is specific for each pathogen.

Activation and cytokine profile of monocyte derived dendritic cells in leprosy: in vitro stimulation by sonicated Mycobacterium leprae induces decreased level of IL-12p70 in lepromatous leprosy

Dendritic cells (DCs) play a pivotal role in the connection of innate and adaptive immunity of hosts to mycobacterial infection. Studies on the interaction of monocyte-derived DCs (MO-DCs) using Mycobacterium leprae in leprosy patients are rare. The present study demonstrated that the differentiation of MOs to DCs was similar in all forms of leprosy compared to normal healthy individuals. In vitro stimulation of immature MO-DCs with sonicated M. leprae induced variable degrees of DC maturation as determined by the increased expression of HLA-DR, CD40, CD80 and CD86, but not CD83, in all studied groups. The production of different cytokines by the MO-DCs appeared similar in all of the studied groups under similar conditions. However, the production of interleukin (IL)-12p70 by MO-DCs from lepromatous (LL) leprosy patients after in vitro stimulation with M. lepraewas lower than tuberculoid leprosy patients and healthy individuals, even after CD40 ligation with CD40 ligand-transfected cells. The present cumulative findings suggest that the MO-DCs of LL patients are generally a weak producer of IL-12p70 despite the moderate activating properties ofM. leprae. These results may explain the poor M. leprae-specific cell-mediated immunity in the LL type of leprosy.

Reacciones por lepra en un centro de referencia nacional en Colombia / Leprosy reactions in a Colombian national reference centre

Introducción. Colombia es el país de América con mayor proporción de casos nuevos de lepra con discapacidad grave. Para disminuir tal discapacidad se requiere el control de las reacciones, principal causa del daño neural en esta enfermedad. Objetivo. Describir las características clínicas y epidemiológicas y el tratamiento de los pacientes con reacciones de tipo 1 y 2 que consultaron al Centro Dermatológico Federico Lleras Acosta. Materiales y métodos. Se trata de un estudio descriptivo que incluyó la población de pacientes con diagnóstico clínico de reacciones de tipo 1 y de tipo 2 por lepra, que acudieron al centro entre los años 2003 y 2009. Resultados. Se estudiaron 96 reacciones, 35 del tipo 1 y 61 del tipo 2. El 75 % de los pacientes provenía de los departamentos de Tolima, Cundinamarca, Santander y Boyacá. El 56 % de las reacciones de tipo 1 se presentaron antes de iniciar la poliquimioterapia para la lepra; el dermatólogo tratante consideró que las reacciones que se presentaron después de suspender la poliquimioterapia eran recaídas. El 94 % de las reacciones de tipo 1 se trataron con corticoides orales. El 97 % de los pacientes con reacciones de tipo 2 presentaron eritema nudoso, y todos se trataron con talidomida. Conclusiones.La clínica de la reacción de tipo 1 puede orientar al diagnóstico de la lepra en un paciente sin el antecedente de esta enfermedad (56 %). La reacción de tipo 1 que se inicia después de suspender la poliquimioterapia para la lepra, podría ser una manifestación de recaída de la enfermedad. La reacción de tipo 2 es más frecuente en hombres, con una relación hombre a mujer de 4:1. El 97 % de los pacientes con reacción de tipo 2 presentó eritema nudoso.

Introduction: Colombia is the country in America with the highest proportion of new cases leprosy with severe disability. To decrease such disability it is necessary to control these reactions, the main cause of nerve damage in leprosy. Objective: To describe the clinical and epidemiological characteristics and the treatment of patients with type 1 and 2 leprosy reactions who consulted the Centro Dermatológico Federico Lleras Acosta. Materials and methods: It is a descriptive study which included patients with clinical diagnoses of type 1 and 2 reactions who were seen in the center between 2003 and 2009. The town of origin of the patients, their age, clinical features and treatments were analysed. Results: We studied 96 reactions in 87 patients, 35 type 1 and 61 type 2 reactions; 75% of the patients came from the departments of Tolima, Cundinamarca, Santander and Boyacá; 77% of type 1 reaction occurred before the beginning of multidrug therapy for leprosy. The reactions that started after stopping the multidrug therapy were considered as a leprosy relapse. Conclusions: Correct identification of type 1 reaction by the general practitioner will allow the diagnosis of leprosy in a large percentage of patients. The type 1 reaction that begins after stopping the leprosy multidrug therapy may be a manifestation of a relapse of the disease.

