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...