Osteoarchaeological evidence for leprosy from western Central Asia.

Published reports of palaeopathological analyses of skeletal collections from Central Asia are, to date, scarce. During the macroscopic examination of skeletal remains dating to the early first millennium AD from the Ustyurt Plateau, Uzbekistan, diagnostic features suggestive of leprosy were found on one individual from Devkesken 6. This adult female exhibited rhinomaxillary changes indicative of leprosy: resorption of the anterior nasal spine, rounding and widening of the nasal aperture, erosion of the alveolar margin, loss of a maxillary incisor, and inflammatory changes in the hard palate. While it is unclear whether the bones of the hands and the feet from this individual were absent as a result of collection strategy or poor preservation, lesions affecting the tibia and fibula were recorded, and the ways in which they may be related to a diagnosis of leprosy are discussed. This is the first skeletal evidence of leprosy from Central Asia and raises questions not only about the spread of the disease in the past, but also about the living conditions of what traditionally were thought of as nomadic peoples.

Leprosy and mortality in the Medieval Danish village of Tirup.

Leprosy was a well-recognized and dreaded disease in Denmark in the Middle Ages (AD 1000-1536). A large fraction of the population was affected by leprosy in the 13th century. This paper analyzes the correlation between signs of leprosy and risk of dying in the small Danish village of Tirup (AD 1150-1350). Seven different dichotomous osteological lesions indicative of leprosy are analyzed, and it is possible to score at least one of these conditions on 135 skeletons of adult or adolescent people (aged 14 or more). Scores were transformed to a statistic, lambda, indicating the likelihood that the person to whom the skeleton belonged suffered from leprosy. The analyses indicate that the prevalence of leprosy among adult people in Tirup was 26% (95% confidence interval, 17-35%). The lambda statistic indicates that people who died with signs of leprosy did not differ in the distribution of age at death from those who did not have such signs. Skeletons showing dental enamel hypoplasia were less likely to come from skeletons with high lambda-values. The association between lambda and dental enamel hypoplasia indicates a relationship between stress in early childhood (ages 1-6 years) and subsequent development of signs of leprosy.

Historia de la Terapéutica de la Lepra / A history of the management of lepra

La Historia de la Terapéutica de la Lepra se divide en tres períodos: incurabilidad, monoterapia y multiterapia. Se describen las diferentes medicaciones en estos períodos y las últimas novedades así como el tratamiento de las reacciones (AU)

An historical and clinical review of the interaction of leprosy and pregnancy: a cycle to be broken.

Since earliest history the person with leprosy has been shut out from society. Laws have prohibited marriage and allowed divorce of those with leprosy. Segregation of the sufferer from the rest of society has been followed by separation of the sexes, and of leprous parents from their children. With the advent of antileprotic drugs, first dapsone then multidrug therapy (MDT), infection can be treated, individuals made non-infectious, and the pool of infection in the community reduced. The clinical signs of leprosy are due not to the degree of infection but to the immunological status of the host. Hormonal changes at puberty and in pregnancy can cause variation of the host's immune status. Pregnancy in women with leprosy is a hazardous undertaking. First appearance of leprosy, reactivation of the disease and relapse in 'cured' patients is likely to occur particularly in the third trimester of pregnancy. Leprosy reactions caused by variation in cell mediated and humoral immunity are triggered off by pregnancy: type 1 reaction (reversal reaction, RR) occurs post partum, while type 2 reaction (erythema nodosum leprosum, ENL) peaks in late pregnancy. Both types of reaction continue long into lactation. Neuritis with loss of both sensory and motor function is associated with relapse and reaction. Relapse, reaction and nerve damage, especially 'silent neuritis', with subsequent deformity and disability, occur not only in women on apparently effective treatment but also in those who have received MDT and have been released from treatment (RFT). To prevent disability, research is urgently needed into the mechanisms of early and late reaction and neuritis. Pregnancy is not only a trigger factor for reaction but an ideal in vivo model for research. Up to 20% of children born to mothers with leprosy may develop leprosy by puberty. While early leprosy in young children is self-healing, when marriage and childbearing take place at an early age the daughters of mothers with leprosy are likely to run the risk of experiencing the adverse effects of pregnancy on leprosy. Increased awareness and health education, as well as long term surveillance of 'cured' leprosy patients, are essential to break a potentially vicious cycle of leprosy and pregnancy. Women with cured leprosy could play an important role in screening for and detection of both early leprosy in children and late, post-MDT RFT, nerve damage in their mothers.

Tuberculosis in leprosy patients detected between 1902 and 1991 in French Polynesia.

From 1902 onward, notification and follow up of leprosy patients has been systematic in French Polynesia. Since 1960, a tuberculosis control program and a register has also been implemented. From 1902 to 1959, 673 cases of leprosy were detected [346 multibacillary (MB), 138 paucibacillary (PB), and 179 unclassified due to the loss of medical files by the time of classification which was done during the 1980s]. Of these 673 cases, 89 (13.2%) died from tuberculosis, giving a mean annual death rate of tuberculosis in leprosy patients of 232 per 100,000. Mortality from tuberculosis in leprosy patients detected between 1901 and 1930 was 20.7%, and decreased to 8.04% in patients detected from 1931 to 1959. In total, it was estimated that 26.4% of the leprosy cases had developed tuberculosis. From 1960 to 1991, 350 new cases of leprosy were detected (141 MB, 209 PB). Of them, 12 (3.4%) developed tuberculosis (7 before detection of leprosy, 5 after detection of leprosy). The dramatic decrease of the proportion of leprosy patients who developed tuberculosis between the periods 1902-1959 (26.4%) and 1960-1991 (3.4%) might be related to the important decline of the tuberculosis situation since 1960. From 1902 to 1959, mortality from tuberculosis occurred significantly more frequently in MB patients (13%) than in PB patients [4%, relative risk (RR) = 3.21, p = 0.003]. From 1960 to 1991, the incidence of tuberculosis seemed more frequent in MB patients (RR = 2.96, p = 0.07) whatever the sequence of detection of the two diseases. Our study suggests that lepromatous patients could share factors of susceptibility to mycobacterial diseases with patients developing tuberculosis.

