The author involved in the National Leprosy Elimination Program (NLEP) in Papua New Guinea (PNG) as a WHO consultant has studied the epidemiological status of the disease from 1980 -2000. The result are shown as follow: - Before implementing multi-drug therapy (MDT), the prevalence rate (PR) of the disease was very high (28.1 per 10,000 population). - After 5 years of MDT introduction, the registered cases reduced dramatically and PR declined to 50%. - Distribution of leprosy was even in the different areas. This related possibly to environment, hygiene, living condition and health net work. - After 10 years of implementing the NLEP, PNG has reached already the goal of leprosy elimination with PR less than 1 per 10,000. - MTD has proved to be very effective in treatment of leprosy. It has important role in changing epidemiological status of leprosy in PNG
leprosy ; Leprosy, Lepromatous

By investigating the trends of leprosy in Khanh Hoa through epidemiological indicators during the period of 16 years (1985 - 2000), we estimate its prevalence to be reduced below the rate of 0,5/10.000 and its incidence to be under 5/100.000 in 2003. Proportions of 2 nd degree disability and of multibaciallary type among newly detected cases remaining unchanged in the past 16 years account for a delay in case -finding and a high level of transmission in population. The risk factors for leprosy- related disabilities include delay of diagnosis and erythema nodosum leprosum. It is likely that improvement of information on leprosy at peripheral level and intergration of leprosy control services into general health care system are necessary for us to reach the goal of leprosy elimination
leprosy ; Leprosy, Lepromatous

No abstract available.
Granuloma* ; Leprosy, Lepromatous*

We report a 23-year-old male with lepromatous leprosy atypically presenting with 5-year history of asymptomatic, verrucous papules, and nodules. Human Immunodeficiency Virus (HIV) testing was positive with depressed CD4 count. In HIV/leprosy co-infection, most of the documented patients were diagnosed with paucibacillary leprosy as immune reconstitution disease (IRD) from treatment-induced immunological recovery. Rarely, multibacillary lepromatous leprosy is encountered in the setting of untreated, severe immunodeficiency. Atypical clinical presentation warrants investigation for concurrent HIV infection.

BACKGROUND: Generalized immune activation occurs early in the course of many infectious disease. Laboratory investigations have shown that immune activation can be quantified by the measurement of soluble immune activation products in serum. Soluble CD25, CD8, and CD4 are major immune activation products. Soluble CD8 and CD4 are indices of CD8+ T cell and CD4+T cell activity, respectively. OBJECTIVE: We estimated the concentrations of these molecules in patients with leprosy. METHODS: The study population consisted of 31 patients with tuberculoid leprosy and 71 patients with lepromatous leprosy(32 cases of M. leprae negative patients and 39 cases of M. leprae positive patients). Serum samples and clinical and laboratory data were collected form each patient and control. The levels of serum soluble CD25, CD8, and CD4 were measured by sandwich enzyme immunoassay. RESULTS: The levels of serum soluble CD25 were significantly raised in leprosy patients as compared to control and did not vary signficantly between tuberculoid and lepromatous leprosy. The soluble CD8 levels in the serum of patients with leprosy did not differ from the levels of the control. The levels of serum soluble CD4 were significantly decreased in the patients with lepromatous leprosy, but not in the patients with tuberculoid leprosy. However, there was no significant correlation between CD25, CD8, and cD4 and bacterial indices in patients with lepromatous leprosy. CONCLUSIONs: There data suggest that non-specific immune activation occurs the spectrum in leprosy, while CD4+ T cell activity is significantly decreased in patients with lepromatous leprosy.
Communicable Diseases ; Humans ; Immunoenzyme Techniques ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Tuberculoid

INTRODUCTION: Along with the remarkable decrease in incidence of Hansen's disease, many physicians have little experience and are unfamiliar with the disease entity. Consequently physicians may make an error in or delay the correct diagnosis more frequently in these days. We feel that the physicians should constantly be interested in Hansen's disease, and be aware of the updated aspects as compared with the past. MATERIAL AND METHODS: We have analysed 13 new patients of Hansen's disease in Busan, Ulsan, and Kyungnam district during last 6 years (2002-2007). The clinical features of 13 new patients were compared with 370 cases reported 30 years ago, in our clinic. RESULTS: Among 13 patients, male was 4 and female was 9. Mean age was 63 years, and the mean duration until diagnosis was 15.6 months. Two patients had familial history of Hansen's disease. In the classification, lepromatous leprosy was 6, borderline lepromatous leproys was 4, mid-borderline leprosy was 1, borderline tuberculoid leprosy was 1, and tuberculoid leprosy was 1. Eight patients of 13 have experienced lepra reaction. Level of BI and PGL-I antibody corresponded with type of the disease. Among 13 patients, 9 patients (69.2%) were resident in Busan. CONCLUSION: There was an increase in female population, and mutibacillary forms of Hansen's disease were more common as compared with the past. Since majority of patients were resident in Busan and the duration until diagnosis was too long, the dermatologist, especially in Busan should be interested in and carry on clinical studies of Hansen's disease constantly.
Female ; Humans ; Incidence ; Leprosy ; Leprosy, Lepromatous ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Leprosy, Tuberculoid ; Male

