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KMID : 0363219770150020123
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Korean Journal of Dermatology
1977 Volume.15 No. 2 p.123 ~ p.131
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A Evaluation of Cell Mediated Immunity in Leprosy Patients and a Study of Treatment of Passive Transfer Immunity by CMI Conversion with Immune Cell Transfer
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金永杓/Kim, Young Pio
田寅淇/黃仁均/Chun, Inn Ki/Hwang, In Kyun
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Abstract
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Leprosy is an infectious disease in which the immune mechanism, in addition to the bacillus, plays an important role in Pathogenesis. As leprosy has two polar types, one of which is characterized by well preserved cellular immunity with a good prognosis and the other which shows no cellular immunity and a poor prognosis, it has been considered the best human model for immunologic research. By studying the differences between these two types, insights into immune deficiencies might well lead to the improved treatment of lepro_natous leprosy(i.e.,no cellular immunity) patients. Therefore, some immuno-therapautic trials for leprosy patients have already been reported by some authors.
In an attempt to survey specific as well as nonspecific cellular immunity in leprosy, the authors performed the lepromin and tuberculin skin tests with DNCB active cutanous sensitization on 203 leprosy patients in residence at the national leprosarium of Korea. All groups of leprosy patients showed decreased skin reactivity to" the three tests, compared with normal, healthy control groups (p <0.01) .
This phenomenon is probably due to disorganization of lymphnode architecture and antigenic competition. Although a statiscally significant difference could not be found in the tuberculin and DNCB sensitization test results among all groups, the tuberculoid leprosy group and the arrested leprosy group showed stronger reactivity than the non-tuberculoid leprosy group. Patients positive for DNCB sensitization showed more positivity to the tuberculin test (66 %) than to the lepromin test (30 %) (p<0.01), thus suggesting that nonspecific CMI and specific CMI exerted diffenent effects. Patients positive for DNCB sensitization also showed a greater probability (77%) to be responsive to either of the other two delayed cutaneous hypersensitivity tests than not. Leprosy patients in the third or fourth decade of life showed 63-66% positivity to DNCB active sensitization, while those in the sixth or seventh decade showed a positivity of 18-28,/,.". These points toward a significant correlation between age and immune status, (p<0.01). The spontaneous. flare tup during DNCB sensitization most frequently occurred on the 10th to 12th. day of sensitization: positive reaction after chalenge was most frequent in 72 hrs. after the test but some reactions were seen as late as five days after the test.
Two pints of whole blood and its equivalent of leukocyte-rich plasma were infused into 10 patients who had shown negative reaction to all three tests. Conversion of delayed cutaneous hypersensitivity among then was as follows; Four in tuberculin test (3 cases of which were strengthenings of preexisting reactivity). 2 in lepromin test, and 4 in DNCB sensitization.
Of the 6 patients who showed a conversion in any one of the delayed cutaneous hypersensitivity evaluation tests, 4 showed conversion in more than two tests.
Of the 10 patients, who received the transfusions (whole blood or leucocyte-rich plasma), 5 cases showed a high fever for 2 days afterwards. The authors regard histocytotoxicity, . incompatible histocompatibility, or perhaps simply a transfusion reaction as the underlying cause of this febrile reaction-. One patient- developed probably a phobia type psychosis following the blood transfusion and was subsequetly dropped from this study. Two months of observation following the transfusion revealed no definite clinical improvement.
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