IgG antibody subclasses, tumor necrosis factor and IFN-gamma levels in patients with type II lepra reaction on thalidomide treatment.

A group of 9 Mexican lepromatous leprosy patients was studied at the beginning of a type II reaction (erythema nodosum leprosum, ENL) and after 1 or 2 months of thalidomide treatment. ENL patients at the onset of the reaction had slightly higher amounts of anti-Mycobacterium leprae IgG1 and IgG2 antibodies, compared to similar lepromatous patients that did not develop ENL. Neither these antibody levels nor IgM and the other IgG subclasses were importantly modified after thalidomide treatment. Serum TNF was significantly higher in the patients that developed ENL compared to those that did not develop the reaction. TNF levels were slightly decreased after 1 month of thalidomide treatment and significantly decreased after 2 months of treatment. Serum IFN-gamma was significantly lower in patients at the onset of ENL and was increased after 1 and 2 months of thalidomide treatment.

[Are there subpolar tuberculoid cases?]. / Existen los casos tuberculoides subpolares?

The idea of the existence of subpolar tuberculoid cases is supported on the spectral conception of Ridley and Jopling who included the subpolar lepromatous patients between LL and BL cases. According with Languillon, we have studied 40 tuberculoid cases to find out clinical, bacteriological, immunological and histopathological parameters of subpolar T cases. The subpolar T cases do exist, they are unstable cases which can slide through the immunological spectrum towards the L pole. These cases are characterized by numerous, symmetrical, dysesthetic tuberculoid lesions with an important neural involvement. Bacilli can be found in a small number in the smears of nasal mucosae in some cases. Mitsuda reaction is always positive and histopathologically the granulomas, lymphocytes and epithelioid cells are in less number without the epidermotropism which is very often seen in polar T cases.

[Lucio-Latapí leprosy and the Lucio phenomenon]. / La lèpre de Lucio-Latapí et le phénomène de Lucio.

The Lucio-Latapí's leprosy or diffuse lepromatous leprosy is a clinical variety of lepromatous leprosy first described by Lucio and Alvarado in 1852 and reidentified by Latapí in 1936. It is frequent in Mexico (23%) and in Costa Rica and very rare in other countries. It is characterized by a diffuse infiltration of all the skin which never is transformed into nodule, by a complete alopecia of eyebrows and eyelashes and body hair, by anhydrotic and dysesthesic zones of the skin and by a peculiar type of lepra reaction named Lucio's phenomenon or necrotic erythema which is a vascularitis of vessels especially of the dermohypodermic union and of the hypodermis. Clinically this vascularitis is represented by well-shaped erythematous spots, later becoming necrotic with scabs, ulcerations and scars. Three points of confusion are stressed: the differences between nodules and nudosities, Lucio's leprosy and Lucio's phenomenon and necrotic erythema and necrotic erythema nodosum leprosum. The differences between the pure and primitive form of Lucio's leprosy and the secondary one is also discussed such as the laboratory findings, histopathological data, pronostic and treatment. Lucio's leprosy is considered the most anergic one of the all immunological spectrum of leprosy.

Antimycobacterial antibodies in diffuse lepromatous leprosy detected by counterimmunoelectrophoresis.

By using the counterimmunoelectrophoresis (CIE) technic it was possible to demonstrate the presence of antimycobacterial antibodies in the sera of patients suffering from lepromatous leprosy. The antigen was prepared from isolated Mycobacterium lepraemurium. The technic was more reliable and quicker than Ouchterlony's classical double diffusion in gel. Clinical application of the method is therefore recommended.

Early signs of leprosy in children.

Leprosy in children is more frequent than generally thought. Diagnosis is not easily made because early signs of the diseases are overlooked. Statistic data from the Dermatologic Clinic Pascua of Mexico City reveal that early signs are cutaneous in 67% of cases: hypochromic and anesthetic infiltration, nodules, and alopecia of eyebrows and eyelashes. Neurological symptoms such as anesthesis, facial paralysis, thickening of nerves and trophic problems are present in 19.3% of cases. The nose mucosae are congested in 9.2% of cases. Systemic manifestations may be present in 4% of cases. Examination of contacts living with lepromatous patients is stressed as the best way to discover the early signs of the disease. Dermatological consultation in general and pediatric hospitals is also recommended. If diagnosis is delayed, leprosy can induce physical, psychological and social disabilitation of the patient.