Lepromatous leprosy patients produce antibodies that recognise non-bilayer lipid arrangements containing mycolic acids

Non-bilayer phospholipid arrangements are three-dimensional structures that form when anionic phospholipids with an intermediate structure of the tubular hexagonal phase II are present in a bilayer of lipids. Antibodies that recognise these arrangements have been described in patients with antiphospholipid syndrome and/or systemic lupus erythematosus and in those with preeclampsia; these antibodies have also been documented in an experimental murine model of lupus, in which they are associated with immunopathology. Here, we demonstrate the presence of antibodies against non-bilayer phospholipid arrangements containing mycolic acids in the sera of lepromatous leprosy (LL) patients, but not those of healthy volunteers. The presence of antibodies that recognise these non-bilayer lipid arrangements may contribute to the hypergammaglobulinaemia observed in LL patients. We also found IgM and IgG anti-cardiolipin antibodies in 77% of the patients. This positive correlation between the anti-mycolic-non-bilayer arrangements and anti-cardiolipin antibodies suggests that both types of antibodies are produced by a common mechanism, as was demonstrated in the experimental murine model of lupus, in which there was a correlation between the anti-non-bilayer phospholipid arrangements and anti-cardiolipin antibodies. Antibodies to non-bilayer lipid arrangements may represent a previously unrecognised pathogenic mechanism in LL and the detection of these antibodies may be a tool for the early diagnosis of LL patients.

Deciphering the contribution of lipid droplets in leprosy: multifunctional organelles with roles in Mycobacterium leprae pathogenesis

Leprosy is an infectious disease caused by Mycobacterium leprae that affects the skin and nerves, presenting a singular clinical picture. Across the leprosy spectrum, lepromatous leprosy (LL) exhibits a classical hallmark: the presence of a collection of M. leprae-infected foamy macrophages/Schwann cells characterised by their high lipid content. The significance of this foamy aspect in mycobacterial infections has garnered renewed attention in leprosy due to the recent observation that the foamy aspect represents cells enriched in lipid droplets (LD) (also known as lipid bodies). Here, we discuss the contemporary view of LD as highly regulated organelles with key functions in M. leprae persistence in the LL end of the spectrum. The modern methods of studying this ancient disease have contributed to recent findings that describe M. leprae-triggered LD biogenesis and recruitment as effective mycobacterial intracellular strategies for acquiring lipids, sheltering and/or dampening the immune response and favouring bacterial survival, likely representing a fundamental aspect of M. leprae pathogenesis. The multifaceted functions attributed to the LD in leprosy may contribute to the development of new strategies for adjunctive anti-leprosy therapies.

La lepra y el testículo / Leprosy and the testis

Introducción. La afección testicular es frecuente en la lepra lepromatosa, daño que se incrementa cuando cursa con eritema nudoso leproso. Objetivo. Presentar un paciente con lepra lepromatosa y eritema nudoso leproso con grave compromiso testicular. Materiales y métodos. Se estudió un hombre de 28 años con lepra lepromatosa desde los 22, que durante la poliquimioterapia para la lepra presentó eritema nudoso leproso crónico que afectó ambos testículos y no respondió al manejo convencional. El dolor persistente obligó a practicar orquidectomía izquierda. Resultados. Este testículo presentaba atrofia tubular y fibrosis notorias, conglomerados de macrófagos espumosos, sin bacilos, hiperplasia focal de células de Leydig, endarteritis y arteritis linfocitaria y granulomatosa de vasos pequeños y medianos; estos cambios también estaban presentes en el epidídimo. Un estudio llevado a cabo dos años después de terminar su tratamiento y de la orquidectomía izquierda, demostró azoospermia, testosterona total normal, testosterona libre discretamente disminuida y hormonas lutropina (luteinizante) y folitropina (estimulante del folículo) elevadas. No había disminución de la libido ni de su actividad sexual. Se revisaron los conceptos generales sobre el eritema nudoso leproso y las alteraciones que la lepra produce en el testículo. Conclusión. La lepra lepromatosa puede conducir a hipogonadismo. Los programas de lepra deben contemplar esta complicación para corregir y evitar sus secuelas.

