Global efforts to control leprosy by intensive chemotherapy, including rifampin, have led to a significant decrease in the number of registered patients. But emergence of rifampin-resistant strains of pathogenic mycobacteria has threatened the usefulness of this drug in treating mycobacterial diseases. Mutations in the rpoB gene, encoding the betasubunit of RNA polymerase, were reported to result in resistance to rifampin in several mycobacterial species, including M leprae. To prevent the emergence and transmission of drug-resistant leprosy and to identify and treat existing cases, it is necessary to establish rapid methods for detection of drug resistance in M leprae. However, M. leprae has not been cultivated on artificial media; therefore, to identify drug susceptibility patterns, bacteria must be tested using Shepard's mouse footpad assay. This in vivo method requires at least 6 months and relatively large numbers of bacteria. Recently, there have been advances in the elucidation of molecular events responsible for drug resistance in mycobacteria Sequences of the rpoB, genes were analyzed for 43 isolates of Mycobacterium leprae from leprosy patients in Korea. Three isolates(6.98%) showed representative mutations in the rpoB, genes, suggesting the emergence of rifampin-resistant M. leprae.
Animals ; Bacteria ; DNA-Directed RNA Polymerases ; Drug Resistance ; Drug Therapy ; Humans ; Korea* ; Leprosy ; Mice ; Mycobacterium leprae ; Rifampin

Hansen's disease, chronic infectious disease caused by Mycobacterium leprae. The different clinical presentations of the disease are determined by the quality of the host immune response. The bacteria have affinity for the skin and peripheral nerves and are likely the cause of neuropathy, a cardinal manifestation of the disease. WHO recommends a protocol of multidrug therapy(MDT), which effectively controls the disease, hence contributing to the global elimination program. Early detection of leprosy and treatment by MDT are the most important steps in preventing deformity and disability. For the understanding of recent characteristics of the new & relapse Hansen' disease in Institute for Leprosy Research Korea, we are summarized and reported the epidemiological factors. During recent 5 years(2004-2008), we were experienced 26 new cases and 12 relapse cases of Hansen's disease in our institute, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. 1. In 26 new cases, the mean age is 64.11 in 18 Koreans and 27.75 in 8 foreigners(Indonesia, Nepal, Philippines, Sri Lanka, Thailand), the types of Hansen's disease are 19 lepromatous, 2 borderline and 5 tuberculoid, mean BI is 3.7+, mean O.D. of PGL-I antibody is 0.697, numbers of TTC repeat are 12(7 cases), 11(6 cases), 13(5 cases), 10(4 cases), 16(2 cases), and 31(1 case) and of GACATC repeats are 4(all 18 Koreans) and 3(all 8 foreigners). Among 26 new cases, 1 case(53ACC/GCC) has the mutation of folP1 gene and all new cases have no mutation of rpoB gene. 2. In 12 relapse cases(all Koreans), the mean age is 61.08, the types of Hansen's disease are all 12 lepromatous, mean BI is 4.8+,and mean O.D. of PGL-I antibody is 0.960, and numbers of TTC repeat are 11(6 cases), 12(4 cases), and 13(1 case), and of GACATC repeats are 4(all 12 Koreans). Among 12 relapse cases, 3 cases(55CCC/CGC) and 1 case(53ACC/ GCC) have the mutation of folP1 gene and 3 cases(425TCG/TTG) and 1 case(420CAC/GAC) have the mutation of rpoB gene. 2 relapse cases have the mutation of folP1 & rpoB gene.
Bacteria ; Biopsy ; Communicable Diseases ; Congenital Abnormalities ; Enzyme-Linked Immunosorbent Assay ; Korea ; Lepromin ; Leprosy ; Mycobacterium leprae ; Nepal ; Peripheral Nerves ; Philippines ; Recurrence ; Skin ; Sri Lanka

In 2007, we find 3 new cases and 3 relapse cases, diagnosis by the clinical finding, skin smear, skin biopsy, lepromin test, ELISA for PGL-I antibody, and DNA-PCR. The results obtained were summarized as follows: 1. In 3 new cases, 2 Koreans are 70 and 79 years old, one foreigner (Filipino) is 38 years old, mean BI is 2.8, and mean O.D. of PGL-I antibody is 0.22, and numbers of TTC repeat are 10(Korean), 11(Korean), and 12(Filipino), and of GACATC repeats are 4(2 Koreans) and 3(1 foreigner/ Filipino). All new cases have no mutation of folP1 & rpoB gene. 2. In 3 relapse cases, the mean age is 56.8, mean BI is 5.6+, and mean O.D. of PGL-I antibody is 0.70, and numbers of TTC repeat are 11(2 cases), and 12(1 case), and of GACATC repeats are 4(all 3 Koreans). Among 3 relapse cases, 2 cases have the mutation of folP1 gene and 2cases have the mutationo frpoB gene, especially one case have the mutation of both folP1 & rpoB gene.
Biopsy ; Emigrants and Immigrants ; Enzyme-Linked Immunosorbent Assay ; Humans ; Lepromin ; Leprosy ; Recurrence ; Skin

