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Volume 62, Number 4, December 1991 Published Quarterly for The Volume 62, Number 4, December 1991 LEPROSY REVIEW Published Quarterly for the British Leprosy Relief Association ISSN 0305-7518 Leprosy Review A journal contributing to the better understanding of leprosy and its control British Leprosy Relief Association LEPRA Editorial Board PRO~ESSOR J . L. TURK (Chairman and Edilor) DR R . J . W . R EES , C.M .G . (Vice-Chairman) The Royal Coll ege of Surgeons National Institute fo r Medical Research Department of Pa thology, The Ridgeway 35- 43 Lincoln's Inn Field Mill Hill, London NW7 IAA London W C2A 3PN JANE EVILLE, M .B.E. DR M . J . COLSTON 5 Sandall Close National Institute for Medical Research Ealin g The Ridgeway, Mill Hill Lo ndo n W 5 IJ E London NW7 I AA PROFESSOR P. E. M . FINE DR PATRI CIA ROSE Department of Epidemiology Allendale Ho use and Populati on Sciences A ll endale Road London School of H ygiene Hexha m N E46 2DE and Tropical Medicine Keppel Street DR M . F. R . WATERS , O .B. E. London W C I E 7HT Hospital fo r Tro pical Diseases DR S. LUCAS 4 St Pa ncras W ay School of Medicine Lo ndo n NW l OPE University Col1ege and Middlesex Medical School, London DR H . W . WH EATE , O .B.E. U ni versi ty Street 50 Avenue Road, Belmo nt, Sulto n Lo ndo n W C IE 6JJ Surrey SM2 6JB Editorial Office: Lepra, Fa irfax House, Causton Road, Colchester C01 1 PU , England Assistant Editor: Jennet Batten, 94 Church Road, Wheatley, Oxon OX9 1 LZ, England Leprosy Review is published by the British Leprosy Relief Association (LEPRA) with the main objective of contributing towards the better understanding of leprosy a nd its control. Original papers o n al1 aspects of leprosy, including research, a re welcomed. In addition, Leprosy Review seeks to publish info rmation of educational value which is of direct benefit to the contro l of leprosy under field conditio ns, a nd hence to the individual patient. The J o urnal aims to interpret what is being done in other disciplines, particularly for field workers. From time to time the Editorial Board invites specia l articles or edito ri als from experts in various parts of the world, and gives considera ti o n to the production of a supplement or special number devoted to a particula r subject or theme of major impo rta nce. British Leprosy Relief Association Registered Offices: Fa irfax House, Causton Road, Colchester C01 7PU CONTENTS Editorial 353 Environmental mycobacteria and human disclIsc . .I . M . G RANGE Original Articles .,62 C omp'Hison of polymcrasc chain reliction tcchniquc with other mcthods for detcction of Mycobacterium lepml' in tissues of wild ninc-banded armadillos. C. K . JOIl . V. DRAI N, D . L. WILLI AMS, T. P. G ILLIS, R . W . T RUMAN , R . M . SANCHEZ, A . T. D EMI NG and R . C. HA STINGS 374 Lipid-laden mllcrophages in bone nlllrrow of leprosy patients. R . S EN , P . K . SEHGAL. V. D IXIT. U MA S ING H. S. D . C HAU DII ARY , R . S IKK A a nd V. K . JAI N 38 1 S quamous ccll carcinoma in chronic ulccrs in leprosy: a rcview of 38 consecutive cases, J . H . RI CHARI) US a nd T. C. S MI TH 389 asalmyillsis in leprosy. S. H USA IN, G . N . MA LAVIYA, A . G IRI)HAR . SR EEV ATSA a nd B. K . G IRUHAR 395 An educational approach to leprosy control: an c,'aluation of kuowlcdl:e. altitudes and practice in two poor localities iu Bombay. India, . C ROO K, R . RAMAS UIlIlA N, A . SA MY a nd B. SING H -1 02 Psychosocial aspects of deformed leprosy patients underl:oing surgical correction. U . R AMA NAT HA N, G . N . M AL AVIYA , NooTAN JAI N a nd S. II USA IN 410 T he private G P a nd leprosy: a study. M . W . U PLE KAR a nd R. A . C ASH S pecial Article 420 Paltern of le prosy in Queensland. Austra lia. 1855- 1990, G . H . R EE Letters to the Editor -1 3 1 Type II (ENL) reaction in histoid leprosy in II child. V. N . SEHGAL. A . K . C HAU I) ARY , D . M . MAHAJA N a nd B. S. BED I 432 S uggested ncw technique for skin biopsy under field conditions, R . M . Ci-IATU RV ED I a nd S. K ARTIKEYA N 434 Comment: Positive Mitsuda lepromin reaction in long-term treated lepromatous le prosy and tuberculoid relapse in le promatous leprosy. J . WA LTE R 435 Re ply. PAT RI CIA R OSE a nd M . F . R . WA TERS 436 C omment: C arvable silicone rubber prosthe tic implant for atrophy of the first web in the hand, R . PREM K UMA R -1 38 Book Review -1 39 