Subject(s)
Leprosy, Lepromatous/pathology , Aged , Biopsy , Clofazimine/administration & dosage , Cyclosporine/administration & dosage , Dapsone/administration & dosage , Diabetes Complications , Humans , Leprosy, Lepromatous/drug therapy , Male , Neurologic Examination , Prednisone/therapeutic use , Rifampin/administration & dosageABSTRACT
OBJECTIVE: To inventory the changes in leprosy epidemiology in the Netherlands. DESIGN: Retrospective. SETTING: Academic Medical Centre (Amsterdam) and University Hospital Dijkzigt (Rotterdam), the Netherlands. METHOD: The medical records of all new leprosy patients in the period 1970-1991 were analysed. RESULTS: Between 1970 and 1991, 622 new leprosy patients were registered; 371 men (59.6%) and 251 women (40.4%). Most patients came from Surinam (73.3%) and Indonesia (7.2%). The mean time lapse between onset and treatment in the Netherlands was 10.1 years. Switching from monotherapy to combination therapy (1979) had no effect on the incidence of reversal reactions (cellular hypersensitivity in immunologically unstable patients), but did affect the incidence of erythema nodosum leprosum during the treatment. CONCLUSION: Leprosy in the Netherlands is an important disease, mainly from Surinam. The main advantage of combination therapy is the shortened duration of treatment. The treatment of choice is the one recommended by the WHO, the combination therapy with rifampicin administration once a month, because of the few adverse effects.
Subject(s)
Leprosy/epidemiology , Adult , Aged , Drug Administration Schedule , Drug Therapy, Combination , Emigration and Immigration , Ethnicity , Female , Humans , Leprostatic Agents/administration & dosage , Leprostatic Agents/therapeutic use , Leprosy/drug therapy , Leprosy/ethnology , Leprosy, Borderline/epidemiology , Leprosy, Lepromatous/epidemiology , Leprosy, Tuberculoid/epidemiology , Male , Middle Aged , Netherlands/epidemiology , Retrospective StudiesSubject(s)
AIDS-Related Opportunistic Infections/diagnosis , Leprosy, Borderline/diagnosis , Leprosy, Lepromatous/diagnosis , AIDS-Related Opportunistic Infections/epidemiology , Adult , Biopsy , Female , Humans , Leprosy, Borderline/complications , Leprosy, Borderline/drug therapy , Leprosy, Borderline/epidemiology , Leprosy, Lepromatous/complications , Leprosy, Lepromatous/drug therapy , Leprosy, Lepromatous/epidemiologySubject(s)
Cyclosporine/therapeutic use , Hypersensitivity, Delayed/drug therapy , Leprosy, Borderline/drug therapy , Leprosy, Lepromatous/diagnosis , Adult , Aged , Drug Monitoring , Drug Therapy, Combination , Humans , Hypersensitivity, Delayed/complications , Hypersensitivity, Delayed/diagnosis , Leprostatic Agents/therapeutic use , Leprosy, Borderline/complications , Leprosy, Borderline/diagnosis , Leprosy, Lepromatous/complications , Male , Treatment OutcomeSubject(s)
Emigration and Immigration , Drug Administration Schedule , Retrospective Studies , Ethnicity , Leprostatic Agents/administration & dosage , Leprostatic Agents/therapeutic use , Leprosy, Borderline/epidemiology , Leprosy, Tuberculoid/epidemiology , Leprosy, Lepromatous/epidemiology , Leprosy/etiology , Leprosy/ethnology , Leprosy/drug therapy , Netherlands , Drug Therapy, CombinationSubject(s)
Male , Humans , Adult , Aged , Leprosy, Borderline/complications , Leprosy, Borderline/diagnosis , Leprosy, Borderline/drug therapy , Leprosy, Lepromatous/complications , Leprosy, Lepromatous/diagnosis , Hypersensitivity, Delayed/diagnosis , Hypersensitivity, Delayed/drug therapy , Drug Therapy, CombinationABSTRACT
With the introduction of reproducible serological tests it was hoped that relapses in leprosy patients, after discontinuing treatment, could be detected before damaging reactions occurred and before the patients became infectious. The possible value of an ELISA using a semisynthetic analogue of phenolic glycolipid-I to detect antibodies to this antigen in order to predict a relapse in multibacillary patients was investigated. In contrast to that reported for paucibacillary patients, this test was useful to detect early relapses in multibacillary patients. In 3 out of 4 multibacillary patients who relapsed, the ELISA-values were increased. The decreased ELISA-values in the one relapsed patient could be attributed to the corticosteroid therapy. In the multibacillary patients who did not relapse after RFT, the ELISA-values were consistently low or decreased. In only one patient did the ELISA-values increase following his release from treatment and this patient was clinically suspected of developing a relapse.
Subject(s)
Antibodies, Bacterial/analysis , Glycolipids/immunology , Leprosy/drug therapy , Adult , Aged , Antigens, Bacterial/immunology , Enzyme-Linked Immunosorbent Assay , Follow-Up Studies , Humans , Leprosy/immunology , Leprosy/pathology , Male , Middle Aged , Mycobacterium leprae/immunologyABSTRACT
A panel of 17 mouse monoclonal antibodies (MoAb) raised against Mycobacterium leprae (M. leprae) antigens was used to detect antigenic determinants in normal human skin. An indirect immunoperoxidase technique was used. Eight of the MoAb detected epidermal antigens similar to patterns well known for human sera. Five of these MoAb detected determinants in the dermis, too. These observations may indicate a certain degree of similarity between the antigenic determinants occurring in M. leprae and in the human host. We propose that such a similarity on the one hand may facilitate the survival of M. leprae in the human host when the antigens are not recognized as "non-self," a situation which seems to occur in lepromatous leprosy, when the patients' tissues are loaded with bacteria virtually without any immune response. On the other hand, M. leprae antigens which mimic host antigens may induce an auto-immune reaction against the host's own antigens, which could explain the immune reaction in tuberculoid leprosy and during a "reversal reaction" when M. leprae is not observed in the host tissues, but extensive granuloma formation occurs.