Hepatitis B virus infection in lepromatous and tuberculoid patients from Senegal.

Hepatitis B Virus (HBV) seric markers (HBs Ag, anti-HBs, and HBe Ag) were studied in 987 Senegalese leprosy patients (lepromatous: LL; tuberculoid: TT) in comparison with 6187 healthy adults (controls). Two populations of leprosy patients from ILAD (Institut de Léprologie Appliquée de Dakar) were studied: The First study (i.e.: study I) between 1973 and 1977 included 553 patients (329 LL; 224 TT). The Second study (i.e.: study II) between 1982 and 1986 included 434 patients (236 LL; 198 TT). HBV serological markers were tested by various techniques. By RIA, they were present in 98% and 96.5% in the studies I and II respectively. Each marker was studied and compared to the control population. HBs Ag detected by RIA was present in 25.5% (study I) and 23.0% (study II) when comparing to 15.2% in the control group. This marker was correlated with leprosy forms (LL and TT), age, sex, ethnic group.

[Clinical and bacteriological assessment 8 years after triple-drug therapy for multibacillary leprosy in Senegal]. / Bilan clinique et bactériologique huit ans après trichimiothérapie pour lèpre multibacillaire au Sénégal.

Increasing resistance to dapsone (DDS) leads to recommend triple drug chemotherapy (TCT) in multibacillary leprosy (ML). To determinate long term evolution, we evaluated patients who received TCT 8 years ago. Between 1974 and 1976, 30 patients with ML received TCT (rifampicin, prothionamid, and DDS) during 6 or 12 months. At this time satisfactory clinical and bacteriological findings were reported, and from then DDS was given alone. Twelve of the thirty patients have been evaluated in 1983. Six patients had bacteriological index greater than or equal to 2+, three of them had clinical relapse. Seven of the twelve patients did not take regularly DDS; the six relapses belong to this group.

[Osteoarticular lesions in leprosy (experience 1960-1982)]. / Lésions ostéo-articulaires dans la lèpre (expérience 1960-1982).

Bone changes are frequent in leprosy involving small distal bones of the limbs and, in advanced cases, some cranial bones. The various kinds of osteitis and their radiologic features are described as well as the arthritis to which they can give way. These changes may result directly from the infection by M. leprae indirectly through nerve damage and also by pyogenic infections. The therapeutic tactic is discussed according to this approach of the various types of bones and joint damage.

[Leprosy and hepatitis B]. / Lèpre et hépatite B.

In 1966, B. S. Blumberg, investigating for carriers of the "Australia" antigen which he had discovered two years before, finds that the percentage is significantly more elevated in a group of leprous patients than in controls. In this initial work, realized at Cebu, Philippines, he mentions a higher percentage of this antigen carriers among the lepromatous than among the tuberculoid patients. He explains his findings by a genetic hypothesis and by the fact that lepromatous patients are more often hospitalized than the tuberculoid ones, thus narrowest contacts could favour the antigen transmission. Later, the established relation between Australia antigen and hepatitis B incites the authors to disregard the very deceiving genetic hypothesis and to build up the most important characteristic of lepromatous leprosy--cell immunity--as opposed to the tuberculoid form where cell immunity is normal. Investigation for seric markers of hepatitis B virus in patients with tuberculoid or lepromatous leprosy provides a model for the study on "cell immunity and hepatitis B". The juxtaposition of geographic areas with high prevalence of leprosy patients and of HBs Ag carriers is a supplementary argument for the study of their connection. Up to now, about fifty works have been published on this subject. Most of them investigate detection of HBs Ag and a few of HBe Ag and HBs Ac. This bibliographical study, including a personal study, reviews markers of hepatitis B virus replication in leprosy patients, incidence of hospitalization and age of these patients, as well as the methodology used.

[Surgical decompression of neuritis of Hansen's disease]. / Décompression chirurgicale des névrites de la maladie de Hansen.

The recent progress were focused on: the identification of the general immunological mechanism of the hansenian neuritis, demonstrated by endoneural biopsies; the different pathology of the two categories of neuritis; the pathophysiologic derangements, inducing hypoxia or anoxia in the truncular involved segment. The adjuvant role of the canals is important; the clinical differences of the two categories of neuritis and the cases we shall treat by emergency; the importance of antireactionnal treatment and of the notation by tests for the study of the results. The goals are the hemodynamic decompression, useful in the first stage of ENL neuritis, the mechanical decompression of neural fasciculus and the urgent exeresis of necroses or evacuation of febrile abscess. Three technics a re studied: Extraneural and epineural decompression fascicular endoneural necrosis, neurolysis and complex neurolysis for evaluated ENL neuritis and for endoneural necrosis. The different indication according to the two categories: medico-surgical treatment for ENL neuritis, and according the precocity and the delay of the antireactional treatment, and also the absolute emergency of the necrosis and febrile abscess. The results of the treatment of 258 cases of recent neuritis are presented.

Once-monthly rifampicin plus daily dapsone in initial treatment of lepromatous leprosy.

In an international multicentre controlled single-blind trial of 93 previously untreated lepromatous leprosy patients the therapeutic effects of adding rifampicin, 450 mg/day orally or 1,200 mg once monthly in a single oral dose, to dapsone (50 mg/day orally) for the first 6 months of treatment were compared. Clinical and histopathological improvements and bacteriological regression, indicated by the decreases in the bacterial and morphological indices of the skin and nose-blow smears, were satisfactory and practically identical after 6 months' treatment. The once-monthly rifampicin schedule was better tolerated than the daily one. In view of the good therapeutic efficacy and tolerability, the much lower cost of treatment (about one-tenth of that of the daily rifampicin regimen) and the possibility of administration under supervision, once-monthly rifampicin given in a single oral 1,200 mg dose should be recommended, along with a standard dapsone regimen, for large-scale, initial, and intensive combination treatment of patients with lepromatous and borderline-lepromatous leprosy, to help prevent an increase in dapsone resistance. A third antileprosy drug (e.g., clofazimine) may be added to this initial dual-treatment regimen.