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Background: The number of new leprosy cases reported annually is falling worldwide, but remains relatively high in some populations. Because of the long and variable periods between infection, onset of disease, and diagnosis, the recently detected cases are a reflection of infection many years earlier. Estimation of the numbers of sub-clinical and clinical infections would be useful for management of elimination programmes. Back-calculation is a methodology that could provide estimates of prevalence of undiagnosed infections, future diagnoses and the effectiveness of control. Methods: A basic back-calculation model to investigate the infection dynamics of leprosy has been developed using Markov Chain Monte Carlo in a Bayesian context. The incidence of infection and the detection delay both vary with calendar time. Public data from Thailand are used to demonstrate the results that are obtained as the incidence of diagnosed cases falls. Results: The results show that the underlying burden of infection and short-term future predictions of cases can be estimated with a simple model. The downward trend in new leprosy cases in Thailand is expected to continue. In 2015 the predicted total number of undiagnosed sub-clinical and clinical infections is 1,168 (846-1,546) of which 466 (381-563) are expected to be clinical infections. Conclusions: Bayesian back-calculation has great potential to provide estimates of numbers of individuals in health/ infection states that are as yet unobserved. Predictions of future cases provides a quantitative measure of understanding for programme managers and evaluators. We will continue to develop the approach, and suggest that it might be useful for other NTD in which incidence of diagnosis is not an immediate measure of infection. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of leprosy multidrug therapy (MDT) on cell-mediated immunity (CMI) and antibody responses at diagnosis in untreated paucibacillary (PB) (n = 15) and multibacillary (MB) patients (n = 15) using a panel of Mycobacterium leprae recombinant antigens (rMLs) (CMI: 46f, ML0276, ML2055, leprosy IDRI diagnostic 1 [LID-1], and ML2629, as negative control; serology: LID-1, 46f, 92f, and 33f, as negative control, and phenolic glycolipid I [PGL-I]) and at 2 time points after MDT (PB: 8–20 months; MB: 4–22 months). At diagnosis, PB patients produced interferon gamma (IFNγ), and MB patients exhibited low/absent response. Shortly after MDT, IFNγ production in PB patients declined except for LID-1; MB patients produced IFNγ to LID-1. Almost 2 years after MDT, IFNγ levels declined in PB and MB patients. Most untreated PB patients were seronegative to PGL-I and rML, remaining so after MDT. Most untreated MB patients were seropositive to all antigens, and IgG to rMLs declined after MDT. Reduction in antigen-specific CMI in PB and in antibody response in MB patients may help monitor MDT effectiveness. [ABSTRACT FROM AUTHOR]

Background Worldwide, leprosy represents a significant cause of disability due to progressive neurological impairment. Screening for leprous neuropathy is performed with Semmes-Weinstein monofilament (SWM) or ballpoint pen testing (BPT), which results in underreporting of its prevalence. The Pressure-specified sensory device (PSSD; Sensory Management Services, LLC, Baltimore, MD) is a sensitive, noninvasive, portable, neurosensory instrument, which has not been field-tested for leprosy screening. Early identification of leprous neuropathy would permit early antibiotic treatment to prevent contagion and early microsurgical neurolysis. Methods A prospective, clinical diagnostic, cross-sectional study screened a consecutive sample of patients for leprous neuropathy in the leprosy-endemic province of Los Ríos, Ecuador. Patients meeting the World Health Organization criteria for leprosy and complaining of neuropathy symptoms were classified as leprous neuropathy patients. Patients without any signs of leprosy were used as normal controls. Bilateral ulnar nerve screening with the PSSD, SWM (0.07, 0.4,2,4,10, and 300 g), and BPT was performed in all patients. Sensitivity and specificity were calculated and compared across tests. A total of 71 patients (142 nerves) were evaluated. Results Compared with the 10 g SWM and the BPT, the PSSD was found to have significantly higher sensitivity (78.3 vs. 0% with p < 0.001, for both) with comparable specificity (97.8 vs. 100% with p > 0.999, for both). Compared with the 0.07 g SWM (lightest filament in our series), the PSSD showed better sensitivity (78.3 vs. 65.2%, p = 0.514) and significantly higher specificity (97.8 vs. 51.1%, p < 0.001). Conclusions The PSSD provides superior diagnostic accuracy for detecting leprous neuropathy as compared with SWM and BPT. [ABSTRACT FROM AUTHOR]

An editorial is presented on the World Leprosy Day which is celebrated to raise awareness for people affected by leprosy. Topics discussed include the role of French humanitarian Raoul Follereau in World leprosy day; information on the epidemiology of leprosy; and the ways to prevent it along with the issue relating to leprosy if it is not treated early.

