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LETTER TO EDITOR
Year : 1997  |  Volume : 63  |  Issue : 6  |  Page : 385-387

Lepromin response with dharmendra antigen in patients with leprosy




Correspondence Address:
J Mohanty


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Source of Support: None, Conflict of Interest: None


PMID: 20944389

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How to cite this article:
Mohanty J, Mohanty H C. Lepromin response with dharmendra antigen in patients with leprosy. Indian J Dermatol Venereol Leprol 1997;63:385-7

How to cite this URL:
Mohanty J, Mohanty H C. Lepromin response with dharmendra antigen in patients with leprosy. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2018 Nov 19];63:385-7. Available from: http://www.ijdvl.com/text.asp?1997/63/6/385/4627


To the Editor

Skin test with lepromin is the only in vivo immunological skin test used as an aid to the classification and prognosis of leprosy. [1] The importance of the test has greatly increased since the development of in vitro, immuno­logical tests (LTT and LIMIT) [2] The test is now being increasingly used especially for epidemiological studies with the ultimate object of controlling the spread of leprosy. Dharmendra antigen is a suspension of de­fatted leprosy bacilli first reported by Dharmendra in 1941-1942. But it was fur­ther standardised by bacterial count by Sengupta et al 1979. This antigen evokes an early as well as late reaction with an intrad­ermal dose of 0.1ml. [3],[4],[5]

This study was undertaken to assess the im­munological status or CMI state in leprosy patients across the spectrum of disease using lepromin test. One hundred patients of vari­ous types of leprosy of both sexes attending the Department of Skin. STD and Leprosy, S.C.B. Medical College, Cuttack, were se­lected for lepromin test with 0.1 ml of Dharmendra antigen. Early reaction (Fernandez) was read after 48 to 72 hours [2] and late reaction (Mitsuda) after 21 to 28 days of inoculation over the flexor surface of right forearm [4],[5] Induration of 5 mm and above with erythema of 10 mm or more was con­sidered as positive.

The early responses were graded as erythematous oedema doubtful E (less than 5 mm) 1 + (5 to 9 mm) 2 + (10 to 14 mm) and 3 + (15 mm and above). Absence of any reponse was considered negative. Simi­larly late response graded as lack of evident reponse negative (-ve) Elevation or infiltra­tion 3 o 4 mm doubtful (±) nodule (5 mm) 1 +, 5 mm) to 10 mm, 2 +, 10 mm above, 3+ [4],[5]

Out of 100 cases (TT 10, BT 25, BB 20, BL 20, PNL (Polyneuritic leprosy) 10, IL (Inde­terminate leprosy) 5) tested with Dharmendra lepromin, 41% gave lepromin positive reaction both at early and late read­ing where as 26% showed doubtful ( ~) and 33% gave negative response. All the ten TT cases and majority (80%) of BT cases showed moderate to strong posi­tive lepromin response of 2 + and 3+. Only 20% with IL and 10% with BL and 40% of PNL gave mild to moderate positive response of 1+ and 2+.

Out of 41 cases with positive result 13 cases were found to be 1 + at both early and late reading. Eleven cases were moderately posi­tive (2.+) at early and 12 cases at late reading and 17 cases were seen to be strongly posi­tive (3 +) at early reading and 16 at late read­ing, almost equal response at both reading. Lepromin test is strongly positive in all TT cases and in majority of BT cases indicating presence of cellular immunity and delayed hypersensitivity response and good progno­sis [2]sub It is negative in all LL cases, majority of BL cases showing absence of immunity and absolute immunological unresponsiveness and bad prognosis. Intensity of cutaneous re­sponse is progressively decreasing along with spectrum of the disease from TT-BB-LL [4] Maximum number of doubtful response in BB indicates possibility of shift in the char­acter of lesion to either end of spectrum during treatment [4] Results of lepromin test in IL cases vary from negative to weak or moderate positive. IL cases with negative lepromin test are likely to pass on to the lepromatous type and are kept on follow up. Cases with mono or polyneuritic involve­ment without any existing skin lesions may show lepromin response varying with under­lying pathology of nerve involvement: posi­tive in case of tuberculoid pathology, weakly or moderately positive or negative with bor­derline pathology and negative with lepromatous pathology [2] Dharmendra lepromin induces both early and late reac­tion as seen in this study and also in other works by Dharmendra et al and early reac­tion coincides with the late reaction [2],[5] So it is worth while to do a study of LT in a nor­mal population to detect negative cases which should be followed up for evidence of lep­rosy in future.

 
  References Top

1.Ramu G. Ten year study of lepromin response in child contacts of leprosy. Ind J Dermatol Venereol Leprol 1958; 54: 295-299.  Back to cited text no. 1    
2.Dharmendra. The nature of the lepromin reaction. The lepromin test, In: Leprosy Vol.2, Editor Dharmendra, Samant and Company, Bombay 1037.  Back to cited text no. 2    
3.Fernandez JMM. The early reaction induced by lepromin. Int J Leprosy 1940; 8: 1-2.  Back to cited text no. 3    
4.Sinha S, Sengupta U, Ramu G, et al Assessment of Dharmendra antigen standardisation of the anti­gen. Leprol India 1979; 57: 316-322.  Back to cited text no. 4    
5.Ravindranathan O, Sarojini P A. Comparitive study of lepromin reaction in indeterminate lep­rosy and controls. Indian Dermatol Venereol Leprol 1988; 54: 24-26.  Back to cited text no. 5    




 

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