Objective. So far, it has not been established a satisfactory method for early diagnosis and studying on epidemiology for leprosy, we want to develop a molecular biological method for solv...Objective. So far, it has not been established a satisfactory method for early diagnosis and studying on epidemiology for leprosy, we want to develop a molecular biological method for solving this point. Materials and methods. Based on the M. leprae gene coding groEL, 65kD and 16S rRNA, three polymerase chain reactions were developed by using plikaytis’, Woods’ and Pattyn’s procedures. It was optimized that the experimental parameters for each PCR, and a comparative study on practivity among three PCRs was also conducted for practical purpose.Results and conclusion. For detecting infection with M. leprae, all of PCRs established by us were highly sensitive and specific, but for practicl purpose, the woods’ PCR optimized by us ought to be chosen firstly.展开更多
Immune-deficient nude mice were inoculated with nude mouse derived Mycobacteriurn leprae by multiple routes (intravenously. subcutaneously at the foot pads and ears). The results showed that these inoculated animals w...Immune-deficient nude mice were inoculated with nude mouse derived Mycobacteriurn leprae by multiple routes (intravenously. subcutaneously at the foot pads and ears). The results showed that these inoculated animals were capable of producing a great number of Mycobacterium leprae to a level 10(11-12) per gram of tissue. and were detected histopathologically to have heavy leproniatous lesions. The dissemination of the infection was found particularly in sites with lower body temperature.The organisms have a partiality to striated muscles and peripheral nerves. The authors suggest that experimental leprosy in nude mice is a very useful tool for leprosy resarch. especially in countries without armadillos. Compared with the single-route inoculation reported previously. multiple-route inoculation is more available.展开更多
Introduction:Type II lepra reaction(T2LR)is a rare immune-mediated complication in patients with leprosy and is typically treated with glucocorticoids and thalidomide.Idiopathic intracranial hypertension(IIH)is marked...Introduction:Type II lepra reaction(T2LR)is a rare immune-mediated complication in patients with leprosy and is typically treated with glucocorticoids and thalidomide.Idiopathic intracranial hypertension(IIH)is marked by increased intracranial pressure leading to symptoms like headache and vision loss.Here,we report a rare case of concomitant T2LR and IIH.Case presentation:A 35-year-old woman with leprosy had been treated with corticosteroids and thalidomide for T2LR over a period of 2 years.She subsequently experienced progressive vision loss,which was initially misdiagnosed as optic neuritis.After high-dose glucocorticoid treatment,her condition worsened.The patient was later found to have elevated intracranial pressure and was ultimately diagnosed with IIH.She was treated with cerebrospinal fluid diversion,which relieved her symptoms.The patient was mildly obese and had received high-dose corticosteroids.T2LR is associated with increased proinflammatory cytokine levels,so the IIH condition was speculated to be related to T2LR.Discussion:Evidence suggests that inflammatory mediators in T2LR may increase choroid plexus permeability,raising intracranial pressure.Long-term glucocorticoid use is associated with IIH,as it may increase intracranial pressure through local cortisol activation in the choroid plexus.The patient’s misdiagnosis of optic neuritis,due to a lack of typical IIH symptoms,delayed appropriate treatment and led to vision loss.Conclusion:While this case may represent an extreme instance as T2LR and IIH are both rare conditions,it highlights a broader issue:prolonged steroid use can increase intracranial pressure to varying degrees,however not all patients with elevated intracranial pressure experience headaches.This case emphasizes the importance of considering IIH in patients on chronic corticosteroids treatment presenting with unusual vision changes.Clinicians should be aware of this possibility and conduct thorough evaluations for high risk populations to detect such complications.展开更多
INTRODUCTIONLeprosy caused by Mvcobacterium leprae （M. leprae）, is a chronic granulomatous disease affecting the skin and peripheral nervous system, which is transmitted through direct contact with nontreated or ina...INTRODUCTIONLeprosy caused by Mvcobacterium leprae （M. leprae）, is a chronic granulomatous disease affecting the skin and peripheral nervous system, which is transmitted through direct contact with nontreated or inadequate treatment patients. Diagnosis of leprosy depends on the clinical signs and symptoms and slit skin smear positivity. However, it＇s sometimes similar with other granulomatous disease caused by mycobacterial infection. Early stage leprosy is difficult to diagnose by clinical criterion alone because the sensitivity of acid-fast bacilli staining is quite low. The polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） shows the great advantage in rapid identification and diagnosis for early cases and has a differentiation between leprosy and nonleprosy cases.展开更多
