ABSTRACT
PURPOSE: Cortisol levels in the circulation and at the sites of peripheral inflammation regulate type 1 (Reversal) reactions in leprosy akin to delayed type hypersensitivity reactions (DTH). In this study we determine the extent to which the differential mRNA expression of genes encoding cortisone-cortisol shuttle enzymes (11 ß hydroxysteriod dehydrogenase I & II (11 ß HSD I & II)), circulatory levels of proinflammatory cytokines (IL-6, IL-7, IP-10, IL-17F, IL-23, TNF-α, IL-1ß, PDGF BB and CRP) and cortisol are associated with development of type 1 reactions in leprosy. METHODS: Urine, blood and incisional skin biopsy samples from site of lesions were collected from 49 newly diagnosed untreated leprosy cases in T1R and 51 cases not in reaction (NR). mRNA expression levels of genes encoding 11 ß HSD I & II in skin biopsy samples were determined by realtime PCR. Cortisol levels from the lesional skin biopsies, serum and urine samples and serum proinflammatory cytokine levels were measured using ELISA. RESULTS: The mean expression ratios of 11 ß HSD I & II are significantly lower in leprosy cases with T1R when compared to the NR leprosy cases. Cortisol levels in lesional skin biopsies and in urine are significantly lower (p=0.001) in leprosy cases with T1R. Serum cytokine levels of IP-10, IL-17F, IL-IL-6 and TNF-α are significantly higher (p<0.05) in leprosy cases with T1R when compared the NR leprosy cases. CONCLUSION: Our study indicated an association of urinary and lesional skin cortisol levels with the manifestation of T1R in leprosy. IP-10, IL-17F, IL-6 and TNF-α can be potential prognostic serological markers and gene expression markers for early detection of type 1 reactions in leprosy.
Subject(s)
Cytokines/immunology , Hydrocortisone/immunology , Inflammation Mediators/immunology , Leprosy/immunology , 11-beta-Hydroxysteroid Dehydrogenase Type 1/genetics , 11-beta-Hydroxysteroid Dehydrogenase Type 1/immunology , 11-beta-Hydroxysteroid Dehydrogenase Type 1/metabolism , 11-beta-Hydroxysteroid Dehydrogenase Type 2/genetics , 11-beta-Hydroxysteroid Dehydrogenase Type 2/immunology , 11-beta-Hydroxysteroid Dehydrogenase Type 2/metabolism , 11-beta-Hydroxysteroid Dehydrogenases , Adolescent , Adult , Chemokine CXCL10/blood , Cytokines/blood , Enzyme-Linked Immunosorbent Assay , Female , Gene Expression/immunology , Humans , Hydrocortisone/blood , Hydrocortisone/urine , Hypersensitivity, Immediate/blood , Hypersensitivity, Immediate/immunology , Hypersensitivity, Immediate/urine , Inflammation Mediators/blood , Interleukin-17/blood , Interleukin-6/blood , Leprosy/blood , Leprosy/urine , Male , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction , Skin/immunology , Skin/metabolism , Skin/pathology , Tumor Necrosis Factor-alpha/blood , Young AdultABSTRACT
Monitoring childhood leprosy in terms of incidence and occurrence of deformities are crucial for better control and understanding the transmission of the disease. In this paper, a profile of all new untreated leprosy patients below 15 years of age who reported at a Leprosy Referral Centre in West Bengal during 2004-2006 are described. Of 151 children studied, 84 (55.6%) were males, 33% were multibacillary and of them, 30% were smear positive. 16% had already developed grade 2 disability (WHO). Multiple nerve involvement was seen in a quarter of children. These findings highlight the seriousness of leprosy among children and the great need to address these issues urgently. Awareness, active case detection especially among contacts and motivation are the essential needs of the hour to prevent tragedy of deformed children due to a totally manageable disease.
