Blastogenic response with autologous plasma and Mitsuda's reaction in leprosy patients and their unaffected sibs.

Many investigators have evaluated the influence of genetic constitution on the susceptibility to leprosy in studies linked to different types of research. To determine the possible existence of a family trait linked to the lymphoproliferation and to lepromin reactivity we studied the blastogenic response to phytohaemagglutinin, lepromin and M. leprae and the Mitsuda's reaction in leprosy patients and their unaffected sibs. Sixty-eight individuals were studied, 34 were leprosy patients (17 lepromatous and 17 tuberculoid leprosy) and the remaining were their sibs previously matched by sex and age. The indices of blastogenesis and lepromin reactivity were lower in lepromatous than in tuberculoid patients, that confirmed the immunological polarity of the two types of leprosy. Both the lymphoproliferation and Mitsuda's reaction results suggest different cell immune responses in leprosy patients and their unaffected sibs, so that the hypothesis of a family trait favouring the similarity of responses to these tests among sibs becomes unlikely.

Censo Epidemiológico de lesôes e afeccôes cutâneas em escolares de Ribeirâo Prêto, S. P., Brasil / Epidemiologieal census of cutaneous lesions in schoolchildren of R. Preto, S.P., Brazil

Um total de 5150 escolares de 6 a 16 anos foram examinados em uma cidade subtropical. Excluídas cicatrizes e lesôes traumáticas a prevalência de dermatoses foi de 72%. As mais comun (>2%) foram nevos pigmentados (72%),cicatrizes e lesôes residuais (36%), efélides (19,6%), pediculose (19,6%), dermatite seborréica (19,5%), dermatoviroses (18,6%), acne (15,7%), lesôes traumáticas (9,5%), pitiríase capitis (5%), piodermites (4,3%), dermatite eozematosa (2,6%), estrófulo + picada de inseto (3,1%), ceratose palmar el ou plantar (2,1%) e disidrose (2%). Muitos doentes apresentaron dois ou mais tipos de lesoes ou affeccôes cutâneas. A prevalencia de vibix, estomatite angular, dermatoses actínicas, ictiose, pele xerótica, intertrigo, milia, livedo reticular, hipertricosee escabiose foi menor porén relativamente elevada (de 1,61 a 0,66%). A prevalencia foi discretamente maior em escolares de sexo masculino que no feminino e as diferencas estatisticamente significantes (p<0,001). A diferenca de prevalência entre os grupos etarios nâo foi significante para masculinos e femininos. As meninas aprentaron taxa mais elevada de pediculose, enquanto em meninos prevaleceram pitiríase alba (dartro volante), pitiríase versicolor e piodermites. As condicôes sócioeconômicas parecen ter tido influencia nas taxas de prevalênia de pediculose, pitiríase alba e "tinea pedis", mas nâo nas de dermatoviroses, pitiríase versicolor e piodermite. Os resultados e comentários sâo válidos para uma àrea subtropical semelhante à de Ribeirâo Prêto, com as mesmas características ecológicas, socio-econômicas e de populacâo. Quando se planeja um programa de saúde pública em escolas é importante realizar antes um censo epidemiológico ou estudo piloto, a fim de obter as relevantes informacôes bàsicas.

Lymphocyte blastogenesis and lepromin reactivity in leprosy patients and their parents.

To determine whether there is an inherited familiar trait linked to the lymphocyte blastogenesis test (LTT), under stimulation with PHA, lepromin and Mycobacterium leprae in culture medium containing autologous plasma, this test was carried out in patients with the polar forms of leprosy and their parents. The lepromin reaction was also studied in the patients and their parents because, since the test is negative in lepromatous (L) patients and a greater proportion of negativity is detected among their relatives, it might be assumed that the lymphocytes of these individuals could have a lower tendency towards blastogenesis than lymphocytes of tuberculoid (T) patients and their relatives. Thirty individuals were studied, ten of them being leprosy patients (4 L and 6 T) and the remaining their parents; 115 LTT, including control and stimulated cultures, were performed. In the limited number of patients and parents studied, the results showed that mothers of either L or T patients displayed a similarly low response to the stimulants M. leprae and lepromin. The lepromin reaction was negative in all L patients and positive in 3 out of 8 parents, as well in all the T cases and their fathers. Fathers and their T descendants were lepromin positive and there was a certain relationship between this reactivity and blastogenesis. This might suggest a possible inherited familiar trait related to a relative degree of resistance. However, further evidences from studies with larger number of subjects are required to support this hypothesis.

