Ebenezer G J, Daniel S, Norman G, Daniel E, Job C K
Department of Histopathology and Experimental Pathology, Schieffelin Leprosy Research and Training Centre, Karigiri 632 106, Vellore, Tamil Nadu, India.
Indian J Lepr. 2004 Jul-Sep;76(3):199-206.
A study was carried out to determine whether or not viable bacilli persist in MB patients treated with 12-month and 24-month multidrug therapy (MDT). In the first group, 60 untreated lepromatous patients who had an initial average bacterial index (BI) of 3+ or more were enrolled. At the completion of 12 months of MDT, skin biopsies were obtained and M. leprae concentrate was inoculated into the footpads of five thymectomized and irradiated (T900r) mice. Rees technique was used for the mouse footpad (MFP) experiment. Harvesting was done it the 6th, 9th and 12th months. Out of the 60 biopsies inoculated into mouse footpads to check the viability of bacilli, 2 skin biopsies (3.3%) showed significant growth and 10 (16%) showed equivocal growth. 27 patients also had nerve biopsies tested for growth in MFP studies. None of the inoculated nerve biopsies showed significant multiplication in the MFP experiments. However, 4 biopsies (14%) showed equivocal growth. In the second group, 20 patients had skin biopsies and 10 had nerve biopsies done at the end of 24 doses of MDT in order to test the viability of bacilli; none of the skin or nerve biopsies from these patients showed any growth. This study showed that M. leprae present in the tissues after 24 doses of MDT are not viable and the drug schedule of 24 doses is adequate to treat leprosy patients, irrespective of their BI. However, a small (3.3%) percentage of the patients with a high BI harbour viable bacteria in the skin after 12 doses of treatment. Since a large majority of the patients (38 patients) who had a high initial BI responded well to the treatment, it is important to find out the reason for the lack of response in two patients. One of the reasons may be the presence of drug-resistant strains. It is important to follow up on these patients for a longer duration to ascertain whether or not they would relapse.
开展了一项研究，以确定在接受12个月和24个月多药疗法（MDT）治疗的麻风病患者中是否仍有存活的杆菌。在第一组中，纳入了60例未经治疗的瘤型麻风病患者，其初始平均细菌指数（BI）为3+或更高。在12个月的MDT治疗结束时，获取皮肤活检样本，并将麻风分枝杆菌浓缩物接种到5只胸腺切除并经辐射（T900r）的小鼠脚垫中。采用里斯技术进行小鼠脚垫（MFP）实验。在第6、9和12个月进行收获。在接种到小鼠脚垫以检查杆菌活力的60份活检样本中，2份皮肤活检样本（3.3%）显示有显著生长，10份（16%）显示生长不明确。27例患者还进行了神经活检，以检测在MFP研究中的生长情况。在MFP实验中，接种的神经活检样本均未显示出显著增殖。然而，4份活检样本（14%）显示生长不明确。在第二组中，20例患者在24次MDT治疗结束时进行了皮肤活检，10例进行了神经活检，以检测杆菌的活力；这些患者的皮肤或神经活检样本均未显示任何生长。这项研究表明24次MDT治疗后组织中存在的麻风分枝杆菌无活力，24次的药物疗程足以治疗麻风病患者（无论其BI如何）。然而，在12次治疗后，一小部分（3.3%）初始BI较高的患者皮肤中仍存在存活细菌。由于大多数初始BI较高的患者（38例）对治疗反应良好，因此找出两名患者无反应的原因很重要。原因之一可能是存在耐药菌株。对这些患者进行更长时间随访以确定他们是否会复发很重要。