Objective:This study was performed to compare the efficacy and safety of methotrexate(MTX)plus prednisolone versus prednisolone monotherapy in patients with erythema nodosum leprosum(ENL).Methods:This comparative clin...Objective:This study was performed to compare the efficacy and safety of methotrexate(MTX)plus prednisolone versus prednisolone monotherapy in patients with erythema nodosum leprosum(ENL).Methods:This comparative clinical study was performed in the Chittagong Medical College Hospital,Bangladesh from June 2018 to December 2019.Nineteen patients were selected according to inclusion criteria and randomly allocated to either the MTX plus prednisolone group(Group A,n=10)or the prednisolone monotherapy group(Group B,n=9).All patients were followed up until the end of the 6-month duration of therapy to observe the clinical outcomes and adverse effects.Results:All patients in both groups showed significant improvement(P=0.005 and P=0.008 in Group A and B,respectively).However,prednisolone-related adverse events were more frequent in Group B.Conclusion:The present study has demonstrated that a combination of prednisolone and MTX is a safer and more effective treatment than steroid monotherapy in ENL patients including the healing of nodules.However,this combination therapy did not appear to have a significant steroid-sparing effect,possibly because of the small sample size and short study period.Therefore,a well-designed multicenter randomized controlled trial is recommended for validation of MTX with prednisolone for the management of ENL.展开更多
Background Detection of infection with Mycobacterium leprae allows timely prophylactic treatment,thereby reducing transmission as well as the risk of permanent,leprosy-associated nerve damage.However,since there is no...Background Detection of infection with Mycobacterium leprae allows timely prophylactic treatment,thereby reducing transmission as well as the risk of permanent,leprosy-associated nerve damage.However,since there is no worldwide-implemented standard test for M.leprae infection,detection of infection in asymptomatic individuals remains a major challenge for control programs in endemic areas.In previous studies,we developed and fiield-tested a lateral flow assay(LFA)quantitatively detecting human IgM against M./eprae-specific phenolic glycolipid I(anti-PGL-I),a marker for both active and past infection.This rapid test utilizes luminescent,background-free,up-converting reporter particles(UCP)and immunochromatography(i.e.the UCP-LF test platform)for accurate quantitation of anti-PGL-I IgM without operator bias.The aim of this study was to evaluate the final version of this quantitative UCP-based rapid test(i.e.PGL-I QURapid),using serum and fingerstick blood(FSB).Methods The test comprises a lateral flow strip,in a standard plastic or biodegradable cassette.It can be provided with a humanized,recombinant control to monitor test performance and calculate accurate anti-PGL-I IgM levels.The performance of this QUR-test was assessed using serum and FSB from patients with leprosy(n=214),tubercu-losis(n=20),buruli ulcer(n=19),leishmaniasis(n=14),non-tuberculous mycobacterial(n=35)infections,as well as healthy Dutch individuals(n=710)and humanized,recombinant anti-PGL-I IgM antibodies.Plot receiver operating characteristic curves were created and sensitivity(Sn),specificity(Sp)and the area under the curve were calculated to evaluate test performance.Results Test results classified multibacillary leprosy patients with 95.0%Sn and 100%Sp using serum and 91.5%Sn and 99.8%Sp using FSB.Qualitative test results could be read after 2 min flow time,with accurate quantitation from 10 min onwards.The new anti-PGL-I IgM control supports production of batches with predetermined seroposi-tivity thresholds and monitoring of the PGL-I QUR-test in various settings.Conclusion The operational version of the PGL-I QURapid with point-of-care applicability,meets the WHO target product profile criteria.Thus,this QUR-test is ready for public health implementations.展开更多
目的:了解云南、四川、贵州三省麻风菌株基因型的地理分布。方法:从云南省丘北县、四川省凉山州、贵州省兴义市分别采集59、21、31例麻风患者皮损活检,提取麻风菌DNA,对6-7、AC9、GTA9 3个数目可变的串联重复(variable-number tandem re...目的:了解云南、四川、贵州三省麻风菌株基因型的地理分布。方法:从云南省丘北县、四川省凉山州、贵州省兴义市分别采集59、21、31例麻风患者皮损活检,提取麻风菌DNA,对6-7、AC9、GTA9 3个数目可变的串联重复(variable-number tandem repeat,VNTR)位点的PCR产物测序,确定各位点重复序列数进行分型。结果:三省在6-7位点上有5种基因型,云南以7个拷贝的基因型为主,其它两地区的菌株在该位点的等位基因型为7、8、9,其分布无显著性差异。AC9位点上有4种基因型,三省均以8个拷贝的基因型为主。GTA9位点有非常明显的多样性。云南GTA9为9个拷贝的菌株占总菌株数的18.18%。结论:本研究结果提示麻风菌的基因型与地理分布有关。但需要以更多的位点,了解以VNTR为主的基因分型能否应用于麻风病的传染源和传播链的流行病学研究。展开更多
文摘Objective. So far, it has not been established a satisfactory method for early diagnosis and studying on epidemiology for leprosy, we want to develop a molecular biological method for solving this point. Materials and methods. Based on the M. leprae gene coding groEL, 65kD and 16S rRNA, three polymerase chain reactions were developed by using plikaytis’, Woods’ and Pattyn’s procedures. It was optimized that the experimental parameters for each PCR, and a comparative study on practivity among three PCRs was also conducted for practical purpose.Results and conclusion. For detecting infection with M. leprae, all of PCRs established by us were highly sensitive and specific, but for practicl purpose, the woods’ PCR optimized by us ought to be chosen firstly.
