History of chemotherapy of leprosy.

Chemotherapy of leprosy over the past 70 years has passed through several phases, from sulfones, to clofazimine, and to highly bactericidal drugs like rifampicin. The use particularly of the more potent drugs in effective combinations and the development of standard multidrug therapy regimens have made a huge difference in the successful treatment of leprosy as well as in reducing tremendously the prevalence of leprosy globally. A major contributing factor to development of better drugs and drug combinations has been the introduction of the mouse footpad model to evaluate the in vivo activity of drugs against Mycobacterium leprae. The World Health Organization has recommended multidrug therapy, which has been used to treat more than 15 million patients in the last 30 years and has set an excellent record with regard to its very high rate of cure, very low occurrence of relapse, and very rare occurrence of drug resistance.

Los 100 años de tratamiento de Fontilles: 1ª Parte / No disponible

Objetivos: analizar y conocer el trabajo realizado en el Sanatorio, relativo al tratamiento específico de leprorreacciones y de úlceras en sus diferentes etapas cronológicas. Valorar la influencia de los tratamientos en el Sanatorio de Fontilles y en el pronóstico de los pacientes con lepra atendidos allí durante los 100 años de funcionamiento. Hacer un fondo histórico que recopile los diferentes tratamientos. Metodología: Fuentes: Revista Fontilles. Trabajos del Sanatorio de Fontilles. Apéndice Sanitario. Revista de Leprología 1964 y 1973. Manual actualizado de Leprología 2008 y entrevistas con profesionales sanitarios. Primera etapa: del inicio del Sanitario hasta la utilización del Promin. Segunda etapa: desde el empleo del Promín hasta las recomendaciones de la OMS de 1982. Tercera etapa: desde las recomendaciones de la OMS de 1982 hasta la actualidad. Resultados: En la primera etapa los que destacan son los etilésteres de chaulmoogra. En la 2º etapa son muchos los fármacos ensayados pero destacan las sulfonas, la Clofazimina y la Rifampicina. Se llega a la negativización en piel en monoterapia con los tres. Se necesita dar tratamiento indefinido con Sulfonas para prevenir recaídas. Mejores resultados en monoterapia con Sulfonas y Clofazimina que Rifampicina. En década de los 70 empiezan las asociaciones de fármacos. Se controlan mejor las leprorracciones gracias a los corticoides y la talidomida. En tercera etapa ya empiezan a emplear la poliquimioterapia recomendada de la OMS alargando la duración del tratamiento para asegurarse la curación. Conclusión: En primera etapa no hay cura. En segunda etapa con la monoterapia de sulfonas se llega a la curación de los enfermos y se convierte en enfermedad crónica. Se controlan mejor las leprorreacciones. En tercera etapa se curan los enfermos en menor periodo de tiempo, se tratan las sulfonorresistencias, hay un mejor cumplimiento, menos leprorreacciones, menos efectos secundarios y menos secuelas y no hay recaídas. Hay un descenso gradual de número de ingresos y de residentes debido a la disminución de número de casos nuevos, por mayor número de altas y porque el tratamiento se realiza de forma ambulatoria. Muchos enfermos se quedan en Fontilles, por miedo al rechazo de la sociedad, por las incapacidades que presentan y por no tener familiares

Aim: Evaluate the work carried out at the Sanatorio Fontilles concerning the specific treatmen of leprosy, leprosy reactions and ulcers during the different periods of time and review the efficacy of the different treatments administered during these 100 years. Methods: References: Journal Revista Fontilles, Trabajos del Sanatorio de Fontilles, Manuel Actualizado de Leprología 2008 and also interview with medical and paramedical staff members. First period: from the inauguration of the institution until the use of Promin; Second Period; from the use of Promin until 1982 when multidrug therapy (MDT) is recommended by the World Health organization and the third and last period from 1982 to actual times. Results: During the first period the use of chaulmoogra oil is reviewed. During the second period several drugs were administered in monotherapy: dapsone, clofazimine and rifampicin and patients were rendered skin smear negative. The treatment with dapsone was chronic to avoid relapses. In the 70s drug combinations were started and leprosy reactions were controlled by the administration of corticoids and thalidomide. In the last period the WHO recommended MDT is implemented. Conclusion: During the first period there is no effective cure available but during the second period the patients can be cured with dapsone monotherapy and the disease is considered chronic and leprosy reactions can be more effectively controlled. In the last period the affected individuals can be cured in a shorted period of time with less drug resistance, fewer leprosy reactions and adverse drug effects together with a significant reduction in relapses. The number of resident patients is gradually reduced since the disease can be treated on an outpatient basis. Many patients decide to voluntarily reside in the Sanatorium due to their disabilities or for the fear of social stigma

[About a note published in 1926 on a BCG vaccine trial in leprosy treatment]. / À propos d'une note de 1926 sur un essai du BCG dans le traitement de la lèpre.

