Serological distinction of integral plasma membrane proteins as a class of mycobacterial antigens and their relevance for human T cell activation.

This study pertains to classification and antigenic analysis of mycobacterial plasma membrane proteins in relation to human T cell proliferative responses, using a 'fast grower' Mycobacterium fortuitum as model. Membrane vesicles, prepared by sonication and differential centrifugation, were subjected to biphasic Triton X-114 extraction for isolation of integral peripheral (aqueous phase) proteins. Neither protein pool showed any appreciable overlap serologically. SDS-PAGE showed five prominent bands in peripheral and three in the integral protein pool, whereas immunoblotting with rabbit antisera identified only two major antigens (60 and 67 kD) in the former and five (24, 34, 42, 51 and 54 kD) in the latter. ELISA with a panel of anti-mycobacterial MoAbs revealed that nine out of 12 previously known antigens were present in the peripheral protein pool. Only two of them (33 and 40 kD) were additionally detected amongst integral proteins. The membrane-associated immunosuppressive moiety lipoarabinomannan was semiquantitatively located in aqueous phase. In bulk T cell proliferation assays, seven out of 10 subjects belonging to a 'responder' background (BT-BB leprosy patients and healthy contacts) showed high responses for Myco. fortuitum antigens. Proliferative response with integral proteins was comparable to that with whole membrane, but it was significantly higher (P < 0.0005) than the response with peripheral proteins. The distinction and relevance of integral membrane proteins as a class of mycobacterial antigens make them worthy of consideration in a subunit vaccine design.

Sequential clinico-histological studies in psoriasis following methotrexate therapy.

Ten cases of psoriasis were studied to see the pattern of histological resolution and to evaluate clinico-histological correlation in psoriasis following weekly methotrexate therapy. Five sequential biopsies were taken in each patient. Scaling was first to regress followed by induration and erythema in 18, 26 and 35 days, respectively. Uniform granular layer appeared in 4 days, stratum corneum became orthokeratotic in 7 days, mitotic activity got restricted to basal layer in 7 days and rete ridges elongation was reduced to half in 11 days. Mild acanthosis, cellular infiltrate and vascular dilatation pesisted even after full clinical regression. Interestingly, 5 out of 10 biopsies revealed increase in cellular infiltrate and oedema after first methotrexate pulse.

Comparative study of short term results in two multidrug regimens in multibacillary leprosy.

Thirty lepromatous and Borderline lepromatous leprosy patients were treated with multidrug therapy in an open trial. Fifteen of them received the standard WHO multidrug regimen ie., rifampicin 600 mg and clofazimine 300 mg monthly, supervised, and dapsone 100 mg daily and clofazimine 100 mg on alternate days as self administered; the other 15 received a modified multidrug therapy regimen comprising of rifampicin 600 mg, clofazimine 100 mg and dapsone 100 mg daily for 21 days as suggested by the Indian Association of Leprologists, followed by the standard WHO regimen. The observation period was six months. Clinical, bacteriological, histological and immunological parameters were studied. The fall in morphological index was much faster in patients receiving modified multidrug therapy regimen compared to those receiving the standard WHO regimen. Otherwise, there was no difference between the two groups of patients. Five patients developed type I (upgrading) reaction with one developing ulnar nerve paralysis. No untoward effects of drugs were noted in the study subjects except for darkening of skin colour of all the patients.

Neuritic leprosy: epidemiology and therapeutic responsiveness.

We studied epidemiology, progression and therapeutic responsiveness in 62 cases of neuritic leprosy. Numbness was the main presenting symptom. Mononeuritis involving the ulnar nerve, followed by the common peroneal nerve was the commonest presentation. The lepromin test was positive in 34 cases while a slit-skin smear was negative in all cases. We treated 20 of these cases with dapsone monotherapy and 5 cases (25%) developed a skin lesion after an average duration of 3 months' treatment. We treated 42 cases with a combination of dapsone and rifampicin, and 3 cases (7%) developed a skin lesion after an average duration of 2-6 months. The subsequent diagnosis in cases developing skin lesions was borderline--lepromatous in 1 case, borderline-tuberculoid in 4 cases, tuberculoid in 2 cases and indeterminate in 1 case.

Dyskeratosis Congenita with Adenocarcinoma of Stomach.

A 32 years old male had dyskeratosis congenita with adenocarcinoma of stomach along with occurrence of carcinoma of stomch in four affected family members. The patient presented with progressive reticulate hyperigmentation of the face, neck, upper trunk and arms, hypopigmented macules, lacrimation and epigastric pain.

Dystrophic Epidermolysis Bullosa (Cockayne-touraine Type).

Dystrophic epidermolysis bullosa of Cockayne-Touraine type in a 37-year ole male.

Multidrug therapy in hospitalised leprosy cases.

Fifty eight cases including 44 paucibacillary and 14 multibacillary leprosy diagnosed at Command Hospital SC Pune were hospitalised for the entire period of multidrug therapy. 76% cases belonged to high endemic states of India. Reactions occurred in 13 cases during treatment, type I in 10 and type II in three. 7 Multibacillary cases experienced reaction. 69% reaction patients developed reaction within two months of starting MDT and all of them were multibacillary. Usually it took 3-6 months for majority (61.5%) of reactions subside completely. In 65.5% paucibacillary patients activity subsided within twelve months, however 70.5% paucibacillary cases took more than six months to exhibit subsidence of activity. In 13 multibacillary cases activity subsided by 18 months though bacteriological negativity was obtained from fourth to twelve months.

Adenoid Cystic Carcinoma of the Skin.

