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Tropical medicine is characterized by its focus on targeted research, which has improved biomedical knowledge for application to diagnosis, treatment, and prevention of illness. The UN Development Program/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases is promoting research to improve application of the results of targeted research. Combining a primary health care strategy with tropical medicine can help ensure that the real needs of the population will be met while research continues, maximizing effectiveness and social impact. Three examples from Peru illustrate the efficacy of this combined approach. A sanitary dermatology study was conducted in Alto Amazonas, a province of the Department of Loreto with a 1980 population estimated at 103,681 living in 68.977 sq. km of jungle. An intensive training program was held for physicians, nurses, auxiliaries, and other health personnel as well as the prospective health promoters who would participate in the pilot program to diagnose and control Hansen's disease (leprosy). The training included preparation of specimens for serological and other studies and other diagnostic procedures. Two 4-member field teams covered the entire province in 18 months, during which they censused 57,927 persons and clinically examined 47,160. After diagnosis of Hansen's disease was confirmed, a project physician or nurse initiated treatment with the multidrug regimen recommended by the World Health Organization and instructed the patient in the procedures to be followed to avoid incapacity. The auxiliary in the nearest health post supervised treatment and referred the patient to a higher level if adverse reactions occurred. 45 patients with Hansen's disease were detected during the study, along with 784 with leishmaniasis, 290 with malaria, and 164 with tuberculosis. All patients diagnosed with these conditions received treatment. A clinical and epidemiological study of leishmaniasis in Andean valleys combined health education, treatment, community development, and other interventions. The incidence of leishmaniasis has been increasing in Peru, and 15,000 new cases are projected for 1992. Active collaboration with the populations involved was sought through the primary health care system. A number of different organizations participated in the work. Field studies conducted primarily in the Purisima Valley included a census, recruiting of promoters and other health workers to diagnose cases, surveillance of new cases, systematic study of leishmaniasis vectors in houses and outside, and observation of the activity patterns of the population that might increase risk of disease. Positive correlations were found with the concentration of vectors inside houses and with seasons of increased agricultural activity. The third example concerned migrant workers from the highlands who contracted leishmaniasis in the jungle. They formed associations to seek assistance from the health system.
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PMID:[Research in tropical medicine and primary health care in Peru]. 823 94

More than half the world's population is at risk of the tropical diseases malaria, leprosy, schistosomiasis, lymphatic filariasis, onchocerciasis, Chagas disease, African trypanosomiasis and leishmaniasis, and half a billion people are infected with at least one of these diseases. We present statistic on the population at risk and the infected population, and on the major morbidity and mortality attributable to each of these diseases. During the next decade the prevalence of leprosy, Chagas disease, and onchocerciasis is expected to fall, but for the other tropical diseases the epidemiological situation may remain stagnant or even worsen.
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PMID:The burden of tropical diseases. 846 89

Mankind has been stricken with "major" epidemic diseases throughout its history. The most serious among them immediately threaten man's life e.g. plague, cholera, smallpox, typhus, and dysentery, besides, there are others which take a slower course e.g. lues, leprosy, leishmaniasis, tuberculosis, and malaria. Yet, the "lesser" epidemic diseases like diphtheria, scarlet fever, mumps, pneumococcosis, influenza, and most recently AIDS may also turn into "major" ones. Originally, man exclusively depended on his genetic makeup for protection, and being particularly prone to attacks of disease he was subject to natural selection. Thus, only one human species survived, the homo sapiens. Interbreeding achieved biologic adaptation and created a balanced genetic polymorphism. Advancing in his degree of civilization, man formed groups, developed clothing, fire, houses, and tools, and his increasing cultural awareness allowed him to migrate from the tropical climates to more temperate, and less disease-infested zones. Immigration and wars, and the accompanying infections jeopardized and diminished entire populations and eradicated highly developed cultures like that of the American Indians. The plague, coming from Asia, and lues, from America, as well as cholera, influenza, and smallpox spread around the whole globe. Fear and terror led to irrational conclusions and triggered persecutions. The attitude of accepting disease as a God-sent fate (Hiob), or a God-sent punishment suppressed reasonable measures against disease. The necessary official measures have increasingly restricted liberty, and this patronizing treatment needs to be opposed with a higher sense of responsibility. Medical art has developed from more healing towards prophylactic and predictive medicine, which prognosticates the individual susceptibility to particular infections, and other risk factors.
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PMID:[Effect of major epidemics on cultural awareness]. 857 53

