Development and evaluation of real-time RT-PCR assay for quantitative estimation of viable Mycobacterium leprae in clinical samples.

Detection of live organisms by molecular methods has special significance in leprosy where causative organism can not be cultivated in vitro. Such techniques would be especially important for monitoring the progress of the disease. While real-time RT- PCR technology will be appropriate for this purpose, there is very little experience of use of such tools in leprosy. This study describes the development of a quantitative RT-PCR targeting 16S rRNA based on primers used in a semi quantitative RT-PCR and its application on clinical samples including slit scraping and biopsies. RNA was extracted from biopsies from 3 lepromatous leprosy (LL) cases and standard curve was generated by plotting crossing over point against the dilutions of input RNA quantity (number of bacilli used for RNA extraction). Real-time RT-PCR was performed for quantitative detection of live M. leprae in 28 slit (13/28 smear positive) scrappings and 32 biopsies (22/32 smear positive). Number of viable bacteria as estimated by solid stained bacilli and real-time PCR correlated (no difference p>0.05). The test achieved a theoretical analytical sensitivity limit of up to single live bacillus even considering 11.3% efficiency of RNA preparation which was calculated by spiking of known number of leprosy bacilli in non leprosy skin biopsies (PCR negative). All smear positive cases were positive by this assay. This assay appears to be a promising tool for detection and quantification of viable bacilli in selected clinical situations and should be of use even in smear negative cases also.

Male gonads in leprosy--a clinico-pathological study.

Sixty male leprosy patients (mean age 27.2 +/- 5.04 years) selected at random, were studied for gonadal involvement with the mean duration of illness 4.17 +/- 3.27 years. Only lerpomatous and borderline leprosy cases developed testicular and epididymal changes. Testicular pain and/or swelling (lepromatous 62.5%, borderline 30%) was the main presenting feature. Altered sexual function was observed in 34(56.6%) cases, and 11 patients revealed altered sexual hair pattern. Gynecomastia was seen in 9 cases. Reduced testicular size along with its soft feeling was present in 25% of cases while no testicular sensation was felt in 8 (13.3%) cases, and impaired testicular sensation in 9 (15%) of them. Spermogram revealed azoospermia in 19 (35%) and oligospermia in 16 (26.6%) cases. Histo-pathology revealed evidences of leprous pathology irrespective of testicular size, semen picture and clinical manifestations. There was marked variation in histopathological findings in testes and hence it was difficult to categorise them into vascular, interstitial and obliterative phase.

Necro-destructive Herpes Zoster.

A 40 year old male patient had herpes zoster involving ophthalmic and maxillary divisions of the right trigeminal nerve which resulted in destruction of alveolar processes of bone, falling of teeth and forming of the oro-antral fistula.

Giant Intradiploic Epidermoid Cyst.

A giant intradiploic epidermoid cyst was seen in a 13 year old male manifesting as a swelling in the right sub-temporal region along with proptosis of the right eye for the last 6 years. There was no intracranial extension of the cyst. Removal of the cyst was followed by complete recovery of the proptosis of the eye.

Rapidly progressive (crescentric) glomerulonephritis in erythema nodosum leprosum: case report

A autora faz a introduçäo do trabalho uma abordagem sobre o tabagismo como importante fator associado a doenças respiratórias, cardiovasculares e a alguns cânceres. Lembra também sobre as implicaçöes do tabagismo na gravidez e descreve alguns estudos sobre fumante passivo e refere algumas informaçöes epidemiológicas. Propöe-se a: 1- Estudar a prevalência de tabagismo entre estudantes da Universidade de Säo Paulo, campus de Ribeiräo Preto, em 1988. 2- Analisar a tendência desta prevalência no perído de 1980-1988. 3. Analisar a relaçäo entre escolhas das marcas e o custo das mesmas. Foi feito um levantamento em 1988, com questionário padronizado e com a mesma metodologia utilizada em 1980, 1981 e 1986. As principais conclusöes foram: 1- A prevalência do tabagismo nas diferentes unidades da USP, em dezembro de 1988 foi: FMRP, 11,9% EERP, 21,2%, FFRP, 8,7; FORP, 8,9%; e prevalência de extabagista foi respectimente: 6,8%; 9,3%; 7,5% e 6,5%. 2- As mulheres fumam tanto quanto os homens em 1988 entre os alunos inqueridos. 3- Até 1986, há tendência geral de declínio em todas as escolas; em 1988, esta tendência näo tem significado estatístico. 4- A tendência segundo o gênero alterou-se no período estudado, em 1980 e 1981 os homens fumam mais que as mulheres e em 1986 e 1988, homens e mulheres fumam igualmente. Foram levantadas e discutidas várias hipóteses no sentido de tentar explicar esta tendência geral de declínio e as mudanças ocorridas neste período quanto a prevalência nos dois gêneros

Histo-functional status of kidney in leprosy.

