Alpha-1-antitrypsin in leprosy.

Estimation of Alpha-1-antitrypsin (AAT) levels was carried out in 52 patients of various types of leprosy. Fifty age and sex matched healthy individuals served as controls. The mean level of AAT in controls was 290.12 +/- 59.56 mg/dl. In patients of tuberculoid leprosy (TT), borderline tuberculoid leprosy (BT) and borderline leprosy (BB), the AAT levels were found to be 284 +/- 47.03, 314.37 +/- 31.56 and 324.44 +/- 32.05 mg/dl respectively. These were statistically insignificantly raised when compared with controls. In borderline lepromatous leprosy (BL), lepromatous leprosy without erythema nodosum leprosum (LL without ENL) and in LL with ENL there was a statistically significant rise in AAT levels. The maximum levels of AAT were observed in patients of LL with ENL (mean 500.8 +/- 93.44 mg/dl. P less than 0.001).

Cardiac dysautonomia in lepromatous leprosy.

Cardiovascular autonomic functions were studied in 32 patients of lepromatous leprosy, including 12 patients of lepra reaction. Fifty age and sex matched healthy subjects served as controls. Variable degree of autonomic dysfunction was observed in the study group. The derangement of autonomic functions in patients of leprosy can be explained on the basis of neurotrophic action of lepra bacilli that infiltrate the sympathetic and the parasympathetic fibres.

Regional lymph node involvement in tuberculoid leprosy.

A study of regional lymph nodes in 44 cases of proved tuberculoid leprosy (BT & TT) is presented. Out of 26 cases of tuberculoid polar (TT) leprosy, 76.92% showed presence of paracortical lymphocytes, 61.52% showed presence of granuloma and 11.54% showed presence of acid fast bacilli in lymph nodes. In the borderline tuberculoid (BT) group, 61.1% showed granuloma, 72.22% showed presence of paracortical infiltration by lymphocytes and 11.11% showed presence of A.F.B. in lymph nodes. Lesions of tuberculoid leprosy have been conclusively demonstrated in the low resistant tuberculoid (BT) leprosy and polar tuberculoid leprosy (TT). The presence of paracortical lymphocytes in large numbers in the lymph nodes could indicate high cell mediated immunity (CMI) and possibly a tuberculoid end of the spectrum. The skin lesions and lymph nodes had comparative histopathology.

A study of systolic time intervals in lepra reaction.

Systolic time intervals (STI) were measured in 20 control subjects and 20 cases of lepromatous leprosy in lepra reaction. Significant differences in the pre-ejection period (PEP), PEP/LVET and isovolumic contraction (IVCT) were observed between the groups. The abnormalities of STI observed in patients of lepra reaction are characteristic of left ventricular dysfunction in patients of lepra reaction.

Bacillaemia in lepra reaction: its correlation with liver pathology.

Thirty patients of lepromatous leprosy in a state of reaction (ENL) were studied for bacillaemia and a correlation was made with liver pathology. Buffy coat smears were examined in all, eliminating as far as possible the chances of contamination of blood by the skin bacilli. Thirteen out of thirty patients showed presence of acid fast bacilli (AFB) in the buffy coat smear. Hepatic involvement in the form of leprous granuloma was observed in all, of which 93.3% showed presence of AFB. It is concluded that during reaction the possibility of heightened bacillaemia is less likely and that the systemic spread of infection is not accentuated during the bouts of reaction.

Study of alpha one antitrypsin activity in lepra reaction.

In our earlier study (Yemul et, al, 1983) we have reported elevation of serum alpha one antitrypsin levels in patients of lepromatous leprosy and lepra reaction. In this study estimation of serum alpha one antitrypsin levels in fifty lepra reaction patients (8 of type 1 and 42 of type II) and fifty age and sex matched healthy controls is described. Alpha one antitrypsin levels were elevated in lepra reaction patients (type I--mean value of 332 mg% and S.D. +/- 118.8 and type II--mean value of 450 mg% and S.D. +/- 73.7) when compared with the healthy controls (mean value of 285 mg% and S.D. +/- 66.05). The increase in levels in type II lepra reaction patients was statistically significant. The results are discussed to correlate the increased levels of alpha one antitrypsin and the high bacterial load leading to the release of various proteases in type II lepra reaction.

Electrocardiographic changes in lepra reaction.

The electrocardiographic (E.C.G.) changes were evaluated in 54 patients of lepra reaction. Abnormalities of the E.C.G. observed were in the form of prolongation of QTc in 24 (44.44%), ST-T changes in a (16.66%), bundle branch block and ventricular extrasystoles in 2 each (3.70%). The mean QTc interval in 64 normal adults was 0.41 second (S.D. +/- 0.03, range 0.36 to 0.44 second). It was 0.44 second (S.D. +/- 0.05, range 0.38 to 0.52 second) in patients of lepra reaction. The difference in the QTc values in the two groups was statistically significant (P less than 0.01). The E.C.G. abnormalities in patients of lepra reaction appears to be due to myocardial involvement.