Inhibition of Human Lymphoproliferative Responses by Mycobacterial Phenolic Glycolipids JEAN-JACQUES FOURNIE,T* ELIZABETH ADAMS, RAYMOND J

Total Page:16

File Type:pdf, Size:1020Kb

Inhibition of Human Lymphoproliferative Responses by Mycobacterial Phenolic Glycolipids JEAN-JACQUES FOURNIE,T* ELIZABETH ADAMS, RAYMOND J INFECTION AND IMMUNITY, Nov. 1989, p. 3653-3659 Vol. 57, No. 11 0019-9567/89/113653-07$02.00/0 Copyright X3 1989, American Society for Microbiology Inhibition of Human Lymphoproliferative Responses by Mycobacterial Phenolic Glycolipids JEAN-JACQUES FOURNIE,t* ELIZABETH ADAMS, RAYMOND J. MULLINS, AND ANTONY BASTEN Clinical Immunology Research Centre, University of Sydney, 2006 Sydney, Australia Received 17 April 1989/Accepted 8 August 1989 The effect of mycobacterial phenolic glycolipids from Mycobacterium leprae, M. bovis BCG, and M. kansasii on in vitro proliferative responses by human blood mononuclear cells from healthy BCG vaccinees was investigated. All three phenolic glycolipids inhibited proliferation in a concentration-dependent manner. Inhibition was independent of the stimulus used and involved neither antigen-presenting cells nor antigen- specific CD8+ suppressor T cells. It was concluded that the phenomenon may be a general property of mycobacterial phenolic glycolipids, perhaps analogous to the growth-modulating properties of gangliosides. Despite the lack of specificity of inhibition in vitro, de facto specificity may occur in vivo by virtue of the localization of glycolipid in the leprosy lesions. The apparent lack of protective immunity in patients with surface of the antigen-presenting cell (APC) for several days leprosy is associated with the persistence of viable myco- (18), thereby interfering with the subsequent proliferative bacteria within host tissues and a lack of degradation by responses of murine lymphocytes to a variety of stimuli (8). macrophages. Because the microbicidal function of macro- Thus, the studies with both these antigens emphasize the phages is largely dependent on activation by antigen-specific importance of the potential interaction between mycobacte- T lymphocytes, the occurrence of infection could be second- rial glycolipids and macrophages in interfering with T-cell ary to interference in the activation process by mycobacte- activation. rial antigens. Among these antigens, the abundant mycobac- The most widely studied glycolipid from M. leprae is Phe terial cell wall glycolipids constitute the active interface GL-I, largely on account of its capacity to elicit a strong between the pathogen and its environment and therefore antibody response in leprosy patients, particularly those at have the potential to modulate the host response. The the lepromatous end of the spectrum (2). However, this Phe glycolipids are of different types: the phosphatidylinositol GL-I also interacts with the cellular arm of the immune mannosides, the phosphorylated lipoarabinomannam (LAM) system at the level of both macrophage function and lym- found in most mycobacteria, the glycopeptidolipids from the phocyte proliferation. For example, pretreatment of mono- Mycobacterium avium-M. intracellulare-M. scrofulaceum cytes with Phe GL-I from M. leprae results in inhibition of complex, the trehalose-containing lipooligosaccharides from the oxidative burst in response to bacterial antigens (30), M. kansasii and M. xenopi, and the phenolic glycolipids (Phe whereas the ability of macrophages to kill Phe GL-I-coated GL) found in M. bovis BCG, M. leprae, M. kansasii, M. Staphylococcus aureus cells has been shown to be grossly marinum, and M. gastri (reviewed in reference 5). impaired (26). In addition, there is some evidence that the Data about the effects of some but not all of these Phe GLs may act as virulence factors by scavenging oxygen glycolipids on the in vitro response by human lymphoid cells radicals released by activated macrophages (10). are available. LAM is a potent inhibitor of in vitro prolifer- Phe GL-I was initially reported to cause inhibition of ation of peripheral blood mononuclear cells (PBM) from concanavalin A (ConA)-induced proliferation of PBM from healthy subjects or patients with tuberculosis when stimu- patients with lepromatous disease but not from those with lated by mycobacterial or other antigens, the effect being tuberculoid disease or from healthy controls (23). The mech- dependent on the presence of monocytes