RESUMO
The E.N.T. Surgeon may be confrontede with various presentations of leprosy, which takes three main forms. Current patterns of migration mean that the disease may be encountered in any country and early diagnosis os of great importance to the patient for his future benefit and, with lepromatous leprosy, to the community to prevent dissemination of M. Leprae, the causative organism. The classification, clinical presentation and means of confirming the diagnosis are stated.
Assuntos
Masculino , Feminino , Humanos , Doenças Faríngeas/diagnóstico , Doenças Nasais/diagnóstico , Hanseníase/diagnóstico , Hanseníase/microbiologia , Hanseníase/patologia , Mucosa Nasal/microbiologia , Mucosa Nasal/patologia , Mycobacterium leprae/isolamento & purificação , Palato/patologia , ÍndiaRESUMO
The choice of controls in clinical trials of new antileprosy drugs involves problems which may be best solved, not by using individual controls, but by employing as a standard for comparison the average improvement in bacterial index made by large numbers of patients during standard DDS treatment. Such a standard makes it possible to compare one new drug directly with another. The procedure is illustrated in the case of three new antileprosy drugs, (a) Ciba 1906, (b) diaminodiphenyl sulphoxide (DDSO), and (c) I. C. I. Compound 15,688, or diethyldithiolisophthalate (ETIP). Ciba 1906, which has now been studied for 3-1/2 years, is an active and valuable drug which nevertheless makes its greatest achievements during the first six months of treatment, when it is usually decidedly superior to DDS. THereafter its activity approximates that of DDS. DDSO is slower but very steady in action, and has advantages and disadvantages compared with DDS. Compound 15,688 has a remarkable effect in some patients, producing a phenomenal change in the bacterial index and in the morphology of bacilli for a very short time, after which drug resistance develops. By the judicious use of these drugs during their period of optimal activity, associated where appropriate with DDS, it may be possible to attain new levels of effectiveness in the chemotherapy of leprosy.
Assuntos
Esquema de Medicação , Hanseníase , Hanseníase/diagnóstico , Hanseníase/prevenção & controleRESUMO
A detailed account is given of the course of leprosy in a group of very heavily infected villages in Eastern Nigeria between the years 1941 and 1956. Conditions for observation were exceptionally favorable. Three surveys in 1941, 1947, and 1955 provided an exact evaluation of the situation at those times, while cooperation of a high order on the part of the people enabled the course of the disease, under the impact of the various influences coming to bear upon it, to be followed year by year. In the 1941 survey 369 active cases were found, a prevalence of 121 per mille in a population of 3,057, with a low proportion of lepromatous cases and large numbers of early cases involving all age groups and both sexes. During the next two years the prevalence rate continued to rise until it reached a peak figure of 170 at the end of 1943. Thereafter it began to fall. By 1947 it was 76 per mille, and by 1955 it had fallen to 17. In total, 302 new cases were encountered during the following 16 years of observation. No less than 153 of these were seen between 1941 and 1943, but in 1944 there was a sharp fall and thereafter the numbers of fresh cases each year continued at a low and declining level. Single macular lesions were presented by 57 per cent of the new cases. The extent, type-distribution and progress of the disease are consistent with the unstable conditions prevailing during the ascendancy of an epidemic rather than with an infection which has been long endemic. In 1941 it must have been approaching its peak. Conditions were then ideal for the spread of the disease, and it is possible that the influx of people with leprosy into the area during the previous decade had an important bearing on the situation. Possible causes for the rapid and great decline in the disease which started in 1944 are discussed. The results of a recent tuberculin survey make it extremely unlikely that tuberculosis had any part in it. A lepromin survey has shown that in 1957 the level of positive reactors is still not high, and the natural evolution of the disease is unlikely to have been an important factor. Deaths and removals among leprosy patients may have had a small influence, as may improvements in personal and public hygiene. Nevertheless, leprosy control measures, made effective bu the great cooperation of the people, appear to have been the decisive factor. Treatment hindered the development of lepromatous leprosy. Simple methods of isolation removed open cases...
Assuntos
Hanseníase , Hanseníase/etnologiaRESUMO
Derívase esta comunicación del re-examen de los datos contenidos en u estudio ya presentado por Lowe y McNulty, con referencia particular a los resultados de pruebas tuberculínicas con dosis pequeñas (von Pirquet con TA) y luego en los negativos con dosis altas (50 UT de DPP, intradérmicamente). Los resultados se correlacionan con los de la reacción a la lepromina. Entre 278 adultos sanos, 79 (29 por ciento) fueron positivos a la Pirquet. De estos positivos, 96 por ciento también reaccionaron a la lepromina; pero una gran proporción de los negativos fueron también lepromino-negativos. De los 199 individuos negativos a la primera prueba con tuberculina, no menos de 144 (73 por ciento) fueron positivos a la prueba con 50 UT. La mayor parte de estos positivos (84 por ciento) figuraban entre los reactores a la lepromina, en tanto que la mitad de los negativos a altas dosis también fueron negativos a la lepromina. En los resultados en los 81 niños comprobados, hubo una semejanza fundamental, pero con notables diferencias cuantitativas. De ellos, sólo 10 (12 por ciento) reaccionaron a la Pirquet, pero, lo mismo que antes, casi todos (90 por ciento) fueron positivos a la lepromina. De los 71 negativos a la Pirquet, apenas una mayoría indudable (59 or ciento) fueron también positivos a la lepromina, pero en este caso, todos los que no reaccionaron a las dosis grande de tuberculina fueron también negativos a la lepromina. Apúntase que, en casi todos los individuos de alto sensibilidad a la tuberculina, este estado se asociaba con positividad a la lepromina y que hubo también una correlación bastante alta entre los que sólo fueron positivos a la dosis alta de tuberculina. Sin embargo, no hubo tal correlación entre los que fueron absolutamente negativos a la tuberculina. Considérase posible, y con respecto a los niños hasta probable, que algunas de las reacciones a la tuberculina a dosis alta fueran de naturaleza anespecífica. Un punto del mayor interés que se estudia más a fondo es la incapacidad específica de los enfermos lepromatosos para volverse reactores a la lepromina, aun siendo hipersensibles a la tuberculina o habiendo sido vacunados con BCG.