Adenoid cystic carcinoma commonly arises from the major and minor salivary glands. Primary cutaneous adenoid cystic carcinoma is extremely rare. The tumour was hard, non-tender, and fixed to the underlying stucture with visible congested veins. Histopathologically, large cell masses with adenoid or cribriform pattern, forming cystic spaces at places were seen. Solid epithelial nests and a few ductal structures were also seen. Plumonary metastases were another unusual feature in our patient perhaps not reported before.

Leprosy with pellagroid features (a case report).

A case of leprosy with pellagroid features is presented. Diagnosis of leprosy was confirmed by bacteriological and histopathological examination. A therapeutic trial with nicotinic acid did not result in any improvement. Occurrence of scaling in leprosy is discussed.

Dermatitis Cruris Pustulosa et Atrophicans.

Fifteen male soldiers having dermatitis cruris pustulosa et atrophicans were studied clinically, bacteriologically, histopathologicafly and immunologically. Average age at detection was 26 years. Skin lesions were classically distributed on the legs. Staphylococcus aure was grown from the lesions. Histopathological findings were of eczematous pattern with polymorphic cellular infiltrate in the dermis. IgG and IgA levels in blood were increased.

Herpes,zoster with Wrist Drop and Aberrant Lesions.

A patient having herpes zoster involving C6, 7, 8, Dl and 2 segments, developed ipsilateral wrist drop and aberrant lesions. Paralytic deformity preceded the skin eruption by one day.

Study of finger print patterns in leprosy.

Finger print patterns of 150 male leprosy patients (100 paucibacillary and 50 multibacillary leprosy) were compared with 50 matched controls. Significant differences were found in finger print patterns of multibacillary leprosy patients and controls. No differences in dermatoglyphic patterns were observed between paucibacillary leprosy and controls. The total finger ridge count (TFRC) in both types of leprosy was slightly lower than controls. A significant difference in individual finger ridge count on digit 1 of right hand was noted in paucibacillary leprosy cases as compared to controls.

Quantification of thermal sensory loss in follow up of progress in leprosy.

Thermal sensory perception quantitatively was studied in follow up of 10 lesions (4 TT, 3 BT and 1 Indeterminate case) of cases put on poly therapy as per WHO regime, for 6 months. Significant thermal sensory improvements was noticed in 4 lesions after 4 months of therapy. Within 2 months of therapy, 3 cases showed improved perception of heat sensation but 1 showed deterioration. Recovery of sensations did not correspond to other clinical parameters of improvement in all the cases. The utility of quantitative evaluation of thermal sensory perception in follow up of leprosy cases is discussed.

Inoculation leprosy developing after tattooing--a case report.

A case of Inoculation Leprosy following tattooing in a soldier is being reported. Escape of infection in one tattoo and occurrence of disease in another when tattooing was done simultaneously, is of interest. Possible mechanism for such occurrence is discussed.

Quantification of thermal sensory perception in leprosy (a preliminary report).

An instrument called 'Thermosense' was designed and developed for quantitative assessment of thermal sensory perception. Preliminary testing on 20 healthy adult males showed that 39 degrees C was perceived as hot in 19 individuals on the forearm and arm. The perception on the finger tips was less than forearms. In 5 cases of leprosy (BT 4, TT 1) testing showed detectable difference in thermal perception within the lesion, in the skin, in the vicinity of the lesion and the uninvolved skin.

Epidemiological and clinical aspects of leprosy in Indian armed forces.

Epidemiological and clinical aspects of leprosy in 1911 cases of the disease in armed forces personnel were studied. Typewise distribution of cases was Tuberculoid 53.53%, Lepromatous 20.57%, Indeterminate 8.74%, Borderline 11.67% and Polyneuritic 5.49%. Maximum leprosy cases occurred in those belonging to Uttar Pradesh 17.11%. Maximum number of cases were detected (88.55%) in age group 20-39 years. Incidence of leprosy increased with increased years of service. 11.82% patients were illiterate. 89.85% patients earned Rs. 200 to 499 per month. 56.08% patients had no landed property. Houses of 47.29% cases were located in congested areas. 68.23% patients had to support larger families. In 95.94% cases no family members were examined for leprosy. Diet, smoking and alcohol appear to have had no relation to disease in cases studied. Clinical presentation of cases was classical and typespecific. Skin eruption and loss of sensation were the commonest symptoms. Leprosy lesions were detected on almost all parts of body. Thermal sensation was the commonest modality lost. Ulnar, lateral popliteal and greater auricular were the frequently affected nerves. Amongst complications paralytic deformities were common (16.09%). 545 complications were detected in 1911 cases. While 84.29% patients had put in more than 4 years of service, the source of infection was known only in 0.57% positively (intrafamilial).

Pattern of Contact Dermatitis Amongst Soldiers.

Six hundred and fifty seven cases suspected to have contact dermatitis reporting at 14 dermatological centres of armed forces hospitals during a 12-month period were investigated. One hundred sixty one cases Showed positive patch tests. Sixty-five cases showed positive patch tests with footwear materials including rubber, leather and canvas. Clothing, topical medicaments, airborne allergens and marking ink were responsible in 5.75%, 25%, 3.82% and 0.85% patients respectively.

Idiopathic Calcinosis of Scrotum.

A 33 year old male had a s increasing hard nodule on the lower part of the scortal skin, for the last 10 years. Histopathology revealed calcified masses without any ifflammatory recction.

Inoculation leprosy subsequent to dog bite. A case report.

Development of leprosy lesion at the site of inoculation or injury is described by many workers off and on. An interesting case of indeterminate leprosy developing at the site of dog bite is being reported.