in culture (14). anism of this effect was thought to be due to triggering of M. Further studies have revealed that this molecule can also leprae-specific T suppressor cells by the specific oligosac- inhibit purified protein derivative (PPD)- or M. Ieprae- charide epitope on Phe GL-I (24). On the other hand, induced responses by PBM from leprosy and patients attempts to induce M. leprae-specific T lymphocytes in mice healthy individuals (20) as well as influenza virus-specific proliferation of CD4+ T-cell clones (25). Since proliferation with Phe GL-I have yielded little evidence of a specific cellular response to the glycolipid (6, 21). induced by macrophage-independent stimuli such as inter- More recently, the effect of Phe GL-I on proliferative leukin-2 (IL-2) and anti-CD3 antibody was not inhibited by responses to ConA in leprosy patients across the clinical LAM, the findings indicate that LAM exerted its effect at the level of antigen processing by macrophages. spectrum as well as in healthy contacts has been studied. Similar results have been found with glycopeptidolipids, The results indicated that Phe GL-I usually exerts a nonspe- (the serovar-specific antigens of M. avium, M. intracellulare cific inhibitory effect on proliferation, which occurs regard- less of the type or even the presence of leprosy, although in and M. scrofulaceum). This type of glycolipid is resistant to a minority of patients and healthy contacts the mitogen degradation by macrophages, so that it remains intact on the response was actually enhanced (27). These findings sug- gested that Phe GL-I was unlikely to determine the type of * Corresponding author. leprosy or to induce a specific T-suppressor cell response. t Present address: Centre de Recherches de Biochimie et de The conflicting results in the literature prompted the G6ndtique Cellulaires du Centre National de la Recherche Scienti- current study, which was designed to test whether higher fique, 118 route de Narbonne, 31062 Toulouse, France. purified mycobacterial glycolipids could in fact influence the 3653 3654 FOURNIE ET AL. INFECT. IMMUN. in vitro proliferative response by T cells and, if so, by what 30 ng/ml. Leu-O-Me was freshly diluted in PBS and used at mechanism. A variety of antigens and mitogens were used to a final concentration of 5 nM as previously described (29). control for specificity, and cells from healthy BCG vaccinees The IL-2 source was the culture supernatant from the gibbon and continuous cell lines served as targets to avoid the cell line MLA 144 used at a final concentration of 20%. potentially confounding effects of chronic infection and Monoclonal antibodies. The anti-CD3, CD4, CD8, and treatment associated with the use of PBM from leprosy CD25 (Tac) monoclonal antibodies were purchased from patients. Initial experiments were performed with the Phe Becton Dickinson and Co., Mountain View, Calif., and the GLs from M. leprae (Phe GL-I), M. kansasii (Phe GLK-I), secondary anti-mouse antibodies fluorescein isothiocyanate and M. bovis BCG (Phe GLB-I) (which differ only in their and phycoerythrin conjugate were obtained from Silenius oligosaccharide portion), and Phe GLK-I was used in the Laboratories, Hawthorn, Australia, and Amersham Interna- remainder because of its fully elucidated structure and ready tional Plc, Amersham, United Kingdom, respectively. availability in pure form (15, 16). Preparation of cells. Samples of blood from healthy BCG Inhibition of proliferation was found to be independent of vaccinees were collected in preservative-free heparin at 10 the Phe GL studied, of the stimulus to proliferation, and of IU/mi (Weddel Pharmaceuticals, Thomleigh, New South the presence of APC or CD8' T cells. The mechanism Wales, Australia). PBM were separated on Ficoll-Hypaque appeared to be a nontoxic functional effect on proliferating gradients. T lymphocytes and APC were further separated CD4+ lymphocytes. The degree of inhibition was correlated from PBM by AET-treated sheep erythrocyte rosetting, as in most cases with the concentration of glycolipid in culture, described previously (28), into E+ and E- cell-enriched although there was a large degree of individual variation. populations, respectively. Fluorescence-activated cell sorter Despite the apparent lack of specificity of the effect, it was (FACS) profiles of the E+ population revealed consistently concluded that inhibition may be a general property