Introduction. Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. Material and methods. The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. Results. The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. Conclusion. Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.

Colonization by Helicobacter pylori of leprosy patients in Spain: immunomodulation to low molecular weight antigens of H. pylori

We studied the prevalence of Helicobacter pylori in patients with leprosy and the effects of co-infection on the immune response to Helicobacter antigens in the polar groups of leprosy (lepromatous and tuberculoid). We showed that there is no difference in the prevalence of H. pylori in patients with leprosy as compared to a non-leprosy population. We also demonstrated that the immune response to low molecular weight H. pylori antigens (35, 26 and 19 kDa) differs in patients with lepromatous as compared to those with tuberculoid leprosy. In lepromatous leprosy, we show that there is a higher prevalence of the 35 and 26 kDa antigens, but a lower prevalence of the 19 kDa antigen. These immunological results are consistent with previous histopathological studies illustrating a more severe gastrointestinal inflammation in lepromatous patients; importantly, a response to the 35 kDa antigen is recognized as a marker for the development of ulcerative disease.

Alelos HLA-DRB1 en pacientes infectados con patógenos intracelulares en Rosario, Santa Fe / HLA-DRB1 alleles in patients infected with intracellular pathogens in Rosario, Santa Fe

En el desarrollo de la respuesta inmune a patógenos intracelulares participa el elevado polimorfismo de las moléculas HLA de clase II. El objetivo de este trabajo fue establecer la participación de los alelos HLA-DRB1 en personas con infección con Trypanosoma cruzi (T. cruzi) o con Mycobacterium leprae (M. leprae). Se estudiaron 252 individuos de la ciudad de Rosario, divididos en: 86 personas seropositivas para T cruzi (sin compromiso cardiológico de relevancia), 85 pacientes con diagnóstico de Lepra y 81 individuos controles, sin evidencia de patologías. El ADN genómico fue extraído de sangre periférica utilizando el método de salting out y empleado como templado para amplificar por PCR el segundo exón polimórfico de HLA-DRB1. Los alelos fueron tipificados mediante la técnica de PCR­-SSOP. La comparación de frecuencias mostró prevalencia de los alelos DRB1 *0409 y DRB1 *1503 en los individuos seropositivos para T. cruzi con respecto al grupo control. Por otra parte, el análisis estadístico indicó una disminución significativa del alelo DRB1 *1103 en pacientes con esta tripanosomiasis. Al examinar las frecuencias observamos en el grupo de pacientes con Lepra un aumento significativo de los alelos DRB1 *1401 y DRB1 *1406. Además observamos que las proporciones de los alelos DRB1 *0808 y DRB1 *1103 en los enfermos son significativamente inferiores con respecto al grupo control. Los alelos HLA DRB1 podrían actuar solos o en combinación con otros genes para conferir susceptibilidad o resistencia a estas infecciones en la población de Rosario, Argentina.

In the development of the immune response to intracellular pathogens implicated the high polymorphism of HLA class II molecules. The aim of this study was to establish the involvement of the HLA-DRB1 alleles in infected subjects with T. cruzi or leprosy patients in Rosario, Argentina. We studied 252 individuals who divided into: 86 positive people for T. cruzi without cardiac damage, 85 patients diagnosed with leprosy and controls 81 individuals without evidence of disease. Genomic DNA was extracted from peripheral blood using the standard salting out method and used as a template to amplify by the PCR the polymorphic second exon of the HLA­-DRB1. PCR products were hybridized separately with sequence-specifics oligonucleotides (SSOP). Statistical analysis indicated that of increased frequencies of DRB1 *0409, and DRB1 *1503 in individuals with Chagas' disease. DRB1 *1103 allele was prevalence in the group control and could be associated with resistance to the presence of trypanosomiasis. DRB1 *1401 and DRB1 *1406 alleles were significantly more prevalent in leprosy patients, whereas a decreased frequency of DRB1 *0808 and DRB1 *1103 alleles was found, by comparison with the group control. The HLA-DRB1 alleles could act alone or in combination with other genes to confer differential susceptibility and also protection to these diseases in Rosario, Argentina.

