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제목 |
What's New in Leprosy? |
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저자 |
G.K. Wilson |
소속 |
The Leprosy Mission, Taegu, Korea |
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년도 |
1968 |
권 |
5 |
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호 |
1 |
번호 |
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시작페이지 |
5 |
끝페이지 |
8 |
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첨부 |
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요약 |
Another advance has been made in the field of tissue culture of Mycobacterium leprae
leading to further possibilities in clinical leprosy, such as drug dosage and management
of patients.
After Shepard of Atlanta, Georgia, in 1962, was the first to inoculate successfully M.
Leprae into the foot pads of a certain strain of mice, in February this year, it was
reported that M.leprae injected into thymectomised mice subjected to high dose body
radiation, will multiply and produce widespread granulomata showing leprosy pathology.
So that, whereas before M.leprae could be cultivated in mouse footpads but did not
produce any pathological changes in the surrounding tissue, now culture can be
performed with the production of typical leprosy pathology.
Well, what does all this mean to the physician in the general hospital or the nurse in
the rural clinic faced with a leprosy patient? It has led to at least three interesting
facts.
Firstly, looms DDS ,per week is an adequate therapeutic dose. DDS is still the most
potent and cheap drug available against leprosy. Tissue culture has shown that M.
Leprac is extraordinarily sensitive to DDS-much more so than to the other more ex-
pensive drugs available today.
It has been shown that 50㎎. DDS twice per week is equally as effective as 600㎎ per
week, and also, it will Produce many fewer reactions.
Well, someone may say, what about DDS resistance? The answer is that DDS
resistance certainly does occur, but that it is very rare, and needs to be proved by
tissue culture. The most convincing experiment was performed at Sungei Buloh, Malaya.
Out of a total of 2,000 patients, 9 were selected as having had no improvement in skin
smears for 5 years. Of these 9, 5 showed improvement when brought under close
supervision and given sulphone by injection. Tissue culture subsequently showed no
sign of DDS resistance. These 5 had therefore not been taking the treatment correctly,
or were not absorbing DDS properly.
The remaining 4, however, did not improve under these conditions, and were the very
4 who showed DDS resistance on tissue culture. They had all DDS for 14 years or
more.
Please note that the patients had shown no bacteriological improvement for 5 years.
Many of us used to become impatient if improvement in skin smears did not occur in 6
months, and changed the drug. However, 5-8 years should be allowed in patients with
the severe forms of leprosy before even considering the possibility of drug resistance. In
Taegu, we have seen improvement in skin smears on as little as 1-2㎎ DDS per week,
giving a total of 127㎎ over 6months.
To summarise, a dose of 100㎎. DDS per week is a very adequate the rapeutic dose
and will produce fewer reactions and neuritis.
Secondly, tissue culture is confirming the previous assumption that only the rod
shaped bacillus is viable and capable of multiplication. Clinically, this mean that the
Morphologic Index is much more important than the Bacterial Index. The Morphologic
Index is defined as the number of complete rod-shaped bacilli per 100 organisms
examined.4 new positive patient may therefore show a reduction in Morphologic Index
from 50 or 60% solid rods, to only 5 or 10% after 6 months treatment, even though the
Bacterial Index may show very little improvement |
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내용 |
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