[Chemotherapy of Hansen's disease in Japan--present status].

In order to know leprosy chemotherapy status in Japan, three recently conducted Government-supported nation-wide survey, namely chemotherapy research group survey (Takizawa, 1994, 71 cases) follow up result of Takizawa's study (Miyagi, 1997, 59 cases) and leprosy patient registry (Goto, 1996, 130 cases) were compared and analyzed. For most fresh and relapse cases, multi-drug therapy were applied, among them rifampicin/dapsone or rifampicin/dapsone/clofazimine combinations were selected in about half of new cases and about 1/3 of relapse cases. In many cases dose and intervals were based on WHO protocol, however smaller dosage was used in some cases. Quinolone (ofloxacin) was used in 40% of cases during the therapy. Reversal reaction was observed in 7/71 cases and erythema nodosum leprosum was observed in 6/71 cases. In order to prevent chemotherapy-induced deformities, we propose a modified protocol for new cases accompanied by reactional status, which starts with clofazimine monotherapy and followed by WHO/MB.

Neuropathological analysis of dementia in a Japanese leprosarium.

In a neuropathological study of consecutive autopsies, prevalence and cause of dementia in a Japanese leprosarium were investigated, where more than 95% of inpatients with a mean age of 70 years are now free from active leprosy. In 10 years (1983-1992), clinically overt dementia at death was 35/136 (25.7%) in the age group over 65 years (mean age 79.4). Autopsy was performed in 85 cases (mean age 81 years), and clinically overt dementia was seen in 25 subjects (29.4%). Neuropathologically, Alzheimer's disease (AD) was seen in 9 cases (10.6%), vascular dementia (VD) in 9 cases (10.6%), mixed type in 3 cases (3.5%) and unclassified in 4 cases (4.7%). In the age group of 65-84 years, AD was 5/58 (8.6%), VD was 4/58 (6.9%), mixed type was 2/58 (3.4%), and unclassified was 1/58 (1.7%). Compared with previous Japanese general population-based data, where VD was more frequent than AD, the rate of dementia in our leprosarium was high, and pathologically confirmed AD was as common as VD. Recently, a prophylactic effect of the antileprosy and anti-inflammatory drug DDS (dapsone, 4,4'-diaminodiphenyl sulfone) has been suggested. Lepromatous patients take more DDS (51.9%) than tuberculoid patients (11.5%), however, as the dementia rate of tuberculoid leprosy (17.9%) in those 65-84 years old is similar to lepromatous leprosy (15.9%) in our study, we do not support their viewpoint.

[Changes and present status of a Japanese National Leprosarium--analysis of smear positive rate and relapse in Hoshizuka-Keiaien between 1972-1991].

Change of clinical features of leprosy in a Japanese National Leprosarium Hoshizuka-Keiaien during 20 years (1972-91) was studied by analyzing clinical records. (1) Skin slit smear positive rate among lepromatous and borderline cases once increased from 16.3% (1972) to 28.8% (1981) and then declined to 3% (1991). (2) Relapse was 4.25 cases per annum among 817 patients (0.52% per annum). Relapse of lepromatous leprosy (0.42% per annum) is decreasing, and borderline or neuritic relapse (0.12% per annum) of previously lepromatous cases is the major feature in recent years. (3) In lepromatous relapse cases, it took 3.5 years in average to become smear negative again, but this duration is shortening in recently relapsed cases. (4) Number of erythema nodosum leprosum is remarkably decreased, but iridocyclitis is still observed. (5) 85% of inpatients in 1991 are classified as clinical cure (Japanese criteria 1989). By the advance of chemotherapy and aging of the inpatients (average age: 68 years), geriatric diseases, instead of leprosy, are becoming major problems in Japanese National Leprosaria.