Cytokines in leprosy, I. Serum cytokine profile in leprosy

Background Leprosy is a chronic infectious disease characterized by a broad spectrum of clinical forms depending on the patient's immune response, in particular cell-mediated immune response. Methods Cytokines can play a role in the cell-mediated immune response. Serum levels of interferon-gamma (IFN-γ), interleukin-2 (IL-2), interleukin-2 receptor (IL-2R), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and interleukin-1beta (IL-1β) were measured by enzyme-linked immunosorbent assay (ELISA) in 55 untreated leprosy patients and 35 reactional leprosy patients, in addition to 20 age- and sex-matched healthy controls. Results Leprosy patients showed significantly higher serum levels of the studied cytokines (except IL-2) compared with healthy controls. When the two poles were compared, tuberculoid leprosy (TT) patients showed significantly higher levels of IFN-γ and TNF-α with significant negative correlations with the bacterial index (BI), whereas lepromatous leprosy (LL) patients showed significantly higher serum levels of IL-2R, IL-10, and IL-1β with significant positive correlations with the BI. Both type I and type II reactional patients showed significantly higher serum IFN-γ, IL-2R, and IL-1β, in addition to IL-10 in type II reactional patients, compared with nonreactional leprosy patients. When compared with each other, type I reactional patients showed increased levels of IFN-γ, whereas type II reactional patients showed increased levels of IL-10. Conclusions In leprosy patients, both IFN-γ and TNF-α are immunoprotective, whereas IL-2R, IL-10, and IL-1β are immunosuppressive. Our results indicate that type I reaction, with increased levels of IFN-γ, is a cell-mediated immune response, whereas type II reaction, with increased levels of IL-10, is essentially an immune complex disease.     

Childhood leprosy: profiles from a leprosy referral hospital in West Bengal, India

Monitoring childhood leprosy in terms of incidence and occurrence of deformities are crucial for better control and understanding the transmission of the disease. In this paper, a profile of all new untreated leprosy patients below 15 years of age who reported at a Leprosy Referral Centre in West Bengal during 2004-2006 are described. Of 151 children studied, 84 (55.6%) were males, 33% were multibacillary and of them, 30% were smear positive. 16% had already developed grade 2 disability (WHO). Multiple nerve involvement was seen in a quarter of children. These findings highlight the seriousness of leprosy among children and the great need to address these issues urgently. Awareness, active case detection especially among contacts and motivation are the essential needs of the hour to prevent tragedy of deformed children due to a totally manageable disease.     

T-lymphocyte cytokine profiles in compositae airborne dermatitis

Compositae airborne dermatitis is a well-recognized disorder characterized by erythematosquamous lesions and papules on light-exposed areas. The presence of positive patch test reactions and the absence of specific serum IgE suggest delayed-type hypersensitivity, the murine model of which is characterized by a Th1 cytokine production profile [high amounts of interferon (IFN)-gamma and interleukin (IL)-2; little or no IL-4 and IL-5]. The aim of this study was to evaluate the cytokine profile of T-cell lines and T-cell clones from peripheral blood in a 38-year-old non-atopic male woodcutter affected by seasonal airborne contact dermatitis. The patient showed positive patch test reactions to several Compositae extracts (Achillea millefolium, Chamomilla recutita, Tanacetum parthenium, T. vulgare) and sesquiterpene lactone mix. On prick testing with Compositae and other plants, serum-specific IgE levels and phototesting were negative or normal. Allergen-specific T-cell lines produced with Compositae extracts showed a good in vitro cell proliferation only to C. recutita extract. Serial cloning performed using the C. recutita-specific T-cell lines revealed an alphabeta+CD4+ phenotype with high amounts of IFN-gamma and IL-4 in T-cell clones. Thus, these cells expressed a preferential Th0 phenotype. These data suggest that in addition to IFN-gamma, other T-cell derived cytokines, such as IL-4, may play a part in the immunopathogenesis of contact dermatitis.     

Serial measurement of serum cytokines, cytokine receptors and neopterin in leprosy patients with reversal reactions

Serum levels of cytokines (IL-4, IL-5, IFN-gamma, TNF-alpha), cytokine receptors (TNFR I and II) and one monokine (neopterin) were estimated in seven leprosy patients to establish disease associated markers for reversal reactions (RR). Sera were collected at diagnosis of leprosy, at the onset of reversal reaction and at different time points during and at the end of prednisone treatment of reactions. It was expected that the serum cytokine and monokine profile before and at different time points during reactions would provide guidelines for the diagnosis and monitoring of reversal reactions in leprosy. The cytokines and cytokine receptors were measured by ELISA, whereas a radioimmunoassay was used for neopterin measurement. Six of the seven patients showed increased levels of neopterin either at the onset of RR or 1 month thereafter, and levels declined on prednisone treatment to that seen at the time of diagnosis without reactions. No consistent disease associated cytokine profile was observed in these patients. Interestingly, serum TNF-alpha levels were increased in the same patients even after completion of prednisone treatment, indicating ongoing immune activity. In conclusion, this study demonstrates that despite cytokines levels in leprosy serum being inconsistent in relation to reversal reactions, serum neopterin measurement appears to be an useful biomarker in monitoring RR patients during corticosteroid therapy.     

