Serological distinction of integral plasma membrane proteins as a class of mycobacterial antigens and their relevance for human T cell activation.

This study pertains to classification and antigenic analysis of mycobacterial plasma membrane proteins in relation to human T cell proliferative responses, using a 'fast grower' Mycobacterium fortuitum as model. Membrane vesicles, prepared by sonication and differential centrifugation, were subjected to biphasic Triton X-114 extraction for isolation of integral peripheral (aqueous phase) proteins. Neither protein pool showed any appreciable overlap serologically. SDS-PAGE showed five prominent bands in peripheral and three in the integral protein pool, whereas immunoblotting with rabbit antisera identified only two major antigens (60 and 67 kD) in the former and five (24, 34, 42, 51 and 54 kD) in the latter. ELISA with a panel of anti-mycobacterial MoAbs revealed that nine out of 12 previously known antigens were present in the peripheral protein pool. Only two of them (33 and 40 kD) were additionally detected amongst integral proteins. The membrane-associated immunosuppressive moiety lipoarabinomannan was semiquantitatively located in aqueous phase. In bulk T cell proliferation assays, seven out of 10 subjects belonging to a 'responder' background (BT-BB leprosy patients and healthy contacts) showed high responses for Myco. fortuitum antigens. Proliferative response with integral proteins was comparable to that with whole membrane, but it was significantly higher (P < 0.0005) than the response with peripheral proteins. The distinction and relevance of integral membrane proteins as a class of mycobacterial antigens make them worthy of consideration in a subunit vaccine design.

Sequential clinico-histological studies in psoriasis following methotrexate therapy.

Ten cases of psoriasis were studied to see the pattern of histological resolution and to evaluate clinico-histological correlation in psoriasis following weekly methotrexate therapy. Five sequential biopsies were taken in each patient. Scaling was first to regress followed by induration and erythema in 18, 26 and 35 days, respectively. Uniform granular layer appeared in 4 days, stratum corneum became orthokeratotic in 7 days, mitotic activity got restricted to basal layer in 7 days and rete ridges elongation was reduced to half in 11 days. Mild acanthosis, cellular infiltrate and vascular dilatation pesisted even after full clinical regression. Interestingly, 5 out of 10 biopsies revealed increase in cellular infiltrate and oedema after first methotrexate pulse.

Comparative study of short term results in two multidrug regimens in multibacillary leprosy.

Thirty lepromatous and Borderline lepromatous leprosy patients were treated with multidrug therapy in an open trial. Fifteen of them received the standard WHO multidrug regimen ie., rifampicin 600 mg and clofazimine 300 mg monthly, supervised, and dapsone 100 mg daily and clofazimine 100 mg on alternate days as self administered; the other 15 received a modified multidrug therapy regimen comprising of rifampicin 600 mg, clofazimine 100 mg and dapsone 100 mg daily for 21 days as suggested by the Indian Association of Leprologists, followed by the standard WHO regimen. The observation period was six months. Clinical, bacteriological, histological and immunological parameters were studied. The fall in morphological index was much faster in patients receiving modified multidrug therapy regimen compared to those receiving the standard WHO regimen. Otherwise, there was no difference between the two groups of patients. Five patients developed type I (upgrading) reaction with one developing ulnar nerve paralysis. No untoward effects of drugs were noted in the study subjects except for darkening of skin colour of all the patients.

Neuritic leprosy: epidemiology and therapeutic responsiveness.

We studied epidemiology, progression and therapeutic responsiveness in 62 cases of neuritic leprosy. Numbness was the main presenting symptom. Mononeuritis involving the ulnar nerve, followed by the common peroneal nerve was the commonest presentation. The lepromin test was positive in 34 cases while a slit-skin smear was negative in all cases. We treated 20 of these cases with dapsone monotherapy and 5 cases (25%) developed a skin lesion after an average duration of 3 months' treatment. We treated 42 cases with a combination of dapsone and rifampicin, and 3 cases (7%) developed a skin lesion after an average duration of 2-6 months. The subsequent diagnosis in cases developing skin lesions was borderline--lepromatous in 1 case, borderline-tuberculoid in 4 cases, tuberculoid in 2 cases and indeterminate in 1 case.