of less than 3% of remaining monocytic cells. CD8+-depleted glycolipids, with the potential for de facto specificity owing and CD8+-enriched T-cell populations were obtained from to their high concentration within the lesions of leprosy. E+ cells by using an anti-CD4 monoclonal antibody panning procedure (32). The nonadherent (CD8+-enriched) popula- MATERIALS AND METHODS tion was 52% CD8+, and the adherent (CD8+-depleted) population was less than 4% CD8+, as assessed by FACS Preparation of purified Phe GLs. Phe GLK-I, the major analysis. Monocyte-macrophage-selective depletion of the tetrasaccharidic Phe GL from M. kansasii, was extracted lymphocyte population was performed by treatment of E+ from cultures with chloroform-methanol and purified by cells with 5 mM Leu-O-Me in serum-free medium (5 x 106 liquid chromatography as already described (15). Purified M. cells per ml) for 40 min at room temperature. The remaining bovis BCG Phe GL B-I and M. leprae Phe GL-I were kind population was found by FACS analysis to contain less than gifts from, respectively, A. Vercelonne and C. Asselineau, 0.5% monocytes or macrophages, as described previously Centre de Recherches de Biochimie et de Genetique Cellu- (29), and consequently could not be stimulated to proliferate laires du Centre National de la Recherche Scientifique, by lectins (data not shown). Toulouse, France. The glycolipids were stored in sterile The antigen-specific helper T-cell line EABCG reactive to filtered ethanol stock solutions at 4°C and a concentration of M. bovis BCG sonic extract is part of a larger collection of 100 ,ug/ml. BCG-specific T-cell lines and was generated from PBM of a Reagents.
Recommended publications
  • Chapter 3 Bacterial and Viral Infections
    GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge.
    [Show full text]
  • Leprosy – Eliminated and Forgotten: a Case Report Shiva Raj K.C.1,5* , Geetika K.C.1, Purnima Gyawali2, Manisha Singh3 and Milesh Jung Sijapati4
    K.C. et al. Journal of Medical Case Reports (2019) 13:276 https://doi.org/10.1186/s13256-019-2198-1 CASE REPORT Open Access Leprosy – eliminated and forgotten: a case report Shiva Raj K.C.1,5* , Geetika K.C.1, Purnima Gyawali2, Manisha Singh3 and Milesh Jung Sijapati4 Abstract Background: Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. Case presentation: In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. Conclusion: An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality.
    [Show full text]
  • Lepromatous Leprosy Simulating Sweet Syndrome
    ISSN: 2469-5750 Zemmez et al. J Dermatol Res Ther 2018, 4:056 DOI: 10.23937/2469-5750/1510056 Volume 4 | Issue 1 Journal of Open Access Dermatology Research and Therapy CASE REPORT Lepromatous Leprosy Simulating Sweet Syndrome Youssef Zemmez1*, Ahmed Bouhamidi1, Salwa Belhabib2, Rachid Frikh1, Mohamed Boui1 1 and Naoufal Hjira Check for updates 1Department of Dermatology-Venereology, Mohammed V Military Training Hospital, Rabat, Morocco 2Department of Pathological Anatomy, Mohammed V Military Training Hospital, Rabat, Morocco *Corresponding author: Youssef Zemmez, Department of Dermatology-Venereology, Mohammed V Military Training Hospital, Rabat, Morocco, Tel: 0658150805, E-mail: [email protected] Abstract Leprosy or Hansen's disease is an infection by Mycobac- terium leprae (M. leprae), whose prevalence has consid- erably decreased since the application of the new anti-lep- rosy strategies advocated since 1982 by the World Health Organization (WHO). However, in the endemic countries several cases of leprosy are reported annually. We report a clinical case of lepromatous leprosy revealed by dissemi- nated maculopapular lesions simulating a Sweet syndrome highlighting the importance of knowing how to evoke this diagnosis in patients from endemic areas. Keywords Lepromatous leprosy, Rash, Sweet syndrome Introduction Lepromatous leprosy is generally manifested by Figure 1: a) Maculopapular erythematous lesions of the non-inflammatory lesions, hypochromic macules, and face; b) Papulonodular erythematous lesions in forearms progressive erythematous papulo-nodules. We report and hands. an observation of lepromatous leprosy in a 62-year-old patient from rural Morocco who was diagnosed with abdomen (Figure 2a and Figure 2b). The neurological maculopapular lesions. examination showed hypoesthesia in gloves and socks, with bilateral hypertrophy of the ulnar nerve.