Hansen disease (leprosy) continues to be prevalent in some regions of Africa, Asia, and South America, and each year 100 to 300 cases are reported in the United States, especially in immigrants and patients exposed to armadillos. Treatment depends on patient presentation. Hansen disease remains highly stigmatized, though it is now clear that it is not readily transmitted through casual physical contact. [ABSTRACT FROM AUTHOR]

Leprosy is an infectious disease that has now been reported for more than 2000 years. The leprosy elimination goal set by the World Health Organization (WHO), i.e. a global prevalence rate < 1 patient per 10,000 population, was achieved in the year 2000, but more than 200,000 new case patients are still reported each year, particularly in India, Brazil, and Indonesia. Leprosy is a specific infection: (i) it is a chronic infection primarily affecting the skin and peripheral nerves, (ii) Mycobacterium leprae is one of the last bacterial species of medical interest that cannot be cultured in vitro (mainly because of its reductive genome evolution), and (iii) transmission and pathophysiological data is still limited. The various presentations of the disease (Ridley-Jopling and WHO classifications) are correlated with the patient's immune response, bacillary load, and by the delay before diagnosis. Multidrug therapy (dapsone, rifampicin, with or without clofazimine) has been recommended since 1982 as the standard treatment of leprosy; 6 months for patients presenting with paucibacillary leprosy and 12 months for patients presenting with multibacillary leprosy. The worldwide use of leprosy drugs started in the 1980s and their free access since 1995 contributed to the drastic decline in the number of new case patients. Resistant strains are however emerging despite the use of multidrug therapy; identifying and monitoring resistance is still necessary. [ABSTRACT FROM AUTHOR]

Background: The role of the host immunity in determining leprosy clinical forms and complications is well recognized, implying that changes in the immune status may interfere with several aspects of the disease. Therefore, we hypothesized that the presence of viral co-infections and associated immunological changes will have a clinical impact on leprosy outcomes. The aim of our study was to determine the clinical impact of human immunodeficiency virus (HIV), human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on the development of reactions, neuritis, neuropathy and relapses. Methodology/Principal Findings: Cohort study in 245 leprosy subjects from Bahia, Brazil. Patients were followed from the time of diagnosis until at least the end of multidrug therapy. Viral co-infection was detected in 36 out of the 245 patients (14.7%). Specific co-infection rates were 10.6% for HBV, 2.9% for HIV, 2.5% for HTLV-1 and 0.8% for HCV. All four groups of co-infected patients had higher rates of neuritis and nerve function impairment compared to non co-infected leprosy subjects. The relapse rate was also higher in the co-infected group (8.3%) versus patients without co-infection (1.9%); relative risk 4.37, 95% confidence interval 1.02–18.74. Conclusions/Significance: Leprosy patients should be screened for HBV, HCV, HIV and HTLV-1 co-infections. Besides contributing to better health care, this measure will facilitate the early detection of severe complications through targeting of higher risk patients. [ABSTRACT FROM AUTHOR]

Background: India is a major contributor to the global burden of leprosy and tuberculosis (TB), which adversely affects the poorest tribal communities. Despite prioritisation by disease control programmes, programme performance for leprosy and TB in tribal communities continues to be a challenge. In addition to access to services and infrastructural limitations, socio-cultural concepts of illness causation and related help seeking (HS) rooted in distinct features of tribal culture need to be addressed to improve programme outcomes. Methods: A cultural epidemiological survey of leprosy and TB patients was carried out using a locally adapted, semi-structured explanatory model interviews. A total of 100 leprosy and 50 TB patients registered for treatment at government health facilities were selected randomly from tribal dominant blocks of the Thane district, Maharashtra state. The perceived causes (PCs) of leprosy and TB in patients were compared based on prominence categories. The relationship between PCs as predictors, and disease conditions and HS preferences as outcome variables were assessed using multivariate logistic regression. Results: In the multivariate logistic regression model with disease conditions as outcome variables, TB patients were significantly more likely to report PCs in the categories of ingestion; health, illness and injury; and traditional, cultural and supernatural. Tuberculosis patients more frequently first sought help from private facilities as compared to leprosy patients who preferred government health facilities. In a combined analysis of leprosy and TB patients employing multivariate logistic regression, it was found that patients who reported PCs in the environmental and contact-related categories were more likely to visit traditional rather than non-traditional practitioners. In another multivariate combined model, it was found that patients who reported PCs in the traditional, cultural and supernatural category were significantly more likely to visit private rather than public health facilities. Conclusion: Cultural concepts about illness causation and associated HS behaviours should be considered as priorities for action, which in turn would provide the necessary impetus to ensure that tribal patients seek help in a timely and appropriate manner, and could facilitate improvement in programme performance in general. [ABSTRACT FROM AUTHOR]