By 1926, two French physicians working in Indochina, R. Pons and L. Chastel, have suggested to treat leprosy by subcutaneous injections of bacillus Calmette-Guerin. This treatment appeared efficient since the lepromatous lesions quickly regressed and the Hansen bacillus disappeared from the nasal mucus. These results were quickly confirmed by other authors. They were all more appreciated than, at this time, the Chaulmoogra oil and its products, the only available drugs, were poorly efficient against the disease. Nevertheless, although not a panacea, the BCG therapy allowed to relieve these unfortunate patients until the beginning of the 1950's when an effective treatment by sulfones was at length available.

Historia de la lepra, internacionalización de enfermedades con la conquista de América y otras pandemias / No disponible

No disponible

[Leprosy--a stigma in the 21st century]. / Lepra--stigma a XXI. században.

For the initiation of the French journalist Raoul Follereau in 1954 the UNO inaugurated the Leprosy Day (Martyr's Day) that is celebrated on the last Sunday of January every year. Although the bacterium that causes leprosy was isolated by the Norwegian scientist Gerhard Henrik Armauer Hansen in 1873 and from 1982 this disease can be cured with a special pharmaceutical complex, still 219.826 new leprous are detected on Earth every year, according to the data published in August, 2010 by WHO-experts. Ancient Chinese and Hindu source-strings from 600 B. C. are referring to leprosy, however, the disease was imported by the army of Alexander the Great from India around 327-326 B. C. Even the Old and the New Testament from the Holy Bible are mentioning leprosy in several details. During the Middle Ages the Military and Hospitaller Order of St. Lazarus of Jerusalem, established in the Holy Land in 72 A. D., did pioneer work in nursing leprous. In the process of time the medical attendance concerning leprous was organized in special hospitals called "leprosoriums" built on river-banks. Special office and even services were organized for the treatment and isolation of the people infected. Although medical science has prevailed against leprosy, and almost simultaneously even jurisprudence defended the patients' rights via legislation, still mankind can regrettably not get rid of this disease that stigmatizes seriously.

A short history of dapsone, or an alternative model of drug development.

From 1936 until 1996, the drug dapsone treated a diverse array of diseases, including tuberculosis, leprosy, malaria, and AIDS-related pneumonia. This article explores how dapsone transformed from a cure for one disease into a treatment for a totally different malady. This process of reinvention in the clinic represents an alternative model of drug development that the historical literature, focused on success in the laboratory, has largely ignored. The core of the paper discusses the reinvention of dapsone as an antimalarial in the Vietnam War through trials led by Robert J. T. Joy, a physician and military officer. As a case study, it offers a fresh perspective on the clinic-as-laboratory approach that other scholars have addressed in a civilian context. Viewing the randomized clinical trial (RCT) through a military prism will demonstrate how a combat environment combined with the regimentation of the armed forces affected the standard methodology of the RCT.

A short history of dapsone, or an alternative model of drug development.

From 1936 until 1996, the drug dapsone treated a diverse array of diseases, including tuberculosis, leprosy, malaria, and AIDS-related pneumonia. This article explores how dapsone transformed from a cure for one disease into a treatment for a totally different malady. This process of reinvention in the clinic represents an alternative model of drug development that the historical literature, focused on success in the laboratory, has largely ignored. The core of the paper discusses the reinvention of dapsone as an antimalarial in the Vietnam War through trials led by Robert J. T. Joy, a physician and military officer. As a case study, it offers a fresh perspective on the clinic-as-laboratory approach that other scholars have addressed in a civilian context. Viewing the randomized clinical trial (RCT) through a military prism will demonstrate how a combat environment combined with the regimentation of the armed forces affected the standard methodology of the RCT.

