A note on the lepromin reaction in males and females of the general population of Cordova, Mactan Island, Cebu, Philippines

In view of the current interpretation of reactivity to lepromin as an indication of resistance to lepromatous leprosy, and of the much greater frequency of lepromatous leprosy in males than in females, a comparison has been made of the results of the lepromin test in 776 males and 1,075 females of the general population of Cordova, Mactan Island, Cebu. Those tested were not known to have had household exposure to leprosy, and all were free from signs of the disease when examined within a year prior to testing. The number of acceptable positive early (fernandez) reactions was extremely small; 3.0 per cent in males and 6.1 per cent in females. The proportion of late (Mitsuda) reactions increased from 17.7 per cent for males and 14.1 per cent for females under 5 years of age to 94.6 and 97.0 respectively, for those of 20 years and over. No substantial difference between the sexes was found in any age group. For all ages, after adjustment for differences in age constitution, the percentage of late positives was for males, 66.5 per cent and for females, 69.9 per cent. As far as reactivity of apparently healthy persons to lepromin may be accepted as an indication of their resistance to leprosy, there is no evidence in these results that males are less resistant than females.

Tuberculization and reactivity to lepromin. Association between lepromin and tuberculin reactions in schoool children in Cordova and opon Cebu, Philippines

1- A study has been made of the association between the reactions to tuberculin (first and second strength PPD) and early and late reactions to lepromin in 544 children of ages 7 to 9, inclusive, attending public schools in Cordova and Opon, Mactan Island, Cebu. In these municipalities the prevalence of leprosy is about 20 per 1,000 of which one-third is of the lepromatous type. Tuberculosis is known to be frequent. 2- The following percentages were positive: First PPD, 14.0; first and second PPD, 71.9; early lepromin (Fernandez), 4.4; and late lepromin (Mitsuda), 65.3. 3- Only 24 children showed an early lepromin reaction of 10 mm. or larger with infiltration. All of these had typical late reactions. Eight of the 24 were positive to first strength PPD; all of the remaining 16 reacted to the second strength. 4- The occurrence and intensity of the Mitsuda reaction were positively associated with occurrence and intensity of reaction to PPD. If it be granted that a high proportion of reactions to the second strength PPD were attributable to infection with the tubercle bacillus, then tuberculization of the population may have been responsible for concurrent acquirement of reactivity to lepromin. 5- There were, however, disagreements in both directions. There were 9.5 per cent of the children who were negative to the second PPD but positive to lepromin (Mitsuda). In all but one of these the lepromin reactions were small. On the other hand, there were 16.2 per cent who were positive to the second strength PPD but negative to lepromin. In 63.6 per cent of 88 children showing this type of disagreement, the reaction to tuberculin was 2 + or larger. The only explanation of these disagreements which is in conformity with thhe tuberculization hypothesis is that in some persons the two types of response are dissociated. Certain individuals are apparently capable of developing tuberculoid lesions when acid-fast bacilli are injected into the skin but have either lost or never possessed hypersensitivity to tuberculin. In other cases, hypersensitivity is present but capacity to localize the bacilli in the skin by formation of a tubercle is absent...