[Leprosy survey conducted in the Central African Republic from 1982 to 1985 among the Ba-Benzele Pygmies]. / Enquête sur la lèpre en République Centrafricaine, de 1982 à 1985, chez les Pygmées Ba-Benzélé.

A leprosy survey was conducted from 1982 to 1985 among 2650 semi-sedentarized Pygmies in two camp-villages in the Central African Republic. Leprosy is endemic there, with an estimated prevalence rate of 1.05% and an annual detection rate of 0.2%. In view of its close relations with other neighbouring ethnic groups this Pygmy community can be considered as a target population the study of which provides indications on the transmission and typical course of leprosy in the region and also as a potential focus of contamination. However, the concurrent presence of endemic tuberculosis made it necessary during the survey to look for clinical associations of leprosy and tuberculosis in patients so that the standard multidrug treatment schedules comprising rifampicin could be adjusted accordingly.

Evaluation of five treatment regimens, using either dapsone monotherapy or several doses of rifampicin in the treatment of paucibacillary leprosy.

The objective of the present study was to define short-course treatment regimens for PB leprosy and to compare them with the 'classical' dapsone treatment and the WHO-PB regimen. Five treatment regimens were studied and evaluated by the histologic evolution. The regimens were: (1) dapsone 100 mg daily, non-supervised for 3 years; (2) RMP 900 mg supervised, once weekly, 8 doses; (3) idem 12 doses; (4) RMP 600 mg, once monthly, supervised, 6 doses and during this treatment dapsone 100 mg daily unsupervised; (5) RMP 600 mg together with dapsone 100 mg daily, supervised for 6 days. For each of these regimens there were between 114 and 195 person-years of follow-up. Results are comparable for the 5 treatment regimens, and reach 65-75% cure rates at 36 months and 80-90% at 48 months after the start of therapy. The relapse rate for all groups is about 0.5% per year. The difficulty for the diagnosis of relapse in PB leprosy is discussed. It is concluded that treatment of PB leprosy can be relatively simple but that a relatively long time is needed to evaluate its effect.

[Immunomodulator treatment of multibacillary leprosy using extracts of microbial ribosomes]. / Traitement immunomodulant de la lèpre multibacillaire par extraits de ribosomes microbiens.

Ribomunyl can in practice be profitably included in the range of immunostimulants, but it requires weekly injections and hence surveillance that will also enable any adverse reactions to be monitored. Its action and tolerance after polychemotherapy have still to be studied. On the basis of our experience, we feel that only isoprinosine, whose effectiveness and good tolerance we have demonstrated, can be used for self-treatment in a mass campaign.

[Polychemotherapy of leprosy in the Central African Republic, 1987]. / La polychimiothérapie de la lèpre en République Centrafricaine, en 1987.

The Central African Republic, which once had the highest Hansen disease prevalence rate in the Central African States, had exemplary results in the control carried out on the basis of sulfonic monotherapy since 1958. In 1983, a cluster sample survey in Upper-Sangha seemed to show that the prevalence of the disease was underestimated. It then became necessary to adopt a new national strategy whose objective would be to reduce the prevalence of leprosy in the country by 50% within five years. For this, a "National Programme for the Control of Leprosy in C.A.R." has been developed; in part it foresees the setting up of polychemotherapy for patients. These treatment protocols should insure healing of paucibacillary forms within six months and of multibacillary forms within twenty-four months. The new strategy of screening and decentralized treatment required retraining personnel and combining health education at individual and collective levels. The preliminary results of a national survey for the evaluation of the prevalence of leprosy are presented.

[Comparison of 3 therapeutic regimens in paucibacillary leprosy. Preliminary note]. / Comparaison de trois régimes thérapeutiques dans la lèpre paucibacillaire. Note préliminaire.

Between 1980 et 1983 all PB patients presenting at the Institut Marchoux, Bamako, took part in a prospective randomized therapeutic trial and were allocated to one of the following regimens: DDS 100 mg 7/7 3 years, RMP 900 mg 1/7 8 doses, RMP 900 mg 7/7 12 doses. At this moment 24, 29 and 22 patients respectively have been followed for periods of 24 to 56 months. With the exception of some irregular drug intake in the DDS patients followed either by relapse or delay in improvement, the efficacity as judged by histopathological examinations did not reveal any difference between the regimens. The study continues.

[Staining of Mycobacterium leprae: comparison between the Lapeyssonnie and Causse technic on the one hand and Thelep's technic on the other in the evaluation of the bacteriological index]. / Coloration du Mycobacterium leprae: comparaison des techniques de Lapeyssonnie et Causse d'une part et de Thelep d'autre part dans l'évaluation de l'indice bactériologique.

In the present review, two staining techniques have been compared to evaluate bacteriological index: the Lapeyssonnie and Causse's technique, used in french speaking Africa, and the one recommended by the O.M.S. scientific panel on chemotherapy of leprosy, Thelep. It appears that the former facilitates the finding of a greater number of bacilli. More efficient, it is also easier and faster than the latter one and, consequently, more adapted to logistic constraints attached to the fight against endemic leprosy in Africa.

Comparative study of two regimens of combined chemotherapy of one year duration in multibacillary leprosy. Results after four and five years' follow-up.

Two therapeutic regimens of one-year duration were administered to two groups of 20 previously untreated multibacillary leprosy patients. Regimen A was rifampin 600 mg twice weekly, prothionamide 500 mg, and dapsone (DDS) 100 mg daily for six months, followed by 100 mg DDS daily for another six months. Regimen B was identical to Regimen A but without prothionamide. Follow-up was for 4 1/2 and 5 years in 15 and 14 patients, respectively. Clinical improvement was rapid, and the bacterial index (BI) of the patients diminished by one unit per year after stopping treatment. Five patients were skin-smear negative at 54 months. The BI in the nasal mucosa became negative after 48 months. There were many attacks of erythema nodosum leprosum between month 3 of treatment until 13 and 21 months. Up to now no relapses have been observed. These results have confidence limits of 20% and 23%, respectively. However, when the results of the two regimens are added, the confidence limit for six months' twice weekly rifampin together with DDS and followed by six months of DDS and 4 1/2 years follow-up is 12%.

[Action of desoxyfructo-serotonin on Mycobacterium leprae. Results of inoculation of human biopsy specimens in the mouse after a year of treatment]. / Activité de la désoxyfructo-sérotonine sur Mycobacterium leprae. Résultats de l'inoculation de biopsies humaines à la souris après un an de traitement.

M. leprae, extracted from cutaneous biopsies of 4 out of 7 patients treated with DFS during one year at doses of 1000 to 1500 mg/day were injected in mouse foot pads. Bacterial multiplication was observed in each case. The purely bacteriostatic activity of DFS for M. leprae, previously observed in mice, is thus confirmed. The eventual place of DFS in the therapy of leprosy is discussed.