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

BACKGROUND: The recent experimental observations suggested that location of M. leprae in the Schwann cells was mediated by epineurial and endoneurial endothelial cells, giving M. leprae access to the inner compartment of nerves and thus to Schwann cells. CD1 is a family of nonpolymorphic beta2-microglobulin-associated transmembrane glycoproteins that is structurally related to classical MHC Ag-presenting molecules, but is encoded by a separate genetic locus. Recent reports have described that human T cells specifically recognize foreign lipid and glycolipid antigens presented by CD1 proteins. Thus, it appeared likely that CD1 represents the key component of a MHC - independent pathway for antigen presentation to T cells. OBJECTIVE: we observed expression of antigen presenting molecules, such as MHC class I, II and CD1, in the vascular endothelial cells and inflammatory cells of leprosy skin lesion. METHODS: MHC class I, II and CD1 expression were studied using immunohistochemical stains. RESULTS: 1. In immunohistochemical stain of HLA-A, B, C, the level of expression in vascular endothelial cells of the borderline tuberculoid leprosy is higher than that of borderline lepromatous leprosy, but lower than that of normal skin tissue. 2. In HLA-A,B,C expression of the inflammatory cells, the level of borderline tuberculoid leprosy is higher than that of borderline lepromatous leprosy and of normal skin tissue(p>0.05). 3. Expression levels of HLA-DP, DQ, DR on endothelial cells decrease significantly in order of normal tissue, borderline tuberculoid leprosy, borderline lepromatous leprosy, lepromatous leprosy(p<0.05). 4. Expression levels of HLA-DP, DQ, DR on inflammatory cells decrease in order of lepromatous leprosy, borderline lepromatous leprosy, borderline tuberculoid leprosy, normal tissue, but statistical significance did not exist. 5. In immunohistochemical stains of CD1b, 3 sections of all 4 normal skin sections and 1 section of 3 borderline tuberculoid leprosy sections showed focal positivity on the dermal inflammtory cells, but borderline lepromatous leprosy sections did not show any positive inflammatory cells. 6. Epidermal Langerhans cells showed positivity on immunohistochemical stains of CD1a and CD1b. CONCLUSION: These results suggest that expression of MHC class I and II on the vascular endothelial cells and expression of CD1b on the inflammatory cells decrease in order of immunity of lepromatous skin lesion and that vascular enothelial cells play an important role in the pathogenesis of leprosy.
Antigen Presentation ; Coloring Agents ; Endothelial Cells* ; Genetic Loci ; Glycoproteins ; HLA-A Antigens ; HLA-DP Antigens ; Humans ; Langerhans Cells ; Leprosy* ; Leprosy, Borderline ; Leprosy, Lepromatous ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Leprosy, Tuberculoid ; Schwann Cells ; Skin* ; T-Lymphocytes

Immunohistochemical staining was performed in 20 skin granulomas of 16 patients with leprosy using antisera against lysozyme and S-100 protein. In lepromatous leprosy, lysozyme positive cells and S-100 protein positive cells were rarely found in the dermis. However, the histoid leprosy specimen had large numbers of lysozyrne positive cells and S-100 protein positive cells in granuloma. In borderline group, lysozyme positive cells and S-l00 protein positive cells were found in the dermis. S-100 protein positive cells were diffusely distributed throughuut the granuloma in borderline lepromatous leprosy, while they were often found in lymphocytic mantle in borderline tuberculoid leprosy. In tuberculoid leprosy, lysozymal staining was encouritered in epitheloid cells and giant cells, but S-100 protein positive cells were predominantly found encircling granuloma. In the epidermis, great numbers of S-l00 protein positive cells were found in tuberculoid leprosy than in lepromatous leprosy.
Dermis ; Epidermis ; Giant Cells ; Granuloma ; Humans ; Immune Sera ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Leprosy, Tuberculoid ; Muramidase* ; S100 Proteins ; Skin

For comparison of clinical classification of leprosy to histopathologic classification, a detailed histopathologic study, using hematoxylin and eosin stain and Ziehl-Neelsen stain, was done on 72 fresh uncomplicated cases of leprosy. The clinical classification was done using the criteria of Ridley and Jopling (1966), and the microscopic features were classified according to Ridley's(1974) definition. Clinical classification revealed that 8 of total 72 patients had tuberculoid(TT), 9 had borderline tuberculoid (BT), 5 had borderline(BB), 10 had borderline lepromatous.(BL), and 31 had lepromatous leprosy(LL). Nine patients were claasified as indeterminate(I) group. Histopathologic classification showed that 3 cases presented tuberculoid(TT), 10 presented borderline tuberculoid(BT), 4 presented borderline(BB), 9 presented borderline lepromatous(BL), 20 presented subpolar leprornatous(LLs), and 10 presented polar lepromatous(LLp) histopathologic characteristics, Sixteen cases were classified as indeterminate(I) leprosy by histopathologic findings. On comparison of clinical classification to histopathologic classification, the two were in consonance with each other in 50 cases(69.4%) and the disparity between them was noticed in 22 cases(30.6%). Among the 22 cases which showed disparity, there was a shift of one step either towards the tuberculoid or lepromatous end of the spectrum in 15 cases, and ihe remaining 7 cases were classified as indeterminate group beaause of nonspecific histopathologic changes.
Classification* ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Leprosy* ; Leprosy, Paucibacillary

