Image Morphometric Analysis of B Cells and Plasma Cells in Erythema Nodosum Leprosum With Clinicopathological Correlation.

ABSTRACT: Erythema nodosum leprosum (ENL) occurs as an immunological complication of multibacillary leprosy (MBL). The pathogenesis of ENL is long considered to be a T-cell-mediated process. The role of B cells and plasma cells in ENL is not well described in the literature. Therefore, we investigated the B-cell and plasma cell infiltrates in the skin biopsies of biopsy-proven cases of ENL by immunohistochemistry and image morphometry and compared the result with paucibacillary leprosy and MBL. Moreover, we sought a correlation of the B-cell and plasma cell infiltrates with different clinical, hematological, histopathological, and bacteriological parameters as well as the T-cell subsets in the skin biopsies. Our study highlighted a significant reduction in the number of B cells from paucibacillary leprosy to MBL to ENL, although there was no significant variation in the plasma cell infiltrate. The plasma cell infiltrate correlated with absolute neutrophilia in the blood and the presence of eosinophils in the ENL lesions. Both B cells and plasma cells positively correlated with CD4-positive T-helper cells and the CD8-positive cytotoxic T cells. Besides, the B cells also correlated positively with the CD3-positive pan T cells in the biopsy and negatively correlated with the T-regulatory:T-cell ratio. Our results suggested the role of B cells and plasma cells even at the tissue level in the pathobiogenesis of ENL.

[Hematological, hemostatic and biochemical alterations induced by clofazimine and clarithromycin, in single and multiple doses, in rats]. / Alterações hematológicas, hemostáticas e bioquímicas induzidas pela clofazimina e claritromicina, em doses única e múltiplas, em ratos.

Clarithromycin and clofazimine have been used to treat leprosy, tuberculosis and infections caused by the Mycobacterium avium complex. Since there is a scarcity of data on the toxicity of therapeutic regimens that include these drugs, this study had the aim of determining the adverse effects of these therapies, through evaluation of hematological, hemostatic and biochemical parameters. The drugs were administered to male Wistar rats, as monotherapy, in regimens of single and multiple doses. Clarithromycin caused increases in the numbers of mononuclear and polymorphonuclear leukocytes. Both of the drugs inverted the proportions between mononuclear and polymorphonuclear cells and increased the numbers of polymorphonuclear cells and degenerating cells. Clofazimine and clarithromycin prolonged the prothrombin time and clarithromycin also prolonged the activated partial thromboplastin time. Clarithromycin caused increases in total and direct bilirubin. Both of the drugs increased the plasma levels of gamma-glutamyltransferase. Therefore, clofazimine and clarithromycin induce hematological, hemostatic and hepatic changes.

Alterações hematológicas, hemostáticas e bioquímicas induzidas pela clofazimina e claritromicina, em doses única e múltiplas, em ratos / Hematological, hemostatic and biochemical alterations induced by clofazimine and clarithromycin, in single and multiple doses, in rats

Claritromicina e clofazimina têm sido utilizadas no tratamento da hanseníase, tuberculose e infecções causadas pelo complexo Mycobacterium avium. Como os dados sobre a toxicidade de esquemas terapêuticos que incluem estes fármacos são escassos, este estudo teve como objetivo determinar os efeitos adversos destas terapias, por meio da avaliação dos parâmetros hematológicos, hemostáticos e bioquímicos. Os fármacos foram administrados em ratos machos Wistar, em monoterapia, em regime de doses única e múltipla. Claritromicina provocou aumento de leucócitos mono e polimorfonucleares. Ambos os fármacos inverteram a proporção entre células mono e polimorfonucleares e provocaram aumento do número de células polimorfonucleares e células em degeneração. Clofazimina e claritromicina prolongaram o tempo de protrombina e claritromicina também prolongou o tempo de tromboplastina parcial ativa. Claritromicina causou aumento de bilirrubinas total e direta e, ambos os fármacos, elevaram os níveis plasmáticos de gama-glutamiltransferase. Portanto, clofazimina e claritromicina induzem alterações hematológicas, hemostáticas e hepáticas.