Lepra tuberculóide en Mexico

La lepra tuberculoide es del tipo benigno de la enfermedad, no infectante, regresivo y de curación espontánea, las manifestaciones clínicas son en piel y nervios periféricos. Fué descrita por primera vez por Jadassohn en 1898. Se le forma crónica mas estable, que cursa habitualmente con leprominorreación positiva y baciloscopia negativa, la segunda es de aparición aguda, nemos estable, en la qual encontrar al principio la baciloscopía positiva y leprominorreación negativa es casi la regla. En los niños la lepra tuberculoide adquiere caracteres especiales, distinguiéndose en éstos 3 tipos de lesiones: nodulares, liquenoides y sarcoides. Para conecer los aspectos clínicos y epidemiológicos de la lepra tuberculoide en México, se hizo una revisión de los archivos del Centro Dermatológico Pascua, de 1955 a 1964, hallándose un total de 1046 expedientes de lepra, de loscuales 190 correspondieron al tipo tuberculoide, encontrádose que es más frequente en el sexo feminino en el adulto de 21 a 50 anos de edad, más frecuentemente diseminada, predominante la variedad fija y la lesion eritematoescamosa

Proposições para a proteção social dos hansenianos, suspeitos e comunicantes / Proposals for social protection of HD patients, suspects and contacts

Os autores apresentam resumidamente uma série de proposições, justificadas neste mesmo trabalho ou em publicações anteriores, e que se destinam a minorar o sofrimento moral dos doentes de lepra e dos seus familiares e comunicantes, bem como dos casos suspeitos de lepra. Entre as medidas apresentadas contam-se: 1- A suspensão do disgnóstico de lepra em casos benignos, tuberculóides ou indeterminados, diexando-se êstes contudo, sob observação e tratamento. 2- Liberdade de escolha, por parte do doente, dos locais de vigilância, de modo que êle possa fazer-se examinar em localidade distinta daquela em que vive e é conhecido. 3- Redução do tempo de internação ao mínimo compatível com a exigências profiláticas, devendo o doente tratar-se em dispensário sempre que isso for possível. 4- Facilitação da regalia de domiciliar, em condições higiênicas adequadas. 5 - Facilitação de visitas aos hospitais de lepra, principalmente aos comunicantes Mitsuda-positivos. 6- Pavilhões para casos "queimados" em todos os hospitais de lepra. 7- Recomendações aos escritores, poetas, jornalistas, cinegrafistas, oradores, radio-anunciadores e outros profissionais com influência sobre a opinião pública, para que evitem empregar as palavras "lepra" "leproso" em sentido pejorativo e que não usem argumentos em que a lepra aparece excessivamente dramatizada ou de carater sensacional. (Proposção aceita oficialmente pelo Congresso). 8- Organização de um "board" para-oficial constituido de dermato-leprólogos funcionando em seus próprios consultórios particulares, mas em comunicação íntima e constante com o serviço oficial de lepra, e a que os doentes poderão acorrer para maior sigilo ou comodidade. Descreve-se o modo de organização de "board" dessa natureza, que viria regularizar e oficializar uma situação já  existente em muitos países...

The depigmented patch in leprosy: a clinical and pathological study

In this paper an attempt has been made to present a description of the depigmentated patch in leprosy from the clinical and pathological view points. The relationship of this particular type of lesion to the disease as a whole is discussed. The different clinical varieties of patch are then dealt with together with a brief reference to certain attributes of this type of lesion. The histological changes are next reviewed and lastly an attempt is made to correlate the clinical picture with the histological findings.My thanks are due to LIEUT.-COL.H.W. Actom, I.M.M., the Director, the School of Tropical Medicine and Hygiene, Calcutta for helpful suggestions during the course of this investigation and to Dr. E. MUIR, M.D., F.R.C.S. (Edin.), in change of Leprosy search for permission to publish this paper.

The depigmented patch in leprosy: a clinical and pathological study

In this paper an attempt has been made to present a description of the depigmentated patch in leprosy from the clinical and pathological view points. The relationship of this particular type of lesion to the disease as a whole is discussed. The different clinical varieties of patch are then dealt with together with a brief reference to certain attributes of this type of lesion. The histological changes are next reviewed and lastly an attempt is made to correlate the clinical picture with the histological findings.My thanks are due to LIEUT.-COL.H.W. Actom, I.M.M., the Director, the School of Tropical Medicine and Hygiene, Calcutta for helpful suggestions during the course of this investigation and to Dr. E. MUIR, M.D., F.R.C.S. (Edin.), in change of Leprosy search for permission to publish this paper.