Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:
3325. Banta HD. Global issues on the agenda at the World
Health Assembly: discussion of HIV/AIDS,
leprosy, access to drugs. JAMA. 286(1):29-30, 2001 Jul 4.
3326. Danda D. Cherian AM. Rheumatological manifestations
of leprosy and lepra reaction. Indian
Journal of Leprosy. 73(1):58-60, 2001
Jan-Mar.
3327. Fine PE. Floyd S.
Stanford JL. Nkhosa P. Kasunga A.
Chaguluka S. Warndorff DK. Jenkins PA.
Yates M. Ponnighaus JM. Environmental
mycobacteria in northern Malawi: implications for the epidemiology of
tuberculosis and leprosy. Epidemiology
& Infection. 126(3):379-87, 2001
Jun.
Abstract
More than 36000 individuals
living in rural Malawi were skin tested with antigens derived from 12 different
species of environmental mycobacteria. Most were simultaneously tested with
RT23 tuberculin, and all were followed up for both tuberculosis and leprosy
incidence. Skin test results indicated widespread sensitivity to the
environmental antigens, in particular to Mycobacterium scrofulaceum, M.
intracellulare and one strain of M. fortuitum. Individuals with evidence of
exposure to 'fast growers' (i.e. with induration to antigens from fast growers
which exceeded their sensitivity to tuberculin), but not those exposed to 'slow
growers', were at reduced risk of contracting both tuberculosis and leprosy,
compared to individuals whose indurations to the environmental antigen were
less than that to tuberculin. This evidence for cross protection from natural
exposure to certain environmental mycobacteria may explain geographic
distributions of mycobacterial disease and has important implications for the
mechanisms and measurement of protection by mycobacterial vaccines.
3328. Hughes RG. Drake-Lee
A. Nasal manifestations of
granulomatous disease. [Review] [13 refs]
Hospital Medicine (London).
62(7):417-21, 2001 Jul.
Abstract
Granulomatous disease
frequently affects the head and neck region, particularly the nose and sinuses.
This article describes the most common infectious and non-infectious conditions
and their clinical features. [References: 13]
3329. No Abstract
3330. Krupnick AI. Shim H.
Phelps RG. Cunningham-Rundles
C. Sapadin AN. Cutaneous granulomas masquerading as
tuberculoid leprosy in a patient with congenital combined immunodeficiency.
[Review] [30 refs] Mount Sinai Journal of Medicine. 68(4-5):326-30, 2001 Sep-Oct.
Abstract
Combined immunodeficiency
disorders are characterized by abnormalities in cellular and humoral immunity.
This classification includes common variable immunodeficiency (CVI), a primary
immunodeficiency disorder characterized by hypogammaglobulinemia, recurrent
bacterial infections, and significant T-cell abnormalities. Associated
autoimmune diseases include rheumatoid arthritis, pernicious anemia, idiopathic
thrombocytopenic purpura, and systemic lupus erythematous. Granulomatous
lesions in lymphoid tissues, solid organs, and skin have been reported. We
describe a patient with CVI who developed cutaneous granulomas with perineural
invasion; to our knowledge, this is a previously undescribed feature.
[References: 30]
3331. Kumarasinghe SP. Some useful clinical clues and techniques in
the diagnosis of tuberculoid leprosy.
International Journal of Dermatology.
40(4):301-3, 2001 Apr.
3332. No Abstract
3333. Lima CS. Ribeiro ML.
Souza LA. Sardella AB. Wolf VM.
Pessolani MC. Intracellular signals triggered during association of
Mycobacterium leprae and Mycobacterium bovis BCG with human monocytes.
Microbial Pathogenesis. 31(1):37-45,
2001 Jul.
Abstract
To gain a better understanding
of mycobacteria-host cell interaction, the present study compared the signal
transduction events triggered during the interaction of Mycobacterium leprae
(the causative agent of leprosy) and of Mycobacterium bovis BCG (an attenuated
strain used as a vaccine against leprosy and tuberculosis) with human
monocytes. The assays consisted of pre-treating or not THP-1 cells (a human
monocytic cell line) with different kinase inhibitors, followed by incubation with
fluorescein-labelled bacteria and analysis of bacterial association via
fluorescence microscopy. The specific tyrosine kinase (TK) inhibitor tyrphostin
AG126 provided the highest rates of association inhibition (>90% for BCG and
>65% for M. leprae). The early activation of TKs during mycobacteria-host
cell interaction was confirmed by immunoblot analysis, demonstrating that in
several host cell proteins mycobacteria stimulated tyrosine phosphorylation.
The use of the drugs wortmannin and bisindolylmaleimide I which, respectively,
inhibit phosphatidylinositide 3-kinase (PI 3-kinase) and protein kinase C
(PKC), produced lower but consistent results within a 35--60% association
inhibition range for both bacteria. Dose response curves with these inhibitors were
obtained. Similar results were obtained when primary human monocytes were used
as host cells, strongly suggesting that TK, PKC and PI 3-kinase signals are
activated during the interaction of human monocytes with both pathogenic and
attenuated species of mycobacteria. Copyright 2001 Academic Press.
3334. No Abstract
3335. Marlowe SN. Lockwood DN. Update on leprosy. [Review] [10 refs] Hospital Medicine
(London). 62(8):471-6, 2001 Aug.
Abstract
Leprosy, a result of infection
by Mycobacterium leprae, is a leading cause of peripheral neuropathy. The World
Health Organization aimed to eliminate leprosy as a public health problem by
2000, but this has not been attained. Patients with leprosy continue to present
in the UK. The diagnosis of leprosy is frequently not considered, with
resultant pathological and psychological problems for patients. [References:
10]
3336.
3337. Mohamed KB. Facial lesions
resembling leprosy. International
Journal of Leprosy & Other Mycobacterial Diseases. 69(1):35-7, 2001 Mar.
3338. Natrajan M. Katoch K.
Katoch VM. Patients presenting
with defined areas of sensory loss--a preliminary study. Indian Journal of Leprosy. 73(1):17-26, 2001 Jan-Mar.