Clarithromycin and clofazimine have been used to treat leprosy, tuberculosis and infections caused by the Mycobacterium avium complex. Since there is a scarcity of data on the toxicity of therapeutic regimens that include these drugs, this study had the aim of determining the adverse effects of these therapies, through evaluation of hematological, hemostatic and biochemical parameters. The drugs were administered to male Wistar rats, as monotherapy, in regimens of single and multiple doses. Clarithromycin caused increases in the numbers of mononuclear and polymorphonuclear leukocytes. Both of the drugs inverted the proportions between mononuclear and polymorphonuclear cells and increased the numbers of polymorphonuclear cells and degenerating cells. Clofazimine and clarithromycin prolonged the prothrombin time and clarithromycin also prolonged the activated partial thromboplastin time. Clarithromycin caused increases in total and direct bilirubin. Both of the drugs increased the plasma levels of gamma-glutamyltransferase. Therefore, clofazimine and clarithromycin induce hematological, hemostatic and hepatic changes.

Effects of horseradish root on functional activity of phagocytes, total blood cell count, and state of the liver in mice with experimental leprosy.

Therapy of experimental leprosy with dried and grated horseradish root administered perorally in a dose of 300 mg/kg mixed food and treatment with purified horseradish peroxidase increased myeloperoxidase activity of blood neutrophils, enhanced antimicrobial functions of phagocytes, decreased leukocytosis, normalized total blood cell count, and produced no adverse effects on the functional state of the liver in mice.

Haematological alterations in leprosy patients treated with dapsone.

OBJECTIVE: To evaluate the haemoglobin concentration (Hb); total white blood cell count (WBC), differential WBC count; platelet count and reticulocyte count in leprosy patients already treated with dapsone. DESIGN: A case-control study. SETTING: Specialist Hospital Ossiomo, which is a Leprosarium and Haematology laboratory, University of Benin Teaching Hospital (UBTH), Nigeria. SUBJECTS: Seventy six leprosy patients (forty males and thirty six females) age range 13-40 years on single dose dapsone. RESULTS: The haemoglobin concentration showed a marked decrease while the reticulocyte count was markedly elevated which was suggestive of haemolytic anaemia. There was also lymphocytosis in patients during pre and post dapsone therapy. CONCLUSION: Leprosy patients on a dosage of 100 mg dapsone, are prone to haemolytic anaemia. Leprosy patients should routinely have their Hb, WBC, platelet count and reticulocyte count determined, while on dapsone therapy in order to ascertain the presence of haemolysis.

Biochemical and hematological side effects of clofazimine in leprosy patients.

Gastrointestinal toxicity and red skin discoloration were the major side effects observed in leprosy patients undergoing long-term treatment with clofazimine (CFZ). Hematological and biochemical alterations have been cited among other side effects; however, their real magnitude and clinical significance at the doses currently employed in therapy have not been sufficiently documented. We therefore investigated the correlation between CFZ plasma concentration and biochemical (transaminases, bilirubins, alkaline phosphatase, gamma-glutamyltransferase, amylase, urea, creatinine, and potassium plasma levels) as well as hematological changes blood and reticulocyte counts, osmotic fragility, detection of Heinz bodies and methemoglobinemia (MHM), following in two regimes of treatment: CFZ as a single drug and CFZ as part of multidrug (MDT) therapy, in combination with dapsone and rifampicin. MHM and hemolytic anemia were detected in the MDT group only. Eosinophilia was found in patients of either group. Determination of hepatic, pancreatic and renal biochemical parameters showed rare, occasional changes of apparently no clinical significance. We conclude that CFZ is a generally well tolerated and safe drug when given as a daily dose of 50mg, which is currently used in leprosy patients.

Haematological alterations in leprosy patients treated with dapsone

OBJECTIVE: To evaluate the haemoglobin concentration (Hb); total white blood cell count (WBC), differential WBC count; platelet count and reticulocyte count in leprosy patients already treated with dapsone. DESIGN: A case-control study. SETTING: Specialist Hospital Ossiomo, which is a Leprosarium and Haematology laboratory, University of Benin Teaching Hospital (UBTH), Nigeria. SUBJECTS: Seventy six leprosy patients (forty males and thirty six females) age range 13-40 years on single dose dapsone. RESULTS: The haemoglobin concentration showed a marked decrease while the reticulocyte count was markedly elevated which was suggestive of haemolytic anaemia. There was also lymphocytosis in patients during pre and post dapsone therapy. CONCLUSION: Leprosy patients on a dosage of 100 mg dapsone, are prone to haemolytic anaemia. Leprosy patients should routinely have their Hb, WBC, platelet count and reticulocyte count determined, while on dapsone therapy in order to ascertain the presence of haemolysis.