[Chaulmoogra oil as scientific knowledge: the construction of a treatment for leprosy]. / O óleo de chaulmoogra como conhecimento científico: a construção de uma terapêutica antileprótica.

The article investigates how knowledge of medicinal plants and related treatment practices are assimilated and transformed. Taking as its focus the use of chaulmoogra oil to treat leprosy, it examines how information on this plant was incorporated and transformed into scientifically validated knowledge when 'Brazilian chaulmoogra' came onto the scene. Pointing to the addition of chaulmoogra byproducts to the Instituto Oswaldo Cruz's production agenda in the 1920s, the study establishes links between productive processes and relates these to the period's scientific context. From the late nineteenth century until the 1940s, chaulmoogra oil was the great hope in efforts to cure leprosy. During this period, chaulmoogric treatment earned a place as scientific knowledge thanks to research studies conducted in laboratories throughout the Western world.

[Leprosy in Germany 100 years and the early development of anti-leprosy drugs]. / Leprakranke in Deutschland und Einführung industriell hergestellter Lepramedikamente vor 100 Jahren.

Leprosy was nearly eliminated in central Europe by the beginning of 18th century. In the 2nd half of the 19th century, leprosy was imported by Lithuanian rural workers immigrating from the Russian empire into East Prussia. At that time, the ways of infection, the bacteria, and essential diagnostic methods were already known, but there was no effective treatment. A leprosarium was founded in 1899 in Memel. Legislation in 1900 and 1904 regulated the fight against the disease. The patients had to be isolated and not allowed to work with others, in contrast to the situation with cutaneous tuberculosis. Patients with lupus vulgaris, which was not infectious, even had suitable jobs in hospitals. In 1907, Antileprol (Bayer) became available, the first industrial preparation developed from chaulmoogra oils, which had been long used in Indian medicine. The situation of patients, however, remained nearly unchanged, up to the middle of the 20th century, when the first effective mycobacteriostatic agents were introduced.

Multidrug therapy in leprosy can prevent relapse- a retrospective study

A retrospective study was done at the Leprosy Control Unit (LCU) in Durgapur of Burdwan district, West Bengal, to determine the relapse rate following multidrug therapy (MDT). A total of 1581 patients (1276 PB and 305 MB) completed MDT regimens during a period of 5 years as per WHO recommendations and National Leprosy Eradication Programme (NLEP) guidelines. The treated patients were kept under surveillance as per NLEP guidelines and searched for relapses. The results of MDT were compared with those of pre-MDT (monotherapy) era at the same centre (total: 405 patients; PB-373, MB-32) andalso with those of the Leprosy Clinic in Gopalpur (only dapsone was given to a total of 189 patients, PB-167, MB-22) Following monotherapy, the relapse rate was 10.06% at the Gopalpur Leprosy Clinic and 12.4% at the Dargapur LCU during the 2 years (PB) and 5 years (MB) of surveillance, whereas following MDT no relapse case was encountered both in PB and MB cases during the surveillance periods recommended by WHO. The results of this study are comparable with those of ohter studies. Though a few studies showed relapses during long-term surveillance beyond the periods recommended by WHO, it is once again established that MDT can prevent relapse in leprosy

Thalidomide and the Titanic: reconstructing the technology tragedies of the twentieth century.

The Titanic has become a metaphor for the disastrous consequences of an unqualified belief in the safety and invincibility of new technology. Similarly, the thalidomide tragedy stands for all of the "monsters" that can be inadvertently or negligently created by modern medicine. Thalidomide, once banned, has returned to the center of controversy with the Food and Drug Administration's (FDA's) announcement that thalidomide will be placed on the market for the treatment of erythema nodosum leprosum, a severe dermatological complication of Hansen's disease. Although this indication is very restricted, thalidomide will be available for off-label uses once it is on the market. New laws regarding abortion and a new technology, ultrasound, make reasonable the approval of thalidomide for patients who suffer from serious conditions it can alleviate. In addition, the FDA and the manufacturer have proposed the most stringent postmarketing monitoring ever used for a prescription drug, including counseling, contraception, and ultrasonography in the event of pregnancy. The Titanic/thalidomide lesson for the FDA and public health is that rules and guidelines alone are not sufficient to guarantee safety. Continuous vigilance will be required to ensure that all reasonable postmarketing monitoring steps are actually taken to avoid predictable and preventable teratogenic disasters.