Prognostic consideration base on study of 38 hanseniasis patients sumetted to Mitsuda tests 23 to 35 years previously

Out of 2775 hanseniasis patients Mitsuda tested by one of the authors from 1933 to 1947, 38 where re-examined in 1970/1971. 28 had been treated regularly, 6 did not receive sulfones. Improvement or disappearance of dermatological lesions occurred in 31 (81,5 por cento), independently of reactivity. All eleven bacteriologically positive out of 19 Mitsuda negative bacteriologically negative, which is partly attributed to sulfones. One treated bacillary negative patient became positive. 28(76,3 por cento) were neurollogically aggravated, independently of reactivity but more evidently among the stronger reactors. As regards classification, all initially tuberculloid, virchovian and dimorphous patients continued in their types or group, but only 7(41,2 por cento) out of the 17 initially indetermined remained so. Four(23,5 por cento) two Mitsuda, two changed to reactional tuberculoid, 6(35,3 por cento), (Mitsuda) changed to the Virchowian type. these developments according to reactivity confirm the pathogenetic theory postulated in 1937 by one of the authors. Mitsuda reactivity remained generally unchanged, rarely increased or decreased. The good prognostic value of the strong Mitsuda test is generally confirmed, but only as regards classification, bacillation nad dermatological lesions, not form the neurological and social viewpoints.

A non-stigamatizing Bible

The tsará-ath of the Hebrew Books, translated as Lepra in the Greek Septuaginta Bible was a ritual defilement based on various skin and scalp lesions and on blemishes, probably mold, on garment, leather, walls and stones. The previous appellation (Lepra) of those lesions changed to Vitiligo, Psoriasis, Tinea, etc. , but is still current for Leprosy, whose signs cannot be found in the Bible. this historical linguistic confusion is an important cause of serious psycho-social, medical and preventive problems in Christian endemic countries, spreading to non-Christian areas. The last known example is that of the highlands of Papua New Guinea, where Hanseniasis was a disease like the others, until the arrival of western influences and religious missions, resulting in stigmatization and ostracization of patients and their families. To ensure that evangelization should neither be accompanied by discrimination nor by misinformation about the disease, some modern Bible translations are no longer using the world Leprosy. This term has also been abandoned by the Brazilian Ministries of Health and Of Social Welfare, as well as by the United States public Health Service, and by the government of Portugal.

N-factor/Anergic Margin or resistance/susctibility to hanseniasis. III. The general acceptance of the theory under other names, a few pending questions and the related researches ahead

In this third and final articles of a series the general acceptance of the “ N-Factor/Anergic Margin theory under other names is reported. Constitucional capacity to react, gentical aplitude and potential immunity stand among the numerous synonyhms for the old (1937) natural N-Factor; lepromatous macrophage defect , specific defect of cell mediated immunity are pathogenetical explanations for the Anergic Margin (AM). However depression and impairment of immunity arte not included among the synonyms for the AM, as, according to the theory, anergy precedes and conditions virchowian hanseniasis, is not caused by it

N-factor/Anergic Magin or resistance/suscetibility to hanseniasis I. The foundations of the theory

The foundations of the the pathogenetical theory N-factor/Anergic Margin postulated in 1937 and completed in 1957 are given. Based on the observation of 2160 persons who had been tested by the author with Mitsuda's and frequently with other alergens , it was hypothesized that all individuals are born Mitsuda negative but gradually become Mitsuda positive with age, after stimulation by Hansen's mycobacterium, Myco tuberculosis BCG or other unknown agents, if they are capable of reacting, depending on the presence of a constitutional natural factor of resistance (N-factor). If infection occurs, the N-factor bearers resist, but tuberculoid lesions may appear if accessory factors coadjuvate. The minority, lacking the N-factor, remains Misuda negative throughout life (Anergic Margin) and, if infected, may progress to the Virchovian aspects after the same coadjuvation . An extensive range of intermediate reactivities should be placed between both extremes of maximal hyperergy and maximal anergy. The eythematous and/or hypochromic macule would be the theoretical initial stage of the tuberculoid, Virchowian and intermediate lesions. The theory contradicted Mitsuda's hypothesis of exhaustion of the Mitsuda positivity to explain the anergy of nodular (Virchovian) patients. It gave support to a genetical basis for predisposition to hanseniasis and was pessimistic about the preventive possibilities of BCG. The general acceptance of the theory - under its original or modified terminology, the pending questions, and the field it represents for future research will be the subjects of following articles of this series

N-fator/Anergic Margin of resistance/suscetibility rto hanseniasis. II. the general acceptance of the theory

In this second article of a series about the pathogenetical theory N-factor/Anergic Margin of hanseniasis, the first sympathethic editorial reactions (1938-1940) and the general acceptance under modified terminology, inherited ability to destroy bacteria or form granuloma, etc. - for the N-factor; defect of cell mediated immunity, constitutional inaptitude to react, etc for the Anergic Margin, will be reviewed in the third article of the series, together with the authors rebuttals to criticisms.