Necrotic erythema nodosum leprosum with oral mucosal involvement.

Leprosy is a chronic, infectious disease with varied clinical presentations. The type 2 lepra reaction / erythema nodosum leprosum (ENL) classically involves extremities and face. Besides to the classical lesions of type 2 lepra reaction sometimes rare findings of vesicular lesions with necroticans may be observed. We are reporting a case of lepromatous leprosy with bullous reaction and necroticans involving usual sites along with the unusual involvement of oral cavity, which on first look mimicked necrotizing vasculitis or other bullous disorders. This manifestation of type 2 lepra reaction in oral mucosa should be kept in mind by the physicians while dealing with a case of type 2 lepra reaction.

Health sector in India--progress, challenges and the way forward.

Health is a priority goal in its own right and a central input into economic development and poverty reduction. Significant achievements have been made in a number of areas which include health parameters, legislation, research and technology and disease control. The life expectancy has gone up by 17% since 1981. In disease control significant achievements are in sight. Some new programmes have been introduced with the changes in disease profile. Significant progress can be seen in leprosy control, blindness control, TB control and iodine deficiency disorder control. Some legislations were also enacted to protect life and personal liberty as the constitution holds the right to healthcare as a fundamental one. Immediate medical relief and preventing major outbreak following disasters is another area to fight with. There are some challenges to face with like propulation stabilisation, to reduce infant and maternal matality, mobilisationof funds on health, to increase manpower, to increase female literacy and so on. Control of some diseases like HIV/AIDS, vector borne ones, cancer, cardiovascular diseases, diabetes, trauma related injuries, mental disorders is another point to improve healthcare delivery. To meet challenges to the health system the way forward has to be multipronged, focusing on finance, manpower, research and social factors like sanitation, drainking water availability, female literacy, etc.

Malignant eccrine spiradenoma: an unusual presentation.

An unusual case of a 60-year-woman with a progressively increasing painless, ulcerated plaque-like lesion in her right groin is described. The lesion was associated with multiple satellite nodules involving the right thigh with massive lymphoedema oft he involved limb. Histology established the diagnosis of an eccrine spiradenoma with malignant transformation in a satellite nodule. Wide surgical excision was not possible and the patient was subjected to palliative radiotherapy.

Pangeria.

A case of pangeria, with multiple leg ulcers and premature senility with a history of cataractomy, starting at the age of 6 years, without any history of consanguinity, is reported.

Minutes Therapy in Psoriasis.

Thirty one cases of widespread psoriasis were treated with daily short-term.

Macrophage membrane alterations in leprosy as determined by change in sialic acid level.

The level of sialic acid removable by neuraminidase from macrophages of bacteriologically-positive lepromatous leprosy (B(+)LL) patient is extremely low, compared to macrophages from tuberculoid leprosy patients or normal individuals. On the other hand macrophages from long term treated bacteriologically-negative lepromatous leprosy (B(-)LL) patients show a much higher level of sialic acid. This higher level is drastically reduced when these macrophages from (B(-)LL) patients are allowed to phagocytose Mycobacterium leprae. This modulation could be host- and pathogen-specific. It is demonstrated that M. leprae infection brings out membrane changes in the macrophages leading to alteration in the surface molecules. Such membrane changes may cause hindrance in the ability of macrophages to participate successfully in the immune process.

Electrocardiographic changes in multi bacillary leprosy.

14 cases of multi bacillary leprosy (BL and LL) were investigated biochemically and ECG recording was done. Serum cholesterol was found to be raised in 4 out of 14 cases and SGOT was raised in 2 cases. P wave, PR interval and QRS complex did not show any changes, ST segment was depressed in 2 cases, T wave was flat in 2 cases and inverted in one case and Q-Tc interval was prolonged (more than 0.40 secs) in 3 cases.

Natural resistance against tetanus in patients with lepromatous leprosy.

Tetanus antitoxin levels in the sera of unimmunized lepromatous patients, often suffering from many ulcerations on their limbs due to physical and thermal trauma, but not developing clinical tetanus, were studied. Sera from 40 such patients with no history of immunization against tetanus, 35 unimmunized matched controls and 12 immunized controls were tested for the presence of tetanus antitoxin by the passive haemagglutination technique. 45% of patients, 17% of controls and all the immunized patients showed adequate serum antibody levels. Eight of the 22 leprosy patients, with no detectable antitoxin on their sera, were immunized with a single dose of tetanus toxoid and all showed sero-conversion four weeks later. 2-Mercaptoethanol (2ME) treatment of these sera showed both IgM and IgG classes of specific antibody in all groups but the level of mature antibody of IgC class was higher in the immunized group. Neutralization test further confirmed the presence of protective antibodies in these sera.

Immune deficit in patients with lepromatous leprosy: its nature and relation to genetic factors, spectrum, and duration of the illness.

Cell-mediated immunity or hypersensitivity to M. leprae and other unrelated antigens, such as tuberculin and dinitrochlorobenzene, was studied in 73 leprosy patients of different histopathologic types. It was found that specific as well as nonspecific anergy intensified as the disease spectrum shifted from the tuberculoid toward the lepromatous immunologic pole. Within the lepromatous group, the impairment of cellular immunity became more pronounced as the bacillary load increased. It was found that the impairment of the cell-mediated immunity towards antigens other than M. leprae became more severe as the duration of the illness increased. Late lepromin responsiveness, which is the hallmark of resistance of an individual to M. leprae, may be absent even before the onset of clinical illness. Its deficit seems to be primary and has a genetic predisposition.

Gut-associated IgA deficiency in lepromatous leprosy.

Sera, intestinal secretions and intestinal biopsies were collected from twelve biopsy-proved lepromatous leprosy patients with the help of a capsule invented by Roy Choudhury. Sera from another twenty-five proved lepromatous cases were also included. Sera and intestinal aspirates from twenty-five normal subjects and twenty patients with intestinal tuberculosis were also taken as controls. Acid-fast organisms, morphologically resembling Mycobacterium leprae, were detected in the intestinal aspirates of only two leprosy patients. Immunoglobulin levels in their sera and elevation secretions were estimated by the single radial immunodiffusion technique. Significant elevation of serum IgG, IgA and IgM, selective IgA deficiency in intestinal aspirates and flattening of intestinal villi along with mononuclear cell infiltration were conspicuous observations in the leprosy group. On the other hand, the patients with intestinal tuberculosis showed elevation of the IgG level in serum as well as in the intestinal secretions. It was postulated that persistent challenge by M. leprae or its antigens to the IgA immunocytes of the intestinal epithelium might have induced tolerance leading to IgA deficiency and subsequent subtotal atrophy of the intestinal villi in the patients with lepromatous leprosy.