Abstract
Thirty patients presenting
with circumscribed areas of clearly demonstrable hypoesthesia were chosen from
amongst those attending this Institute. Their history and clinical features
were recorded, lepromin test was done for reading at four weeks, and peripheral
part of the hypoesthetic area was biopsied for histopathology and
immunostaining. The subjects were predominantly adult males with the
symptomatic sites limited to the extremities. On routine histopathological
examination of the symptomatic sites, the diagnosis of leprosy, using defined
criteria, could be made in six cases (20%). Immunostaining of the remaining
sections showing either no pathology or a nonspecific pathology revealed the
presence of mycobacterial antigen in five of the 24 cases (20.83%). Overall,
leprosy could be diagnosed in 11 of the 30 cases studied (36.66%). This study
shows that leprosy may be an important cause of circumscribed areas of sensory
deficit.
3339. No Abstract
3340. No Abstract
3341. Rastogi N. Legrand E.
Sola C. The mycobacteria: an
introduction to nomenclature and pathogenesis. [Review] [192 refs] Revue
Scientifique et Technique. 20(1):21-54,
2001 Apr.
Abstract
Tuberculosis, caused by
Mycobacterium tuberculosis, and leprosy, caused by M. leprae, are diseases
known since antiquity. In developing countries, tuberculosis is still the
leading cause of mortality due to an infectious disease. Taxonomically,
mycobacteria belong to the genus Mycobacterium, which is the single genus
within the family of Mycobacteriaceae, in the order Actinomycetales.
Actinomycetales include diverse micro-organisms, but mycobacteria and allied
taxa are easily distinguished on the basis of the ability to synthesise mycolic
acids. Mycobacterial species are traditionally differentiated on the basis of
phenotypic characteristics, and the authors provide an updated list of the
biochemical tests currently employed and the culture properties that help to
discriminate among various species of mycobacteria. However, as the phenotypic
characteristics do not allow precise identification of all species, recent
molecular taxonomical approaches for mycobacterial classification and phylogeny
are also described. Mycobacteria are also a leading cause of infection in
various domesticated animals and wildlife. The authors briefly describe the
mycobacteria involved in animal infections, the wildlife reservoirs and
strategies to control bovine tuberculosis, and the use of molecular tools for
diagnostics and epidemiology of mycobacterial infections in animals. The
characteristic of intracellular parasitism is discussed, in addition to the
fate of pathogenic mycobacteria that have the ability to grow inside phagosomes
and phagolysosomes of infected host macrophages. The mycobacterial cell
envelope, which is a complex tripartite structure containing a high proportion
of lipids (approximately 30% to 40% of the total weight) could play a crucial
role in the adaptation of mycobacteria to intracellular growth and survival,
immune modulation and drug resistance. [References: 192]
3342. Shelleh HH. Al-Shayeb AM. Khan SA. Khan LA. Al-Hateeti HS. Cold cellulitis: an unusual presentation of leprosy. Saudi Medical Journal. 22(4):372-3, 2001 Apr.
3343. Truoc LV. Ly HM.
Thuy NK. Trach DD. Stanford CA. Stanford JL. Vaccination against leprosy at Ben San Leprosy
Centre, Ho Chi Minh City, Vietnam. Vaccine.
19(25-26):3451-8, 2001 May 14.
Abstract
Three vaccines, BCG alone, BCG + 10(7) killed Mycobacterium vaccae
and 10(8) killed M. vaccae alone, were studied in children living in close
contact with leprosy. In the year before vaccination, 14/446 (3.1%) children
had developed leprosy. Among those who were not vaccinated, 9/74 (12.2%)
developed the disease in the first 4 years of the study and 5/65 (7.7%)
developed the disease in the second 4 years. In comparison with this, among
those vaccinated, 20/343 (5.8%) developed leprosy in the first 4 years and
5/323 (1.5%) developed leprosy in the second 4 years. This represents 52.5%
protection in the first 4 years and 80.5% in the second 4 years. There were no
significant differences in protection afforded by each of the three vaccines
but the success of the killed preparation of M. vaccae is an important finding.
3344. Vijaikumar M. D'Souza M.
Kumar S. Badhe B. Fine needle
aspiration cytology (FNAC) of nerves in leprosy. Leprosy Review.
72(2):171-8, 2001 Jun.
Abstract
Leprosy is primarily a disease
of the peripheral nerves and a technique that is simpler than nerve biopsy is
required to evaluate nerve involvement, especially in pure neuritic (PN)
leprosy. This study was designed to evaluate the role of FNAC of the nerve in
the diagnosis and classification of leprosy. A prospective study was carried
out on 25 patients with clinically active leprosy and at least one thickened
peripheral sensory nerve. Nerve aspirates were evaluated by May-Grunwald-Giemsa
and Fite's staining. Lepromin test, slit skin smears (SSS), skin biopsies
(except PN cases) and nerve biopsies were performed and compared with FNAC.
FNAC of nerve from 23 cases (92%) yielded diagnostic aspirates. Acid fast
bacilli were observed in six cases by FNAC. FNAC and nerve pathology were
equally comparable with the other parameters evaluated. Based on the results,
cytological criteria were developed for interpreting nerve aspirates and the
cases were classified as paucibacillary (18), BB (2), BL (2), LL (1) and
non-diagnostic (2). All PN cases showed diagnostic paucibacillary type
cytology. FNAC of the nerve yields diagnostic aspirates in leprosy comparable
with nerve pathology and the proposed cytological criteria may be useful in
classification of nerve aspirates.
3345. Wakhlu A. Gaur SP.
Kaushal GP. Misra A. Asthana P.
Sircar AR. Response of Mycobacterium habana vaccine in patients with
lepromatous leprosy and their household contacts. A pilot clinical study. Leprosy Review. 72(2):179-91, 2001 Jun.
Single dose
vaccination was carried out with Mycobacterium habana vaccine, 31 lepromatous
leprosy cases receiving 1.5 mg (1.5 mg = 6.27 x 10(8) bacilli) and 36 household
contacts randomly receiving 1.5, 2.0, 2.5 mg vaccine intradermally. Duration of
study was 18 weeks. Vaccination induced lepromin conversion in 100% of
lepromatous leprosy cases and lepromin negative household contacts and
augmentation of lepromin reactivity in 100% of lepromin positive household
contacts, which was stable for the 15 weeks duration of follow-up. The maximum
augmentation in lepromin reactivity was obtained with 1.5 mg of vaccine, which
is probably the supramaximal dose. Overall, post-vaccination, those without
prior BCG vaccination scars showed higher mean values of lepromin augmentation.
Local vaccination site changes included induration, ulceration, itching, pain
and uncomplicated regional lymphadenopathy, all of which remitted spontaneously
by 15 weeks. Systemic side-effects noted were pyrexia, ENL and jaundice, and
were seen with no greater frequency than that reported in other vaccine trials.
