RESUMO
A review is made of some previous studies on leprosy incidence among contacts, particularly children born of patients in leprosaria. Fluctuations in incidence rate constantly occur, even in the same area. The changes may be due to a number of factor, including different methods of study and varying pathogenic potential which involve susceptibility and resistance among the contacts and intensity and duration of exposure to m.leprae in the enviromment. The incidence is studied in detail in l206 childreen, nearly all of them born in the Culion Sanatorium, and observed closely by the same continuing group of workers for from l year to 20 years during the period l948 through 1967. Most of the children had been separated at birth and brought up in a nursey where they were given lepromin, BCG, or their combinations before being returned tio theier parent at ages of from 1 year to a little over 6 years. a still smaller group among the unisolated children was also given injections
Assuntos
Criança , Hanseníase/prevenção & controle , Hanseníase/transmissão , Hanseníase/tratamento farmacológicoRESUMO
In the foregoing account it has been deemed desirable to trace the general background and setting and the sources of the materials which have served as the basis for the succesive series of studies on childhood leprosy in the Philippines in the past 45 years. The methods employed by the various workers, the scope of their observations, and their main findings are also reviewed. It is evident that no single worker or group has so far been able to deal with the subject in a very comprehensive manner. However, each new attempt has probably added a little to the pre-existing knowledge, or provided fresh stimulus for renewed effort...
Assuntos
Hanseníase/classificação , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Hanseníase/patologiaRESUMO
1- Since May 1948, 100 Culion-born children of leprosy patients have been isolated at birth in the nonleprous environment of the Culion Nursey. Of this number 11 have been released to families outside Culion, 55 have been returned to their parents in the colony after attaining moderate to strong Mitsuda reactions or after successful BCG vaccination, and 33 remained in the nursery in March 1956; 1 died at the age of 10 days of a congenital heart defect. 2-Forty children were given repeated lepromin tests, and the 16 who did not attain 3+ reactivity were then vaccinated with BCG and retested afterward; 12 children were tested with lepromin only after BCG vaccination; 34 were given repeated lepromin tests alone; and 10 had only BCG vaccination. Four children received neither lepromin nor BCG. 3- Of the 11 children released to guardians, 5 have not been heard from. Four were still nonleprous at recent follow-up examinations. Two were brought back to the colony, still nonleprous, at the ages of 3 years 9 months and 1 year 7 months, and they subsequently developed leprous lesions after periods of exposure of 2 years 5 months and 3 years, respectively. 4- The exposure periods in these two cases approximate the average incubation period of cases among unisolated, constantly-exposed children developing similar types of lesions. The first of them had been discharged from the nursery at the age of 2 years 6 months, after receiving four lepromin tests but developing only 1+ reactivity; the other had received neither lepromin nor BCG. Both probably acquired the infection after their return to the colony. Neither had received breast feeding, which indicates that maternal feedings is not a necessary factor in transmission...
Assuntos
Antígeno de Mitsuda , Hanseníase/classificação , Hanseníase/diagnóstico , Hanseníase/prevenção & controle , Hanseníase/tratamento farmacológicoRESUMO
Practically continuos observations of Culion-born children of the patients over the past twenty-four years has revealed that many of them have developed unquestionable leprosy lesions. Approximately three-fourths of the cases of infection actually healed spontaneously, a majority of them apparently permanebtly, in spite of continued residence in the infected environment. There was correlation between the process of healing and the clinical morphology of the initial or earliest recognizable lesions, as well as with bacteriologic, histologic and immunologic features. The papulonodular forms and other definitely circumscribed, thickened lesions were associated with the highest proportions of subsequently healed cases, the infiltration-like, more or less diffusely thickened lesions, with the lowest proportion. The wheal-like and the raised and flat macular lesions occupied an intermediate position, in that order. There was found fairly good correlation between low bacterial content of the lesion, strong Mitsuda reactivity, and a high proportion of healed cases. The correlation between clinical morphology and healing seemed to be even more consistent. Also, the correlation with respect to the healing time showed definite advantage for the circumscribed, thickened lesions. As regards the histologic correlation, healing occurred earlier in the case with lesions with undifferentiated, round-cell or monocytic infiltrates than in those with lesions showing the tuberculoid structure, except with the papulonodules. Knowledge of the clinical morphology of the early lesions and the pattern of their corresponding subsequent course, therefore, is usually of greater value than reliance on uncorrelated histologic, bacteriologic or immunologic observations. Relapses, when they occurred, were chiefly noted within less than three years of apparent healing, gradually becoming more rare after longer pperiods, and practically not seen at all after 10 years. Relapses occurred more frequently in cases whose early lesions were of tuberculoid histology than in those with undifferentiated lesions. They were also more frequently seen among the cases with wheal-like and macular types of early lesions than among those with papuilonodules, lichenoid, or scar-like indurated lesions...
