Discrepancy in the histopathological features of leprosy lesions in the skin and peripheral nerve. Report of a preliminary study.

Simultaneous biopsies of the skin and a cutaneous nerve were done in 36 randomly selected leprosy patients and the histopathological features of the lesion in the two tissues were compared. A discrepancy was noticed in 21 instances. In 19 of these cases the lesions in the nerve were found to be immunologically more deficient and were also bacillated, even when the skin lesion had cleared or regressed. The implications of the findings are discussed and the need for further studies is emphasized.

Rapid, radiolabeled macrophage culture method for detection of dapsone-resistant Mycobacterium leprae.

Mycobacterium leprae cells extracted from the skin biopsies of 14 bacilliferous lepromatous patients were maintained in human-murine macrophage cultures for 3 weeks in the presence of [3H]thymidine and DDS (4,4'-diaminodiphenyl sulfone). All cultures except one containing freshly extracted viable bacilli showed significant incorporation of [3H]thymidine as compared to control cultures containing heat-killed bacilli of the corresponding strain. Six susceptible strains of M. leprae obtained from untreated, freshly diagnosed patients showed significant inhibition of the uptake of the radiolabel in the presence of 3 and 10 ng of DDS per ml per culture. Eight strains of M. leprae obtained from patients clinically suspected of DDS resistance were tested in a similar manner. These strains were also concurrently inoculated in the footpads of mice given orally 10(-2), 10(-3), and 10(-4) g of DDS per 100 g of body weight for 9 months. Concordant results were obtained by both methods: five strains were found to be resistant, one was susceptible, and one was partially resistant. Strain VIII did not incorporate [3H]thymidine in the macrophage cultures and proved to be resistant in the mouse footpad. The macrophage culture system provides a sensitive, rapid screening method for the early diagnosis of DDS resistance.

A study of lepromin reaction in child contacts of leprosy patients and non contact children in Chengalpattu District Tamil Nadu.

In this study early lepromin reaction has been used to detect delayed hypersensitivity reaction to a prior infection with M. leprae, recent studies indicate that a certain number of contacts who develop sub-clinical infection remain anergic to the lepromin test. This is indicated by the Fluorescent leprosy antibody absorption (FLA-ABS) test of Abe (1979) which detects antibodies in the sera of infected individuals. Correlation of this serological test with lepromin response in contacts is in progress in the CJIL, Agra. These anergic contacts are likely to be susceptible to leprosy, a finding which would help in taking prophylactic measures.

A comparison of low and conventional dosages of dapsone in the treatment of lepromatous leprosy.

A therapeutic trial using two dosages of Dapsone with a schedule of administration of the drug once a week was undertaken at the Central Leprosy Teaching and Research Institute, Chingleput. Adult males with active lepromatous leprosy who were either previously untreated, or who had no specific treatment for at least three months immediately prior to their inclusion into this study, were the subjects of this trial. Two dosages, viz., 10 mg. per kg. body weight/week, and 3.3 mg. per kg. body weight/week, were employed in this trial. It was found that Dapsone administered orally as a single dose once a week was therapeutically effective in most of the patients, and improvement, clinical or bacteriological, was directly related to the duration of treatment, irrespective of the dosage of Dapsone. Blood levels of Dapsone in these patients were in general commensurate with the dose of the drug in either group. No adverse effects on any of the visceral functions were encountered during the prolonged use of this schedule of treatment with Dapsone.

WHO co-ordinated short-term double-blind trial with thalidomide in the treatment of acute lepra reactions in male lepromatous patients.

The treatment of lepra reactions constitutes one of the most serious problems in leprosy. For this reason, the first reports in 1965 of the favourable results obtained with thalidomide aroused considerable interest and led WHO, in 1967, to carry out a trial with the co-operation of four centres. A short-term double-blind trial was designed to study the effect of thalidomide, in comparison with acetylsalicylic acid, in the treatment of acute lepra reactions in male lepromatous patients. Acetylsalicylic acid was used instead of a placebo because of its antipyretic and analgesic activity. Because of the severe adverse reactions that may be caused by thalidomide, mainly the teratogenic effects, only males were included in the trial.The results of this short-term study seem to confirm previous reports of the efficacy of thalidomide and indicate that acetylsalicylic acid also seems to be helpful in the management of certain symptoms of lepra reactions.