RESUMO
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
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
1- Biopsy specimens of the sites of lepromin tests in two groups of leprosy patients, thirty-five lepromatous cases in lepra reaction and six nonreaction control cases (four N3 and two L3), were removed from 21 to 49 days after the test injections were made and examined histologically and for the presence of the injected bacilli in the tissues. 2- In the first, or experimental, group the reactions were: three-plus, one cases; two-plus, two cases; one-plus, sixteen cases; and negative, sixteen cases. In the second, or control, group the four neural cases gave: three-plus reaction, one case; and two-plus, three cases; two lepromatous cases were both negative. 3- The specimens from both cases giving the three-plus reactions (one experimental and one control) showed histological tuberculoid pictures. Of the total of five cases in both groups giving two-plus reactions, four showed histological tuberculoid pictures-an 80 percent agreement if the tuberculoid picture in the reaction lesion is to be considered the criterion for a definitely positive test. 4- Of the sixteen cases recorded as giving one-plus reactions, only three, or 19 percent, showed tuberculoid or subtuberculoid pictures, concomitantly with foreign-body tubercles. In the other thirteen, or 81 percent, the histological changes consisted only of more or less marked cellular compact masses, proliferation of connective tissue with slight or dense fibrosis and infiltrations with vacuolated large monocytes, foreign-body giant cells, or foreign-body tubercles. These changes are interpreted to be false positive or nonspecific reactions to the injected lepromin emulsion. 5- Of the total of eighteen negative reactions, in none could either the tuberculoid picture or the foreign-body tubercle be eration or from slight to dense fibrosis, with slight infiltration of large monocytes and foreign-body giant cells (nine cases), slight hypertrophy of the epidermal pegs (two cases), and vacuoles of the injected lepromin in the interstices of connective tissue without cellular reaction (one cases). In six instances no trace of the injection could be demonstrated.
Assuntos
Humanos , Antígeno de Mitsuda/imunologia , Hanseníase/imunologia , Hanseníase/patologiaRESUMO
1- Of forty-eight hospital patients with lepromatous leprosy in various states of lepra reaction that were tested with lepromin, only four, or 8.3 percent, gave clear-cut positive reactions-one 3+ and three 2+. The 1+ reactions are considered not significant, a point to be discussed in a subsequent paper. 2- Irrespective of whether the patients were in the reaction state or not, retests made from two to four months after the original ones tended to give from slightly to moderately stronger lepromin reactions in twenty-four out of forty-eight patients (including the controls) that were retested. 3- No apparent relation in the intensity of the lepromin test to the presence of lepra reaction can be shown in the diferent groups into which the cases had been arbitrarily classified. 4- Similarly, no deductions can be made concerning the intensity of the lepromin test in relation to the time of the injection after the onset of lepra reaction in the mild, or mild brief and mild recurreant cases. 5- From the results of these studies, no apparent conclusion can be drawn to support the hypothesis that lepra reaction is a manifestation of allergy. Lepra reaction remains an obscure condition.
Assuntos
Antígeno de Mitsuda , Hanseníase/complicações , Hanseníase/imunologiaRESUMO
A case of calcification of the ulnar nerves with osteoid change in leprosy is reported.
Assuntos
Hanseníase , Hanseníase/classificação , Hanseníase/complicações , Hanseníase/diagnósticoRESUMO
It was previously reported (1) that in 15 (36 per cent) out of 42 necropsies on "quiescent" and "arrested" cases of leprosy the bacillus was not demonstrated by direct smears from the deeper organs. Histological study of these cases is now reported. In 12 of these 15 cases the bacillus was found in association with foammy cells. Of the remaining 3 cases, in one neither foamy cells nor bacilli were found, in another a very few foamy cells one bacillus, and in the third a few bacilli without foamy cells. The three cases last mentioned are looked upon as instances in which the infection had probably been almost or quite overcome. Foamy cells were found in the nerve trunks in three cases, in the liver in 5 out of 14 cases, in the adrenal in 2 out of 9 cases, and in the testes in 5 out of 9 cases. Tuberculoid lesions were found in the nerve trunks in three cases, never in the lymph nodes or visceral organs. Absorbed globules of the injected drug were found in some or the lymph nodes examined, never in the nerve trunks. The histological evidence indicates that the bacilli found within the foamy cells were undergoing intracellular digestion. When the microorganisms are very scarce in the tissue, demonstration is probably influenced by chance when the "scraped-incision" method of obtaining smears is used. The necessity of a regular, systematic and continuous follow-up of all paroled cases, in order to determine the permanences of "arrest", is emphasized.
Assuntos
Humanos , Hanseníase Tuberculoide/complicações , Hanseníase Tuberculoide/patologia , Hanseníase Tuberculoide/tratamento farmacológico , Hanseníase/prevenção & controleRESUMO
1- Leprotic lesions infiltrated once or a few times with the iodized Hydnocarpus wightiana ethyl esters as made at Culion show, 24 hours after such injection, polymorphonuclear and large mononuclear exudation, with fibrin deposit and degeneration of the exudate cell (Section I). 2- Leprotic lesions similarly injected for many months show, histologically, marked reduction of the lepromatous tissue and fragmentation of the bacilli, as compared with similar control lesions which have been subjected only to the influence of simultaneous intramuscular injections. In these treated lesions are found large mononuclear leucocytes containing peculiar yellowish globules ("globulated cells"), not seen in untreated lesions. (Section I). 3- The particularly rapid effect of the infiltration method of treatment is due evidently to local action, whether this be the reaction to irritation, or the greater concentration of the drug - which may have a specific effect on the bacillus - or both. (Section I). 4- The skin of non-lepers similarly infiltrated with the iodized hydnocarpus ethyl esters, shows 24 hours after an injection an acute reaction similar to that seen in a leproma. (Section II)...