Reflections on some aspects of leprosy among children in Brazil and in other countries.

The authors discuss the classification, clinical aspects, lepromin reactivity, and epidemiologic features of leprosy among children. The most frequent characteristics of each form of leprosy are described. Lepromatous leprosy is less frequent among children in countries of low endemicity and more frequent, even in the most advanced forms, in hyperendemic regions. Borderline forms are rare. In a large number of cases the initial manifestations are those of the indeterminate form and, in an even larger number of cases, of the tuberculoid pole. The evolution from indeterminate to the tuberculoid pole very frequently occurs in a few months or within less than one year. With respect to epidemiology, the authors consider the general frequency of leprosy among children and the frequency of each form of leprosy among children and adults. Data from surveys carried out in Brazil and other countries are presented. Children have a potential for the rapid development of immunoresistance and consequently of lepromin-positivity, and therefore only a few of them eventually develop lepromatous leprosy. This explains the low indices of lepromatous leprosy (approximately 5%) even in hyperendemic areas. Finally, they discuss the factors that may be responsible for the clinical manifestations of leprosy and their characteristics among children.

Indeterminate leprosy in a population survey and in the subsequent follow-ups of children in Burma.

The paper discusses various aspects of indeterminate (I) leprosy in the initial survey undertaken in the Burma BCG trial (69,242 inhabitants), and in the annual examinations of 28,220 children in the trial followed up over periods of five to eight years. Age-specific rates in the initial mass survey are presented. In total 1914 cases were detected (6.2% I, 76% T, 16% L and 1.8% B). Among the children in the BCG trial 768 cases were detected: 255 of them had the I form and their proportion (33%) was much higher than in the population survey. Of these 255 I cases only 4.3% had a negative or doubtful lepromin reaction. Two-thirds of these 255 cases evolved to the tuberculoid pole in less than one year. No L cases appeared in the trial population until ten and eleven years after the start of the trial. It is concluded that whereas a high proportion of indeterminate cases regress spontaneously or evolve towards the T pole, the indeterminate lepromin negative cases are important in the dynamics of the disease, because a proportion of them, if untreated, tend to envolve towards the L form. This stresses the importance of detection and treatment of I cases at an early stage in an effective strategy for controlling leprosy.

Alguns aspectos psicológicos, sociais e econômicos relacionados com a lepra / Some psychological, social and economical aspects related to leprosy

O A. considera certos aspectos psicológicos, sociais e econcômicos em relaçäo à história, manifestaçöes clínicas, evoluçäo dos conhecimentos e tratamento da moléstia. Eles resultariam principalmente da estigmatizaçäo do doente e familiares, e de sua rejeiçäo pela comunidade e até pelos próprios parentes. Estigma e atitude da populaçäo associam-se particularmente à ignorância sobre contagiosidade, aspecto e evoluçäo da doença, e atenuaram-se de modo acentuado, a partir do advento das sulfonas (1941) e de outras drogas. A ampliaçäo de conhecimentos e progresso no tratamento determinaram, em pouco menos de meio século, enfoque mais humano do problema e melhora considerável dos métodos de controle, com benefício enorme para doentes e familiares, e pronunciada reduçäo do impacto psicológico, social e econômico da moléstia