    [Show full text]
  • Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting As
    Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting as Chronic Ulcers with Vasculitis: A Case Report and Discussion Anny Xiao, DO,* Erin Lowe, DO,** Richard Miller, DO, FAOCD*** *Traditional Rotating Intern, PGY-1, Largo Medical Center, Largo, FL **Dermatology Resident, PGY-2, Largo Medical Center, Largo, FL ***Program Director, Dermatology Residency, Largo Medical Center, Largo, FL Disclosures: None Correspondence: Anny Xiao, DO; Largo Medical Center, Graduate Medical Education, 201 14th St. SW, Largo, FL 33770; 510-684-4190; [email protected] Abstract Leprosy is a rare, chronic, granulomatous infectious disease with cutaneous and neurologic sequelae. It can be a challenging differential diagnosis in dermatology practice due to several overlapping features with rheumatologic disorders. Patients with leprosy can develop reactive states as a result of immune complex-mediated inflammatory processes, leading to the appearance of additional cutaneous lesions that may further complicate the clinical picture. We describe a case of a woman presenting with a long history of a recurrent bullous rash with chronic ulcers, with an evolution of vasculitic diagnoses, who was later determined to have lepromatous leprosy with reactive erythema nodosum leprosum (ENL). Introduction accompanied by an intense bullous purpuric rash on management of sepsis secondary to bacteremia, Leprosy is a slowly progressive disease caused by bilateral arms and face. For these complaints she was with lower-extremity cellulitis as the suspected infection with Mycobacterium leprae (M. leprae). seen in a Complex Medical Dermatology Clinic and source. A skin biopsy was taken from the left thigh, Spread continues at a steady rate in several endemic clinically diagnosed with cutaneous polyarteritis and histopathology showed epidermal ulceration countries, with more than 200,000 new cases nodosa.
    [Show full text]
  • Lepromatous Leprosy Masquerading As Rhinophyma
    International Journal of Otorhinolaryngology and Head and Neck Surgery Krishna S et al. Int J Otorhinolaryngol Head Neck Surg. 2015 Jul;1(1):34-36 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20150585 Case Report Lepromatous leprosy masquerading as rhinophyma 1 1 1 2 Sowmyashree Krishna *, Malcolm Pinto , Manjunath Mala Shenoy , Mahesh SG 1 Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India 2Department of Otolaryngology-Head and Neck Surgery, A.J. Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India Received: 26 May 2015 Accepted: 24 June 2015 *Correspondence: Dr. Sowmyashree Krishna, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Leprosy a major global health problem, especially in the developing world, is an infectious disease caused by Mycobacterium leprae. Leprosy has a predilection to with cooler areas of the body. Lepromatous leprosy presents with varied manifestations like nodules, cervical lymphadenitis, hyperpigmented patches and other presentations which can mimic various other diseases and pose a diagnostic challenge in endemic areas. We report a case presenting with nodular infiltration of the nose mimicking rhinophyma who presented with faint reddish swelling over the nose which progressed to nodular infiltration. There was bilateral symmetrical thickening of nerves following which diagnosis was confirmed by slit skin smear and the patient was started on multibacillary multidrug therapy.
    [Show full text]
  • Drug Delivery Systems on Leprosy Therapy: Moving Towards Eradication?