The rate of the relapse of leprosy differs from researcher to researcher, so it is thought that the exact decision on the termination of a treatment would play an important role in lowering the rate of the relapse of leprosy. This study attempts to lower the rate of the relapse of leprosy by the decision for termination of leprosy treatment by using reticulum stain of skin in leprosy which is one of granulomatous diseases, as granuloma can be easily observed in reticulum stain in sarcoidosis which is one of the common granulomatous diseases. The patients for this study consisted of five cases of lepromatous type leprosy, three cases of tuberculoid type leprosy, and one case of borderline tuberculoid leprosy. They were treated by a multidrug therapy, and its clinical lesions were observed every month. Also skin biopsy was performed every six months, and the changes of granuloma and acid-fast bacilli were observed in accordance with hematoxylin-eosin, Fite-Farraco, and reticulum stain which provides a better observation of granuloma lesion. Skin lesion of paucibacillary leprosy disappeared in 8 to 12 months, but seen from skin biopsy, epitheloid cell granuloma began to disappear after several months and after 12 months, it almost disappeared. But in some lesion, it remained until 21 months, and even after 33 months, perivascular inflammatory cell infiltrations were found. Skin lesions of multibacillary leprosy disappeared within 9 to 33 months, and bacilli checked by skin smear turned negative, but according to a skin biopsy, the number or the size of the foamy histiocytic granuloma became smaller. There was an example that it still remained after 84-month treatment. As a rule, reticulum stain in leprosy made reticulum fibers surround granuloma in various ways, so it helped us to observe distinctively granuloma. In a treatment of leprosy, it could prevent the relapse of leprosy that the already treated lesions should be checked with repeated skin biopsies at certain intervals, though skin lesions disappear and bacilli are not found in a skin smear. It is concluded that reticulum stain could be one of the useful methods in observing granulomatous lesions for determination of healing of leprosy.
Biopsy ; Granuloma ; Humans ; Leprosy* ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Recurrence ; Reticulum* ; Sarcoidosis ; Skin*

BACKGROUND: Diagnosis of paucibacillary leprosy is difficult owing to lack of sensitive diagnostic tools. Recently, several investigators have studied the use of polymerase chain reaction(PCR) to detect Mycabacterium leprae. Using nested-PCR the sensitivity and specif city of DNA amplification is considerably improved. OBJECTIVE: The purpose on investigation is to assess the efficacy if nested-PCR which is applied to formalin-fixed, paraffin-embedded biopsies material of patients with 1 prosy. METHODS: Biopsy samples were taken from patients with lepremc tous(11 patients) and tuberculoid (10 patients) leprosy, fixed in formalin, and embedded in parafin. The DNA from samples was extracted and amplified through 25 cycles by using the outside pairs of primer(L and L). The second amplification was allowed thproceed through 15 cycles using insice gairs of primer(L and L4). RESULTS: All twenty one samples showed 347-base-pair products. To confirm that the 347-bp product did correspond to the expected portion of the M. leprae groE gene, the amplified product was digested with Pst I. Pst I dipestion yielded 254-and 93-bp fragmerts, as predicted from the sequence of the M. leprae gene. The senilivity was that a single organism was idntified by nested-PCR. CONCLUSION: The nested-PCR is sensitive, specific, and simple diagiostic tool for leprosy.
Biopsy ; Diagnosis ; DNA ; Formaldehyde ; Humans* ; Keratinocytes* ; Leprosy ; Leprosy, Paucibacillary ; Melanocytes* ; Panax* ; Research Personnel ; Saponins* ; Water*