VDRL titres in early syphilis before and after treatment.

OBJECTIVE: To observe the pretreatment VDRL titres in different stages of early syphilis and evaluate the changes in VDRL titre following treatment using different treatment schedules. DESIGN: Retrospective study was carried out by analysing the records of cases of early syphilis treated between 1976 to 1981. SETTING: Armed Forces personnel treated at different service hospitals in India. SUBJECTS: Of 3183 cases of early syphilis treated with different regimens during this period, 1532 were fully followed-up for a period of 30 months. Records of these 1532 cases were analysed. MAIN OUTCOME MEASURES: Assessment of VDRL titres before treatment and during post treatment surveillance period of 30 months. Attainment of non-reactivity of VDRL test in various stages of early syphilis using different treatment schedules was evaluated. RESULTS: Relatively higher titres were observed in secondary syphilis. Following treatment it was observed that VDRL test was still reactive at the end of 6 months in 16.47% of primary, 27.56% of secondary and 18.95% of early latent cases; at the end of 12 months in 11.38% of primary, 17.25% of secondary and 15.79% of early latent cases while at 30 months reactivity was still observed in 6.60% of primary, 8.39% of secondary and 11.58% of early latent cases. CSF was examined in 1173 cases at 6 months, of which one case revealed VDRL reactivity while two cases showed reactivity amongst 1188 CSF examined at 30 months. There has been no significant difference with broad spectrum antibiotics and 2.4 MU benzathine penicillin. Results were better with 4.8 MU benzathine penicillin and procaine penicillin. CONCLUSION: VDRL test appears to be a reliable test for the follow-up of treated patients in early syphilis. Early treatment prevents development of seropositivity in seronegative syphilis while majority of seropositive cases attain seronegativity by 6 months. Higher doses of benzathine penicillin and procaine penicillin accelerate the speed of seroconversion.

Wars and sexually transmitted diseases in the Indian Army.

PIP: A large majority of the world's soldiers are young, away from home, of low rank, and of low educational level. Many consume large quantities of alcohol and other drugs to cope. This combination of factors leads many soldiers to have sex with prostitutes and other casual partners, placing them at high risk of contracting and transmitting STDs. The worldwide incidence of STD for the US Army in 1978 was 98 per 1000 soldiers. The authors reviewed the records of STD cases treated in the Indian armed forces during the period 1938-78 to find that there was a decline in STDs in the Indian Army from 5.22 per 1000 in 1895 to 2.12 per 1000 in 1978. There was, however, an increase in the incidence of STD during war in the Indian Army, albeit marginal compared to global figures. The incidence of STD in the Indian Armed Forces has been much lower than in any other country. Chancroid was the most common STD, affecting most commonly soldiers aged 21-30 years. Prostitutes remained the most common source of infection. Better education appears to decrease the incidence of infection, there was no homosexuality recorded, marital status had little impact upon the risk of contracting STD, prophylactic measures were taken by only 6% of individuals, and 5% of infected soldiers in 1965 and 7% in 1971 were repeat patients. 60% of the men contracted their STD while on leave just prior to entering the theater of war. The rapid expansion of armed forces which results in relaxed recruiting standards, individual separation from sources of moral influence, the lack of disciplinary and moral control by superiors, the uncertainty of survival, emotional strains, illiteracy, and the lack of adequate recreational facilities support the increased incidence of STD during war. Reasons for the comparatively low incidence of STD among Indian soldiers include good management and discipline, religious faith, social customs, fear of social stigmatization upon contracting STD, close surveillance by military police of soldiers' movements, limited alcohol and drug consumption, patriotic motivation to be as physically and mentally strong as possible for combat, regular medical check-ups, and racial factors.^ieng

Dyskeratosis Congenita with Adenocarcinoma of Stomach.

A 32 years old male had dyskeratosis congenita with adenocarcinoma of stomach along with occurrence of carcinoma of stomch in four affected family members. The patient presented with progressive reticulate hyperigmentation of the face, neck, upper trunk and arms, hypopigmented macules, lacrimation and epigastric pain.