Desafios na era pós genômica para o desenvolvimento de testes laboratoriais para o diagnóstico da hanseníase / Challenges in the post genomic era for the development of tests for leprosy diagnosis

O diagnóstico da hanseníase se baseia em manifestações clínicas e não existe teste laboratorial para diagnosticar casos assintomáticos ou para prever progressão da doença entre indivíduos expostos. Novas análises genômicas comparativas in silico e ferramentas de biologia molecular têm sido empregadas para revelar proteínas exclusivas do Mycobacterium leprae que apresentem potencial aplicação diagnóstica. A hanseníase tuberculóide paucibacilar (PB) apresenta baixo nível de anticorpos e forte resposta imune celular (RIC) tipo Th1/interferon gamma (IFN-γ). A doença lepromatosa multibacilar (MB) apresenta sorologia positiva e fraca RIC. Portanto, testes laboratoriais para diagnosticar hanseníase PB e MB devem contemplar testes de RIC e sorologia. Proteínas recombinantes do Mycobacterium leprae sorologicamente reativas podem ser incorporadas ao antígeno PGLI para melhorar o diagnóstico sorológico de pacientes MB. Proteínas recombinantes e peptídeos sintéticos do Mycobacterium leprae têm sido testados em ensaios de RIC/IFN-γ para diagnosticar casos PB. Sorologia anti-PGLI modificada incorporando novos antígenos do Mycobacterium leprae e ensaios baseados na RIC/produção de IFN-γ devem permitir a detecção precoce de casos MB e PB em países endêmicos.

Leprosy diagnosis is based mainly on clinical manifestations and no laboratory test is available to diagnose asymptomatic disease or to predict disease progression among exposed individuals. Novel comparative genomic in silico analyses and molecular biology tools have discovered unique Mycobacterium leprae proteins with potential diagnostic application. Tuberculoid paucibacillary leprosy (PB) shows low antibodies titers and strong Th1 type/ IFN-γ specific cell mediated immunity (CMI), while lepromatous multibacillary patients (MB) show high antibody titers and low CMI. Therefore, laboratory tests for PB and MB leprosy diagnosis will require CMI and antibody based assays. Serologically reactive recombinant Mycobacterium leprae proteins were identified and may be used in conjunction with PGL-I to improve MB patient diagnosis. Mycobacterium leprae recombinant proteins and synthetic peptides have been tested for CMI-interferon gamma based assays for PB diagnosis. Modified PGL-I serology incorporating new Mycobacterium leprae antigens and CMI tests based on IFN-γ γ production may permit the detection of leprosy PB and MB forms in endemic countries.

Cytokine measurement in lymphocyte culture supernatant of inactive lepromatous leprosy patients.

The aim of the present study was to determine the effects of stimulation of sonicated Mycobacterium leprae (MLS) extract and phorbol myristate acetate (PMA) on the pattern of cytokine production in peripheral blood mononuclear cells (PBMC) and to find out whether there is any difference between stimulation of MLS extract and PMA. Blood samples were collected and PBMC isolated from 43 inactive lepromatous leprosy patients. After culture for 24 hours, lymphocytes were stimulated with MLS extract and PMA. In the culture supernatant, IL-2, 4, 6, 8, TNF-alpha and TGF-beta levels were measured by using ELISA. M. leprae stimulated group IL-6, IL-8, TNF-alpha, TGF-beta levels were found significantly higher than PMA stimulated group (P < 0.05). However, there was no difference between the two groups for IL-4. Only IL-2 levels were higher in PMA stimulated group than M. leprae stimulated group. Sonicated M. leprae extract have a strong effect on cytokine levels in vitro. Our results suggest that antigens with varying specificities favour the production of distinct cytokine patterns following in vitro restimulation.