文摘Immune-deficient nude mice were inoculated with nude mouse derived Mycobacteriurn leprae by multiple routes (intravenously. subcutaneously at the foot pads and ears). The results showed that these inoculated animals were capable of producing a great number of Mycobacterium leprae to a level 10(11-12) per gram of tissue. and were detected histopathologically to have heavy leproniatous lesions. The dissemination of the infection was found particularly in sites with lower body temperature.The organisms have a partiality to striated muscles and peripheral nerves. The authors suggest that experimental leprosy in nude mice is a very useful tool for leprosy resarch. especially in countries without armadillos. Compared with the single-route inoculation reported previously. multiple-route inoculation is more available.
基金supported by the Natural Science Foundation of Hunan Province,China(No.2018JJ6010).
文摘Introduction:Type II lepra reaction(T2LR)is a rare immune-mediated complication in patients with leprosy and is typically treated with glucocorticoids and thalidomide.Idiopathic intracranial hypertension(IIH)is marked by increased intracranial pressure leading to symptoms like headache and vision loss.Here,we report a rare case of concomitant T2LR and IIH.Case presentation:A 35-year-old woman with leprosy had been treated with corticosteroids and thalidomide for T2LR over a period of 2 years.She subsequently experienced progressive vision loss,which was initially misdiagnosed as optic neuritis.After high-dose glucocorticoid treatment,her condition worsened.The patient was later found to have elevated intracranial pressure and was ultimately diagnosed with IIH.She was treated with cerebrospinal fluid diversion,which relieved her symptoms.The patient was mildly obese and had received high-dose corticosteroids.T2LR is associated with increased proinflammatory cytokine levels,so the IIH condition was speculated to be related to T2LR.Discussion:Evidence suggests that inflammatory mediators in T2LR may increase choroid plexus permeability,raising intracranial pressure.Long-term glucocorticoid use is associated with IIH,as it may increase intracranial pressure through local cortisol activation in the choroid plexus.The patient’s misdiagnosis of optic neuritis,due to a lack of typical IIH symptoms,delayed appropriate treatment and led to vision loss.Conclusion:While this case may represent an extreme instance as T2LR and IIH are both rare conditions,it highlights a broader issue:prolonged steroid use can increase intracranial pressure to varying degrees,however not all patients with elevated intracranial pressure experience headaches.This case emphasizes the importance of considering IIH in patients on chronic corticosteroids treatment presenting with unusual vision changes.Clinicians should be aware of this possibility and conduct thorough evaluations for high risk populations to detect such complications.
基金The study was supported by a grant from the National Natural Science Foundation of China （No. 81271761）.
文摘INTRODUCTIONLeprosy caused by Mvcobacterium leprae （M. leprae）, is a chronic granulomatous disease affecting the skin and peripheral nervous system, which is transmitted through direct contact with nontreated or inadequate treatment patients. Diagnosis of leprosy depends on the clinical signs and symptoms and slit skin smear positivity. However, it＇s sometimes similar with other granulomatous disease caused by mycobacterial infection. Early stage leprosy is difficult to diagnose by clinical criterion alone because the sensitivity of acid-fast bacilli staining is quite low. The polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） shows the great advantage in rapid identification and diagnosis for early cases and has a differentiation between leprosy and nonleprosy cases.
