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

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*

Introduction: Hansen’s disease (HD) is a chronic granulomatous disease principally affecting the skin and peripheral nervous system caused by Mycobacterium leprae. The incubation period varies from months to more than 30 years. The tuberculoid form of HD usually presents with a single hypoesthetic patch and skin biopsy shows epithelioid granulomas with absence of bacilli on Fite-Faraco stain. In contradistinction, lepromatous leprosy usually presents with numerous papules, plaques and nodules with induration of the ears and nose. Biopsy shows foamy granulomas with presence of acid-fast bacilli on Fite-Faraco stain. Case summary: We present a case of a 13-year old female who presented with a 3-year history of a single hypoesthetic patch on the left knee. The initial clinical diagnosis was tuberculoid leprosy. However, histopathology revealed a Grenz zone, and a nodular granulomatous infiltrate consisting of epitheloid and foamy histiocytes with scattered lymphocytes. Fite-Faraco stain showed a bacillary index (BI) of 3+. Slit-skin smear revealed a BI of 4+. She was then started on multidrug therapy. Conclusion This case highlights the importance of slit-skin smear and biopsy as routine procedures in all new cases of suspected HD. These procedures will help differentiate multibacillary from paucibacillary forms of the disease which will influence decisions for treatment and prognostication. This case emphasizes that lepromatous leprosy may present with single lesions and may be misdiagnosed as paucibacillary leprosy if skin-slit smear and biopsy have not been done. This case further suggests that there are factors yet undetermined which play significant roles in determining the host response to M. leprae which are believed to influence morphology, configuration, number and distribution of skin lesions.
Leprosy ; Leprosy, Multibacillary

No abstract available.
Leprosy, Multibacillary*

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

INTRODUCTION: This paper documents the variations in the diagnosis and management of multibacillary leprosy patients in three of the biggest case-holding hospitals in Metro Manila. Furthermore, we aimed to discuss the implications of these variations on the country's leprosy control and elimination program.

METHODS: Focus group discussions (FGD) were conducted with 23 health professionals composed of doctors and nurses with at least a year of experience in managing leprosy patients. The topics included procedures on patient diagnosis and management such as treatment duration, patient follow-up and definitions of treatment completion and default. The FGD participants provided suggestions to improve treatment compliance of patients. Their responses were compared with the World Health Organization (WHO) standards and/or the 2002 DOH Manual of Operating Procedures (MOP) for leprosy. Transcripts of the recordings of the FGDs were prepared and thematic analysis was then performed.

RESULTS: There were variations in the hospitals' procedures to diagnose leprosy, in treatment duration, and in patient follow-up. Definitions for treatment completion and default differed not just between hospitals but also with the WHO guidelines and the 2002 MOP. Hospitals extended treatment up to 24 or even 36 months, despite the 12 months stipulated in the MOP. Two hospitals required a slit skin smear and skin biopsy in diagnosis, despite the MOP and WHO provisions that these were not mandatory. One hospital defined default as three consecutive months without treatment, which was different from the MOP and WHO standards and from the other hospitals.

CONCLUSION: Given the variations in patient management, we recommended that the effectiveness of the standard treatment relative to other regimens being practiced by specialists be evaluated.

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

Apoptosis is an unique physiologic process of programmed cell death, playing an important role in the development and homeostasis of both normal and pathologic tissues. In mycobacterial infections, apoptosis of the macrophage is an important defense mechanism, which prevents the spread of the infection. The purpose of this study is to investigate whether apoptosis occurs in leprosy, and whether a positive correlation occurs among caspase-1, 3, 8, IFN-gamma, and iNOS among normal tissue, BT, and LL lesions. TUNEL staining and double immunohistochemical staining with anti-CD8, CD68 antibodies were done in paraffin-embedded tissue sections of 10 cases of paucibacillary leprosy and 8 cases of multibacillary leprosy. The mRNA expression of caspase-1, 3, 8, IFN-gamma, and iNOS was detected by RT-PCR analysis. The results are summarized as follows: 1. The number of apoptotic cells was 3.5+/-1.6 in paucibacillary leprosy and 6.1+/-3.7 in multibacillary leprosy. The difference was statistically insignificant. 2. Caspase-1 mRNA was expressed in order of LL, BT, and normal skin, and the differences were statistically insignificant. 3. Caspase-3 mRNA was expressed in order of LL, BT, and normal skin. Between LL and normal skin, the difference was statistically significant. 4. Caspase-8 mRNA was expressed in order of LL, normal skin, and BT, and differences were statistically significant. Especially, between LL and BT, the difference was statistically significant. 5. IFN-gamma mRNA was expressed in order of LL, BT, and normal skin. Between LL and normal skin, the difference was statistically significant. 6. iNOS mRNA was expressed in order of LL, BT, and normal skin. Between LL and normal skin, the difference was statistically significant. 7. Statistically significant positive correlation between caspase-1 and IFN-gamma, caspase-3 and iNOS, and caspase-8 and iNOS was found in normal tissue, BT, and LL. Statistically significant positive correlation between caspase-1 and IFN-gamma was shown in BT and LL. In conclusion, apoptosis exists in leprosy lesions and apoptotic cells expressing CD8 and CD68 positivity. Number of apoptotic cells in multibacillary leprosy lesions was insignificantly more than that of paucibacillary lesions. Agents inducing apoptosis such as caspase-3, caspase-8, IFN-gamma, and iNOS significantly increased in leprosy lesions, especially in LL lesions comparing to normal tissues. Apoptosis in the LL lesions might rather be an additive result to macrophage activation than play a defense role. Only the mRNA expression of caspase-8 significantly increased in LL lesions more than in BT lesions. So caspase-8 might be a major player of the apoptotic pathway in LL.
Antibodies ; Apoptosis* ; Caspase 3 ; Caspase 8 ; Cell Death ; Homeostasis ; In Situ Nick-End Labeling ; Leprosy* ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Macrophage Activation ; Macrophages ; RNA, Messenger* ; Skin