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Volume - 82, Issue - 1

Editorial
Pages 3 - 5
Original Papers
Pages 6 - 16
  • Trends in new leprosy case detection over 57 years (1952–2008) in Yuxi, Yunnan Province of Southwest China

    • Yu-Ye Li
    • Xiao-An Li
    • Li He
    • Dong Wang
    • Wen-Ying Chen
    • Liang Chen
    • Jian-Bo Lu
    • Yong-Gang Yao
    Volume 82, Issue 1

    | Published on March 2011

    Background:

    Leprosy control and management in China was maintained via a vertical system. Despite substantial achievements in leprosy control in the past decades, leprosy has not been completely eliminated in several endemic areas of Yunnan Province, China.

    Objectives:

    To report the epidemiological trends and management of leprosy in Yuxi, Yunnan Province from 1952 to 2008.

    Design:

    Diagnosis, control, and treatment data for 2223 leprosy cases detected from 1952 to 2008 were analysed.

    Results:

    Two large-scale house-to-house surveys were launched in 1957–1958 and 1964–1965, and a remarkable number of new cases were identified during these two surveys. The overall prevalence rate of leprosy in the Yuxi region presented a roughly unimodal distribution between 1952 and 2008, with a peak (9.27 per 10 000 population) in 1965. This reflects a combination of case detection and duration of treatment. Overall, the age distribution of the patients changed dramatically over the years, and there were only two childhood cases between 1995 and 2008 (both occurring in 1998). Nearly half of the total cases (49.1%) were classified as multibacillary leprosy type. With the introduction and ubiquitous coverage of the WHO multi-drug therapy (MDT) in this area, leprosy elimination was achieved in 1992. In recent years, the majority of cases (>80%) were detected by passive approaches, and there is an increasing tendency to find multibacillary leprosy patients.

    Conclusions:

    Our results provide an overall profile of our 57-year effort regarding the leprosy control in the Yuxi region. The trend in detection of new cases in recent years suggested that the transmission of leprosy has stopped in the area or, at least, dramatically declined.

Original Papers
Pages 17 - 24
  • Adverse effects of Multi-drug therapy in leprosy, a two years’ experience (2006–2008) in tertiary health care centre in the tribal region of Chhattisgarh state (Bastar, Jagdalpur)

    • Harminder Singh
    • Bithika Nel
    • Vivek Dey
    • Pawan Tiwari
    • Naveen Dulhani
    Volume 82, Issue 1

    | Published on March 2011

    Objective:

    To assess the adverse effects of multi drug therapy (MDT) in leprosy patients.

    Methods:

    A prospective and descriptive study carried out in Department of Dermatology, Government Medical College, Jagdalpur. The adverse effects were recorded on the personal record of every individual patient, filled during the course of treatment.

    Results:

    176 patient’s records were analysed, looking for adverse effects. Among the 176 patients, 79 had adverse effects due to one or more components of MDT, 73 had adverse effects due to dapsone, eight due to rifampicin and 16 due to clofazimine. Mean (+ ∕−SD) duration for the development of adverse effects from the start of therapy was 1.99 (+ ∕−0.69) months for dapsone, 3.6 (+ ∕−0.68) months for rifampicin and 7.13 (+ ∕−0.79) months for clofazimine. There was a significant (P < 0.05) correlation between adverse effects and low Body Mass Index (BMI). The suspected drug was stopped and an alternative regime started in nine patients; six had dapsone stopped, two had rifampicin stopped and one had clofazimine stopped.

    Conclusion:

    Adverse effects attributed to MDT are comparable to previous studies and we found that ADR due to Dapsone was very high but most of the ADR were managed by supportive treatment without replacing the suspected drug.

Original Papers
Pages 25 - 35
  • In vitro and skin lesion cytokine profile in Brazilian patients with borderline tuberculoid and borderline lepromatous leprosy

    • James Venturini
    • Cléverson Teixeira Soares
    • Andréa de Faria Fernandes Belone
    • Jaison Antonio Barreto
    • Somei Ura
    • José Roberto Pereira Lauris
    • Fátima Regina Vilani-Moreno
    Volume 82, Issue 1

    | Published on March 2011

    Objective:

    We investigated the in vitro and skin lesions production of cytokines in non-treated borderline tuberculoid (BT) and borderline lepromatous (BL) patients.

    Patients and Methods:

    Seven untreated, non-reactional BT patients and 12 untreated, non-reactional BL patients were studied. Levels of the cytokines IFN-γ, IL-10, TGF-β1 and TNF-α were measured in supernantant of peripheral blood mononuclear cells (PBMC) cultures, stimulated with specific M. leprae antigen (sonicated and whole). The cytokines iNOS, IL-10 and TGF-β1 were detected by immunohistochemistry in skin biopsies.

    Results:

    BT patients produced higher levels of IFN-γ than BL patients; iNOS expression in skin lesions was also higher in BT patients. TGF-β1 was detected in more cells in BL patients; IL-10 expression was similar in both groups. There was a negative correlation between iNOS and TGF-β1 expression in skin biopsies, positive correlation between TGF-β1 in skin lesions and bacillary index, as well as positive correlation between iNOS detected in skin biopsies and PBMC IFN-γ production.

    Conclusions:

    The BT patients had a mainly a Th1-profile of cytokines in their skin lesions and BL patients had aTh2 profile.

Original Papers
Pages 36 - 45
  • Detection of Mutations in folp1, rpoB and gyrA genes of M. leprae by PCR- direct sequencing – A rapid tool for screening drug resistance in leprosy

    • Balaraman Sekar
    • Kamalanathan Arunagiri
    • Balan Nirmal Kumar
    • Sujatha Narayanan
    • Kandhaswami Menaka
    • Puthenparambil Kuruvilla Oommen
    Volume 82, Issue 1

    | Published on March 2011

    Introduction:

    Conventional Mouse foot-pad (MFP) assay for screening drug resistance in M. leprae is cumbersome and time-consuming (approximately 6 to 12 months). Molecular targets for different anti-leprosy drugs have been well defined. Molecular tools for rapid detection of drug resistance in M. leprae have been standardised. A study to compare molecular methods with MFP assay in determining the drug susceptibility of M. leprae was carried out.

    Methods:

    Forty Bacteriological Index (BI) positive patients of leprosy with clinical features of relapse (25), new cases (11) and defaulters (4) were included in the study. A skin biopsy was done and the samples were processed using both MFP assay and Molecular method. PCR assays were carried out to amplify, 388 bp of folP1gene for dapsone resistance, 305 bp of rpoB gene for rifampicin resistance and 342 bp of gyrA gene for ofloxacin resistance, followed by direct DNA sequencing.

    Results:

    Significant growth in the MFP test was obtained in only 28 out of 40 biopsies processed (70%). Ten of these isolates were dapsone resistant; one isolate showed combined resistance against dapsone, rifampicin and clofazimine. Amplification for all three genes was successful in all the 40 (100%) samples. Among folP1 products sequenced, six isolates showed mutations at 53 (or) 55 amino acid positions. Those strains which showed high-level resistance with two log growth in MFP test, and/or showed growth in passage had mutations in folp1 gene. No mutation was detected in rpoB and gyrA products. Thus no molecular evidence of Rifampicin resistance was found in the DNA isolated from biopsies.

    Conclusion:

    Thus PCR-direct sequencing – the rapid and high sensitive molecular technique can be applied for detection of resistance against dapsone, rifampicin and ofloxacin in M. leprae, to over come the limitations of the conventional MFP assay.

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