Leprosy

Leprosy remains an important health problem wordwide. The disease in caused by a chronic granulomatous infection of the skin and peripheral nerves with Mycobacterium leprae. The clinical range from tuberculoid to lepromatous leprosy is a result of variation in the cellular immune response to the mycobacterium. The resulting impairment of nerve fuinction causes be disabilities associated with leprosy. This review summarises recent advances in understanding of the biology of leprosy, clinical features of the disease, the current diagnostic criteria, and the new approaches to treatment of the infection and the immune-mediated complications. Supervesed multi-drug therapy (MDT) for fixed durations is highly effective for all forms of the disease. The widespread implemantation of MDT has been associated with a fall in the prevalence of the leprosy but as yet no reduction in the case-detection rate globally. Thus, leprosy control activities must be maintained for decades to interrupt transmission of infection

Vascular changes in leprosy and its role in the pathogenesis of leprous neuritis

The arteriographic pattern of left hand vessels was studied in 20 patients in leprosy by percutaneous brachial arteriography. Arteriographic abnormalities noted consisted of occlusion, narrowing, tortuosity, dilatation, irregularity and incomplete filling of the lumen by contrast medium. Such abnormal findings were seen in all the arteriograms studied and more than one vessel involvement was noted in over 50 percent cases. This study clearly demonstrated that arterial involvement in leprosy was frequent. No correlation was found between motor weakness and vascular abnormalities. There was no difference in arterial lesions between the patients with and without trophic changes. There was also no correlation between the severity of vascular changes and decline in motor nerve conduction. Degree of histopathological abnormalities in the sural nerve biopsy from these patients showed no features of micro angiopathic neuropathy. It is concluded that the observed vascular abnormalities do not contribute significantly in the genesis of neurological deficit in leprosy.

Somatosensory and autonomic neuropathy as the only manifestation of long standing leprosy

The clinical and neuropathological findings an a patient with "neuritic" leprosy are described. In this rare form of leprosy, skin changes are only minimal or absent anf the diagnosis can be established only by nerve biopsy

Repercussions de la nevrite lepreuse sur la conduction et la douleur nerveuses / Nervous conduction and pain in hansenian neuritis

A study of the nervous conduction with modern technics has lead to classify the nervous damage according to a new and hsitopathological way which seems more convenient than the Seddon's classification. It gives a better understanding of the hansenian neuritis and reasoned procedures for medical or surgical treatment are discussed

Bilan de recherches physiopathologiques sur la nevrite lepreuse: 1-role de la temperature, des microtraumatismes par elongation ou subluxation nerveuse et de la striction canalaire / ?

(Role of temperature, microtraumatisms by elongation or subluxation and canalar stricture.) Cold has a slight aggravating effect on leprosy which is observed in some countries as Iran, South Russia, North India and the Andean cordillera. The subluxation of the ulnar nerve has facilitating effect in the development of the neuritic damage in a limited number of patients. The elongation is important for the production of the ulnar neuritis. The canalar stricture is a major factor causing nerve damage in leprosy. It explains the segmentary localization of the principal damages of the leprous nerves in the proximal areas situated above the tunnels. Intraneural hypertension appears first and is responsible for the swelling of the nerve which gets entraped inside the tunnel. A circulus viciosus is, then, created which maintains and aggravates the intraneural hypertension

Neuritis and paralysis in leprosy

It is not an over-simplication to state that there are two main problems in leprosy, the presence of leprosy bacilli and the presence deformity. Deformity in the limbs, and in the eyelids and cornea, is secondary to involvement of peripheral nerves by the leprosy disease rocess except in the less common instsnces of lepromatous infiltration of skin or bones.