Overall, systemic side-effects were easily controlled and were not accompanied
by clinically detectable nerve or ocular damage. The safety profile
investigations revealed an increase in the mean values of Hb%, RBC count and PCV
in household contacts and of PCV in lepromatous patients, post-vaccination.
Alterations in the liver function tests were also observed in patients of
lepromatous leprosy. Thus, M. habana vaccine appears to be useful in
stimulating specific CMI against M. leprae as evidenced by increased lepromin
reactivity.
Apr 02
4101.
AL-Qubati Y, AL-Kubatia A S:Multidrug therapy-the
pathway for global leprosy elimination. Indian J Lepr 2000, 72(4),
477-90.(013112) July1, 2001.
Emergence
of dapsone-resistant M. leprae and mycobacterial persistance provoked the quest
for another solution. More drug were discovered for treatment of leprosy. But
the real breakthrough was the recommendation of leprosy control activities was
phenomenoal. The impact of MDT has led to the cure of over eight million
leprosy sufferers and the saving of one million patients from becoming
crippled. Leprosy prevalence has decreased by 80% in ten years. By the end of
May 1999 the leprosy burden remained concentrated in only 12 countries of the
world. These achivements are mainly attributed to the development and
world-wide adoption of the MDT programme.
4102.
Brunet RC, Struchiner CJ, Loinaz A. A method for
estimating time dependent intervention benefits under arbitrarily varying age
and exogenous components of hazard. Lifetime Data Anal 2001 Dec;7(4):377-92
A method for estimating the dependence of intrinsic
intervention benefits on time elapsed since the intervention took place is
proposed. The method is aimed at intervention programs against diseases where
one or all of the following components of hazard intensity may undergo
important and unknown variations: 1) the intervention benefits to a subject are
a function of the time elapsed since the intervention took place, or since
inception for a continuing treatment, 2) the subjects vulnerability is an
unknown function of their age, 3) the exogenous or environmental baseline
intensity, to which all are assumed subjected, fluctuates arbitrarily with
calendar time. During the time span of a study, these variables interact in a
complex way, possibly masking the real contribution of the intervention.
However, with very general assumptions about how hazard components interact,
the cumulative hazards of subpopulations treated at different times in the past
are shown to be described mathematically by a convolution of the time elapsed
dependent intervention benefit function with the age and calendar time
dependent baseline intensity. Starting from the cumulative hazards of untreated
and treated subpopulations that had the intervention at different times in the
past, a method of deconvolution through regularization is proposed to
reconstruct the time elapsed dependence of the intervention benefit function.
The regularization technique used is of the 'penalized least square smoothing'
type, it is applied to the solution of Volterra integral equations of the first
kind under noisy inputs. Simulations, to test for the reconstruction of
different modes of time elapsed variation of the intervention benefits, are
carried out on realistically noisy 'data sets' taken to be available at a
limited number of time points. The stability of the estimated reconstructions,
to measurement errors, is examined through repeated simulations with random
noise added to inputs. The method is applied to a Brazilian data set where BCG
vaccination resulted in a small reduction in the cumulated risk of leprosy
infection.
4103.
Cooke GS, Hill AV. Genetics of susceptibility to human infectious disease.
Nat Rev Genet 2001 Dec;2(12):967-77
Before Robert Koch's work in the late nineteenth century,
diseases such as tuberculosis and leprosy were widely believed to be inherited
disorders. Heritability of susceptibility to several infectious diseases has
been confirmed by studies in the twentieth century. Infectious diseases, old
and new, continue to be an important cause of mortality worldwide. A greater
understanding of disease processes is needed if more effective therapies and
more useful vaccines are to be produced. As part of this effort, developments
in genetics have allowed a more systematic study of the impact that the human
genome and infectious disease have on each other.
4104.
Ghorpade A, Ramanan C: Primary penil tuberculoid
leprosy. Indian J Lepr 2000, 72(4),499-500.(013154). July1, 2001. No abstract.
4105.
K, Kashiwabara Y. Multidrug resistant
Mycobacterium leprae from patients with
leprosy. Antimicrob Agents Chemother
2001 Dec;45(12):3635-9
Sequences of the folP1, rpoB, and gyrA genes were analyzed
for 88 isolates of Mycobacterium leprae from leprosy patients in Japan, Haiti,
Indonesia, Pakistan, and the Philippines. Thirteen isolates (14.8%) showed
representative mutations in more than two genes, suggesting the emergence of
multidrug-resistant M. leprae.
4106.
LM, Valdez R, Sordelli DO, Aversa G, Modlin RL,
Sieling PA. Signaling lymphocytic activation molecule expression and regulation
in human intracellular infection correlate with Th1 cytokine patterns. J
Immunol 2001 Nov 15;167(10):5719-24
Induction of Th1 cytokines, those associated with
cell-mediated immunity, is critical for host defense against infection by
intracellular pathogens, including mycobacteria. Signaling lymphocytic
activation molecule (SLAM, CD150) is a transmembrane protein expressed on
lymphocytes that promotes T cell proliferation and IFN-gamma production. The
expression and role of SLAM in human infectious disease were investigated using
leprosy as a model. We found that SLAM mRNA and protein were more strongly
expressed in skin lesions of tuberculoid patients, those with measurable CMI to
the pathogen, Mycobacterium leprae, compared with lepromatous patients, who
have weak CMI against M. leprae. Peripheral blood T cells from tuberculoid
patients showed a striking increase in the level of SLAM expression after
stimulation with M. leprae, whereas the expression of SLAM on T cells from
lepromatous patients show little change by M. leprae stimulation. Engagement of
SLAM by an agonistic mAb up-regulated IFN-gamma production from tuberculoid
patients and slightly increased the levels of IFN-gamma in lepromatous
patients. In addition, IFN-gamma augmented SLAM expression on M.
leprae-stimulated peripheral blood T cells from leprosy patients. Signaling
through SLAM after IFN-gamma treatment of Ag-stimulated cells enhanced
IFN-gamma production in lepromatous patients to the levels of tuberculoid
patients. Our data suggest that the local release of IFN-gamma by M.
leprae-activated T cells in tuberculoid leprosy lesions leads to up-regulation
of SLAM expression. Ligation of SLAM augments IFN-gamma production in the local
microenvironment, creating a positive feedback loop. Failure of T cells from
lepromatous leprosy patients to produce IFN-gamma in response to M. leprae
contributes to reduced expression of SLAM. Therefore, the activation of SLAM may
promote the cell-mediated immune response to intracellular bacterial pathogens.