TOBJECTS: Leprosy is a chronic infection principally affecting the skin and peripheral nerves caused by the obligate intracellular organism Mycobacterium leprae. Complications secondary to the neuropathy can result in deformity and disability. The plantar ulcer is the commonest complication in leprosy. And the plantar pressure is important factors developing plantar ulcer. So the author is studied about the possible predicting factor of the plantar ulcer in patients with leprosy. SUBJECTS AND METHOD: Subjects included 100 leprosy patients, divided two groups according to the recent plantar ulcer history. The author analyzed the relations between that significant factors and various factors (PGL-I titer, sensory level). RESULTS: The correlations between the PGL-I antibody titer(Spearman's rho=0.215, p=0.048) and PGL-I antibody group(Spearman's rho=0.215, p=0.045) and the recent plantar ulcer history were found. CONCLUSION: The author ascertained that the PGL-I antibody titer and PGL-I antibody group PGL-I antibody titer would be the possible tool for predicting the plantar ulcer of the Hansen disease program.
Congenital Abnormalities ; Foot Ulcer ; Humans ; Leprosy ; Mycobacterium leprae ; Peripheral Nerves ; Skin

The Cyberknife is an integrated image-guided, frameless radiosurgery system. The physical component includes a compact 6 MV X-band linear accelerator mounted to the mobile arm of a robotic manipulator and a real- time imaging system connected to a remote image registration console. Two orthogonally positioned diagnostic x-ray cameras provide real time images of the patient's internal anatomy during treatment. The images are processed automatically to identify radiographic features, such as skull bone landmarks or implanted fiducials and are then automatically compared with digitally reconstructed image of the patient's planning CT. In this processing, the direction of the radiation beam is continuously re-adjusted to reflect any changes in the patient position. An analysis of the accuracy of the Cyberknife radiosurgery system found that the machine has a clinically relevant accuracy of 1.0 +/- 0.3mm. While clinical results with intracranial lesions are comparable to frame-based radiosurgical technique using gamma-knife or linac, recent experiences demonstrate the potential to broadly expand the scope of radiosurgery to many extracranial sites especially for cancer patients. The major potential benefit of radiosurgical ablation of malignant tumors are relatively short treatment time in an out-patients setting combined with better local control of the tumor with minimal risk of side effects. Cyberknife radiosurgery offers a new and alternative therapeutic modality for the medically inoperable early cancers, previous irradiated sites, and difficult lesions not amenable to open surgery, as a boost therapy with surgery or external radiation therapy or for rapid symptom relief of palliative care patients. While we are encouraged by excellent local control of early clinical experiences of Cyberknife, we also stressed the importance of long term follow-up results.
Arm ; Fiducial Markers ; Humans ; Outpatients ; Palliative Care ; Particle Accelerators ; Radiosurgery ; Radiotherapy, Image-Guided ; Skull

Purpose: The purpose of this study was to identify changes in physical activity, sleep quality, and quality of life (QOL) during COVID-19 in adults by age group. Methods: An online survey was conducted on a total of 160 participants who were divided into three groups by age; young adults, middle-aged adults, and old adults. The participants responded to the self-reported assessment of the impact of social distancing during COVID-19, International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 Health Survey (SF-36). Descriptive statistics, analysis of variance, and Pearson’s correlation were used for data analysis. Results: There were significant differences between the three age groups in physical activity (p < 0.05) and PSQI (p < 0.01) and a post hoc analysis showed that the young adults’ group had significantly higher physical activity than the old adults’ group, while the old adults’ group had significantly lower scores of PSQI (better sleep quality) than the others. The young adults’ group showed a significant negative correlation between the stress from social distancing and QOL (r = -0.27, p < 0.05) and between PSQI and QOL (r = -0.48, p < 0.05). For the middle-aged adults’ group, there was a significant negative correlation between PSQI and QOL (r = -0.53, p < 0.05). The old adults’ group showed a significant negative correlation between the stress from social distancing and physical activity (r = -0.35, p < 0.05) and PSQI (r = -0.50, p < 0.05), while there was a significant positive correlation between physical activity and PSQI (r = 0.30, p < 0.05) and QOL (r = 0.30, p < 0.05). Conclusion The results of this study could be used as basic data for the promotion of physical and mental health in the post-COVID-19 era

