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KMID : 0351619640050010001
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Kyungpook Medical Journal
1964 Volume.5 No. 1 p.1 ~ p.25
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Studies on Early Leprosy
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Abstract
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The classification of leprosy being used in Korea is in general based on the one decided at The International Leprosy Congress (1953), consisting of two principal types; lepromatous and tuberculoid, and two groups; indeterminate and borderline. There are no detailed reports on basic studies which apply this classification to leprosy patients in Korea, as yet.
With the purpose of re-appraising the applicability of this classification in Korea, clinical,histopathological and immunological studies were: made on 653 cases of fresh, early leprosy patients who visited Kyungpook University Hospital, Taegu, Korea, from January, 1958 to Decem~~er, 1963 without previous treatment in their past history. The results were as follows:
1. According to the classification based on the clinical appearance of the lesion, L type was found in 190 cases (29.1%), T type in 199 cases (30.5%), I group in 222 cases (34.0%), B group in 34 cases (5.2%) and N type in 8 cases(1.2%),
2. According to the classification made on the histopathological findings, 207 cases were of L type (31.7%), 154 cases of T type (23. G%), 255 cases of I group (39.1 %) and 37 cases of B group (5.6%).
3. The histopathological characteristics of each type and group were as follows:
① In all cases of L type lepromata were found and as the disease progresses, a free zone was recognized in almost all cases. Atrophic and fibrotic changes of the dermis were more profound, but damage of peripheral nerves and changes of capillaries (hemangiectasis, hypertrophy and proliferation of endothelial cells) were less than in the T type.
② In T type there was a tuberculous granuloma, but no recognizable free zone. Atrophic and fibrotic changes of dermis were less marked than in L type, but damagc to peripheral nerves and changes in capillaries were more marked than in L type.
③ I group showed nonspecific inflammatory changes and atrophic and fibrotic changes of the dermis and atrophic changes of skin appendages were mild.
④ In B group lepromatous and tuberculoid granulomata were found simultaneously. Giant cells were noted in about half of the cases and a free zone in 21.6%. Other changes were similar to those of T type.
4. As a general rule it is reasonable to apply the histopathological diagnosis to differentiatebetween the types and groups of leprosy and to decide: on the prognosis, only after clinical diagnosis is made. In particular, it is impossible to diagnose I group only on histological findings without support from the clinical diagnosis.
5. In 527 cases (80.?%) clinical diagnosis was found to coincide with histological diagnosis. In all the 653 patients, the rate of coincidence was highest in L type, and relatively low in T type and B group.
6. In general there were relatively greater discre~~ancies between clinical and histological diagnoses in the type or group which presents macul~;s. The macules of B group were especially prone to be confused with those of L type.
7. In cases which showed coincidence between clinical and histological diagnoses, bacteriological examination of the skin was positive in 100% of L type, `~n 23.7% of T type, 15.0 0 of I group and 82.6% of B group, but less cases were found to be l:~ositive in bacteriological examination of biopsie:~.
8. In lepromin reaction, there was the highest degree of coincidence between the Mitsuda late reaction and Dharmendra early reaction. There-fore, the significance of both reactions appears to be e~lual. The rate of agreement of both reactions ivas highest in L type and lowest in T type.
9. Although not much difficulty was found in applying the classification decided at The Internationa;~ Leprosy Congress in Koraa, it seems necessal to re-examine the macules.
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