Lepromatous and Tuberculoid Leprosy: Clinical Presentation and Cytokine Responses

Abstract

The findings of this study suggest that patients with the two distinct forms of leprosy are capable of responding to a polyclonal T-lymphocyte stimulus such as anti-CD3 and provide evidence suggestive of alterations in the immune responses mediated by cytokines that may contribute to the spectrum of disease and response to treatment.

Leprosy: pathogenesis updated

“…Many attempts have been made to explain the clinico‐pathologic spectrum of leprosy. Natural resistance and susceptibility factors, based on positive or negative Mitsuda reactions, were postulated .90−94 Later, it was demonstrated that leprosy patients may have different MHC patterns with HLA variability .16−18 , 94 , 95…”

“…The phenotype analysis has shown interleukin 2 (IL‐2) and interferon gamma (IFN‐γ) as markers of cell‐mediated immunity in tuberculoid leprosy, and interleukin 4 (IL‐4) as an index of humoral immunity in lepromatous leprosy .17 , 18 All these cytokines are produced by CD4+ Th‐1 (helper‐1) and Th‐2 (helper‐2) lymphocytes, involved in cell‐mediated and humoral immunity, respectively. CD8+ T (c‐s) lymphocytes (cytotoxic suppressor) may co‐operate in tuberculoid leprosy, but may play their most significant role in lepromatous leprosy.…”

Leprosy: accessory immune system as effector of infectious, metabolic, and immunologic reactions

“…In type 2 and type 3 leprosy reactions, these responses result from CD4+ Th‐2 and B lymphocytes associated with macrophage TNF‐α and IL‐1. In lepromatous leprosy, activation of macrophage clones that provoke cell‐mediated immunity may account for type 1 reactions (reversal) 93–100 …”

Pseudoathetosis in a patient with leprosy

“…Our patient had widespread involvement of most of the nerves of upper and lower limbs. In leprosy, the M. leprae colonize and proliferate in the Schwann cells of unmyelinated and small myelinated axons 3. Predominant large fibre involvement in our patient was evidenced by loss of joint position and vibration sense, slowing of conduction velocity and prolongation of F latency.…”

“…Skin smear for acid fast bacilli and HIV ELISA were negative. Cerebrospinal fluid revealed protein 60 mg/dl, sugar 75 mg/dl, and 5 lymphocytes/mm 3. Nerve conduction velocity on right median motor nerve was 26.8 m/sec ( F = 27.6 msec), left median motor 50 m/sec ( F = 29.6 msec); right ulnar motor 38.5 m/sec ( F = 32.4 msec), left ulnar motor 44.8 m/sec ( F = 26.4 msec), right peroneal 37.9 m/sec ( F = 63.6 msec) and left peroneal 38.2 m/sec ( F = 48.0 ms).…”