4107.
PN. Detection of Mycobacterium leprae DNA by
polymerase chain reaction in the blood of individuals, eight years after
completion of anti-leprosy therapy. Mem Inst Oswaldo Cruz 2001 Nov;96(8):1129-33
Thirty eight patients with indeterminate leprosy (HI), at
least 4 to 6 years after discharge from multibacillary (MB) or paucibacillary
(PB) schemes of anti leprosy multidrug therapy (MDT), were submitted to
traditional diagnostic procedures for leprosy and to polymerase chain reaction
(PCR) analysis of different clinical samples for detection of Mycobacterium
leprae DNA. No significant difference was observed for any of the parameters
analyzed between PB or MB schemes of treatment and no indications were found
for more efficient outcome of HI using the MB scheme. Remarkably, 18 (54.5%) of
the individuals were PCR positive in at least one of the samples: positivity of
PCR was highest in blood samples and four individuals were PCR positive in
blood and some other sample. Upon comparison of PCR results with clinical and
histopathological parameters, no correlation was found between PCR-positivity
and eventual relapse. This is the first report on detection of M. leprae DNA in
PB patients, more than half a decade after completion of MDT, suggesting that
live bacilli are present and circulating much longer than expected, although
reinfection of the individuals can not be excluded. Overall, we feel that
because of the high sensitivity of the assay, extreme care should be taken
about association of PCR results, efficacy of treatment and disease status.
4108.
Vekatesan K, Nirmal Deo, Girdhar A, Girdhar B K:
Multiple dose pharmacokinetics of clofazimine in leprosy. Indian J Pharmac
2001,33(2), 136-7. (016536) Aug 16, 2023
Study
was conducted to evaluate multiple dose pharmacokinetics of clofazimine. It
suggests that a steady state might be reached with 36-60 daily doses of the
drug. The observation that AUC values/basal plasma levels are not so much
proportionate to the length of the drug administration is indicative of
extensive deposition and retention of the drug in the tissues and slow release
from there.
4696. Cambau
E, Bonnafous P, Perani E, Sougakoff W, Ji B, Jarlier V. Molecular detection of
rifampin and ofloxacin resistance for patients who experience relapse of
multibacillary leprosy. Clin Infect Dis. 2002 Jan 1;34(1):39-45.
Molecular detection of rifampin resistance (rpoB analysis)
in Mycobacterium leprae was determined for 49 patients who experienced relapse
of multibacillary leprosy and for 34 untreated patients. Molecular detection of
ofloxacin resistance (gyrA analysis) was determined for the 12 patients who experienced
relapse and who had received ofloxacin. Results of molecular tests were
compared with the reference susceptibility test in the mouse footpad. Overall,
the efficiency of molecular detection--that is, positive DNA amplification--was
95%, whereas that of the in vivo test was 55% (P<.001). Results of molecular
detection and in vivo test were fully concordant when both were available—that
is, for 35 rifampin--sensitive cases of leprosy (no rpoB mutation), 4
ofloxacin-sensitive cases (no gyrA mutation), 11 rifampin-resistant cases (rpoB
missense mutations), and 1 ofloxacin-resistant case (gyrA mutation). rpoB and
gyrA analysis appears to be an effective method for detection of rifampin and
ofloxacin resistance in patients with leprosy.
4697. Habib
AA, Mozaffar T. The neuropathology of
leprosy. Arch Neurol. 2002 Jan;59(1):138-40. No abstract.
4698. Massa
R, Morello M, Sancesario G, Bernardi G.
Sural nerve without nerve fibers in leprous neuropathy. Arch Neurol.
2002 Feb;59(2):306. No abstract.
4699. Modlin
RL. Learning from leprosy: insights
into contemporary immunology from an ancient disease. Skin Pharmacol Appl Skin
Physiol. 2002 Jan-Feb;15(1):1-6. Review.
Leprosy provides an ideal model to study immune responses in
humans and in skin. Learning from leprosy, we have gained insight into
mechanisms of host resistance and susceptibility to infection. New paradigms
include the role of Th1/Th2 cytokines, the ability of CD1 to present nonpeptide
antigens to T cells, the ability of microbial lipoproteins to stimulate antimicrobial
activity in monocytes and the demonstration that T cells can mediate a direct
antimicrobial activity through release of granulysin. Together, these findings
provide a rationale for developing new strategies to treat and prevent
infectious disease. Copyright 2002 S. Karger AG, Basel
4700. Newton
SM, Lau C, Gurcha SS, Besra GS, Wright CW.
The evaluation of forty-three plant species for in vitro
antimycobacterial activities; isolation of active constituents from Psoralea
corylifolia and Sanguinaria canadensis.J Ethnopharmacol. 2002 Jan;79(1):57-67.
Review.
Extracts from forty-three plant species were selected on
account of reported traditional uses for the treatment of TB and/or leprosy.
These were assayed for antimycobacterial activities. A simple in vitro
screening assay was employed using two model species of mycobacteria, M. aurum
and M. smegmatis. Crude methanolic extracts from three of the plants, C. mukul,
P. corylifolia and S. canadensis, were found to have significant
antimycobacterial activity against M. aurum only (MIC=62.5 microg/ml). Bioassay
guided fractionation led to the isolation of two known benzophenanthridine
alkaloids, sanguinarine (1) and chelerythrine (2), from the roots S. canadensis
and the known phenolic meroterpene, bakuchiol (3) from the seeds of P.
corylifolia. The fractionation of the resin of C. mukul lead to a decrease in
antimycobacterial activity and hence further work was not pursued. Compound (2)
was the most active against M. aurum and M. smegmatis (IC(50)=7.30 microg/ml [19.02
microM] and 29.0 microg/ml [75.56 microM], respectively). M. aurum was the most
susceptible organism to all three compounds. No significant difference in
antimycobacterial activity was observed when the two alkaloids were tested for
activity in media of differing pH values. The activities of the pure compounds
against M. aurum were comparable with those against M. bovis BCG with compound
(2) being the most active (M. bovis BCG, IC(50)=14.3 microg/ml [37.3 microM]).
These results support the use of these plants in traditional medicine.
4701. Singh D; Thakur K; Kalpana; Goel A. Micro bacterium scrofulaceum:
an isolate from pericardial effusion Indian Journal of Tuberculosis 2002 Jan;
49(1): 49-51.