A study of 64 cases of leprosy (44 lepromatous and 20 nonlepromatous) revealed that the duration of the disease has a significant relationship with renal involvement (chi 2 = 16.9, P less than 0.001). Proteineuria, microscopic haematuria, granular and hyaline casts are mainly seen in lepromatous cases and specially with lepra reaction (100%) while few of the non-lepromatous (2%) cases may show these abnormalities. Impaired renal functions are mostly observed in lepromatous leprosy (62.9%) specially those with lepra reaction (100%) while 2% nonlepromatous cases have these impaired renal functions. Histo-pathological studies revealed non-specific changes in 44.4% of cases and those of chronic pyelonephritis in 15.5% of the cases. Renal amyloidosis is less common occurrence (4.4%). The specific lesion, that is 'leproma kidney', is rare and seen in one patient only. Acid fast bacilli could not be seen in any of the kidney tissue. It is therefore, concluded that the renal involvement in the form of inflammatory lesions and non-specific changes in the glomeruli and tubules are very common in lepromatous leprosy specially during the reactive phase.

Rapidly progressive (crescentric) glomerulonephritis in erythema nodosum leprosum: case report.

A middle aged man (48 years) with short duration of illness (7 days) was admitted in the state of acute renal failure with erythema nodosum leprosum. He had repeated episodes of erythema nodosum leprosum in the past. His blood pressure was normal (150/80 mmHg). During his hospital stay he was in the state of progressive anaemia (Hb = 8.8 g/dl to 7.2 g/dl), oliguria (urine out-put = 250-350 ml/day), azotaemia (blood urea = 198 mg/dl to 218 mg/dl) and impaired renal function tests with fatal outcome. Kidneys were smooth, congested and weighing 150 g each with histological features of rapidly progressive (crescentric) glomerulonephritis, a result of immune complex deposition from recurrent erythema nodosum leprosum episodes.

Naevus Lipomatosus Cutaneous Superficialis.

Three female patients aged 30,55 and 4 years had large tumour-like masses, which were progressively increasing in size for the last 4,5 and 4 years respectively. Excision of these lesions and histopathlology revealed mature fat cells in the middle, and lower dermis, interspersed between collagen bundles and surrounding the blood vessels. These findings are characteristic of naevus lipomatosus cutaneous superficials.

Gonadal involvement in leprosy--study of gynaecomastia, testicular and epididymal involvement and therapeutic efficacy of indigenous drugs.

Sixty male patients of leprosy (mean age = 27.2 +/- 5.04 years) selected at random, were studied for gonadal involvement and therapeutic efficacy of two indigenous drugs. Of these 34 were married, with the mean duration of illness 4.17 +/- 3.27 years. Only those with lepromatous and dimorphous leprosy developed testicular and epididymal changes. Testicular pain and/or swelling (lepromatous = 62.5%, dimorphous = 30%) was the commonest presenting feature. Altered sexual function was observed in 34 (56.6%) cases, while 11 patients revealed altered sexual hair pattern and nine gynaecomastia. Reduced testicular size associated with soft feel was present in 25% of cases with no testicular sensation in 8 (13.3%) and impaired testicular sensation in 9 (15%) patients. Spermogram revealed azoospermia in 19 (35%) and oligospermia in 16 (26.6%) patients. Histopathological findings of testicle biopsy revealed evidence of leprous pathological irrespective of testicular size, semen picture and clinical manifestations. Histopathological changes had shown marked variation and so did not enable categorising them into vascular, interstitial and obliterative phases. These changes were believed to be due to the altered gonadal state in leprosy. The therapeutic efficacy of the indigenous preparations, Speman and Tentex forte (Himalaya) was evaluated subjectively as well as objectively in 34 patients. 82.3% of cases showed subjective improvement while objective improvement in spermogram was noted in 87.5% cases with oligospermia. The drugs have no side effect and were well tolerated.

Pilomatrixoma of Male Breast.

Pilomatrixoma is an uncommon tumour,of the skin and is characterised by transition of b@philic ceffs into shadow ceus. The, present cas6" described here because of certain unusual features namely origin from the male breast, production of hair within the tumour and associaion with mfiltr ductcarcinomaafin of the breast.

Modified Zancolli's operation in claw hand in leprosy.

The operative technique of the Modified Zancolli's operation in claw hand is easy. Re-education is easier in Zancolli's capsulorrhaphy than any other operations. Results of this operation are encouraging. It is particularly required when quick turnover of cases is needed and when adequate facilities for physiotherapy is not available. In cases operated by Zancolli's capsulorrhaphy active flexion of metacarpophalangeal joint is possible. Complications are few e.g. pulling of capsulorrhaphy and development of flexion contracture.