Perfil clinico-epidemiológico dos casos de hanseníase atentidos no Hospital Universitário em Campo Grande, Mato Grosso do Sul, de janeiro de 1994 a julho de 2005 / Clinical-epidemiological profile of leprosy patients assisted at the University Hospital of Mato Grosso do Sul Federal University, Campo Grande, MS, from January 1994 to July2005

Estudo descritivo, realizado a partir da coleta de dados de 192 fichas de notificação e controle da hanseníase, do total de pacientes atendidos no período de janeiro de 1994 a julho de 2005, no Ambulatório do Hospital Universitário da Universidade Federal de Mato Grosso do Sul, com o objetivo de traçar o perfil epidemiológico da hanseníase no grupo de pacientes estudados e gerar subsídios à política de controle da hanseníase. As variáveis estudadas constam da ficha de notificação e controle da hanseníase. Observou-se a predominância de casos no sexo masculino (62,5%); na faixa etária de 40 a 59 anos (45,8%); multibacilares (67,2%); da forma clinica dimorfa (35,9%) e virchowiana (27,6%). Setenta e três (73%) por cento dos casos foram avaliados em relação à incapacidade ao inicio do tratamento, encontrando-se 66,7% desses casos sem nenhum problema com as mãos, pés ou olhos e 33,3% com incapacidade ou deformidade ao início do tratamento.

Reaçao tipo 2 (Eritema Polimorfo Hansenico) como primeira manifestaçao clinica de hanseniase na faixa virchoviana / Type 2 reaction (multiforme erythema-like) as the clinical manifestation of leprosy in the lepromatous range

Um individuo de 51 anos de idade iniciou quadro infeccioso com linfonodomegalia inguinal seguida de febre. Foi tratado com antibioticos da familia das penicilinas e desenvolveu lesoes cutaneas em placa tipo eritema polimorfo, cuja biopsia demonstrou hanseniase na faixa virchoviana ativa e reaçao tipo 2. Nao havia dados epidemiologicos ou lesoes cutaneas sugestivas de hanseniase, ou sinais e sintomas de comprometimento neural. O caso mostrou duas peculiaridade, ou seja, reaçao tipo 2 como primeira manifestaçao de hanseniase (previa a poliquimeoterapia) e sob a forma de eritema polimorfo hansenico. Os autores discutem a patogeneses destas manifestaçoes, e lembram que, em regioes endemicas, a hanseniase deve se considerada frente a manifestaçoes tipo eritema polimorfo.

Avaliação de série de casos de eritema nodoso hansênico: perfil clínico, base imunológica e tratamento instituído nos serviços de saúde / Erythema nodosum leprosum case series report: clinical profile, immunological basis and treatment implemented in health services

O eritema nodoso hansênico é evento inflamatório agudo no curso crônico da hanseníase. É considerado evento de base imunológica e importante causa de morbidade e incapacidade física. Avaliou-se o perfil clínico, sorológico e histopatológico de 58 pacientes com eritema nodoso hansênico recrutados sequencialmente entre julho-dezembro de 2000, em área urbana hiperendêmica do Brasil Central (Estado de Goiás). A metade dos pacientes apresentava quadro reacional grave, e em 66 por cento dos casos o primeiro episódio reacional ocorreu durante tratamento específico. A maioria dos casos com eritema nodoso hansênico e dos controles apresentaram reatividade para IgM anti-PGL I. Os achados histopatológicos mais freqüentes no eritema nodoso hansênico foram infiltrado neutrofílico, paniculite, vasculite e agressão neural. Dos pacientes com eritema nodoso hansênico, 96 por cento usaram corticosteróide sistêmico no primeiro episódio. Os casos de eritema nodoso hansênico estavam associados à neurite e raramente usaram talidomida como medicação isolada nos serviços de saúde.