ABSTRACT:
Non-tuberculous mycobacteria (NTM) cause pulmonary disease indistinguishable
form tuberculosis (TB). In the present case. Mycobacterium scrofulaceum was
isolated from pericardial fluid in a five year old child and was confirmed by
molecular deoxyribonucleic acid (DNA) probe specifically designed and biochemical
test at the Central JALMA Institute of Leprosy, Agra. The previous tuberculous
pleural effusion was probably a predisposing factor in this case. No similar
case has been found in literature inspite of our best efforts.
5448. Alto
WA. Treatment of Hansen's disease. Am
Fam Physician. 2002 Apr 1;65(7):1280, 1282; discussion 1282. No abstract.
5449. Bastos
RR. Experience of leprosy. Lancet. 2002
Jun 1;359(9321):1949. No abstract.
5450. Brophy
PJ. Microbiology. Subversion of Schwann cells and the leper's bell. Science.
2002 May 3;296(5569):862-3. No abstract.
5451. Campos
WR, Rodrigurs CA, Orefice F, Monteiro LG. Identification of M. leprae in
conjunctiva of leprosy patients using
the superior tarsal conjunctiva scrape technique. Indian J. Lepr 1998; 74(4):
397-403. Abstract: Technique of superior tarsal conjunctive scrape was
used for identifying M. leprae in the conjunctiva in 56 leprosy patients (all
of them multibacillary), some untreated and others treated with multidrug
therapy). The technique of tarsal conjunctiva scrape was shown to be more
suitable than conjunctival biopsy for identifying lepra bacilli. This technique
is also easier to perfom and has shown a statistical relation between
baciloscopical index of skin (BIsk) and bacilloscopical index of
tarsal conjunctiva (BIconj) values. Thus, if the bacilli can be
identified at tarsal conjunctiva can assume greater systemic bacillary load in
patients.
5452. Cemerski
S, Cantagrel A, Van Meerwijk JP, Romagnoli P. Reactive oxygen species
differentially affect T cell receptor-signaling pathways. J Biol Chem. 2002 May
31;277(22):19585-93.
Oxidative stress plays an important role in the induction of
T lymphocyte hyporesponsiveness observed in several human pathologies including
cancer, rheumatoid arthritis, leprosy, and AIDS. To investigate the molecular
basis of oxidative stress-induced T cell hyporesponsiveness, we have developed
an in vitro system in which T lymphocytes are rendered hyporesponsive by
co-culture with oxygen radical-producing activated neutrophils. We have
observed a direct correlation between the level of T cell hyporesponsiveness
induced and the concentration of reactive oxygen species produced. Moreover,
induction of T cell hyporesponsiveness is blocked by addition of N-acetyl
cysteine, Mn(III)tetrakis(4-benzoic acid)porphyrin chloride, and catalase,
confirming the critical role of oxidative stress in this system. The pattern of
tyrosine-phosphorylated proteins was profoundly altered in hyporesponsive as
compared with normal T cells. In hyporesponsive T cells, T cell receptor (TCR)
ligation no longer induced phospholipase C-gamma1 activation and caused reduced
Ca(2+) flux. In contrast, despite increased levels of ERK1/2 phosphorylation,
TCR-dependent activation of mitogen-activated protein kinase ERK1/2 was
unaltered in hyporesponsive T lymphocytes. A late TCR-signaling event such as
caspase 3 activation was as well unaffected in hyporesponsive T lymphocytes.
Our data indicate that TCR-signaling pathways are differentially affected by
physiological levels of oxidative stress and would suggest that although
"hyporesponsive" T cells have lost certain effector functions, they
may have maintained or gained others.
5453. Chae
GT, Kim MJ, Kang TJ, Lee SB, Shin HK, Kim JP, Ko YH, Kim SH, Kim NH. DNA-PCR
and RT-PCR for the 18-kDa gene of Mycobacterium leprae to assess the efficacy
of multi-drug therapy for leprosy. J Med Microbiol. 2002 May;51(5):417-22.
DNA-PCR and reverse transcription (RT)-PCR for the 18-kDa
protein of Mycobacterium leprae were used to examine the efficacy of multi-drug
therapy (MDT) in leprosy. MDT was administered for 0-24 months. Fourteen
(63.6%) of 22 patients showed positive PCR results after treatment for 12
months and the positive results decreased to 30% after 24 months of MDT. These
results did not correlate with the bacterial index (BI) or the IgM antibody
titre for the phenolic glycolipid (PGL)-1. One-dimensional densitometric
analysis of agarose gels from PCR from the longitudinal study showed a gradual
reduction of the 360-bp band after 12-24 months of MDT. RT-PCR for mRNA of the
18-kDa protein successfully tracked bacterial RNA changes in the biopsies and
confirmed a decrease in the RNA of M. leprae in patients after MDT for 12
months. Thus, DNA-and RT-PCR for the 18-kDa protein of M. leprae are effective
in assessing the efficacy of MDT for leprosy.
5454. Chakrabarty
AN, Dastidar SG, Sen A, Banerjee P, Roy R. Leprosy bacillus – possibly the
first chemoautomatic human pathogen cultivated in vitro and characterised.
Indian J expl Biol. 2001; 39(10), 962-83. No
abstract.
5455. Geluk
A, van Meijgaarden KE, Franken KL, Subronto YW, Wieles B, Arend SM, Sampaio EP,
de Boer T, Faber WR, Naafs B, Ottenhoff TH. Identification and characterization
of the ESAT-6 homologue of Mycobacterium leprae and T-cell cross-reactivity
with Mycobacterium tuberculosis. Infect Immun. 2002 May;70(5):2544-8.
In this paper we describe identification and
characterization of Mycobacterium leprae ESAT-6 (L-ESAT-6), the homologue of M.
tuberculosis ESAT-6 (T-ESAT-6). T-ESAT-6 is expressed by all pathogenic strains
belonging to the M. tuberculosis complex but is absent from virtually all other
mycobacterial species, and it is a promising antigen for immunodiagnosis of
tuberculosis (TB). Therefore, we analyzed whether L-ESAT-6 is a similarly
powerful tool for the study of leprosy by examining T-cell responses against
L-ESAT-6 in leprosy patients, TB patients, and exposed or nonexposed healthy
controls from areas where leprosy and TB are endemic and areas where they are
not endemic. L-ESAT-6 was recognized by T cells from leprosy patients, TB
patients, individuals who had contact with TB patients, and healthy individuals
from an area where TB and leprosy are endemic but not by T cells from
individuals who were not exposed to M. tuberculosis and M. leprae. Moreover,
leprosy patients who were not responsive to M. leprae failed to respond to
L-ESAT-6. A very similar pattern was obtained with T-ESAT-6. These results show
that L-ESAT-6 is a potent M. leprae antigen that stimulates T-cell-dependent
gamma interferon production in a large proportion of individuals exposed to M.
leprae. Moreover, our results suggest that there is significant
cross-reactivity between T-ESAT-6 and L-ESAT-6, which has implications for the
use of ESAT-6 as tool for diagnosis of leprosy and TB in areas where both
diseases are endemic.