基金The authors thankfully acknowledge the assistance of Mr. Sultan Md Elias Uddin. Program Manager, Leprosy control project, Chittagong.
文摘Objective:This study was performed to compare the efficacy and safety of methotrexate(MTX)plus prednisolone versus prednisolone monotherapy in patients with erythema nodosum leprosum(ENL).Methods:This comparative clinical study was performed in the Chittagong Medical College Hospital,Bangladesh from June 2018 to December 2019.Nineteen patients were selected according to inclusion criteria and randomly allocated to either the MTX plus prednisolone group(Group A,n=10)or the prednisolone monotherapy group(Group B,n=9).All patients were followed up until the end of the 6-month duration of therapy to observe the clinical outcomes and adverse effects.Results:All patients in both groups showed significant improvement(P=0.005 and P=0.008 in Group A and B,respectively).However,prednisolone-related adverse events were more frequent in Group B.Conclusion:The present study has demonstrated that a combination of prednisolone and MTX is a safer and more effective treatment than steroid monotherapy in ENL patients including the healing of nodules.However,this combination therapy did not appear to have a significant steroid-sparing effect,possibly because of the small sample size and short study period.Therefore,a well-designed multicenter randomized controlled trial is recommended for validation of MTX with prednisolone for the management of ENL.
基金This study was made possible thanks to a grant from the Q.M.Gastmann-Wichers foundation(AG).
文摘Background Detection of infection with Mycobacterium leprae allows timely prophylactic treatment,thereby reducing transmission as well as the risk of permanent,leprosy-associated nerve damage.However,since there is no worldwide-implemented standard test for M.leprae infection,detection of infection in asymptomatic individuals remains a major challenge for control programs in endemic areas.In previous studies,we developed and fiield-tested a lateral flow assay(LFA)quantitatively detecting human IgM against M./eprae-specific phenolic glycolipid I(anti-PGL-I),a marker for both active and past infection.This rapid test utilizes luminescent,background-free,up-converting reporter particles(UCP)and immunochromatography(i.e.the UCP-LF test platform)for accurate quantitation of anti-PGL-I IgM without operator bias.The aim of this study was to evaluate the final version of this quantitative UCP-based rapid test(i.e.PGL-I QURapid),using serum and fingerstick blood(FSB).Methods The test comprises a lateral flow strip,in a standard plastic or biodegradable cassette.It can be provided with a humanized,recombinant control to monitor test performance and calculate accurate anti-PGL-I IgM levels.The performance of this QUR-test was assessed using serum and FSB from patients with leprosy(n=214),tubercu-losis(n=20),buruli ulcer(n=19),leishmaniasis(n=14),non-tuberculous mycobacterial(n=35)infections,as well as healthy Dutch individuals(n=710)and humanized,recombinant anti-PGL-I IgM antibodies.Plot receiver operating characteristic curves were created and sensitivity(Sn),specificity(Sp)and the area under the curve were calculated to evaluate test performance.Results Test results classified multibacillary leprosy patients with 95.0%Sn and 100%Sp using serum and 91.5%Sn and 99.8%Sp using FSB.Qualitative test results could be read after 2 min flow time,with accurate quantitation from 10 min onwards.The new anti-PGL-I IgM control supports production of batches with predetermined seroposi-tivity thresholds and monitoring of the PGL-I QUR-test in various settings.Conclusion The operational version of the PGL-I QURapid with point-of-care applicability,meets the WHO target product profile criteria.Thus,this QUR-test is ready for public health implementations.
文摘目的:了解云南、四川、贵州三省麻风菌株基因型的地理分布。方法:从云南省丘北县、四川省凉山州、贵州省兴义市分别采集59、21、31例麻风患者皮损活检,提取麻风菌DNA,对6-7、AC9、GTA9 3个数目可变的串联重复(variable-number tandem repeat,VNTR)位点的PCR产物测序,确定各位点重复序列数进行分型。结果:三省在6-7位点上有5种基因型,云南以7个拷贝的基因型为主,其它两地区的菌株在该位点的等位基因型为7、8、9,其分布无显著性差异。AC9位点上有4种基因型,三省均以8个拷贝的基因型为主。GTA9位点有非常明显的多样性。云南GTA9为9个拷贝的菌株占总菌株数的18.18%。结论:本研究结果提示麻风菌的基因型与地理分布有关。但需要以更多的位点,了解以VNTR为主的基因分型能否应用于麻风病的传染源和传播链的流行病学研究。
