An Evalution of Cell Mediated Immunity in Leprosy Patients and a Study of Treatment of Passive Transfer Immunity by CMI Conversion with Immune Cell Transfer.
- Author:
Young Pio KIM
;
Inn Ki CHUN
;
In Kyu HWANG
- Publication Type:Original Article
- MeSH:
Bacillus;
Blood Group Incompatibility;
Blood Transfusion;
Dinitrochlorobenzene;
Fever;
Histocompatibility;
Humans;
Immunity, Cellular*;
Korea;
Lepromin;
Leprosy*;
Leprosy, Tuberculoid;
Phobic Disorders;
Prognosis;
Psychotic Disorders;
Skin;
Skin Tests;
Tuberculin;
Tuberculin Test
- From:Korean Journal of Dermatology
1977;15(2):123-131
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Leprosy is an infectious dis as in which the immune machanism, in addition to the bacillus, plays an important role in Pathogenesis. As leprosy has two polar types, one of which is characterized by well preserved cellular immunity with a good prognosis and the other which shows no cellular immunity and a poor prognosis, it has been considercd the best human model for immunologic research. By studying the differences between these two typs, insights into immune deficiecies might well lead to the improved treatment of leproatous leproy(i.e.no cellular immunity) patients. Therefore, some immuno-theraputic trials for leprosy patients have already been reported by somc authors. In an attempt to survey spcific as well as nonspecific cellular immunity in leprosy, the authors prformed the lepromin and tuberculin skin tests with DNCB active cutanous sensitization on 203 leprosy patients in residence at the national leprosarium of Korea. All groups of Ieprosy patients showed decreased skin reactivity to the three tests, compared with normal, healthy control groups(p<0.01). This phenomenon is probably due to disorganization of lymphnode architecture and antigenic competition. Although a, statiscally significant difference could not be found in the tubercuIin and DNCB sensitization test results among all groups, the tuberculoid leprosy group and the arrested leprosy group showed stronger reactivity than the non-tuberculoid leprosy group. Patients positive for DNCB sensitization showed more positivity to the tuberculin test (66%)than to the lepromin test (30%) (p<0.01), thus suggesting that nonsp cific CMI and specific CMI exerted diffenent effects. Patients positive for DNCB sensitization also showed a greater probability (77%) to be responsive to either of the other two delayed cutanous hyperssensitivity tests than not. Leprosy patients in the third or fourth decade of life showed 63-66% positivity to DNCB active sensitization, while those in the six or seventh decad showed a positivity of 18-28%. These points toward significant correlation batween age and immun status. (p<0.01). The spontansous flare up during DNCB sensitization most frequently occurred on the 10th to 12th day of senitization: positive reaction after chalenge was most frequent in 72 hrs. after the test but some ractions were seen as late as five days after th. test. Two patiants of whole blood and its equivalent of leukocyte-rich plasme were irfused into 10 patients who had shown negative reaction to al! three tests. Conversion of delayed cutaneous hyprs:nsitivity among then was as follows; Four in tuberculin test (3 cases of which were strengthenings of preexisting ractivity). 2 in lepromin test, and 4 m DNCB sensitization. Of th 6 patients who showed a conversion in any one of the delayed cutaneous hypcrsensitivity evaluation tests, 4 showed conversion in more than two tests Of the 10 patients, who receivcd the transfusions (whole blood or lecocyte-rich plasma), 5 cases showed a high fever for 2 days afterrvards. The authors regard histocytotoxicity, incompatible histocompatibility, or perhaps simply a transfusion reaction as the underlying cause of this febrile reaction. One patient developed probably a phobia type psychosis following the blood transfusion and was subseuetly dropped from this study. Two months of observation following the transfusion revealed no definite clinical improvement.