Alguns aspectos psicologicos, sociais e economicos relacionados com a lepra

O A. considera certos aspectos psicologicos, sociais e economicos em relacoes a historia, manifestacoes clinicas, evolucao dos conhecimentos e tratamento da molestia. Eles reseultariam principalmente da estigmatizacao do doente e familiares, e de sua rejeicao pela comunidade e ate pelos proprios parentes. Estigma e atitude da populacao associam-se particularmente a ignorancia sobre contagiosidade, aspecto e evolucao da doenca, e atenuaram-se, de modo acentuado, a partir do advento das sulfonas (1941) e de outras drogas. A ampliacao de conhecimentos e progresso no tratamento determinaram, em pouco menos de meio seculo, enfoque mais humano do problema e melhora consideravel dos metodos de controle, com beneficio enorme para doentese familiares, e pronunciada reducao do impacto psicologico, social e economico da molestia.

Ultrastructure of lymphocytes from patients with paracoccidioidomycosis in the lymphocyte transformation test by phytohemagglutinin.

The morphology and ultrastructure of peripheral blood lymphocytes from patients with paracoccidioidomycosis (PCM) and from unaffected individuals (controls) were studied before and after Ficoll-Hypaque separation and at the end of culture, stimulated with phytohemagglutinin. Patient lymphocytes were cultured in medium with autologous plasma (from the patient himself) and with homologous plasma (from an unaffected donor), while donor lymphocytes were cultured in medium with plasma from a patient or with plasma from the donor himself. The Ficoll-Hypaque mixture caused no morphological or ultrastructural changes in the lymphocytes of patients or of unaffected donors. Patient lymphocytes cultured in medium with autologous plasma showed different degrees of cytoplasmic and nuclear alterations, such as organelle dissolution, vacuoles, amorphous masses, deformed nuclei, and absence of nucleoli. Lymphocytes from control individuals cultured in patient plasma also showed ultrastructural alterations, though they were less marked, and a reduced number of 'blasts'. Patient lymphocytes cultured in medium with homologous plasma (from a control individual) showed a morphology similar to that of lymphocytes from control individuals cultured in medium with their own plasma, although with a lower number of 'blasts'. On the basis of the results obtained using that methodology, we draw the following conclusions: separation by Ficoll-Hypaque does not seem to alter the ultrastructure of patient or donor lymphocytes; patients with diffuse PCM and more markedly impaired general condition can exhibit lymphocytes with morphological and ultrastructural alterations capable of affecting their biological systems and functionality.(ABSTRACT TRUNCATED AT 250 WORDS)

BCG vaccination of children against leprosy: fourteen-year findings of the trial in Burma.

The value of BCG vaccination in preventing leprosy among children was studied in an area of high leprosy endemicity in Burma through a controlled trial; one group of 13 066 children received BCG and another group of 13 176 served as controls. The overall protective effect of BCG, which was only about 20% over the 14-year period, was found to vary with the batch of vaccine, as well as age, sex, and contact status of the children. BCG protection was found to be independent of the initial tuberculin status of the children. The protective effect of BCG against the lepromatous type of leprosy could not be measured because of the low incidence. Protection was observed throughout the fourteen years of the study except for the first year. The results are compared with those of three other major BCG trials in leprosy. The trial has shown that BCG provides only a very modest level of protection and that BCG vaccination is not likely to be an important solution for leprosy control.

Lymphocyte transformation test in patients with American leishmaniasis.

To determine the correlation between the lymphocyte transformation test (LTT) with phytohemagglutinin (PHA) and the clinical forms of American leishmaniasis (AL), duration of the disease and reaction to leishmanin, the authors studied 12 patients and compared them to 25 unaffected individuals. The ulcerated cutaneous form of the disease was observed in 4 patients, the ulcero-nodular lymphangitic form in 1, the mucous cutaneous form with destruction of the nose in 6, and the verrucous form in 1. General patient condition was satisfactory and the Montenegro reaction macroscopically positive with infiltrations of 5-15 mm in diameter. The results revealed no evidence of immunodeficiency among patients. No correlation was observed between clinical forms, duration of the disease and Montenegro reaction and LTT results. LTT with PHA does not appear to be an adequate indicator of the cell immune system in AL cases.