This article examines Cyprus Leper Farm founded at the end of the 1820s or beginning of the 1830s between 1878 and 1955 during the British Period. Britain took over Cyprus with the agreement of the Ottoman government in 1878. Since beginning of the colonial period many improvements were carried out on health systems. British administration in Cyprus enacted two laws dated 1891 and 1929 regarding leprosy. The laws regulated the management of the Farm, and the Chief Medical Officer appointed by the Government. The British Government in Cyprus aimed to decrease the population of the Farm, and to treat the patients, and so provided it with suitable conditions such as bread, water, washing, a church and a mosque. The British administration succeeded in fighting with leprosy. After the remedial treatment of leprosy, the Cyprus Leper Farm was closed in 1955. [ABSTRACT FROM AUTHOR]

Dapsone is used for the treatment of leprosy and a variety of blistering skin diseases. It may cause severe adverse drug reaction(s) with multiorgan involvement. We report the case of a 48-year-old female who developed dapsone hypersensitivity syndrome (DHS), hemolytic anemia, and severe agranulocytosis with secondary cavitating pseudomonal pneumonia due to dapsone. [ABSTRACT FROM AUTHOR]

Leprosy leads to chronic granulomatous inflammation in skin and peripheral nerves that can lead to sensory, motor and autonomic impairments. Autonomic dysfunctions may result in dryness and cracking of the skin. In this study, we present the use of ozone provided by a high-frequency device to treat hand ulcers (wounds) in an 80-year-old man who was diagnosed as multibacillary in 2007. In the first visit, the patient was evaluated and received verbal and written instructions about self-care. Treatment consisted of five sessions, once per week. The ozone provided by a high-frequency device seemed to be useful in the treatment of ulcers, thus, contributing to the healing process. Research that investigates the use of high frequencies in the treatment of ulcers associated or not with other interventions (self-care strategies, protective clothing, adapted tools and footwear adaptation) is strongly recommended. [ABSTRACT FROM AUTHOR]

Objectives: To study cure rate and relapse rate of standard World Health Organization paucibacillary multidrug therapy (PB-MDT) with monthly rifampicin, ofloxacin, and minocycline for six months (ROM-6) among paucibacillary leprosy patients. Methods: A total of 268 patients, detected during active search in Agra district during 2001-2004, who had paucibacillary (PB) leprosy having 1-5 skin lesions and/or one nerve thickening/tenderness, were allocated, using random number tables, to two treatment groups; PB-MDT and ROM-6. On the first day of the month, dose of PB-MDT and of the ROM were given under supervision for 6 months. After completion of drug therapy, patients were followed every 6 months for fi rst 5 years and later annually for next 3 years for monitoring disease status, cure rates, reactions and relapses. Chi square test was used to compare relapse rates. Results: The cure rate at 2 years was 99% in ROM-6 and 97.0% in PB-MDT group, of those who completed treatment and the difference was statistically not signifi cant. At 5 years, only 88 patients in PB-MDT group and 90 patients in ROM-6 group could be followed; all were observed to be cured. However, during the period of 5-8 years, 3 of 67 patients in PB-MDT group and 1 of 73 in ROM-6 group were observed to have relapsed. In all, 10 relapses were noted (3 in ROM-6 and 7 in PB-MDT group) giving a relapse rate of 1.10/100 person years in PB-MDT and 0.435/100 person years in ROM groups (P = 0.053; statistically not signifi cant). Of the 10 relapses, 5 occurred within 5 years (3 in PB-MDT group and 2 in ROM-6), 4 during 5-8 years (3 in PB-MDT and 1 in ROM-6), and 1 occurred in MDT group after 8 years. Limitation: A number of patients were lost to follow up after release from treatment and thus actual number of relapses in the study could not be assessed. Additionally, diagnosis was purely clinical and histology could not be done for reasons related to functional diffi culties in the fi eld. Conclusion: The study shows that PB-MDT and ROM-6 have almost similar acceptability, cure rate and relapse rate. [ABSTRACT FROM AUTHOR]

Babchi ( Psoralea corylifolia L.) is a rare medicinal plant. It has been considered to be efficacious in leprosy and hence given the name ‘Kushtanashini’ (leprosy destroyer) in Ayurveda. The high death rate in wild along with aimless and unlawful gathering and destruction of habitat put the plant in the category of endangered list. In this study a highly reproducible in vitro regeneration system in P. corylifolia using root segments was developed. The effect of different PGRs (Kin BA, and NAA) on the percentage of adventitious shoot induction and the number of shoot buds per root explant was assessed. The maximum response (65.57%) was observed in the media supplemented with 2.22 μM BAP and 6.98 μM Kin. The treatment had in average 39.67 number of shoot buds and 3.37 elongated shoots. Elongation response was best (92.0%) in MS + 2.22 μM BAP + 6.98 μM Kin media fortified with 2.89 μM GA 3 and 39.7 μM PG, producing a mean of 9.3 elongated shoots with an average of 4.6 cm length. An anatomical study showed that the origin of shoot buds were directly from pericycle of root. Elongated shoots were carefully excised and rooted on basal MS + 4.92 μM IBA + 158.6 μM PG, with 92 per cent rooting. Rooted explants survived in soil: vermicompost: vermiculite (1:1:1) with 100% success. [ABSTRACT FROM AUTHOR]

The authors discuss various aspects of leprosy including transmission, elimination, and trends. Topics include the World Health Assembly Resolution in 1991 to eliminate leprosy as a public health issue, introduction of various therapeutic approaches such as dapsone therapy and multidrug therapy (MDT), and pathogenesis of leprosy.