    pharmaceutics Review Drug Delivery Systems on Leprosy Therapy: Moving Towards Eradication? Luíse L. Chaves 1,2,*, Yuri Patriota 2, José L. Soares-Sobrinho 2 , Alexandre C. C. Vieira 1,3, Sofia A. Costa Lima 1,4 and Salette Reis 1,* 1 Laboratório Associado para a Química Verde, Rede de Química e Tecnologia, Departamento de Ciências Químicas, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal; [email protected] (A.C.C.V.); slima@ff.up.pt (S.A.C.L.) 2 Núcleo de Controle de Qualidade de Medicamentos e Correlatos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil; [email protected] (Y.P.); [email protected] (J.L.S.-S.) 3 Laboratório de Tecnologia dos Medicamentos, Universidade Federal de Pernambuco, Recife 50740-521, Brazil 4 Cooperativa de Ensino Superior Politécnico e Universitário, Instituto Universitário de Ciências da Saúde, 4585-116 Gandra, Portugal * Correspondence: [email protected] (L.L.C.); shreis@ff.up.pt (S.R.) Received: 30 October 2020; Accepted: 4 December 2020; Published: 11 December 2020 Abstract: Leprosy disease remains an important public health issue as it is still endemic in several countries. Mycobacterium leprae, the causative agent of leprosy, presents tropism for cells of the reticuloendothelial and peripheral nervous system. Current multidrug therapy consists of clofazimine, dapsone and rifampicin. Despite significant improvements in leprosy treatment, in most programs, successful completion of the therapy is still sub-optimal. Drug resistance has emerged in some countries. This review discusses the status of leprosy disease worldwide, providing information regarding infectious agents, clinical manifestations, diagnosis, actual treatment and future perspectives and strategies on targets for an efficient targeted delivery therapy.
    [Show full text]
  • Commuin ICABLE DI SEASES STUDENT TEXT 1980
    COMMUiN I CABLE DI SEASES STUDENT TEXT 1980 Rural Health Development Project Ministry of Health and Social Welfare Maseru, Lesotho ACK NOWLE;DGEMEN:'TS Nurse C.inician tVaini.nq mateL ial :;are Lesotho adaptations based upon the ME:DiEX proLotype curriculum for L'a.inin mid-Lo vol health workers. ['le prototype MiDEX matLerials 'or developed by Lhe Halth Manpowe r DovelO\opient Sta :ff of the ,Iohn A.Itirls School Med f iie, Univrsity of Iawai . The or.'ig.nili .1 prototypeS we re based on ttraini.nq ex2.U, IiiOn Ce in over a dozen third-world ccuntrios. These were reviaed on the basis of MDS experienaace in Micronesia, Till.and, Pakistan, and Guy ana beftore being made availab.Le to Lesotho under ai UI.S.A.I.D. funded 'ontract. Major adaptation in lesotho began at: the National Nurse Clini~cian T'ira. ninq " ,oqraimmo Curr iculum Adaptation Works:l'.hopt ld a, , 'Mzv.od in ,.nuary L98G. The ncar.y Li fty parti2i.paniLa uce senLtd alI majcr halth and ;i'ualth related ativ iuLits in Lesotho, hoth G ove rnienL and prIvate. h'iie'e participants and othrs workinj as irdividuas and tLhen as rvrev, i commi tees have adapted the Nurse Cli.niciai traini 1 aterLj.sL to eeLt the conditions and nee:ds of Lesoatho. The 6overnment of lenotho and particularly the staff of the Nurse C linir'i.an traini.ing 'rogrmme are grateful to IlMDS for :supilyin, the proottype materials and to a].]. thos individuals h.;Io have nelped in the Lesotho adaptation ioI.
    [Show full text]
  • Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe Between 2009 and 2018
    microorganisms Article Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018 Anna Beltrame 1,* , Gianfranco Barabino 2, Yiran Wei 2, Andrea Clapasson 2, Pierantonio Orza 1, Francesca Perandin 1 , Chiara Piubelli 1 , Geraldo Badona Monteiro 1, Silvia Stefania Longoni 1, Paola Rodari 1 , Silvia Duranti 1, Ronaldo Silva 1 , Veronica Andrea Fittipaldo 3 and Zeno Bisoffi 1,4 1 Department of Infectious, Tropical Diseases and Microbiology, I.R.C.C.S. Sacro Cuore Don Calabria Hospital, Via Sempreboni 5, 37024 Negrar di Valpolicella, Italy; [email protected] (P.O.); [email protected] (F.P.); [email protected] (C.P.); [email protected] (G.B.M.); [email protected] (S.S.L.); [email protected] (P.R.); [email protected] (S.D.); [email protected] (R.S.); zeno.bisoffi@sacrocuore.it (Z.B.) 2 Dermatological Clinic, National Reference Center for Hansen’s Disease, Ospedale Policlinico San Martino, Sistema Sanitario Regione Liguria, Istituto di Ricovero e Cura a Carattere Scientifico per l’Oncologia, Largo Rosanna Benzi 10, 16132 Genoa, Italy; [email protected] (G.B.); [email protected] (Y.W.); [email protected] (A.C.) 3 Oncology Department, Mario Negri Institute for Pharmacological Research I.R.C.C.S., Via Giuseppe La Masa 19, 20156 Milano, Italy; vafi[email protected] 4 Department of Diagnostic and Public Health, University of Verona, P.le L. A. Scuro 10, 37134 Verona, Italy * Correspondence: [email protected]; Tel.: +39-045-601-4748 Received: 30 June 2020; Accepted: 23 July 2020; Published: 24 July 2020 Abstract: Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America.
