Pedunculated digitate papillomatosis around rectum.

This is a report on unusual case of proliferation of dermal and epidermal components having finger-like projection around rectum with extension towards natal cleft in a patient suffering from Hansen's infection.

Initial intensive therapy for multibacillary leprosy patients--in retrospect.

We analysed the results of 4845 multibacillary (MB) patients being treated with multidrug treatment (MDT) in the Srikakulam District of Andhra Pradesh, India. Of these, 2309 (47.7%) patients were given an initial 14-day intensive therapy with rifampicin, clofazimine and dapsone, followed by the WHO recommended pulse therapy. The rest of the cases were given only pulse therapy. The improvement in terms of bacteriological clearance and the proportion of cases declared released from treatment (RFT) was found to be significantly higher among patients treated with only pulse therapy. Clinic attendance was found to be better and more regular in patients treated with intensive therapy, and no relapses were seen with either therapy. The implications of these findings on the operational aspects of programme implementation are discussed.

Seroepidemiological study of leprosy in a highly endemic population of south India based on an ELISA using synthetic PGL-I.

As part of a continuing longitudinal immuno-epidemiological study, blood samples were collected by finger prick from 4243 individuals living in a highly endemic area for leprosy in South India. The samples were tested for IgM antibodies against phenolic glycolipid-I using an ELISA. Seropositivity defined as optical density greater than or equal to 0.2000 was marginally higher in the age group 10-30 years and in females. There was no evidence for a higher level in contacts than in non-contacts. The future prospect for the large scale use of this ELISA in high-endemic populations in special epidemiological investigations or routine control programs as a serological tool to detect leprosy infection appears questionable.

Is bacteriological examination by skin smear necessary in all paucibacillary leprosy patients in mass control programmes?

Skin smear bacteriological examination results of 11,255 paucibacillary leprosy patients from 8 leprosy control units under the National Leprosy Eradication Programme (NLEP) in South India and the Outpatient Department (OPD) of the Central Leprosy Teaching & Research Institute (CLT&RI), Chengalpattu, between 1987 and 1989 were collected and analysed. Only 0.05% of the smears from leprosy control units and 2.49% from the OPD of CLT&RI were found to be positive. Not a single smear from indeterminate, tuberculoid and pure neuritic types of leprosy out of 8263 examined was found positive under field conditions. The relevance of carrying out routine bacteriological examination in mass leprosy control programmes is discussed.

Chest infection due to M. fortuitum in a case of lepromatous leprosy--a case report.

Lepromatous leprosy cases may be immunocompromised due to the extensive disease and also because of steroid therapy for repeated reactions. Such patients are likely to be at higher risk for getting opportunistic infection due to various environmental microbes. This paper reports a case of lepromatous leprosy with repeated lepra reaction who was found to have chest infection due to M. fortuitum. It is suggested that mycobacterial culture and sensitivity should be recommended in cases who are immunocompromised and whose pathological specimens contain acid fast bacilli. Species identification and sensitivity can be very helpful in proper management of such cases who will otherwise pass off as tuberculosis.

Alanine dehydrogenase in mycobacteria--a preliminary report.

Various mycobacterial species namely M. phlei, M. vaccae, M. scrofulaceum, M. avium and M. tuberculosis have been investigated for the presence of enzyme alanine dehydrogenase which could be important for utilization of alanine by TCA cycle. It was found that alanine dehydrogenase was present in all species of mycobacteria tested irrespective of the fact whether they are rapid or slow growers. Electrophoretic mobilities of alanine dehydrogenase from different species of mycobacteria were not found to be significant for taxonomical differentiation of rapid and slow growers.

Effect of pyridine extraction on the acid fastness of mycobacteria.

The effect of pyridine extraction on mycobacterial acid-fastness has been studied using M. leprae and some cultivable mycobacteria. The results revealed that not only M. leprae but some other mycobacteria, notably, M. vaccae and M. phlei also lose their acid-fastness when extracted with fresh pyridine for 2 hours at room temperature. The implication of these findings is discussed.

Hepatitis-B virus infection in patients with leprosy--a brief communication.

The prevalence rate of hepatitis-B surface antigen (HBsAg) were determined in 413 patients of different types of leprosy and 133 healthy controls from the same population, in a study undertaken over a period of more than 3 years. The average frequency of australia antigen (HBsAg) was 7.7% in leprosy cases as compared to 6.0% in their healthy counterparts. Across the spectrum 7.2% of lepromatous patients (LL); 8.5% of borderline lepromatous (BL); 9.1% of borderline borderline (BB); 8.6% of borderline tuberculoid (BT) and 8.8% of tuberculoid (TT) cases were positive for HBsAg. Though the prevalence of australia antigen was slightly higher in borderline tuberculoid, borderline borderline and tuberculoid cases, it is not statistically significant. No association between carriership of HBsAg and lepromatous leprosy could be found in the present study.

Solid, fragmented and granular index as one of the parameters in drug trials.

A bacteriological study of the skin smears of 108 bacteriologically positive cases of leprosy, 30 of them untreated, has been undertaken. In each case solid, fragmented and granular (SFG) index, bacteriological index (BI) and morphological index (MI) of skin smears from 4 sites were calculated. The results show that SFG index together with BI can be used as one of the parameters in drug trials. The importance of SFG index in research and as a routine laboratory procedure in leprosy control units undertaking multi drug therapy is discussed.

Biochemical correlation of M. vaccae with M. leprae.

The biochemical tests, namely, niacin, catalase, nitrate reduction, tween hydrolysis, tellurite reduction, arylsulfatase and urease tests were carried out for all the mycobacteria which are immunogenically closely related to M. leprae. Among them only M. vaccae shows closest relationship with M. leprae when compared with its communicated data. Except for the tellurite reduction test which was variable in case of M. leprae, all the other tests were found similar to that of M. leprae. In the next experiment, the thin-layer chromatographic pattern of mycolates from M. leprae has been compared with that of M. leprae. The presence of Keto-mycolate in the cell wall structure of both M. vaccae and M. leprae also reflects their biochemical relationship at their ultrastructural level.

Sex Education.

Sex education is very important specially for the growing persons as it helps to develop a proper understanding and healthy attitude towards sex. When, where, how and to whom sex education should be started have been discussed. The aim of sex education with special reference to venereal diseases has also been emphasised.

Reversal reaction in patients with lepromatous leprosy after transplantation of human fetal thymic grafts.

An attempt has been made to reconstitute impaired cell-mediated immunity in 1 patient with indeterminate, 4 patients with borderline and 2 patients with polar lepromatous leprosy by grafting three thymus glands obtained from human fetuses of 14--19 weeks gestation. Most of these patients had severe ulcerative erythema nodosum leprosum (ENL) and were intolerant to dapsone. After thymus transplantation these patients were followed for 1 1/2 years. During this period, all conventional chemotherapy had been withdrawn. In most cases, there was dramatic improvement of the clinical condition, resolution of skin lesions, subsidence of ENL, clearance of bacteria from skin and reconstitution of several immunologic deficits; but late lepromin reactivity returned in none, which indicated permanent lose of resistance to Mycobacterium leprae.