Introduction: Leprosy causes nerve injury, which mimics clinical and neurophysiological conditions, rendering it an excellent model of peripheral neuropathy. Methods: A retrospective study including 822 nerve conduction studies (NCS) of 509 patients was developed to appraise the electrophysiological pattern of leprosy neuropathy. NCS of motor and sensory nerves performed before, during, and after multidrug therapy (MDT) were analyzed. Results: During the three periods of MDT, while NCS alterations were similar regarding extension, topography, damage severity, and type of lesion, NCS showed that sensory was more frequent (sural nerve) (92-96%) than motor impairment (70-77%) (ulnar nerve). Conclusion: Once axonal loss has been installed, nerve function is little affected by inflammatory, immune and/or bacterial events since chronic neuropathy has been established, inevitably leading to the wellknown leprosy sequelae occurring at any time before and/or after leprosy diagnosis. [ABSTRACT FROM AUTHOR]

Leprosy or Hansen's disease is an infectious disease caused by the bacterium Mycobacterium leprae. The annual number of new leprosy cases registered worldwide has remained stable over the past years at over 200,000. Early case finding and multidrug therapy have not been able interrupt transmission completely. Elimination requires innovation in control and sustained commitment. Mathematical models can be used to predict the course of leprosy incidence and the effect of intervention strategies. Two compartmental models and one individual-based model have been described in the literature. Both compartmental models investigate the course of leprosy in populations and the long-term impact of control strategies. The individual-based model focusses on transmission within households and the impact of case finding among contacts of new leprosy patients. Major improvement of these models should result from a better understanding of individual differences in exposure to infection and developing leprosy after exposure. Most relevant are contact heterogeneity, heterogeneity in susceptibility and spatial heterogeneity. Furthermore, the existing models have only been applied to a limited number of countries. Parameterization of the models for other areas, in particular those with high incidence, is essential to support current initiatives for the global elimination of leprosy. Many challenges remain in understanding and dealing with leprosy. The support of mathematical models for understanding leprosy epidemiology and supporting policy decision making remains vital. [ABSTRACT FROM AUTHOR]

Background: The current strategy for leprosy control depends mainly on early case detection and providing the recommended multidrug therapy (MDT) dosage. Understanding the molecular mechanisms of drug resistance to each of these drugs is essential in providing effective treatment and preventing the spread of resistant strains in the community. The progress of molecular biology research provides a very efficient opportunity for the diagnosis of drug resistance by in vitro method. Aim: We aimed to investigate the point mutations within the rpoB gene region of the Mycobacterium leprae genome, which are responsible for resistance to rifampicin, in order to determine the emergence of drug resistance in leprosy in the Kolkata region of West Bengal. Methods: A total of 50 patients with a relapse of leprosy were enrolled in the study. Skin smears were obtained for estimation of bacillary index and biopsies were obtained in 70% alcohol for extraction of DNA. The extracted DNA was amplified by M. leprae-polymerase chain reaction (PCR) targeting rpoB gene region. Every single nucleotide base in the sequence is aligned to reference sequence and identity gaps were determined by NCBI - BLAST. Later in-silico analysis was done to identify the changes in the translated protein sequences. Results: A mutation at the base pair position 2275405 where G is replaced by C in the M. leprae genome, which corresponds to the coding region of rpoB gene (279 bp - 2275228 to2275506), was observed in two patients. This missense mutation in CAC codon brings about a glutamic acid to histidine change in the amino acid sequence of RNA polymerase beta subunit at the position 442 (Glu442His), a region specific for rifampicin interaction, which might be responsible for unresponsiveness to rifampicin by manifesting a stable bacteriological index in these 2 patients even after completion of 24 months of multibacillary multi-drug therapy (MB-MDT). Limitations: The major limitations of multipleprimer PCR amplification refractory mutation system (MARS) assay is that it capable of detecting mutation at codon 425 and cannot distinguish any silent amino acid changes. Conclusion: The study indicates the existence of rifampicin drug resistance in Eastern India. [ABSTRACT FROM AUTHOR]

