Microbial colonizers in leprosy skin ulcers and intensity of inflammation

The microflora of 55 patients with leprosy skin ulcers was studied and related to a weighted inflammatory score (IS). The control group consisted of 18 ulcers with different underlying pathology. Leprosy ulcers were characterized by the exclusive presence of two types of branching gram-positive rods; a particular interesting proposal is that Mycobacterium leprae share common antigens with these unusual [quot ]leprosy ulcer associated[quot ] organisms and group G beta-hemolytic streptococci. In the leprosy group, corynebacteria and branching rods accounted for 97% of gram-positive bacilli and Bacillus species constituted only 3%. In the control group, B. species formed 50% of gram-positive rods; the rest were corynebacteria (p = 0.03). In the leprosy group, one third of the gram-positive bacteria were branching rods; none of them was acid fast. Ten of them were identified as Arcanobacterium haemolyticum, and the remaining 7 could not be identified. The IS of leprosy patients was lower than in the control group. The presence of more than two species of facultative or aerobic gram-negative rods or single species of pyogenic gram-positive cocci correlated with a high IS. The presence of two or more different pyogenic cocci resulted in a lower IS. Further studies into the nature of leprosyunique organisms as well as the inflammation inhibition factors in mixed infections are warranted. It is recommended that management of ulcers should consist of the application of local disinfection and early treatment of episodes of inflammation with a combination of fluoroquinolone and penicillin.

Clinical and Histological Discre pancies in Diagnosis of ENL Reactions Classified by Assessment of Acute Phase Proteins SAA and CRP

Resumo: Sixteen out of 45 (36%) leprosy patients with clinical features of acute erythema nodosum leprosum (ENL) did not show the characteristic presence of neutrophils (polymorphs) in histology of the ENL lesion. The acute-phase reactants, serum amyloid A (SAA) and C-reactive protein (CRP) which are systemic markers of inflammation, and IgM and IgG antibody to Mycobacterium leprae were determined in these patients in order to understand the differences in histological diagnosis. Both SAA and CRP were elevated in ENL patients, irrespective of the presence of polymorph infiltrates, as compared to nonreactional lepromatous patients, patients with histologically confirmed reversal reactions and endemic controls, indicating that all clinically diagnosed ENL patients had ongoing inflammatory reactions. On the other hand, IgM and IgG antibodies were significantly lower (> 70%) in ENL patients as compared to nonreactional lepromatous patients. When the two ENL groups [ENL-PMN+ve (positive for neutrophils) and ENL-PMN-ve (negative for neutrophils)] were compared, there were no significant differences in the mean SAA, IgM or IgG antibody concentrations, but CRP was eightfold lower in ENL-PMN-ve as compared to the ENL-PMN+ve group. This may indicate that the timing or modulation of the reaction was different in the two ENL groups. Thus, measurement of the acute-phase response and the ratio of SAA/CRP in particular are helpful in the clinical diagnosis of ENL reactions in leprosy

Is there an acute-phase response in steady-state sickle cell disease?

Metabolic and serum changes during steady-state homozygous sicle cell (SS) disease are consistent with an acute-phase response and raise the possibility that inflammation occurs in SS disease even during the steady state. To test this hypothesis, we measured concentrations of acute phase reactants in patients with SS disease, in patients with sickle cell haemoglobin C (SC) disease, and in normal (AA) control subjects. The concentrations of C-reactive protein and serum amyloid A were increased above 10 mg/L and 5mg/L, respectively (our definition of an acute-phase response) in 18 percent (26/143) of subjects with SS disease even when they were symptom free, in 17 percent (6/35) of subjects with SC disease, and in 1 percent (1/80) of AA controls (p<0.001). We suggest that subclinical vaso-occlusion may generate a covert inflammatory response and that the cytokine mediators of this response may contribute to the metabolic abnormalities and growth failure in sickle cell disease.(AU)

Acute-phase protein response is impaired in severely malnourished children

The reponse of plasma levels of C-reactive protein and serum amyloid A were assessed in two groups of malnourished children. Sixty-six severely malnourished children were studied at admission. Fifty of these had clinical and/or laboratory evidence of infection. C-reactive protein was not elevated in 23 (46 percent) and serum amyloid A was not raised in 29 (58 percent) of these 50 children. Surviving children(n=62) received two doses of diphtheria-pertussis-tetanus vaccine, to which the C-reactive protein and serum amyloid A responses were measured. The first was given early in recovery, the second after nutritional rehabilitation. Ten mildly malnourished children acted as controls, receiving a single dose of diphtheria-pertussis-tetanus vaccine. The responses of both C-reactive protein and serum amyloid A to diphtheria-pertussis-tetanus vaccine were significantly less in early recovery than after nutritional recovery. The response of the midly malnourished group was no different from that of the severely malnourished group in early recovery, but was less than their response on discharge. The acute-phase protein response of malnourished children is impaired. This may have prognostic implications as the reponse plays a central role in promoting healing. (Summary)

The acute phase response in severely malnourished children - abstract

The acute phase response is a non-specific reaction to tissue injury, in which the liver plays a central role. We examined the acute phase response in 52 severely malnourished children by measuring the serum levels of C-Reactive Protein (CRP) and Serum Amyloid A (SAA), using an ELISA technique. Blood was taken both at admission and following a controlled stress, namely, Triple (DPT) Vaccine. Four children died. The surviving children received DPT either at admission (n=16) or early in recovery (time B) (n=32). All the children received a second vaccination with DPT once they had regained > 90 percent weight-for-height (discharge) (n=48). Both acute phase proteins responded in tandem. The admission values were elevated in only 44 percent of the children for CRP and 20 percent for SAA, despite clinical evidence of infection. The magnitude of the response of both acute phase proteins to DPT given at admission or at time B was significantly less than at discharge (p < 0.05). Even at discharge, approximately 20 percent of the children did not have the expected response. Children with oedematous malnutrition were less likely to respond than non-oedematous children. We suggest that, firstly, severly malnourished children are unable to mount an effective acute phase response, which may have functional implications. Secondly, that the inability to synthesize acute phase proteins represents one manifestation of the hepatic dysfunction that occurs in severe malnutrition (AU)

Febrile response in malnutrition

The febrile response to a standard dose of triple (DPT) vaccine was assessed in sixteen malnourished children before and after recovery. Increase in temperature was significantly lower in the malnourished children (p<0.005) (AU)