The Ziehl-Neelson's AFB staining method was mainly used for the AFB observation of the mycobacteria. However, this method has several issues of false negative results, and hence a comparative experiment of the Ziehl-Neelson's AFB staining and the fluorescence staining method was done to remedy this problem. As the fluorescence staining method brightly highlights the AFB in a dark field, and also as it is observed with the lower power objective, it is a method that can better the observation and shorten the time of observation as well. The fluorescence staining method that was used in this experiment did a comparative analysis of the Auramine O-Rhodamine B and the Acridine Orange. The results showed that although the Auramine O-Rhodamine B allows easier observation of the AFB with a high fluorescence expression rate for the multibacillary leprosy sample, the darkness on the periphery makes it hard to observe anything else, while also making it hard to observe the cell changes and paucibacillary leprosy of the AFB. However, the Acridine Orange staining method highlights the cells in dark green and changes the color of the AFB from bright red to orange making it easier to observe bacilli. The results of the study show that the Acridine Orange method is superior to the Auramine O-Rhodamine B method in detecting acid fast bacilli in specimen.
Acridine Orange ; Benzophenoneidum ; Citrus sinensis ; Darkness ; Fluorescence ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Mycobacterium ; Mycobacterium leprae

Epdemiological studies were done on 721 patients detected and confirmed as leprosy patients at the Department of Dermatology at Chonnam University Hospitai in the ten years period from l969 to 1978. Statistically, 491 cases were male and 230 cases were female, comprising 2. 1% of the total number of outpatients (34, 631) and showing a decreasing yearly tendency, The percentage of each group, or type; tuberculoid, borderline, lepromatous and indeterminate, was 53.8%, 9.6%, 31.2%, and 5.4%, respectively. The most common age at discovery for males was 30 39 and for female 20~29 with the largest group being adults aged 20~49, 482 cases (66.9%). The sex ratio was 2.1: l, male to female. However, for the tuberculoid types the ratio was 2.5: 1 which was higher than that of the lepromatous type, I. 7: 1, By disease type the most common age group was 20 29 for tubercekid type, 30 39 for lepromatous and borderline group and 10~19 for the indeterminated group. Geographically, 652 cases(90. 4%) were from Chonnam Province and 61 cases (8.5%) from Chonbuk Province. We also observed some significant sequential changes of the type of disease descovered even though 10 years is a relatively short period. There was a tendency towards decreased detection of the tuberculoid type and increased detection of the borderline an.d indeterminate group.
Adult ; Dermatology ; Female ; Humans ; Jeollabuk-do ; Jeollanam-do ; Leprosy* ; Leprosy, Paucibacillary ; Male ; Outpatients ; Sex Ratio

BACKGROUND: Diagnosis of paucibacillary leprosy is difficult owing to lack of sensitive diagnostic tools. Recently, several investigators have studied the use of polymerase chain reaction(PCR) to detect Mycobacterium leprae. Using nested-PCR the sensitivity and specificity of DNA amplification is considerably improved. OBJECTIVE: The purpose of investigation is to assess the efficacy to nested-PCR which is applied to formalin-fixed, paraffin-embedded biopsies material of patients with leprosy. METHODS: Biopsy samples were taken from patients with lepromatous(11 patients) and tuberculoid (10 patients) leprosy, fixed in formalin, and embedded in paraffin. The DNA from samples was extracted and amplified through 25 cycles by using the outside pairs of primer(L1 and L2). The second amplification was allowed to proceed through 15 cycles using inside pairs of primer(L3 and L4). RESULTS: All twenty one samples showed 347-base-pair products. To confirm that the 347-bp product did correspond to the expected portion of the M. leprae groEL gene, the amplified product was digested with Pst I. Pst I digestion yielded 254-and 93-bp fragments, as predicted from the sequence of the M. leprae gene. The sensitivity was that a single organism was identified by nested-PCR. CONCLUSION: The nested-PCR is sensitive, specific, and simple diagnostic tool for leprosy.
Biopsy ; Diagnosis ; Digestion ; DNA* ; Formaldehyde ; Humans ; Leprosy ; Leprosy, Paucibacillary ; Mycobacterium leprae* ; Mycobacterium* ; Paraffin* ; Polymerase Chain Reaction* ; Research Personnel ; Sensitivity and Specificity

While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. We report a case of leprosy type 1 reaction as the first manifestation of borderline tuberculoid leposy. The patient was a 71-year-old woman who had never received treatment for leprosy. She developed multiple erythematous, swollen lesions on has face, extremities and trunk within a few weeks and suffered from paresthesia, numbness and tenderness on those sites. General symptoms were accompanied by fever, malaise, fatigue and loss of appetite. Histological examination revealed multiple tuberculoid granulomas along with neurovascular bundles. A few acid-fast bacilli were detected on AFB stain. The disease was classified as borderline tuberculoid leprosy. The acute neuritis followed by skin lesions represented leprosy with type 1 reaction.
Aged ; Appetite ; Chronic Disease ; Extremities ; Fatigue ; Female ; Fever ; Granuloma ; Humans ; Hypesthesia ; Leprosy* ; Leprosy, Paucibacillary* ; Neuritis ; Paresthesia ; Skin