Objective This study was conducted to evaluate the effectiveness of uniform multi-drug therapy ( UMDT) in patients with multibacillary ( MB) leprosy. Methods Newly detected MB leprosy patients were treated with six months of UMDT as recommended by the World Health Organization ( WHO). The effectiveness of treatment was evaluated by clinical status and skin smear tests. Results At the start, 114 patients were recruited, examined, and treated. These patients were re-examined and followed annually for up to six years. A total of 75 (65.8%) patients completed six years of follow-up. Dropouts were attributable to death, severe drug reactions, and other reasons. The mean ± standard deviation bacteriological index ( BI) of all patients decreased from 3.01 ± 1.50 before treatment to 0.02 ± 1.84 at the end of year 6, reflecting a mean annual decrease of 0.50. The rate of smear negativity in all patients was 98.7% at the end of year 6 of follow-up. A total of 53 leprosy reactions were observed. One patient relapsed 13 months after the cessation of treatment. Conclusions A 6-month administration of UMDT is effective in MB leprosy patients. The changes in BI values and the frequency of leprosy reactions were similar to those cited in reports in the literature of patients treated with 1- or 2-year regimens of MDT. However, further research should be conducted to confirm the present results. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to observe whether our custom made shoes and total contact insoles can effectively increase the plantar contact areas and reduce peak pressures in patients with leprosy. Design: In the rehabilitation laboratory of a tertiary medical center. Six male and two female leprosy patients were recruited in this study. In this study, parameters related to foot pressures were compared between these patients wearing commercial available soft-lining kung-fu shoes and our custom made shoes with total contact insoles. The custom made shoes were made with larger toe box and were able to accommodate both the foot and the insoles. Custom made total contact insoles were made with the subtalar joints under neutral and non-weight-bearing positions. The insole force measurement system of Novel Pedar-X (Novel, Munich, Germany) was used to measure the plantar forces. The parameters of contact area (cm²), peak plantar pressures (kPa), contact time (s), and pressure time integral (kPa s) were measured. Results: There were significant contact area increases in the right and left foot heel areas, left medial arch, and second to fifth toes after wearing the custom made shoes and insoles. There were significant decreases in peak plantar pressures in bilateral heels, left lateral midfoot, bilateral second to fourth metatarsal areas, and left fifth metatarsal head after wearing the custom made shoes and insoles (p<0.05). Conclusions: Plantar ulceration is a common serious disability in leprosy patients. As a result, footwear and measures able to reduce plantar pressures may be beneficial in preventing plantar ulcers from occurring in these patients. Our custom made shoes and total contact insoles were proven to be effective in increasing contact areas and decreasing peak pressures in plantar surfaces, and may therefore be a feasible treatment option in preventing leprosy patients from developing plantar ulcers. [ABSTRACT FROM AUTHOR]

Leprosy remains an important global health concern, but little has been published about its diagnosis and management in developed settings. It has been postulated that delay in diagnosis is common in developed settings. We reviewed all the cases of leprosy seen at a major tertiary referral centre between 1999 and 2013 and demonstrated that delay in diagnosis is common, especially when patients present with symptoms of leprosy reactions rather than classical symptoms, such as hypo-pigmented hypo-aesthetic skin lesions and neuropathy. [ABSTRACT FROM AUTHOR]

Despite having caused one of the greatest medical catastrophies of the last century through its teratogenic side-effects, thalidomide continues to be an important agent in the treatment of leprosy and cancer. The protein cereblon, which forms an E3 ubiquitin ligase compex together with damaged DNA-binding protein 1 (DDB1) and cullin 4A, has been recently indentified as a primary target of thalidomide and its C-terminal part as responsible for binding thalidomide within a domain carrying several invariant cysteine and tryptophan residues. This domain, which we name CULT (cereblon domain of unknown activity, binding cellular ligands and thalidomide), is also found in a family of secreted proteins from animals and in a family of bacterial proteins occurring primarily in δ-proteobacteria. Its nearest relatives are yippee, a highly conserved eukaryotic protein of unknown function, and Mis18, a protein involved in the priming of centromeres for recruitment of CENP-A. Searches for distant homologs point to an evolutionary relationship of CULT, yippee, and Mis18 to proteins sharing a common fold, which consists of two four-stranded β-meanders packing at a roughly right angle and coordinating a zinc ion at their apex. A β-hairpin inserted into the first β-meander extends across the bottom of the structure towards the C-terminal edge of the second β-meander, with which it forms a cradle-shaped binding site that is topologically conserved in all members of this fold. We name this the β-tent fold for the striking arrangement of its constituent β-sheets. The fold has internal pseudosymmetry, raising the possibility that it arose by duplication of a subdomain-sized fragment. [ABSTRACT FROM AUTHOR]