Quantificacao do estresse oxidativo no sangue de hansenianos sob o efeito ou nao de tratamento especifico / Quantification of the oxidative stress in the blood of people with Hansen's disease undertaking or not a specific treatment

Neste estudo avaliamos a quantificaçäo do estresse oxidativo no sangue de hasenianos sob efeito ou näo de tratamento específico. Foram coletadas amostras de sangue de 62 portadores de hanseníase e 13 sadios. Destes 62 pacientes, 35 eram de forma multibacilar e faziam tratamento com clofazimina, dapsona e rifampicina; 16 de forma paucibacilar tratados com dapsona e rifampicina; 11 dos pacientes estavam sem tratamento, sendo 5 da forma multibacilar e 6 da forma paucibacilar. As amostras foram levadas para análises laboratoriais onde foram feitas as dosagens de metahemoglobina e contagem de corpos de Heinz. Os resultados encontrados foram submetidos à análise estatística com cálculo da Odds Ratio e Intervalo de Confiança 95 por cento. Concluimos que a doença haseníase näo foi a causadora do estresse oxidativo, e sim a terapêutica administrada, e o grupo que fazia uso da clofazimina apresentou piores resultados, ou seja, maior estresse oxidativo.

Cutaneous delayed-type hypersensitivity responsiveness in lepromatous and borderline lepromatous leprosy patients as determined by MULTITEST CMI.

To assess cell mediated immune (CMI) function in patients with lepromatous and borderline lepromatous leprosy (LL and BL), 35 patients were examined with the MULTITEST CMI system to evaluate cutaneous delayed-type hypersensitivity (DTH) responsiveness to 7 recall antigens. Reactions were assessed quantitatively and qualitatively. In addition, patients were classified as "responsive" (> or = 2 positive reactions), "hypo-responsive" (1 positive reaction), or anergic. Only hyporesponsive and anergic patients were re-tested. In 23 patients tested before treatment started (Group 1), 9 were responsive, 4 hypo-responsive, and 10 anergic. Upon re-testing, 10 of the 14 hyporesponsive-anergic subjects showed improvement. In 12 patients assessed after therapy initiation (Group 2), 9 were responsive and 3 others became responsive upon re-testing. Quantitative assessment indicated variable deficiencies in cutaneous DTH reactivity that, in many cases, improved with therapy. Correlations between reactivity and disease severity (LL versus BL) or duration of disease were not observed. The MULTITEST CMI system provided a convenient, safe, and reproducible method to assess cutaneous DTH responsiveness in LL and BL patients. Our findings indicated that most LL and BL patients are able to generate detectable but generally fewer and less robust cutaneous DTH responses to recall antigens, many improving with therapy. However, a semi-quantitative classification whereby patients that reacted to 2 or more antigens were considered "responsive" showed little difference between patients and controls. Overall, the data support the contention that deficits in cutaneous DTH responsiveness probably neither predispose nor necessarily accompany lepromatous disease, a practical consideration as efforts to develop a leprosy vaccine continue.

Detection of S-100 antigen and anti ceramide antibody in sera of leprosy patients with and without reaction.

Levels of anticeramide antibodies and S-100 antigen in leprosy patients with and without reaction are compared in this study. The increase in levels of IgM anti ceramide antibody in the tuberculoid group of patients with reaction, when compared to those without reaction, is significant (P < 0.05). Similarly, significant increase (P < 0.01) was observed in the borderline group with reaction. No significant change in anti ceramide antibody level was observed in the lepromatous group of patients with and without reaction. Mean levels of S-100 were slightly lower in all three groups of patients with reaction, but the differences were not statistically significant.

Cellularity of macrophage granuloma and morphological index.

In the present study, morphological index (MI) and average macrophage count per microscopic field in skin sections of 94 lepromatous (LL) patients is correlated. The subjects included 14 cases with some histoid features. The MI in the lepromatous cases varied from less than one to 40 and the corresponding macrophage counts ranged from 40 to 156. In cases with histoid changes the MI varied from 30 to 60 and the cell count ranged from 215 to 360. The histoid cases showed a higher MI and cell count compared to the other lepromatous cases. There was a positive correlation between MI and macrophage count and the hypercellular state appears to depend on living and multiplying bacteria.