    [Show full text]
  • LEARNING from LEPROSY Be Enjoyed by 50%Of the Urbanpopulation, but Only 15% Monoclonal Anti-Interferon (IFN)-Y Antibodies
    0022- 1767/86/137 1 -0OOiSO2.00/0 THEJOURNAL OF 1MMUNOLoGY Vol. 137. No. 1. July 1, I986 Copyright 0 1986 by The American Association of Immunol~lsts Prlnted In U.S.A. American Associationof Immunologists PRESIDENTIALADDRESS LEARNINGFROM LEPROSY:A PERSPECTIVE ONIMMUNOLOGY AND THE THIRDWORLD BARRY R. BLOOM From the Departmentsof Microbiology and Immunology. andCell Biology, Albert Einstein Collegeof Medicine. Bronx,NY 10461 "If we take the widest and wisest view of a Cause. there is no such thingas a Lost Cause, because there is no such thingas a Gained Cause. We fight for Lost Causes because we know that our defeat and dismay may be the preface to our successors' victory, although that victory itself will be temporary; we fi ht rather to keep somethning alive than in the expectation t fl at anything will triumph. "T.S. Eliot "A Map of the World Without Utopia on It Is not Worth Glancing At." "Oscar Wilde Let mebegin with a case history. notof an individual. tussis,tetanus, tuberculosis, polio, and measles, and but ratherof a country. any of the fortypoorest nations consequently 0.5%of them became lame from polio, 1% on earth. Let me ask you to try to imagine our qualityof died from neonatal tetanus. 2% succumbedto whooping life, if life expectancy at birth in this countrywere 42 yr. cough. and 3%died from measles. We would be living in if infant mortality at birth were 140 per thousand.if 40% a country whose average gross national product per cap- of our children suffered from malnutrition. and if only ita would be $310/yr: in which 37% of males, but only 10%of children were immunized against diphtheria, per-14% of females, would be literate.
    [Show full text]
  • A Rare Case of Coexistence of Borderline Lepromatous Leprosy with Tuberculosis Verrucosa Cutis
    Hindawi Publishing Corporation Case Reports in Infectious Diseases Volume 2016, Article ID 1746896, 4 pages http://dx.doi.org/10.1155/2016/1746896 Case Report A Rare Case of Coexistence of Borderline Lepromatous Leprosy with Tuberculosis Verrucosa Cutis Biswajit Dey,1 Debasis Gochhait,1 Nagendran Prabhakaran,2 Laxmisha Chandrashekar,2 and Biswanath Behera2 1 Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India 2Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India Correspondence should be addressed to Debasis Gochhait; [email protected] Received 13 July 2016; Revised 23 October 2016; Accepted 31 October 2016 Academic Editor: Sinesio´ Talhari Copyright © 2016 Biswajit Dey et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Occurrence of pulmonary tuberculosis with leprosy is known but association of cutaneous tuberculosis with leprosy is rare. We report a case of borderline lepromatous leprosy coexistent with tuberculosis verrucosa cutis in a 29-year-old male, who presented with multiple skin coloured nodules and hyperkeratotic scaly lesions of 3-month duration. Dual infections are associated with high mortality and morbidity. Therefore early diagnosis and management helps to reduce mortality and to mitigate the effects of morbidity. 1. Introduction or motor weakness. The patient denied any drug intake, fever, myalgia, spontaneous blistering or ulceration, neuritic Mycobacterium leprae is the causative agent of leprosy that pain, and testicular pain. None of the family members or affects the skin and peripheral nerves.