Leprosy is a curable disease, having been eliminated from many countries, including India. This has been possible due to the wide availability of effective and safe drugs. Treatment of leprosy has undergone considerable changes over decades, from chaulmoogra oil in 1915 to dapsone monotherapy in 1946, then eventually to multidrug therapy (MDT) in 1982. In the last two decades, reports of resistance to all first-line drugs have appeared in the literature, with the need to conduct clinical trials using newer but highly bactericidal drugs and their combinations against Mycobacterium leprae . [ABSTRACT FROM AUTHOR]

Hansen's disease is manifested in a broad spectrum: clinical and histopathological. These differences arise from an individual's immunological response against diverse components of Mycobacterium leprae. Leprosy constitutes a study model of immunity response, where leprosy reaction type 1 can develop in an increased reaction; in that case, it is called a reverse reaction, or can develop in a withering of the response, which is then called a degrading response. These variations correspond to the instability of the cell immune response. Leprosy reaction 2 differs in that it is produced under appeasement of humoral type of immune response. Leprosy reaction type 1, in reversal variety, is expressed clinically as an inflammatory exacerbation of skin lesions and nervous trunks, with motor and sensitive alterations. This type of reaction is present in the dimorph varieties of Hansen's disease. The recognition of the reactional states is essential to give an early and efficient treatment and to avoid the appearance of the stigmatas of the disease. This paper describes clinical aspects through the presentation of a case and reviews its immunology, epidemiology, histopathology and treatment. [ABSTRACT FROM AUTHOR]

The article presents the study which examined the possible intervention strategies against type reaction (T1R) of leprosy. It claims that TIR occurs more often in such types of leprosy as lepromatous leprosy (LL), borderline tubercoloid (BT), and borderline lepromatous (BL). The study focused on interleukin-3 (CD123) cell populations and the epithelioid-cell phenotype in TIR skin lesions in patients with BL and LL.

MJ is a janitor working in an office building for the past 5 years. He sustained a third-degree burn with a secondary infection and was sent to the county hospital. He was diagnosed with leprosy. The employees in the office building were concerned with the risk of transmission. This article reviews leprosy, and implications for occupational health nurses are discussed. [ABSTRACT FROM AUTHOR]

The editor discusses findings of a study conducted by the World Health Organization (WHO), which reveals its efforts on promoting global awareness on leprosy and its multidrug therapy. The editor overviews the WHO action plan on outlining areas on global leprosy and its collaboration with non-governmental agencies. The editor also notes on the goals of WHO on global leprosy.

Molecular drug susceptibility testing was performed on skin biopsies from 24 leprosy patients from Guinea-Conakry for the first time. We identified primary drug resistance in 4 cases and a dapsone-resistant cluster caused by the same strain. Primary transmission of drug-resistant Mycobacterium leprae, including a rifampicin-resistant strain, is reported. [ABSTRACT FROM AUTHOR]

The article presents a case study of a patient with multiple abscesses of the median nerve as a manifestation of lepra reaction while suffering from leprosy. Topics discussed include the patient's diagnosis of leprous mononeuritis multiplex treated with multidrug therapeutic regimen, the findings from the Slit-skin smear test such as Mycobacterium leprae baciili and nerve abscesses in patients with paucibacillary leprosy.

The article explores the uniform multidrug therapy (U-MDT) as a single regimen for all cases of leprosy. It cites a main criticism of U-MDT on the unnecessary drug to the current paucibacillary treatment and undertreatment of multibacillary cases, and the significant rifampicin resistance. It mentions relapse rate as the ultimate test of efficacy of drug regimens for leprosy. Also noted is the potential problem of clofazimine added to paucibacillary cases.

The article presents two case studies of fever, rush, and organ involvement during leprosy therapy. The first case involves a 65-year-old man who was diagnosed with borderline tuberculoid leprosy, while the other patient is a 39-year-old woman who was diagnosed with lepromatous leprosy. Both patients were given a final diagnosis of dapsone induced hypersensitivity syndrome, described as a life threatening condition in treating leprosy. A discussion about DDS Syndrome is also provided.