5456. Manandhar
R, Shrestha N, Butlin CR, Roche PW. High levels of inflammatory cytokines are
associated with poor clinical response to steroid treatment and recurrent
episodes of type 1 reactions in leprosy. Clin Exp Immunol. 2002
May;128(2):333-8. Abstract: Levels of leprosy antigen-induced
interferon-gamma (IFN-gamma), tumour necrosis factor alpha (TNF-alpha) and
interleukin-10 (IL-10) were measured in 96 leprosy patients with type 1 reactions
(T1R) before, during and after a standard 12-week course of steroids.
Peripheral blood mononuclear cells (PBMC) from leprosy patients with untreated
T1R produced significantly more TNF-alpha than leprosy patients without T1R.
Median levels of IFN-gamma and TNF-alpha in T1R patients fell during treatment
with steroids; however, TNF-alpha levels increased as the steroid dose was
reduced. Median IL-10 levels increased throughout the steroid treatment period
and were associated strongly with TNF-alpha levels. Patients with high cytokine
levels had a poorer recovery of sensory or voluntary muscle nerve function, a
higher risk of reactivation of symptoms during steroid treatment, and a higher
risk of another episode of T1R within 2 months of completing the steroid
regimen. Rapid and effective reversal of the inflammatory process in T1R is
critical to prevent permanent nerve damage from T1R and monitoring cytokine
levels during treatment may be useful.
5457. Mukherjee
J, Majumdar AK, Bandopadhyay A, Acharya B, Reddy MU, Nayak A. Telemedicine for
leprosy. IETE Tech Rev. 2001; 18(4), 243-52.
Indian Institute of Technology, Kharagpur developed a prototype
telemedicine system for the treatment of tropical disease. Keeping in view the
available infrasturcture in the country, designed the system in such a way, so
that it can function even at a very low bit rate data communication channel
(telephone line). The domain of discourse is chronic tropical diseases which
are endemic in the eastern India. To start with , it selected leprosy and
dermatological disorfers. In the proposed system, it adopted a store and
forward approach. The bulk of the patient
information such as patient’s history, signs and symptoms, old
prescription’s diagnostic test reports and images etc are transferred before
doctors at two ends start discussion about the patient. The physicians at the
referral end could browse through the patient-data and advise accordingly.
During online conferencing, the physicians at the two ends could converse with
each other and discuss with respect
to a test report and image by
annotations, diagram, texts etc. the system has also the back-end database
support for storage and retrieval of patients data. Presently a prototype a
system has been developed and installed at the School of Tropical Medicine
(STM), Calcutta for in-house testing and training of the doctors. Briefly
presents different features of this system with respect to the treatment and
diagnosis of leprosy. A few experimental sessions were carried out between
Calcutta and Kharagpur.
5458. Sirmour
SK, Verma PK, Singh JN, Okhandiar P. LDH isozymes with anamalous bands in semen
of leprosy patients. Indian J Lepr. 1998; 74(4), 405-9. Activity of LDH isozymes was evaluated electrophoretically
on 7% acrylamide gel in semen of 37 leprosy patients (15 with borderline, 12
with borderline tuberculoid and ten with lepromatous leprosy) and ten fertile
men of 30-45 years of age. Significantly lower activities were recorded of LDH1
in all categories of leprosy patients. Similarly, lowering of LDH2
activity was noticed in borderline and lepromatous cases only, lowering of LDH4
activity in lepromatous cases only and LDH5 activity was lowered in
borderline leprosy patients. Lowest activity was lowered in borderline leprosy
patients. Lowest activity of LDH3 and absence if LDHx
were significantly higher. This exceptional increase in activity was found to
be due to presence of additional (anomalous) isozymes bands of LDH3,
LDHx and LDH4 in 25% of borderline tuberculoid patients.
Additional bands of LDH3 have also been located in 40% of the
borderline leprosy patients.
5459. Sreevatsa,
Hari M, Gupte MD. Quality control tests for vaccines in leprosy vaccine trial,
Avadi. Indian J Lepr. 1998; 74(4), 389-95.
Anopheles virus is found in deep- forested areas where manual surveys
are very difficult because of inaccessibility. Geographic Information System
(GIS) and a Boolean operator have been used to map areas where the species is
likely to be found. Being a forest-based species, thematic maps of forest
cover, altitude, rainfall and temperature were prepared. Overlaying and
integration of thematic maps were done using Arc/Info NT and analysis by
Arc/view 3.1 (GIS ESRI) software. The results were validated through reported
distribution and were found correct. The technique can cover vast and
inaccessible areas, fast and easily duplicable in other parts of the world.
Once the vector distribution is known, species-specific control measures can be
formulated.
Pathogenesis:
5460. Brahmbhatt
S, Hussain R, Zafar S, Dawood G, Ottenhoff TH, Drijfhout JW, Bothamley G, Smith
S, Lopez FV, Dockrell HM. Human T cell responses to peptides of the
Mycobacterium leprae 45-kD serine-rich antigen. Clin Exp Immunol. 2002
Apr;128(1):140-8.
In order to identify T cell epitopes within the
Mycobacterium leprae 45-kD serine-rich antigen, we analysed responses to
overlapping 17-mer peptides encompassing the whole antigen in non-exposed UK
controls, Pakistani leprosy patients and tuberculosis patients in both the
United Kingdom and Pakistan. This antigen has been described as M.
leprae-specific, although it has a hypothetical homologue in M. tuberculosis.
Human peripheral blood mononuclear cells were stimulated with peptide for 5
days and IFN-gamma measured in supernatants by ELISA. Some peptides were
recognized more frequently by T cells from tuberculoid leprosy patients than
those from UK controls, suggesting that such T cell epitopes might have
diagnostic potential, while other peptides induced greater responses among UK
control subjects. Short-term cell lines confirmed that these assays detected
specific T cell recognition of these peptides. However, many tuberculosis
patients also recognized these potentially specific peptides suggesting that
there could be a true homologue present in M. tuberculosis.