Dystrophic Epidermolysis Bullosa (Cockayne-touraine Type).

Dystrophic epidermolysis bullosa of Cockayne-Touraine type in a 37-year ole male.

Multidrug therapy in hospitalised leprosy cases.

Fifty eight cases including 44 paucibacillary and 14 multibacillary leprosy diagnosed at Command Hospital SC Pune were hospitalised for the entire period of multidrug therapy. 76% cases belonged to high endemic states of India. Reactions occurred in 13 cases during treatment, type I in 10 and type II in three. 7 Multibacillary cases experienced reaction. 69% reaction patients developed reaction within two months of starting MDT and all of them were multibacillary. Usually it took 3-6 months for majority (61.5%) of reactions subside completely. In 65.5% paucibacillary patients activity subsided within twelve months, however 70.5% paucibacillary cases took more than six months to exhibit subsidence of activity. In 13 multibacillary cases activity subsided by 18 months though bacteriological negativity was obtained from fourth to twelve months.

Adenoid Cystic Carcinoma of the Skin.

Adenoid cystic carcinoma commonly arises from the major and minor salivary glands. Primary cutaneous adenoid cystic carcinoma is extremely rare. The tumour was hard, non-tender, and fixed to the underlying stucture with visible congested veins. Histopathologically, large cell masses with adenoid or cribriform pattern, forming cystic spaces at places were seen. Solid epithelial nests and a few ductal structures were also seen. Plumonary metastases were another unusual feature in our patient perhaps not reported before.

Leprosy with pellagroid features (a case report).

A case of leprosy with pellagroid features is presented. Diagnosis of leprosy was confirmed by bacteriological and histopathological examination. A therapeutic trial with nicotinic acid did not result in any improvement. Occurrence of scaling in leprosy is discussed.

Dermatitis Cruris Pustulosa et Atrophicans.

Fifteen male soldiers having dermatitis cruris pustulosa et atrophicans were studied clinically, bacteriologically, histopathologicafly and immunologically. Average age at detection was 26 years. Skin lesions were classically distributed on the legs. Staphylococcus aure was grown from the lesions. Histopathological findings were of eczematous pattern with polymorphic cellular infiltrate in the dermis. IgG and IgA levels in blood were increased.

Herpes,zoster with Wrist Drop and Aberrant Lesions.

A patient having herpes zoster involving C6, 7, 8, Dl and 2 segments, developed ipsilateral wrist drop and aberrant lesions. Paralytic deformity preceded the skin eruption by one day.

Study of finger print patterns in leprosy.

Finger print patterns of 150 male leprosy patients (100 paucibacillary and 50 multibacillary leprosy) were compared with 50 matched controls. Significant differences were found in finger print patterns of multibacillary leprosy patients and controls. No differences in dermatoglyphic patterns were observed between paucibacillary leprosy and controls. The total finger ridge count (TFRC) in both types of leprosy was slightly lower than controls. A significant difference in individual finger ridge count on digit 1 of right hand was noted in paucibacillary leprosy cases as compared to controls.

Quantification of thermal sensory loss in follow up of progress in leprosy.

Thermal sensory perception quantitatively was studied in follow up of 10 lesions (4 TT, 3 BT and 1 Indeterminate case) of cases put on poly therapy as per WHO regime, for 6 months. Significant thermal sensory improvements was noticed in 4 lesions after 4 months of therapy. Within 2 months of therapy, 3 cases showed improved perception of heat sensation but 1 showed deterioration. Recovery of sensations did not correspond to other clinical parameters of improvement in all the cases. The utility of quantitative evaluation of thermal sensory perception in follow up of leprosy cases is discussed.

Inoculation leprosy developing after tattooing--a case report.

A case of Inoculation Leprosy following tattooing in a soldier is being reported. Escape of infection in one tattoo and occurrence of disease in another when tattooing was done simultaneously, is of interest. Possible mechanism for such occurrence is discussed.