Biochemical and hematological side effects of clofazimine in leprosy patients

Gastrointestinal toxicity and red skin discoloration were the major side effects observed in leprosy patients undergoing long-term treatment with clofazimine (CFZ). Hematological and biochemical alterations have been cited among other side effects; however, their real magnitude and clinical significance at the doses currently employed in therapy have not been sufficiently documented. We therefore investigated the correlation between CFZ plasma concentration and biochemical (transaminases, bilirubins, alkaline phosphatase, gamma-glutamyltransferase, amylase, urea, creatinine, and potassium plasma levels) as well as hematological changes blood and reticulocyte counts, osmotic fragility, detection of Heinz bodies and methemoglobinemia (MHM), following in two regimes of treatment: CFZ as a single drug and CFZ as part of multidrug (MDT) therapy, in combination with dapsone and rifampicin. MHM and hemolytic anemia were detected in the MDT group only. Eosinophilia was found in patients of either group. Determination of hepatic, pancreatic and renal biochemical parameters showed rare, occasional changes of apparently no clinical significance. We conclude that CFZ is a generally well tolerated and safe drug when given as a daily dose of 50mg, which is currently used in leprosy patients.

Effects of horseradish root on functional activity of phagocytes, total blood cell count, and state of the liver in mice with experimental leprosy

Therapy of experimental leprosy with dried and grated horseradish root administered perorally in a dose of 300 mg/kg mixed food and treatment with purified horseradish peroxidase increased myeloperoxidase activity of blood neutrophils, enhanced antimicrobial functions of phagocytes, decreased leukocytosis, normalized total blood cell count, and produced no adverse effects on the functional state of the liver in mice.

Effects of peroxidase therapy on functional state of the liver and phagocytes and blood cell counts in mice with experimental leprosy.

We studied the effects of long-term therapy with horseradish peroxidase administered orally to mice with experimental leprosy. Horseradish peroxidase stimulated phagocyte myeloperoxidase activity that correlated with their functional activity, reduced leukocytosis, and produced no adverse effects on the liver.

Influence of acetylator phenotype on the haematological and biochemical effects associated with dapsone in leprosy patients.

Methaemoglobinaemia and haemolytic anaemia were the principal side-effects observed in 30 leprosy patients undergoing long-term treatment with dapsone as a single drug or as part of multidrug therapy. Hepatic, pancreatic and renal evaluations showed no relevant clinical changes. Since N-acetylation is a major metabolic pathway for dapsone, slow acetylation phenotype may be a risk factor for the development of these reactions. To confirm this hypothesis we correlated acetylator phenotype and the haematological and biochemical effects induced by dapsone. No excess proportion of slow acetylators was found. We conclude that slow acetylators are not at greater risk of developing haematological side-effects of dapsone than fast acetylators.

T and CR+ lymphocyte profile in leprosy and the effect of treatment.

Thymus-derived lymphocytes (T lymphocytes) and complement receptor-bearing lymphocytes (CR+ lymphocytes) were estimated by using erythrocyte rosettes and erythrocyte-antibody-complement rosettes as markers in untreated lepromatous and untreated tuberculoid patients and in healthy controls. Treated lepromatous cases were also investigated. Ten cases of untreated lepromatous patients were reassessed 6 months or more after therapy commenced. A significant decrease in both percentages and absolute numbers of CR+ cells in the untreated lepromatous leprosy subjects was observed. This decrease showed a return to normal levels after treatment. The percentage of T cells in the untreated lepromatous cases was normal; however, the absolute numbers of T cells and the total lymphocyte count showed a significant decrease. After therapy, the T cell population was unchanged but the total number of lymphocytes increased significantly with treatment. The absolute number of T and CR+ cells was significantly less in the untreated than in the treated lepromatous patients.

Thymus-dependent lymphocytes of peripheral blood in leprosy patients.

Study of the numbers of thymus-derived lymphocytes by the rosette assay (T-RFC) in patients with leprosy reveals that lower than normal numbers of T-RFC are regularly seen in those patients with the active lepromatous form of this disease. Essentially normal numbers of T-RFC were found in inactive lepromatous, borderline, and indeterminate types of leprosy. The lowest percentages and lowest absolute numbers of T-RFC were encountered in patients with lepromatous leprosy resistant to chemotherapy. Patients with lepromatous leprosy complicated by erythema nodosum leprosum show numbers of T-RFC that are more nearly normal than the numbers of T-RFC in patients with uncomplicated lepromatous leprosy. These findings are discussed with respect to the pathogenesis of lepromatous leprosy and the T-RFC deficiency demonstrated in this disease. The possibility that transient defects in T-RFC numbers or function may predispose to lepromatous leprosy is proposed.