We had given the Anti-PGL-1 ELISA test to the 235 leprosy patients in our Hospital from July 1999 to Aug 2000. There are 48 patients(20.4%) who are over 200 PGL-1 Ab score and 11 patients(4.7%) who are over 500. The patients who are over 500 of PGL-1 Ab score are all lepromatous leprosy and they have been treated from 5 to 49 years. Two patients among them are positive patients and 9 patients are to be observed only I think that they need to be followed up and if the score of Ab has incresed. We suspect that those patients will become active.
Enzyme-Linked Immunosorbent Assay* ; Humans ; Leprosy ; Leprosy, Lepromatous

While for the last thirty years Dapsone (4,4, diaminodiphenyl sulfone; DDS) has been the chemotherapeutic treatment of choice in the management of leprosy, other non-sulfone compounds have been used when patients have shown either sulfone resistance or sulfone sensitivity. Unfortunately, however, there have gradually appeared a significant number of dapsone resistant and non-sulfone resistant patients (i. e., patients resistant to the conventional chemotherapeutic management of leprosy), thus necessitating the synthesis of additional antileprotic medication. At present, it appears that Lamprene (Clofazimine) is the most adequate preparation for the treatment of sulfone and/or other anti-leprotic drug resistant cases, as well as reactive states. The work of Browne and Hogerzeil in 1962, and subsequent studies by ether workers, have demonstrated lamprenes anti-leprotic and anti-inflamatory effects. The drug has also been need successfully in the management of the reactive patient. However, as its most untoward side effect, the drug causes an unsightly darkening of the skin in those areas where the concentration of M. leprae is greatest. Because the literature provides only sparse data on the effect of lamprene on the morphological (MI) and bacteriological (BI) indices of bacteriologically open patients, the authors undertook the following study: Eighteen dapsone resistant patients, two of whom were in lepra, reaction, received a daily dose of 100mg. of lamprene during a period. ranging from 4 to 22 months. Patients were kept under close clinical observation and bacteriological samples were taken at an average of three month intervals from eight different sites on the body, All subjects were in residence at the National Leprosy Hospital of Korea on Sorok island. The study yielded the following results: 1) Within 3 to 8 months after the administration of lamprene, the MI decreas d to the base line in all patients save one. 2) In the short term administered group (less than 10 months), 6 of 1R patients showed a BI increase in inverse proportion to an MI decrease during the initial stage of lamprene administration. However, the BI began to decrease between the 4th and 5th months of treatment. Of the remaining 7 patients, all showed a decrease in both BI and MI. 8) In the long term administered group (more than 10 months), the BI, an indicat- or in the evaluation of long term administration, gradually decreased in 4 of 5 patients. In the remaining patients the BI increased. The authors regard the inverse relationship between the BI and MI as the result of the increment of bacilli secondary to the destruction of M. leprae by lamprene. That groups showed a decrease in both BI and Ml is interpreted as lamprenes biochemical intervention so as to render M. leprae more susceptible to phagocytosis. While. no ready explanation can account for the single case in which the BI increased and the MI also increased, the pos. ibility that there might be a strain of M. leprae resistant to lamprene must be ruled out. thus, given the above results, the authors conclude that lamprene is a valuable antileprotic drug not only for DDF>resistant patients but also for patients in lepra reaction. Moreover, this drug seems to find its best setting in the leprosarium where the untoward side effect of darkened skin does not in any way diminish the patients social relationships.
Clofazimine* ; Dapsone* ; Ether ; Humans ; Korea ; Leprosy ; Leprosy, Lepromatous* ; Phagocytosis ; Skin

No abstract available.
Acupuncture ; Foreign Bodies ; Granuloma, Foreign-Body ; Leprosy ; Leprosy, Lepromatous

Recently, many reports suggest that the activation of Toll-like receptor 2 (TLR2) by microbial lipoproteins may initiate innate defense mechanism against infectious pathogens. Especially, TLR2 is critical in the immune response to mycobacterial infections and the mutations in the TLR2 have been shown to confer the susceptibility to severe infection with mycobacteria. A previous study reported that there is a mutation of TLR2 (TLR2-R677W) in lepromatous leprosy. In this study, thus, we performed the functional study on TLR2 by measurement of IL-12 production in serum and monocytes from leprosy patients with TLR2 mutation (R677W) to verify the relation between TLR2 and the susceptibility to leprosy. Tuberculoid leprosy patients showed higher serum levels of IL-12p70 compared with those of lepromatous leprosy. In contrast with the lepromatous leprosy patient with TLR2 mutation, especially, the group with wild-type TLR2 showed 2-fold increase levels of IL-12p70. Functional studies demonstrated that monocytes from patient with the TLR2 mutation, in comparison to the wild-type TLR2, is significantly less responsive to Mycobacterium leprae lysate. Our results reveal that TLR2 has a important role in the IL-12 production from monocytes and the susceptibility of lepromatous leprosy.
Humans ; Interleukin-12* ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Tuberculoid ; Lipoproteins ; Monocytes ; Mycobacterium leprae ; Toll-Like Receptor 2