5461. Brophy
PJ. Microbiology. Subversion of Schwann cells and the leper's bell. Science.
2002 May 3;296(5569):862-3. No abstract.
5462. Chae
GT, Kim MJ, Kang TJ, Lee SB, Shin HK, Kim JP, Ko YH, Kim SH, Kim NH. DNA-PCR
and RT-PCR for the 18-kDa gene of Mycobacterium leprae to assess the efficacy
of multi-drug therapy for leprosy. J Med Microbiol. 2002 May;51(5):417-22.
DNA-PCR and reverse transcription (RT)-PCR for the 18-kDa
protein of Mycobacterium leprae were used to examine the efficacy of multi-drug
therapy (MDT) in leprosy. MDT was administered for 0-24 months. Fourteen
(63.6%) of 22 patients showed positive PCR results after treatment for 12
months and the positive results decreased to 30% after 24 months of MDT. These
results did not correlate with the bacterial index (BI) or the IgM antibody
titre for the phenolic glycolipid (PGL)-1. One-dimensional densitometric
analysis of agarose gels from PCR from the longitudinal study showed a gradual
reduction of the 360-bp band after 12-24 months of MDT. RT-PCR for mRNA of the
18-kDa protein successfully tracked bacterial RNA changes in the biopsies and
confirmed a decrease in the RNA of M. leprae in patients after MDT for 12
months. Thus, DNA- and RT-PCR for the 18-kDa protein of M. leprae are effective
in assessing the efficacy of MDT for leprosy.
5463. Geluk
A, van Meijgaarden KE, Franken KL, Subronto YW, Wieles B, Arend SM, Sampaio EP,
de Boer T, Faber WR, Naafs B, Ottenhoff TH. Identification and characterization
of the ESAT-6 homologue of Mycobacterium leprae and T-cell cross-reactivity
with Mycobacterium tuberculosis. Infect Immun. 2002 May;70(5):2544-8.
In this paper we describe identification and
characterization of Mycobacterium leprae ESAT-6 (L-ESAT-6), the homologue of M.
tuberculosis ESAT-6 (T-ESAT-6). T-ESAT-6 is expressed by all pathogenic strains
belonging to the M. tuberculosis complex but is absent from virtually all other
mycobacterial species, and it is a promising antigen for immunodiagnosis of
tuberculosis (TB). Therefore, we analyzed whether L-ESAT-6 is a similarly
powerful tool for the study of leprosy by examining T-cell responses against
L-ESAT-6 in leprosy patients, TB patients, and exposed or nonexposed healthy
controls from areas where leprosy and TB are endemic and areas where they are
not endemic. L-ESAT-6 was recognized by T cells from leprosy patients, TB
patients, individuals who had contact with TB patients, and healthy individuals
from an area where TB and leprosy are endemic but not by T cells from
individuals who were not exposed to M. tuberculosis and M. leprae. Moreover,
leprosy patients who were not responsive to M. leprae failed to respond to
L-ESAT-6. A very similar pattern was obtained with T-ESAT-6. These results show
that L-ESAT-6 is a potent M. leprae antigen that stimulates T-cell-dependent
gamma interferon production in a large proportion of individuals exposed to M.
leprae. Moreover, our results suggest that there is significant
cross-reactivity between T-ESAT-6 and L-ESAT-6, which has implications for the
use of ESAT-6 as tool for diagnosis of leprosy and TB in areas where both
diseases are endemic.
5464. Hailu
A. The use of direct agglutination test (DAT) in serological diagnosis of
Ethiopian cutaneous leishmaniasis. Diagn Microbiol Infect Dis. 2002
Apr;42(4):251-6.
Leishmania aethiopica (L.a.) is the main species of
Leishmania that causes Ethiopian cutaneous leishmaniasis (ECL). The routine
diagnosis of ECL depends on parasitological examination of smear, culture or
biopsy. In this study, DAT was set-up and evaluated for its diagnostic
performance using defined sera of 45 ECL patients, 18 visceral leishmaniasis
(VL) patients, 12 patients with other diseases, and 37 normal controls. The
test was also evaluated in 64 patients clinically diagnosed as ECL, leprosy, or
other skin diseases. Using L.a. derived antigen, the sensitivity and
specificity of the test was determined to be 90.5% and 91.8% respectively.
However, using antigen derived from a non-homologous strain, only 4 sera of 21
active ECL patients were positive. Eighteen sera of VL patients were positive
irrespective of the different antigen sources. The data show that DAT can be a
useful addition to the diagnosis of ECL.
5465. Lockwood
DN. Leprosy elimination-a virtual phenomenon or a reality? BMJ. 2002 Jun
22;324(7352):1516-8. Review. No abstract.
5466. Manandhar
R, Shrestha N, Butlin CR, Roche PW. High levels of inflammatory cytokines are
associated with poor clinical response to steroid treatment and recurrent
episodes of type 1 reactions in leprosy. Clin Exp Immunol. 2002
May;128(2):333-8.
Levels of leprosy antigen-induced interferon-gamma
(IFN-gamma), tumour necrosis factor alpha (TNF-alpha) and interleukin-10
(IL-10) were measured in 96 leprosy patients with type 1 reactions (T1R)
before, during and after a standard 12-week course of steroids. Peripheral
blood mononuclear cells (PBMC) from leprosy patients with untreated T1R
produced significantly more TNF-alpha than leprosy patients without T1R. Median
levels of IFN-gamma and TNF-alpha in T1R patients fell during treatment with
steroids; however, TNF-alpha levels increased as the steroid dose was reduced.
Median IL-10 levels increased throughout the steroid treatment period and were
associated strongly with TNF-alpha levels. Patientswith high cytokine levels
had a poorer recovery of sensory or voluntary muscle nerve function, a higher
risk of reactivation of symptoms during steroid treatment, and a higher risk of
another episode of T1R within 2 months of completing the steroid regimen. Rapid
and effective reversal of the inflammatory process in T1R is critical to
prevent permanent nerve damage from T1R and monitoring cytokine levels during
treatment may be useful.
