Tuberculization and reactivity to lepromin. Association between lepromin and tuberculin reactions in schoool children in Cordova and opon Cebu, Philippines

1- A study has been made of the association between the reactions to tuberculin (first and second strength PPD) and early and late reactions to lepromin in 544 children of ages 7 to 9, inclusive, attending public schools in Cordova and Opon, Mactan Island, Cebu. In these municipalities the prevalence of leprosy is about 20 per 1,000 of which one-third is of the lepromatous type. Tuberculosis is known to be frequent. 2- The following percentages were positive: First PPD, 14.0; first and second PPD, 71.9; early lepromin (Fernandez), 4.4; and late lepromin (Mitsuda), 65.3. 3- Only 24 children showed an early lepromin reaction of 10 mm. or larger with infiltration. All of these had typical late reactions. Eight of the 24 were positive to first strength PPD; all of the remaining 16 reacted to the second strength. 4- The occurrence and intensity of the Mitsuda reaction were positively associated with occurrence and intensity of reaction to PPD. If it be granted that a high proportion of reactions to the second strength PPD were attributable to infection with the tubercle bacillus, then tuberculization of the population may have been responsible for concurrent acquirement of reactivity to lepromin. 5- There were, however, disagreements in both directions. There were 9.5 per cent of the children who were negative to the second PPD but positive to lepromin (Mitsuda). In all but one of these the lepromin reactions were small. On the other hand, there were 16.2 per cent who were positive to the second strength PPD but negative to lepromin. In 63.6 per cent of 88 children showing this type of disagreement, the reaction to tuberculin was 2 + or larger. The only explanation of these disagreements which is in conformity with thhe tuberculization hypothesis is that in some persons the two types of response are dissociated. Certain individuals are apparently capable of developing tuberculoid lesions when acid-fast bacilli are injected into the skin but have either lost or never possessed hypersensitivity to tuberculin. In other cases, hypersensitivity is present but capacity to localize the bacilli in the skin by formation of a tubercle is absent...

Considerações sobre a vacinação antivariolica e as reações tuberculinicas na lepra

Num total de 1.076 doentes de lepra vacinados contra a variola, 38 se apresentaram á consulta dentro de 1 a 20 dias após (notadamente do 3º ao 5º dia) com sintomatologia da reação leprotica, sendo 36 com lesões cutaneas nodulares, 1 com nevrites e 1 com artralgias. Em 36 desses casos, a R.L. seguiu-se a uma vacinação positiva. A prova de Mantoux em 23 desses doentescom tuberculina a 1:10000 foi positiva apenas em 12 casos e o exame clinico negativo para tuberculose na totalidade dos casos. Essa investigação foi feita com o proposito de eliminar o fator tuberculose, sobre o qual a vacinação poderia ter agido, provocando indiretamente a R.L. Também essa prova de Mantoux foi seguida de R.L em 6 casos, sendo que 4 após reações negativas. Em um desses casos o sintoma evidente foi uma nevrite aguda do cubital do mesmo braço em que se fez a prova. A ação terapeutica da vacinação antivariolica foi estudada em 16 casos, num periodo de pouco mais de 2 anos. Ficaram inalterados 6 casos, 4 melhoraram e 6 pioraram, tendo-se iniciado a piora já antes da vacinação. Fezem os AA. uma revista bibliografia do eritema nodoso em dermatologia e de suas interpretações. Criticam a hipotese de Denney e Hopkins da "simbiose" entre o bacilo de lepra e o virus vacinal, admitindo por fim tratar-se de um fenomeno paralergico. Negam a ação terapeutica da vacinação sobre a lepra nos casos observados, e lembram o papel possivel da paralergia na determinação de certas nevrites.