The anemia still remains the most common hematologic disorder in the world despite improvements in general health and nutrition. Recently, the prevalence of anemia in the persons affected leprosy aged over 60 years was reported 22.4% in 60-69 years and 47.4% in 70 years or older in male and was reported 33.8% in 60-69 years and 46.0% in 70 years or older in female. This study was aimed at assessing the causes of anemia in the persons affected leprosy aged over 60 years. For evaluation of anemia, including prevalence, typing, and cause, hemoglobin, MCV(mean corpucular volume), RDW(red blood cell distribution width), ferritin, iron, TIBC, reticulocyte count, serum vitamin B12, serum folate and etc were checked. The proportion of the anemia classified by MCV was 6.6%(microcytic), 63.2%(normocytic), and 30.3%(macrocytic) and a half of the anemia was attributed to chronic diseases, 14.5% to anemia of iron deficiencies, 5.3% to anemia of nutrient(vitamin B12 & folate) deficiencies, 3.9% to anemia of hemolysis, and a quarter(27.6%) was "unexplained". We will consider about the evaluation of more detailed causes of anemia in persons affected leprosy, and management plan for anemia in them by the in-depth studies.
Anemia* ; Blood Cells ; Chronic Disease ; Female ; Ferritins ; Folic Acid ; Hemolysis ; Humans ; Iron ; Leprosy* ; Male ; Prevalence ; Reticulocyte Count ; Vitamin B 12

M. immunogenum was identified as the etiologic agent of a variety of hospital-acquired infections, including an outbreak of keratitis, and as the potential cause of hypersensitivity pneumonitis in industrial metal-grinding machinists. This microorganism appears to differ from other members of the M. chelonae?abscessus group. Clinically significant isolates have been recovered from skin lesions, corneal ulcers, joint fluid, central venous catheter sites, and blood. There have been some cases of M. immunogenum skin infection reported. We report a suspected case of cutaneous Mycobacterium immunogenum infection in a 23-year-old male, migrant Workers from Sri Lanka, who presented with an erythematous plaque on his right ear. M. immunogenum was suspected by PCR-restriction fragment length polymorphism & sequencing of PCR product. The patient was treated with clarithromycin & ofloxacin. The lesion started to improve 4 weeks after initiation of the therapy. We have the patient in therapy for 3 months, and the lesion is slowing disappeared.
Alveolitis, Extrinsic Allergic ; Central Venous Catheters ; Clarithromycin ; Ear ; Humans ; Joints ; Keratitis ; Male ; Mycobacterium* ; Ofloxacin ; Polymerase Chain Reaction ; Skin ; Sri Lanka ; Transients and Migrants ; Ulcer ; Young Adult

BACKGROUND: Conventional acid-fast bacilli (AFB) staining cannot differentiate viable from dead cells. Propidium monoazide (PMA) is a photoreactive DNA-binding dye that inhibits PCR amplification by DNA modification. OBJECT: The author evaluated whether PMA real-time PCR is suitable for the viablity of Mycobacterium leprae (M. leprae) in specimens of cultivation in mouse foot pads. METHODS: A total of 55 diluted suspensions from mouse foot pads were quadruplicated and subjected to PMA treatment and/or heat inactivation, and were also tested to compare the ΔCT values (CT value in PMA-treated samples-CT value in non-PMA-treated samples). Real-time PCR was performed using QuantiTect SYBR® Green PCR Kits(Qiagen, USA), and the CT value changes after PMA treatment were compared between PMA treatment and/or heat inactivation groups. RESULTS: The increase in the CT value after PMA treatment was significant in heat inactivated group(4.26) and non-heat inactivated group(1.12)(both P = 0.000). In the ROC curve analysis, the cutoff ΔCT value for maximum sensitivity (100%) and specificity (97.1%) for differentiating dead from live cells was 2.41 CONCLUSIONS: PMA real-time PCR is a useful approach for evaluating viablity of M. leprae.
Animals ; DNA ; Foot ; Hot Temperature ; Mice ; Mycobacterium leprae* ; Mycobacterium* ; Polymerase Chain Reaction ; Propidium* ; Real-Time Polymerase Chain Reaction* ; ROC Curve ; Sensitivity and Specificity ; Suspensions

One of the risks of combination therapy is probably the collective side effects. Fortunately, side effects reported worldwide after the use of MDT in thousands of patients remain mild and rare. This study analyses retrospectively some of the risks associated with the use of WHO-multidrug therapy (MDT) in Korea. Case records of 40 new cases of leprosy attending the Institute for Leprosy Research during 1991-2000, were analysed for adverse drug reactions involving the liver and blood. There were only some reports of suspected hematological adverse reactions(RBC count, hematocrit &, platelet count) associated with the use of MDT, but we could not find the clinical association of that finding. So we sustain that the MDT, recommended by KCDC, is relatively safe.
Blood Platelets ; Drug-Related Side Effects and Adverse Reactions ; Hematocrit ; Humans ; Korea ; Leprosy* ; Liver ; Retrospective Studies