Evaluation of testing modalities for peripheral neuropathy in lepromatous Hansen's disease.

To assess methods for detecting peripheral neuropathy, 28 previously untreated patients with lepromatous Hansen's disease underwent upper extremity manual muscle testing, sensory testing by using monofilaments, and electrophysiological nerve conduction studies (motor and sensory) at their initial examination. All but three patients demonstrated some abnormality identified by at least one of the testing procedures. Sensory testing with monofilaments located the greatest number of abnormalities found in 24 of the 28 patients. Next, electrophysiological testing demonstrated neuropathy in 21 of the 28 patients tested; 20 of these patients had sensory abnormalities and 20 had motor irregularities. The least sensitive method was manual muscle testing, which detected abnormalities in only 12 patients. Furthermore, sensory testing with monofilaments revealed peripheral neuropathy in 5 patients whose electrophysiological studies showed normal sensory patterns, and electrophysiological testing detected abnormalities in 1 patient whose sensory monofilament examination was normal. The results of this study support the usefulness of all three testing modalities.

Antibodies to mycobacteria in human tuberculosis. II. Response to nine defined mycobacterial antigens with evidence for an antibody common to tuberculosis and lepromatous leprosy.

Antibodies to mycobacterial antigens were found in the sera of 33 of 52 patients with active tuberculosis by microimmunodiffusion tests. The highest titered sera were examined by a technique in which sera are placed in an intermediate gel between a reference goat antiserum field and a gel containing the antigens separated by one-dimensional electrophoresis. Special patterns caused by the presence of patient's serum during the two-dimensional electrophoresis showed that nine distinct antibodies could be designated by anodal migration of the corresponding nine antigens and the band position with respect to the reference pattern. Six of these antibodies were detected only by sera from selected patients, while the other three antibodies, "Lep," "Da," and "USJ 6," were also detected by the goat antiserum. Lep is present in patients with lepromatous leprosy but had never been described in those with tuberculosis. Monospecific human antisera were used to detect Lep and Da, and new antibody, during fractionation of mycobacterial culture filtrate.