Deformities in leprosy patients attending urban leprosy clinic at Varanasi

Analysis of records of urban leprosy clinic of the University Hospital, Varanasi for deformities was done for the years 1979 to 83. Gross deformity rate was 3.73 percent only. The majority of cases of deformity were in borderline type of leprosy. The commonest deformity was claw hand. It is discussed that dapsone treatment does not increase the chance of deformity. The rate, however, increased with age.     

In vivo cytokine profiles in allergic and irritant contact dermatitis

Local cytokine profiles in skin biopsies from allergic and irritant patch test reactions were determined by in vivo immunohistochemistry to differentiate between these 2 clinically identical afflictions especially at the time of final reading in diagnostic patch testing. Biopsies were taken from established allergic persons after specific allergic patch test.-, to epoxy resin (1%) and formaldehyde (1%) and from non-allergic individuals with irritant patch tests to sodium lauryl sulfate (10%) and formaldehyde (8%). At 72 h after application of the agents, significantly enhanced frequencies of dermal infiltrating cells, producing IL-1α, TNF-α. IL-2. and IFN-γ per 100 infiltrating cells in the dermis. were observed in allergic as well us irritant patch test reactions, as compared to normal skin. Significantly higher frequencies of IL- Iα-producing cells were observed in biopsies from epoxy resin (1%) allergen-affected and sodium lauryl sulfate (10%) irritant-affected skin as compared to formaldehyde (1%) allergen-affected skin. In addition, significantly higher frequencies of TNF -α reproducing cells were observed in epoxy resin allergen-affected skin us compared to Formaldehyde (1%) allergen-affected and formaldehyde (8%) irritant affected skin. The allergic and irritant patch test reactions showed similar levels of expression of the Thl cytokines IL-2 and IFN-γ in the dermis. confirmed by probe based detection of IL-2 mRNA and IFN-γ- mRNA, In conclusion, the described similarity shows that allergens and irritants can induce the same profile of IL-la. TNF-α. IL-2. and IFN-γ production, resulting in the near impossibility of discriminating between allergic and irritant contact dermal is at the lime of patch test reading.     

Bedside urinalysis in untreated leprosy patients

The study included 53 patients of untreated leprosy attending University Hospital, Banaras Hindu University during study period of 1 1/2 years. The various types of leprosy included 9,14,16 and 14 cases of tuberculoid, borderline, lepromatous and leprosy with type II reaction respectively. Majority of the patients were below the age of 49 years with male preponderance. 66.04% of patients came from the rural area. Painful micturation (dysuria) (13.20%) was the commonest urinary complaint recorded on enquiry. Specific gravity of urine did not show any change. Abnormal proteinuria was noted in 16.98%, 11.32%, 7.54% and 3.77% of patients of leprosy with reaction, lepromatous, borderline and tuberculoid group respectively. Significant haematuria, pyuria and epithelial cells were noted in all the groups. Haematuria was recorded in focal segmental Glomerulonephritis (GN), mesangioproliferative and diffuse endocapillary Glomerulonephritis (GN) incidence of which was 7.89%, 7.89% and 5.26% respectively in the biopsy tissue. Significant pyuria was noticed in all the groups except minimal change GN.     

Disability in leprosy patients after MDT

Disabilities continue to develop and increase in severity with dapsone monotherapy. This study shows the impact of MDT on disabilities. We interviewed the patients of Chiraigaon block (population,185,521) who had completed MDT under NLEP. There had been significant increase in number of patients with grade-ll and III disability during the course of MDT. This could have been reduced if regular disability examination was done. Long lag period between the onset of disease and start of MDT was an important reason for high disability rate.     

重复开展消除麻风运动对当地新发现病人情况的影响

目的:观察贵州省兴义市重复开展消除麻风运动对当地新发现麻风病人的影响.方法:收集1996～2004年新发现麻风病人的有关资料进行比较分析.结果:9年共发现麻风病人166例,平均每年发现18.4例,年均发现率为2.65/10万.1999年首次开展消除麻风运动后3年,新病人中的2级畸残率和延迟期呈明显下降趋势,低于开展前3年的水平.两次开展消除麻风运动时的畸残率和平均延迟期均达较高水平,提示该地区虽两次开展消除麻风运动但麻风流行程度仍处于较高水平.结论:重复实施消除麻风运动可促进某些流行病学指标的好转,应反复多次开展.