Assuntos
Pré-Escolar , Criança , Hanseníase , Hanseníase/classificação , Hanseníase/complicações , Hanseníase/diagnósticoRESUMO
This article, adopted from an official memorandum not designed for publication, deals with the problems of the "negatives" at the Culion Sanitarium, i.e., those inmates whose disease has so thoroughly cleared up that they are entitled to release or discharge. There are 440 such individuals, constituing about 25 per cent of the inmate population. They are of two categories, namely, adults (268) brought from elsewhere as patients, and children (172) born at Culion who have shown manifestations of the disease but are now clean. Among the adults, 216 (81 per cent) are unwilling or unprepared to leave. The reasos most frequently given are difficulties arising from mutilations due to the disease (171 adults have them in some degree), or the desire not to leave spouses or other relatives not ready for discharge. An important factor, discussed from more than one point of view, is the normality of life in the Culion Reservation and the many opportunities of self-help. Incidentally, less than one quarter of the adult negatives had taken any treatment during the past six months. Even among the patients still bacteriologically positive, less than one-half are taking treatment, in some cases because of difficulties with sulfone, but more often because they do not wish to become negative and therefore liable to be discharged. Many, but by no means all, have been at Culion so long that they have lost contact with the outside world. The negative-children group, almost all without interested relatives outside and 15 of them are already married to other inmates, is an especially intersting one from several points of view. They have had no outside contacts and therefore are highly "institution-minded". With a single exception, they have had no antileprosy treatment; their lesions disappeared spontaneously, not one of them showing any deformity resulting from the disease. Such cases have rarely shown any tendency to relapse. The conditions of life of patients at Culion are discussed. Recommendations are offered which, although intended only for local application, have features of wider interest.
Assuntos
Hanseníase , Hanseníase/classificaçãoRESUMO
1- An autopsied case of very early leprosy in a 17-months-old child of leprous parents is reported. 2- The single, isolated, heavily bacillated lesions discovered two months before death, no longer identifiable clinically two days before death, was found in histological sections after a systematic search for it. 3- Histologically the lesion was a very young leproma with beginning formation of foamy cells and numerous bacilli, in close association with three scars that presumably were due to scabies. 4- Evidence is presented which tends to corroborate the belief that the early skin lesions of leprosy is the primary inoculation lesion. This conclusion is based on the finding of bacilli in considerable numbers only in the corresponding reagional lymphatic nodes of drainage, with none in the other groups of lymph nodes, the nerves, or the other organs examined. 5- The spread of the infection in this case of early leprosy by way of the lymphatics is discussed.
Assuntos
Hanseníase/complicações , Hanseníase/congênito , Hanseníase/diagnóstico , Hanseníase/genética , Hanseníase/patologiaRESUMO
One hundred and ten unisolated nonleprous children of leprous parents, ranging in age from newly-born to eighteen months, all closely observed since birth, were given the lepromin test repeatedly at intervals of four months, with special attention to the appearance of early, recognizable lesions of leprosy, and the results of the tests were analyzed and correlated with the clinical observations. Sex was found to have on the lepromin reaction. The frequency of positive reactions was in direct relation to the age, a small but not negligible proportion of undoubtedly positive reactions accurring, in the first test, among the children less than one year old. In the retests there was a further progressive increase in the proportion of positive reactors which could not wholly be attributed to further ageing, but was probably in part the effect of retesting. Thus a majority of the children who were still less than one year old gave definitely positive reactions in the second or third test. Retesting of strongly positive reactors with a markedly reduced dose of lepromin more frequently resulted in a distinctly diminished reaction in the absence of manifest leprosy than when lesions were already in evidence. The appearance or existence of early leprotic lesions in the children was associated with an apparently undiminished, and possibly even greater tendency to react positively to the test. Both the duration and the constancy of exposure to leprous environment seemed also to bear a direct relation to the proportion of positive reactions.Intercurrent disease not of a serious nature showed no depressing influence on the reaction.
Assuntos
Humanos , Antígeno de Mitsuda/administração & dosagem , Antígeno de Mitsuda/efeitos adversos , Antígeno de Mitsuda/imunologia , HanseníaseRESUMO
A group of 240 children born of leprous parents, ranging in age from newly born to 8 years, has been observed with the object of detecting the earliest clinically recognizable changes that may be attributed to leprosy. A group of 78 children of nonleprous parents was also examined once, for comparison. The observation were for the most part clinical, microscopic examination of smears having been made only for definitely suspicious lesions: sections could not be obtained except from cases that came to autopsy. The commonest type of suspected (that is unidentified) skin lesion found that could not be attributed directly to known nonleprotic skin affections was the hazy pale area first described by Chiyuto. Its incidence was found to increase with age, and it was observed in 96 per cent of all the children of lepers above one year of age. Of much less frequent occurrence were the rough, scaly or granular pale areas and the pale mottlings which showed no definite relation to age, the markedly pale or depigmented areas without definite borders, and the gooseflesh, follicular, or lichenoid areas which were found more frequently in the older than in the younger age groups...