The development of immunodiagnostic tests for paucibacillary leprosy (PB) is based on Mycobacterium leprae specific-cell mediated immunity (CMI)/IFN-γ production. Recently, novel M. leprae protein antigens that stimulate CMI have been described. This study evaluated different M. leprae antigen combinations in whole blood assay (WBA). Five study groups were tested (20 per group): newly diagnosed, untreated PB patients and multibacillary leprosy patients (MB); household contacts of MB patients (HHC); healthy endemic controls (EC); pulmonary tuberculosis patients (TB). WBA (heparinized, 24 h 37 °C 5 % CO were stimulated with: 10 μg/ml of each individual M. leprae recombinant protein (rML) and five combinations of rML (46f + LID-1, ML0276 + LID-1, ML2055 + ML1632 + ML2044, ML0276 + 46f, ML2055 + LID-1)- M. leprae cell sonicate (MLCS, 10 μg/ml), PHA (1 μg/ml), and PBS alone. Human IFN-γ ELISA (QuantiFERON®-TB Gold/QFT-G, Cellestis) was performed using stimulated plasma (arbitrary cut-off = 50 pg/ml). Three out of five antigen combinations (46f + LID-1, ML0276 + LID-1, ML2055 + ML1632 + ML2044) were able to increase the levels of IFN-γ production in WBA in a larger number of responders among both PB leprosy and contacts. However, the magnitude of IFN-γ responses was higher among contacts. The antigen combination (46f + ML0276) stimulated IFN-γ only in symptomatic PB leprosy patients and not in asymptomatic contacts. Few controls (EC, TB) responded to combinations (0-15 %), indicating the specificity of the response in an endemic area with high BCG coverage. The synergistic effect of new combinations of M. leprae proteins upon IFN-γ production in WBA indicates their potential use for the development of an interferon gamma release assay/IGRA for the diagnosis of PB leprosy. [ABSTRACT FROM AUTHOR]

Background Despite the widespread use of multidrug therapy, leprosy remains an important public health concern in many regions. Detection is generally limited to clinical exam. Methods As a two-tiered active case finding strategy, we used the LID-1 (leprosy IDRI diagnostic-1), and PADL (protein advances for the diagnosis of leprosy) antigens for serological examination of 2526 individuals randomly selected from 10 472 residents in a leprosy hyperendemic area (Cajazeiras, Paraiba, Brazil). Almost all seropositive (95%) and a subset of seronegative (17%) subjects then underwent clinical evaluations. Results Prevalence of clinically apparent leprosy was 2.3% (19 cases among 834 fully examined individuals). LID-1 and PADL demonstrated a high sensitivity for supporting leprosy diagnosis at 89% and 87%, with positive predictive values (PPV) of 3.5% and 3.7%. The specificity for clinically apparent leprosy was low at 42% and 38%, respectively, and was likely reduced due to the presence of many asymptomatic individuals infected with Mycobacterium leprae. Conclusions Our data indicate the utility of the LID-1 and PADL antigens as primary screening tools for the detection of M. leprae infection and identification of leprosy patients. The follow-up of seropositive subjects could clarify the predictive value and utility of detecting anti-LID-1 and PADL antibodies within leprosy control programs. [ABSTRACT FROM PUBLISHER]

Abstract: We synthesized a series of novel dapsone–thalidomide hybrids (3a–i) by molecular hybridization and evaluated their potential for the treatment of type 2 leprosy reactions. All of the compounds had analgesic properties. Compounds 3c and 3h were the most active antinociceptive compounds and reduced acetic acid-induced abdominal constrictions by 49.8% and 39.1%, respectively. The hybrid compounds also reduced tumor necrosis factor-α levels in lipopolysaccharide-stimulated L929 cells. Compound 3i was the most active compound; at concentrations of 15.62 and 125μM, compound 3i decreased tumor necrosis factor-α levels by 86.33% and 87.80%, respectively. In nude mice infected with Mycobacterium leprae in vivo, compound 3i did not reduce the number of bacilli compared with controls. Compound 3i did not have mutagenic effects in Salmonella typhimurium strains TA100 and TA102, with or without metabolic activation (S9 mixture). Our results indicate that compound 3i is a novel lead compound for the treatment of type 2 leprosy reactions. [Copyright &y& Elsevier]

Mycobacteria represent a class of powerful pathogens, including those causing tuberculosis and leprosy, which continue to be worldwide health challenges. In the last 20 years, an abundance of non-coding, small RNAs (sRNAs) have been discovered in model bacteria and gained significant attention as regulators of cellular responses, including pathogenesis. Naturally, a search in mycobacteria followed, revealing over 200 sRNAs thus far. Characterization of these sRNAs is only beginning, but differential expression under environmental stresses suggests relevance to mycobacterial pathogenesis. This review provides a comprehensive overview of the current knowledge of sRNAs in mycobacteria, including historical perspective and techniques used for identification and characterization. [ABSTRACT FROM AUTHOR]