5467. Mempel
M, Musette P, Flageul B, Schnopp C, Remling R, Gachelin G, Kourilsky P, Ring J,
Abeck D. T-cell receptor repertoire and
cytokine pattern in granuloma annulare: defining a particular type of cutaneous
granulomatous inflammation. J Invest Dermatol. 2002 Jun;118(6):957-66.
Granuloma annulare is a common granulomatous infiltration of
the skin of unknown etiopathogenesis. We analyzed granuloma annulare biopsies
in 11 patients and could find in all patients significant numbers of CD4-T
cells. These cells showed a broad usage of the different T cell receptor Vbeta
families and a rather unbiased repertoire when the complementary determining
region 3 spectra were analyzed by the Immunoscope technique. Comparison with
the peripheral blood mononuclear cell repertoire, however, identified in all
patients few skin-specific expansions, which were for one patient also present
in two distinct skin sites. Extensive sequence analysis of the complementary
determining region 3 region confirmed the presence of a limited number of
skin-specific expansions together with various nonspecific T cell
infiltrations. Analysis of the intralesional cytokine expression revealed
abundant production of interleukin-2, which was not dominant in granulomas from
leprosy patients and was not reflected by the cytokine profile in peripheral
blood mononuclear cells. These results demonstrate the capacity of the
granulomatous response to recruit T cells in high numbers with only few clones
expanding specifically. The high local production of interleukin-2 might
thereby play an important role in the nonspecific attraction of T cells to the
granulomatous site.
5468. Meyer
TN, Thoma A, Fawcett S, Ginty M, Veltry K. Decompression of the common peroneal
nerve: experience with 20 consecutive cases. Plast Reconstr Surg. 2002 Apr
15;109(5):1755-6; discussion 1756. No
abstract.
5469. Rambukkana
A, Zanazzi G, Tapinos N, Salzer JL. Contact-dependent demyelination by
Mycobacterium leprae in the absence of immune cells. Science. 2002 May
3;296(5569):927-31.
Demyelination results in severe disability in many
neurodegenerative diseases and nervous system infections, and it is typically
mediated by inflammatory responses. Mycobacterium leprae, the causative
organism of leprosy, induced rapid demyelination by a contact-dependent mechanism
in the absence of immune cells in an in vitro nerve tissue culture model and in
Rag1-knockout (Rag1-/-) mice, which lack mature B and T lymphocytes. Myelinated
Schwann cells were resistant to M. leprae invasion but undergo demyelination
upon bacterial attachment, whereas nonmyelinated Schwann cells harbor
intracellular M. leprae in large numbers. During M. leprae-induced
demyelination, Schwann cells proliferate significantly both in vitro and in
vivo and generate a more nonmyelinated phenotype, thereby securing the
intracellular niche for M. leprae.
5470. Rodriguez
I, Alvarez EL, Fernandez C, Miranda A. Comparison of a recombinant-antigen
enzyme immunoassay with Treponema pallidum hemagglutination test for
serological confirmation of syphilis. Mem Inst Oswaldo Cruz. 2002
Apr;97(3):347-9.
A recombinant-antigen enzyme immunoassay (EIA), BioSCREEN
anti-Treponema pallidum, was compared favorably with the T. pallidum
hemagglutination test, in the detection of specific antibodies in different
groups of sera from patients with primary (n = 38), secondary (n = 10), early
latent (n = 28) and congenital syphilis (n = 2), patients with leptospirosis (
n= 8), infectious mononucleosis (n = 7), hepatitis (n = 9), diabetes mellitus
(n = 11), rheumatoid arthritis (n = 13), leprosy (n = 11), tuberculosis (n =
9), HIV/Aids ( n= 12), systemic lupus erythematosus (n = 4), rheumatic fever (n
= 3), old-persons (n = 9), pregnant women (n = 29) and blood donors (n = 164).
The coincidence between them was 95.1%. The sensitivity and specificity of the
EIA were 93.3% and 95.5%, respectively. Fifteen serum specimens belonging to
old-persons, pregnant women, blood donors, and patients with human
leptospirosis, hepatitis, diabetes mellitus, tuberculosis and rheumatic fever
gave false-positive results by Venereal Disease Research Laboratory and/or
Rapid Plasma Reagin. The EIA can be used as alternative method for the
serological confirmation of syphilis.
5471. Zumla
A, Grange J. Infection and disease caused by environmental mycobacteria. Curr
Opin Pulm Med. 2002 May;8(3):166-72. Review.
Many species of mycobacteria that normally live as
environmental saprophytes, the environmental mycobacteria (EM), are opportunist
causes of disease in humans and animals. Many, but not all, cases are
associated with some form of immune deficiency. An increasing number of species
and clinical presentations are being described, and advances are being made in
the understanding of the underlying predisposing factors. In recent years, four
aspects of EM disease have become particularly relevant to human health: (1)
the high prevalence of EM disease in patients with AIDS; (2) the emergence of
Buruli ulcer, an ulcerative skin disease caused by Mycobacterium ulcerans, as
the third most prevalent mycobacterial disease; (3) the effect of infection by
EM on the immune responses to BCG vaccination and on the course and outcome of
tuberculosis and leprosy; (4) the controversy over the involvement of
mycobacteria, notably M. avium subspecies paratuberculosis, in human inflammatory
bowel disease. These aspects change the status of EM from mere curiosities to
important direct, indirect, and putative causes of serious and increasingly
common human disease.
Vaccines
5472. Gupte
MD et al. Comparative leprosy vaccine
trial in South India. Indian J Lepr 1998; 74(4):369-88. Provides results from a
controlled, double blind, randomised, prophylactic leprocy vaccine trial
conducted in South India. Four vaccines, viz BCG, BCG + killed M. leprae, M. w
and ICRC were studied in this trial in comparison with normal saline placebo.
From about 300000 people, 216000 were found eligible for vaccination and among
them, 171400 volunteered to participate in the study. Intake for the study was
completed in two and a half years from January 1991. There was no instance of
serious toxicity of side effects subsequent to vaccination for which premature
decoding was required. All the vaccine candidate was safe for human use.
Decoding was done after the completion
of second survey in December 1998. Results for vaccine efficacy are
based on examination of more than 70% of the original “vaccinated” cohort
population, in both the first and the second resurveys. It was possible to
assess the overall protective efficacy of the candidate vaccines against
progressive and serious forms of leprosy. BCG + killed M. leprae provided 64%
protection (CI 50.4-73.9), ICMR provided 65.5% protection (CI 1.9-43.8) and BCG
gave 34.1% protection (CI 13.5-49.8)…