Renal involvement in leprosy.

Renal involvement was studied in 70 patients with leprosy by urine analysis, detailed biochemical investigations and renal histopathology. Of these 70 patients, 40 had lepromatous and 30 had non-lepromatous leprosy. Creatinine clearance was reduced in 20 patients. Renal biopsies were studied in 50 cases (25 lepromatous, 25 non-lepromatous); of which in 13 cases (10 lepromatous, 3 non-lepromatous) abnormal histopathological lesions were found by light microscopy. Amyloidosis was seen in only one lepromatous patient. No acid-fast bacilli and leproma like lesion were demonstrated in any case.

Uptake of purine and pyrimidine nucleosides by macrophage-resident Mycobacterium leprae: 3H-adenosine as an indicator of viability and antimicrobial activity.

Freshly extracted human- and armadillo-derived Mycobacterium leprae maintained within murine macrophages incorporated significant levels (p less than 0.05 to p less than 0.001) of 3H-adenosine and 3H-hypoxanthine by 6 and 9 days of the culture period. The incorporation of 3H-adenosine was twofold or more higher than 3H-thymidine in 10 out of 15 human-derived M. leprae isolates. Macrophage-adapted bacilli incorporated 10-14-fold higher levels of 3H-adenosine compared to the same bacilli maintained in axenic cultures. The incorporation of these two labels was inhibited by dapsone and rifampin, indicating the utility of in vitro radiometric assays for screening antileprosy drugs and drug sensitivity/resistance in patients.

A study of relapse in paucibacillary leprosy in a multidrug therapy project, Baroda District, India.

In order to judge the value of therapeutic regimens in paucibacillary leprosy, knowledge of incubation time of relapses is essential, as this will define the length of time patients have to be followed up after treatment has been stopped. The prospective study of relapse includes paucibacillary cases of leprosy belonging to a non-lepromatous group consisting of tuberculoid, neuritic and indeterminate. Data are presented on the incubation time of 21 relapses after multidrug therapy in Baroda district; 76.19% of relapses occur during the first 2 years. This figure is most important in the analysis of results of drug trials in paucibacillary leprosy. This figure should also be relevant to regimens including drugs that are more bacteriocidal than dapsone, since the bacteriocidal activity has a bearing on the minimal necessary duration of treatment, but not on the incubation time of relapses. With the introduction of bactericidal drugs e.g. rifampicin in multidrug therapy, the incidence of relapse are very low, hence relapse rates fall down to a very low level after multidrug therapy. Our study shows a mean relapse rate of 0.19% after multidrug therapy. Factors associated with the occurrence of relapse are discussed.

Impact of multidrug therapy on leprosy in Baroda district (Gujarat).

Though much information is available on MDT organising, it poses a challenge to the field staff due to limited field trials conducted and varied field conditions. The MDT project was begun on 11th June, 1984 in Baroda by the Govt. of India, with active assistance of State Government, the World Health Organisation and the Swedish International Development Agency. The Drug combinations for MB cases were Rifampicin 600 mg, Clofazamine 300 mg and dapsone 100 mg daily for 14 days intensive supervised therapy followed by once a month (Pulse) supervised dose of Rifampicin 100 mg, Clof. 300 mg and dapsone 100 mg for minimum period of 2 years or more if indicated and Clof 50 mg daily with dapsone 100 mg daily unsupervised for minimum period of 2 years or more if indicated, for PB cases, dapsone 100 mg daily for 6 months along with Rifampicin 600 mg supervised (Pulse) once a month for minimum period of 6 months or more if indicated. Total number of active cases at commencement of MDT was 10706, out of these 10348 (96.37%) brought under MDT till Dec. 1987. Amongst 10348, old active cases 9112 (88.05%) are cured with MDT, (3110 MB + 6002 PB) 180 old MB cases BI is still positive inspite of completed 24 pulse. The rest 1056 (10.23%) stopped the treatment for various reasons. 790 (74.81%) cases have left the villages to earn their livelihood, 30 (2.86%) were being treated by skin specialist, 86 (7.19%) refuse to continue the treatment inspite of best efforts of field staff. New cases detected since June 1984 till Dec. 1987 are 7628, out of which 7549 (96.28%) brought under treatment. Now cases cured till Dec. 1987 are 4640 (1120 MB + 3520 PB) 17 cases relapsed after MDT (15 PB + 2 MB). 280 (1.56%) cases got complications, 250 developed reactions, 3 cases Jaundice, 15 cases Gastritis and rest 12 got moderate to severe anaemia. The prevalence rate came down from 5.81 to 1.01% per thousand population till Dec., 1987. The deformity rate came down amongst new cases from 6.15 to 1.50% till Dec. 1987. regularity of treatment among PB cases is 90.84% as compared to 90.48% for MB cases. The study showed that MDT can be implemented in tribal, rural and urban populations with high rate of compliance.

Comparison of radiometric macrophage assay and fluorescein diacetate/ethidium bromide staining for evaluation of M. leprae viability.

Earlier studies from our laboratory reported that a radiometric Mycobacterium leprae resident macrophage assay was a useful in vitro indicator of bacillary viability with good correlation with the established mouse foot pad model. The present study compares our assay with the recently described fluorescein diacetate/ethidium bromide (FDA/EB) method. M. leprae extracted from the dermal lesions of 73 bacilliferous leprosy patients were tested concurrently by both techniques. Good correlation (r = 0.52, p less than 0.001) was found between the radiometric assay evaluating DNA synthesis and the FDA/EB staining reflecting the presence of active esterase enzyme. In addition, the utility of the FDA/EB staining in the monitoring of therapy was established. Twenty-two patients treated for greater than 1 year showed lower numbers of green fluorescing bacilli when compared to 19 untreated or short-term-treated individuals.

Renal Involvement in Leprosy.

Renal involvement in 20 lepromatous leprosy (LL) and 5 non- lepromatous patients was assessed by (a) biochemical analysis of blood and urine, (b) renal functional tests, and (c) histopathological examination of renal biopsies. Ten age-matched healthy normals formed the control group. LL patients had a varying degree of renal involvement as indicated by the presence of pus cells, granular, hyaline and red cell casts, reversal of albumin/globulin ratio and lowered creatinine clearance rates. Renal biopsies showed significant histopathological lesions in 50% of lepromatous as compared to 20% of the non-lepromatous patients. The pathological changes were predominantly of chronic glomerulonephritis followed by chronic pyelonephritis and interstitial nephritis. Surprisingly none of the patients studied showed granulomas, acid-fast bacilli or amyloid in the kidney.