Lepromin vs purified bacillus suspension. II. Comparative tests with a purified bacillus suspension

Comparative tests of Wade's "purified acillus suspension" and the standard lepromin prepared from the same pool of leproma have been made in the Philippiones, Netherlands New Guinea, East Africa and South Africa. Consistently in the comparisons the standard lepromin gave more positive Mitsuda reactions, or more strong reactions, than the suspension; and in the healthy children tested the PBS sometimes gave negative results when the reactions to lepromin were positive. For this reason alone it would not be satisfactory for use in field work in which children are involved. Lepromin gave more early reactions than the suspension in the cases for which that effect was reported (Philippines), suggesting that in the preparation of the latter the immediately-available antigenic elements had partly been eliminated. The suspension on the whole caused somewhat less ulceration of the reaction lesions, which is a point in its favor. However, contrary findings were not infrequent, so use of the product could not be advocated strongly on that ground. The results in tuberculoid cases permit comparison of the reactivities of the four different regional groups, whether considering average sizes of the reaction lesions or the percentage of the stronger reactions. Despite the high percentages of positive reactors in the Philippine subjects, the New Guinea people proved to be distinctly more so, and the East African cases the most reactive of all. The South African cases were much less reactive in comparison. The question of why people living in different environments differ materially in reactivity remains an intriguing problem.

Leprosy and tuberculosis. A comparative study with the aid of skin tests with tuberculin, killed BCG, and the Dharmendra lepromin in South African Bantus

The purpose of this study was to acquire information on the immunological relationship between leprosy and tuberculosis, with respect to the theory that tuberculosis protects against leprosy. The results indicated that the late reaction to lepromin, produced in some tuberculin-negative healthy people was slightly intensified and accelerated in patients with tuberculosis and tuberculoid leprosy, which could be explained by the nonspecific Dienes effect. Gross hypersensitivity cannot be ruled out as an explanation. If cross hypersensitivity in our study were identical with cross-immunity, which is not certain, it would mean that BCG has a protective influence against leprosy....

Is erythema nodosum leprosum a favorable occurrence?

1- The average period of treatment until the disease could be declared arrested, in these cases in which that came about, was 57 months in the 23 patients without ENL, but 72 months in the 74 such patients with ENL. Statistically this difference in time is highly significant. There were more of these arrested patients with ENL than without it. 2- The average bacteriological index of the whole lot of ENL cases (200 patients) was higher than that of the whole group without ENL (142 patients), and the time required for the elimination of the bacilli was longer for the ENL group. 3- A mild degree of ENL retarded the arrest of the disease as much as did a severe degree of the condition. 4- The incidence of ENL increased with the duration of the disease. 5- There seems to be no great differences in occurrence of ENL among the various treatment groups (diasone, DDS, streptomycin, PAS, INH). 6- ENL is not a reaction to the drug treatment alone, as it does not occur in nonlepromatous cases under type of treatment. 7- ENL is not a favorable sign.

Positive lepromin reactions with suspensions of normal tissue particles

1- Positive early and "lepromin" reactions have been obtained with suspensions of normal skin and of normal liver particles in patients with tuberculoid leprosy. These suspensions gave negative results in patients with lepromatous leprosy. 2- The results of the experiments support the hypothesis that in the Mitsuda reaction we are dealing with a foreign-body reaction. 3- Besides the particles of normal tissue, the leprosy bacilli may also act as foreign bodies, due to the fact that they are not broken down readily. 4- If the assumption is correct that the Mitsuda reaction is a foreign- body reaction, then it is incorrect to attempt to prove any immunological relationship between leprosy and tuberculosis by means of this reaction. 5- Active lepromin was also prepared from lepromatous liver and spleen.

The value of the histological criterion for the classification of leprosy. A study of reports by several examiners of the same histological preparations

There are reported the results of a study of the same histological preparations from cases of leprosy by several histopathologists from several countries whose experience has been with general dermatological material, few having had any experience at all with leprosy material. There were great differences in opinion, showing that the judgment of the histopathology of leprosy is very difficult. The practical consequences are stressed.

The histopathology of acute panniculitis nodosa leprosa (erythema Nodosum leprosum)

The histological features of 20 specimens of acute panniculitis nodosa leprosa (erythema nodosum leprosum) are studied. The most important feature is shown to be a panniculitis. The histological picture in P. N. L. is shown to be distinct from those of classical erythema nodosum, erythema induratum, sarcoid of Darier and Roussy, and the cutaneous form of polyarteritis nodosa, all of which conditions may bear a clinicl resemblance to P. N. L. Although P. N. L. occurs most frequently in treated cases, the lepromatous state is essential for its development. It is suggested that the term "panniculitis nodosa leprosa" describes more accurately the lesion now known as erythema nodosum leprosum.