We recently showed that M ycobacterium leprae ( ML) is able to induce lipid droplet formation in infected macrophages. We herein confirm that cholesterol ( Cho) is one of the host lipid molecules that accumulate in ML-infected macrophages and investigate the effects of ML on cellular Cho metabolism responsible for its accumulation. The expression levels of LDL receptors ( LDL- R, CD36, SRA-1, SR- B1, and LRP-1) and enzymes involved in Cho biosynthesis were investigated by qRT- PCR and/or Western blot and shown to be higher in lepromatous leprosy ( LL) tissues when compared to borderline tuberculoid ( BT) lesions. Moreover, higher levels of the active form of the sterol regulatory element-binding protein ( SREBP) transcriptional factors, key regulators of the biosynthesis and uptake of cellular Cho, were found in LL skin biopsies. Functional in vitro assays confirmed the higher capacity of ML-infected macrophages to synthesize Cho and sequester exogenous LDL- Cho. Notably, Cho colocalized to ML-containing phagosomes, and Cho metabolism impairment, through either de novo synthesis inhibition by statins or depletion of exogenous Cho, decreased intracellular bacterial survival. These findings highlight the importance of metabolic integration between the host and bacteria to leprosy pathophysiology, opening new avenues for novel therapeutic strategies to leprosy. [ABSTRACT FROM AUTHOR]

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The author focuses on India's leprosy elimination monitoring (LEM), which refers to supervising the reduction of case transmission to a predetermined low level, that is, prevalence rate (PR) of less than 1 case/10,000 population. Topics discussed include the detected leprosy cases in the world, the specific objectives of LEM and the LEM survey which was conducted in the country's 13 high priority states including Delhi, Orissa and West Bengal.

The armadillo could be considered as an experimental model for leprosy studies. Mycobacterium leprae main host cells are macrophages and Schwann cells. However, endocytosis and germicidal activities of armadillo macrophages and monocytes have not yet been evaluated. The aim of this research was to evaluate endocytosis and NBT-reduction activities of monocyte-derived macrophages (MDM) and monocytes from non-infected armadillos, as well as to determine tumor necrosis factor (TNF) levels during stimulation with phorbol myristate acetate (PMA). Mononuclear cells of peripheral blood were purified using the ficollhypaque technique. The monocytes obtained were transformed to MDM after being incubated for 8 days in an RPMI-1640 medium supplement with fetal calf serum at 37°C. Endocytosis and NBT-reduction were evaluated by yeast ingestion. TNF production by stimulation with PMA was evaluated through a bioassay with L-929 cells. The results revealed an endocytosis of 71.77 ± 4.11% and 60.66 ± 6.9% (P<0.001) for armadillo MDM and monocytes respectively, whereas NBT-reduction was 16.57 ± 4.79% and 17.66 ± 4.08%, respectively. With the addition of recombinant human IFNα for 24 h, endocytosis and NBT reduction by MDM were 89.92 ± 6.17% (P<0.001) and 36.42 ± 4.31% (P<0.001), respectively. Low levels of TNF are produced (10 U/ml) when MDM and armadillo monocytes are stimulated with 25 and 50 ng/ml of PMA, in comparison with human U-937 cells. In conclusion, MDM and armadillo monocytes show diminished activities in oxidative bactericidal mechanisms and in TNF production when stimulated with PMA. [ABSTRACT FROM AUTHOR]

The article focuses on the comparison of the biblical tzara'at as discussed in chapters 13-14 of Leviticus and leprosy or Hansen's disease (HD) in the medical perspective. It mentions the similarities of tzara'at and HD due to their skin symptoms, such as hideous facial deformity, rotting of some body parts, and loss of feeling. It mentions that while tzara'at can heal without drugs, HD is incurable and can only be controlled using medicine.

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Commelina benghalensis is a perennial herb, used in the traditional medicine system for the treatment of various ailments like leprosy, sore throat, opthalmia, burns, pain and infammation and also used as depressant, demulcent, emollient and laxative. In the present study, ethanol extract of C. benghalensis roots was pharmacologically investigated to evaluate peripherally acting analgesic activity by acetic acid-induced writhing in Swiss Albino mice and centrally acting analgesic activity by hot-plate and tail-fick tests in mice. Anti-infammatory activity was also evaluated using the carrageenan-induced mice paw edema model. In all the experiments, the extract was administered orally at the doses of 250 and 500 mg/kg bodyweight. The ethanol roots extract demonstrated a significant (P<0.0001) inhibition of writhing as compared with the control group in acetic acid-induced writhing test in mice. The extract also significantly (P<0.0001) raised pain threshold level in both hot-plate and tail-fick tests in mice. Analgesic activity was in dose dependent manner in all the experimental models. The extract exhibited signifcant (P0.0001) inhibition of paw edema at both doses after carrageenan administration, which revealed potential anti-infammatory activity of the extract in dose dependent manner. The experimental results demonstrated that the ethanol extract possesses potential analgesic and anti-infammatory activities. [ABSTRACT FROM AUTHOR]

The article focuses on the treatment of Hansen's disease, formerly known as leprosy, in Governador Valadares, Minas Gerais, Brazil during the 1980s, from the perspective of collective memory. Topics discussed include government policy on the treatment of the disease, in the context of public welfare policy, the history of research on the disease in Brazil, and the history of Hansen's disease in this region, in the context of labor migration.