|
KMID : 0386319680050010005
|
|
Korean Leprosy Bulletin
1968 Volume.5 No. 1 p.5 ~ p.7
|
|
|
What´s New in Leprosy?
|
|
Wilson,G.K
|
|
|
Abstract
|
|
|
Another advance has been made in the field´ of tissue culture of Mycobacterium leprae leading to further possibilities in clinical leprosy, such as drug
dosage and management of patients.
After Shepard of Atlanta, Georgia, in 1962, was the first to inoculate successfully M. leprae into the foot pads of a certain strain of mice, in February this year, it was reported that Me leprae injected into thymectomised mice subjected to high dose body radiation, will multiply and produce widespread granulomata showing leprosy pathology.
So that, whereas before M.leprae could be cultiv￢ated in mouse footpads but did not produce any pathological changes in the surrounding tissue, now culture can be performed with the production of typical leprosy pathology.
Well, what does all this mean to the physician in the general hospital or the nurse in the rural clinic faced with a leprosy patient? It has led to at least three interesting facts.
Firstly, 100mg DDS per week is an adequate therapeutic dose.DDS is still the most potent and cheap drug available against leprosy. Tissue culture has shown that M. leprac is extraordinarily sensitive to´ DDS-much more so than to the other more expensive drugs available today.
If has been shown that 50mg. DDS twice per week is equally as effective as 600mg per week, and also, it will produce many fewer reactions.
Well, someone may say, what about DDS resistance? The answer is that DDS resistance certainly does occur, but that it is very rare, and needs to be proved by tissue culture. The most convincing experiment was performed at Sungei Bulbh, Malaya. Otit of a total of 2,000 patients, 9 were selected´ as having had no improvement in skin smears for 5 - yam. Of these 9; 5- showed improvement when
brought under close supervision and given sulphone by injection. Tissue culture subsequently showed no sign of DDS resistance. These 5 had therefore not: been taking the treatment correctly, or were not. absorbing DDS properly.
The remaining 4, however, did not improve under these conditions, and were the very 4 who showed. DDS resistance on tissue culture. They had all DDS. for 14 years or more.
Please note that the patients had shown no bacteriological improvement for 5 years. Many of us used, to become impatient if improvement in skin smears did not occur in 6 months, and changed the drug. However, 5-8 years should be allowed in patients. with the severe forms of leprosy before even consisdering the possibility of drug resistance. In Taegu, we have seen improvement in skin smears on as, little as 1-2mg DDS per week, giving a total of 127-mg over 6months.
To summarise, a dose of 100mg. DDS per week, is a very adequate therapeutic dose and will produce fewer reactions and neuritis.
Secondly, tissue culture is confirming the previous, assumption that only the rod shaped bacillus is viable and capable of multiplication. Clinically, this mean that the Morphologic Index is much more important. than the Bacterial Index. The Morphologic Index is defined as the number of complete rod-shaped bacilli per 1100 organisms examined. A new positive patient may therefore show a reduction in Morphologic Index from 50 or 60% solid rods, to only 5- or 10%after 6 months treatment, even though the Bacterial Index may show very little improvement.
This is very important from a public health and. epideiniologica1 point of view It supports the need to put every patient under treatment as soon
general orthopedic and plastic surgery patients, including leprosy-another step towards integrating leprosy with other diseases.
So that the outlook continues to improve. 1. DDS dose can be reduced.
2. M.I. gives a more accurate field method of
assessing results of treatment and progress.
3. A new vaccine opens up hope for prevention. 4. The recognition and treatment of sulphone
hypersensitivity can save considerable disability. 5. The recognition of early sensory and motor
impairment and prompt treatment can likewise
save considerable disability.
6. The government has taken over its rightful responsibility for leprosy control.
In the words of Dr. Robert Cochrane, "A Mission cannot meet the need, but it can show how the need can be met".
In closing, let me say that there is still a big need for education, there is still a lot of ignorance, particularly in villages. Old customs take years of re-education.
It may not now be needed so much in cities, but
it is still needed in the villages.
The need for education is evident in 3 ways;
1. Education of the patients in understanding a little of the disease, the need for continuous regular treatment under medical supervision, and trying to live normal lives with it.
2. Education of the general public, especially the village farmers, to accept leprosy patients like other diseases and not as the cures of the spirits that takes time.
3. Education of the public health authorities, health centres and sub-centres, into treating leprosy as a disease together with other disease in the overall public health programme.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
 
|
|