BCG vaccination of children against leprosy: fourteen-year findings of the trial in Burma

The value of BCG vaccination in preventing leprosy among children was studied in an area of high leprosy endemicity in Burma through a controlled trial; one group of 13066 children received BCG and another group of 13176 served as controls. The overall protective effect of BCG, which was only about 20% over the 14-year period, was found to vary with the batch of vaccine, as well as age, sex, and contacts status the children. The protective effect of BCG against the lepromatous type of leprosy could not be measured because of the low incidence. Protection was observed throught the fourteen years of the study except for the firts year. The results are compared with those of three other major BCG trials in leprosy. The trial has shown that BCG provides only a very modest level of protection and that BCG vaccination is not likely to be an important solution for leprosy control.

Lymphocyte transformation test in patients with paracoccidioidomycosis.

The lymphocyte transformation test (LTT) by phytohemagglutinin was carried out on lymphocyte cultures from patients with paracoccidioidomycosis, in medium with autologous plasma (from the patient) or homologous plasma (from an unaffected individual), and lymphocyte cultures from unaffected and apparently normal individuals, in medium with autologous plasma (from the individual) or homologous plasma (from a patient with paracoccidioidomycosis). Blastogenesis was evaluated morphologically by 'blast' percentage, and the results analyzed according to clinical form of the disease and general condition of the patient. In the medium containing autologous plasma, percentages below the lower limit of the confidence interval for the distribution of the values for apparently normal individuals were encountered more frequently among patients with diffuse extrapulmonary paracoccidioidomycosis and in poor general condition. When the lymphocytes from patients with the disease were cultured in medium containing homologous plasma, blastogenesis increased in most cases. The lymphocytes of unaffected individuals exhibited a lower response more frequently when cultured in medium containing plasma from patients with the disease than when cultured in medium containing their own plasma. These results suggest that existence of factor(s) inhibiting blastogenesis in the plasma of these patients. In addition to such factor(s), an intrinsic lymphocyte defect may also occur in some patients, which might prevent a greater response to phytohemagglutinin even in homologous plasma. Smears of lymphocytes cultured in autologous plasma and obtained from patients, especially those with diffuse extrapulmonary disease and in regular or poor general condition, and smears from most of the controls whose lymphocytes were cultured in the plasma of these patients revealed deeply stained cells with altered morphology and considerably reduced in number.(ABSTRACT TRUNCATED AT 250 WORDS)

[Analysis of inter and intrapathologist concordance and discordance in a comparative study of the Madrid and Ridley-Jopling classifications of leprosy]. / Analyse de la concordance et de la discordance interet intrapathologistes dans une étude comparative des classifications de la lèpre de Madrid et de Ridley-Jopling.

Eighty-six patients of leprosy have been examined by three leprologists; they have been classified according to the Madrid classification and their lesions biopsied and sent to two pathologists for independent histopathological examination. The pathologists have not received any information regarding the cases. Firstly the "senior" pathologist (A) utilized the Madrid classification and the "junior" pathologist (B) the Ridley-Jopling classification. In a second phase, the "senior" pathologist utilized the Ridley-Jopling classification and the "junior" pathologist the Madrid classification. Both pathologists did not know their own previous histopathological diagnosis at the second phase. The analysis of concordance and discordance between the histopathological diagnosis of the two pathologists and for the same pathologist, on utilizing the two classifications, have elicited the following conclusions: 1. There has been more concordance between the two pathologists on utilizing the Madrid classification than the Ridley-Jopling classification for the lepromatous, borderline and tuberculoïd in reaction patients. 2. The comparison of the two classifications for each pathologist on "blindly" examination of the material, has shown more concordance for the "senior" pathologist than for the "junior" pathologist. 3. These observations have convoyed to the final conclusion that the Ridley-Jopling classification brings some difficulties to the pathologists with limited experience in leprology and therefore it should be utilized only by experienced pathologists. 4. This preliminary study shows the necessity of performing another one with larger number of patients, in the active phase, with larger number of pathologists, preferably from different countries, and by utilizing the same methodology of "blind" examination of the material.