Teachj!lg Materials and Services Library se rvices for primary hea lth care T O OL: Re fe rence Centre Services C hristoffel Blind e nmissio n (Le pra O phtha lmic C o urse. K a ri giri , India, 199 1 Health wo rkers a nd blindness preventio n in le prosy. Video I nte rna tio na l Fo unda tio n o f De rma to logy Surgery a nd anaest hesia a t the d is trict h osp ita l. WHO Prel'eII /ioll o/iJlilltill l'ss ill lepro.IT Health learning materials for develop ing countries. WH O 44 2 News and Notes T{)\\'{/rtis I'lilllil/{lliOIl 0/ leprosy, WH O Forty-fo urth W o rld Hea lt h A ssembly- e limina tio n o f leprosy by the yea r 2000. WHO a ti o na l Leprosy E ra dicati o n Progra mme. India, 1990 TDR ('11 '.1' . Decem ber 1990 Third W o rld G ui de 199 1 92, OXFAM . E ngla nd H eiser Progra m for Research in Leprosy Firs t D.:cade H ealth Actio n Inte rna ti o na l (HAl) The continuing sp read of A ID S The Arkleton T rust. U K Complia nce a nd m edicati o n m o nito ring . APR EX Tube rc ulosis in the Sudan- NeliriJIogical disorders ill Ethiopia by Redda T e kle- Haima no t Integra ted Re ha bilita ti o n C linic fo r le p rosy pa tie n ts. Bo mbay W a ll Jo urna l, Bo mbay Lep rosy Project W e llcom e M edal for M edical Anthropo logy. 1990 Multiple drug therapy manua l fo r Pa kista n a nd A zad Kashmir U K Training Ins titutio ns: Third W orld a nd Tro pical Health WHO regio na l o fll ces 450 Index Lepr Rev (1991) 62, 353-361 Editorial ENVIRONMENTAL MYCOBACTERIA AND HUMAN DISEASE in the latter part of the last century, the causative organisms of leprosy and tuberculosis were described, respectively, by Armauer Hansen in 1874 and Robert Koch in 1882. These bacteria were distinguished from all others known at that time by a characteristic acid-fast staining property by Paul Ehrlich in 1883. In 1898, when the generic name Mycobacterium was introduced, no other acid-fast bacillus had been formally described and named but from that time onwards many such organisms were isolated from environmental sources and from diseased mammals, birds and cold-blooded animals. A few were also isolated from patients, but their role as human pathogens was not seriously considered until the middle of this century when two new mycobacterial skin diseases, swimming pool granuloma I and M. ulcerans infection,2 later termed Buruli ulcer, were described and when Runyon published his classical description of the four groups of mycobacteria causing pulmonary disease.3 Many unsatisfactory collective names including 'atypical', 'anonymous', 'tubercu­ loid' and 'MOTT (mycobacteria other than typical tubercle) bacilli' have been given to these mycobacteria but when it became apparent that these species were not primarily pathogenic but widely distributed in nature, the name 'environmental mycobacteria' (EM) was generally adopted. At present there are about 60 known mycobacterial species: 41 are included in the Approved Lists of Bacterial Names4 published in 1980 and the others have been described subsequently.5 Cultivable mycobacteria are divisible into two main groups: the slow and rapid growers, which, by antigenic analysis and DNA homology, appear to belong to two quite distinct subgenera. The ecology of the environmental mycobacteria It is not generally appreciated just how common the EM are in nature. Sphagnum marshes contain very large numbers6 and they are also readily isolated from mud, compost, wet soil, surface water, rivers and estuaries.7 Some species colonize piped water supplies and have been isolated from taps and showerheads. There is also evidence that mycobacteria are washed into estuaries, taken up into aerosols generated by breaking waves and wafted inland by sea breezes and thereby sensitize people who inhale them.8 Some species or strains are more hydrophobic than others and thus more readily enter 0305-7518/91/062353+09 $01.00 © Lepra 353 354 J M Grange aerosols.9 There is also some evidence of an association between hydrophobicity and virulencelo so that strains entering aerosols may be more likely to cause disease than other environmental strains. The population of EM varies quantitatively and qualitatively from region to region, being affected by temperature, dryness, pH and mineral content of the environment and possibly by the availability of nutrients derived from decomposing vegetable material.
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