    [Show full text]
  • Hodgkins Lymphoma: a Case Diagnosed by Pathology Section Fine Needle Aspiration Cytology
    Case Report Lepromatous Lymphadenitis Mimicking Non- Hodgkins Lymphoma: A Case Diagnosed by Pathology Section Fine Needle Aspiration Cytology PREM SINGH, DEEBA MUSHTAQ, JYOTI BALA, KALYANI KAPUR, AKSHAY RANA ABSTRACT to be a case of non-Hodgkin’s lymphoma and was taken for Objectives: To report a case of generalized lymphadenopathy in further investigations. a man, clinically suspected as non-Hodgkin’s lymphoma and to Results: Fine needle aspiration was performed on the lymph present the usefulness of FNAC as a diagnostic tool for leprosy node which established lepromatous leprosy as the cause of in patients presenting with lymphadenopathy. lymphadenopathy.This was further confirmed by lymph node Methods: A 46 year old man from Uttar Pradesh (India) with biopsy and its histopathological examination. generalized lymphadenopathy. Initially diagnosed as tuber- Conclusion: The standard tools for diagnosis of leprosy are cular lymphadenitis, he was prescribed a course of anti- mainly skin slit smears or skin biopsy of the affected area of skin. tubercular treatment to which he did not respond. He was When the presentation is with lymphadenopathy, then FNAC of hence referred to our institute, where he clinically suspected the lymph node provides for an infallible tool for diagnosis. Key Words: Lepromatous lymphdenitis, Lymphoma, Non-Hodgkin`s lymphoma INTRODUCTION some were multinucleated, interspersed with reactive lymphoid Leprosy first described in ancient Indian texts from the 6th century cells and plasma cells. Few focal collections of epithelioid cells B.C. is a non fatal infectious disease caused by Mycobacterium were also seen. The foamy macrophages showed intracellular leprae whose clinical manifestations are largely confined to skin, and extracellular negative bacillary images arranged in a parallel peripheral nervous system and upper respiratory tract (1).
    [Show full text]
  • Coexistence of Cutaneous Tuberculosis (Scrofuloderma) and Hanseniasis-A Rare
    DOI: 10.7860/JCDR/2014/7050.4033 Case Report ection Coexistence of Cutaneous Tuberculosis S (Scrofuloderma) and Hanseniasis-A Rare icrobiology icrobiology M Presentation CHANDAN KUMAR DAS1, ASHOKA MAHAPATRA2, MANASI MANASWINI DAS3, DEBASISH SAHOO4, NIRUPAMA CHAYANI5 ABSTRACT Cutaneous tuberculosis, pulmonary tuberculosis and hanseniasis are all caused by different spp. of Mycobacterium, an intracellular pathogen whose development depends on impaired cell mediated immunity. Scrofuloderma is the most common variant of cutaneous tuberculosis, which is characterized by a direct extension of the skin which overlies the infected lymph gland, bone or joint, that breaks down to form an undermined ulcer. We are reporting a rare association of Scrofuloderma (cutaneous tuberculosis) with Hanseniasis (leprosy) in an adult male whose immune status was controversial. Keywords: Co-infection , M. tuberculosis, leprosy CASE REPORT Pus was drained out and it was sent for gram staining, Ziehl Neelsen A 65-year-old man, a farmer by occupation, got admitted to the staining, routine and mycobacterial cultures. Cutaneous biopsy was surgery OPD of S.C.B. Medical College, Cuttack,India with the sent for histopathological studies and blood was sent for routine complaint of a painless discharging ulcer over right inguinal region. tests as well as HIV and VDRL test. Three consecutive sputum The lesion had started as a pea sized papule [Table/Fig-1], that Ziehl Neelsen stainings and X-rays of chest were done for excluding had progressed to a nodule and a pustule, leading to draining pulmonary TB. X-ray of the right thigh was done to detect any bony sinus within a span of 6 months.
    [Show full text]