Treated-cured indeterminate leprosy: a search for predictive histopathological and immunohistochemical parameters in skin biopsies taken from patients at admission and at clinical discharge.
In a previous study an index (sigma 3) resulting from the summation of three parameters, i.e., presence of bacilli, even in small numbers, in various dermal structures, multiple positive antigen sites as detected by anti-BCG antiserum and dermal nerve involvement, identified 72.22% of cases of indeterminate leprosy which progressed to multibacillary leprosy. The present study was undertaken to investigate possible parameters which might be indicative of indeterminate leprosy which would persist unchanged or be cured (treated cured patients). Thirty treated cured indeterminate leprosy patients were selected from the files of the São Paulo Health Institute and studied by histopathological, immunohistochemical and statistical methods similar to those employed in the previous study. The sigma 3 index was 4.10 +/- 0.60, a finding that places this group of patients in a position close to that of patients changing to paucibacillary leprosy but statistically different from that of patients progressing to multibacillary leprosy. Moreover, it was found that patients belonging to this group have heterogeneous single parameters, some of them suggestive of multibacillary and others of paucibacillary leprosy. Immunologically based techniques mainly employing rabbit anti-BCG serum as the primary antibody have proved to be valuable to detect antigen sites in biopsies from indeterminate leprosy patients and should be used together with the bacillary index during the follow up and clinical discharge control of such patients. In the present study, we show that clinical discharge of these patients did not mean a complete clearance of bacillary antigens.
Takahashi
D
D
Institute of Tropical Medicine, University of São Paulo Medical School, Brasil.
Andrade
H F
HF
Wakamatsu
A
A
Manini
M
M
de Brito
T
T
D000047:Academies and Institutes; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy / Q000592:standards*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D006651:Histocytochemistry / Q000592:standards; D006801:Humans; D007150:Immunohistochemistry / Q000592:standards; D007918:Leprosy / Q000145:classification / Q000453:epidemiology / Q000473:pathology*; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D011237:Predictive Value of Tests; D012189:Retrospective Studies