When infected with Leishmania species, patients develop specific antibodies that constitute the basis of serodiagnosis. using Western blot analysis we studied the specificity of anti-leishmania donovani antibodies in patients with visceral leishmaniasis, healthy subjects living in an endemic and non-endemic areas, and patients of other infectious diseases like malaria, leprosy, tuberculosis and tropical splenomegaly. Sera from patients with kala-azar recognised numerous antigens that had a molecular weight of 150 KD, 145 KD, 120 KD, 92 KD, 87 KD, 72 KD, 65 KD, 56 KD, 50 KD, 40 KD, 26 KD, 21 KD, 14 KD, AND 12 KD. The 150, 145, 120, 92, 87, 81, 65, 25, 21, 14, and 12 KD antigens had the greatest specificity for kala-azar sera while the bands of molecular weights 72, 56, 50, and 40 KD were found to be cross reactive with sera of patients of other diseases.
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PMID:Evaluation of antibody responses in Indian kala-azar by immunoblot. 862 3

Dapsone-induced agranulocytosis is a rare adverse effect. There are various reports of agranulocytosis in patients treated with dapsone for malaria prophylaxis and other dermatological diseases. However, this adverse reaction in leprosy is not often encountered. We describe agranulocytosis in a young patient who was taking dapsone (100 mg) for borderline-tuberculoid leprosy in a rural environment.
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PMID:Dapsone agranulocytosis in a leprosy patient. 894 59

The occurrence of an unexpected side effect following the use of Maloprim (pyrimethamine/dapsone) for malaria chemosuppression in 3-59 months old children in Sierra Leone is reported. As part of a trial of chemoprophylaxis and insecticide-impregnated bed nets, 2000 children received either Maloprim or placebo; 4% of children who received Maloprim fortnightly for more than 3 months developed hyperpigmented macules, whereas none of the children who received placebo did so. Histopathological examination of full thickness skin biopsies showed macrophages containing melanin in the dermal layer. Clustering of cases was noted among siblings, suggesting the possible involvement of genetic factors in the pathogenesis of these skin reactions. One child was accidentally re-exposed to Maloprim after the drug had been withdrawn and he developed a severe reaction. No other serious side effect was noted. Hyperpigmented lesions similar to those reported in this study have been described previously in patients with leprosy treated with dapsone, and the dapsone component of Maloprim is the likely cause of the skin reactions seen in children given this drug for malaria chemoprophylaxis.
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PMID:Hyperpigmented dermal macules in children following the administration of Maloprim for malaria chemoprophylaxis. 919 70

Genetically determined differences in immune responses to environmental agents may underlie susceptibility to many autoimmune and infectious diseases. Leprosy provides an example of a polarity in the type of immune response made to an infectious agent, and there is evidence that the major histocompatibility complex is genetically linked to leprosy type. It was found that HLA-DR2 is associated with both tuberculoid and lepromatous types of leprosy; however, a variant at position -308 of the promoter of the neighboring tumor necrosis factor (TNF) gene was increased in frequency in lepromatous (odds ratio = 3.0, P = .02) but not tuberculoid leprosy. Some studies have found higher serum levels of TNF in lepromatous than tuberculoid leprosy, and high TNF levels are found in malaria and leishmaniasis, which are also associated with this TNF allele. It is speculated that this association reflects genetic variability in cytokine production, which influences the immune response to and clinical outcome of leprosy.
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PMID:Tumor necrosis factor promoter polymorphism and susceptibility to lepromatous leprosy. 923 25

An easy-to-use technique for detection of antibodies specific for the parasite L. donovani in human serum sample has been developed. The method is based on an evanescent wave generated from a tapered configuration of decladded optical fibre and does not require any volumetric measurement. Tapered fibres are immobilized with the purified cell surface protein of L. donovani by covalent bonding. Treated fibres are incubated with the patient serum for 10 min followed by incubation with goat anti human IgG tagged FITC. Fluorescent intensity from the fibre has been shown to be proportional to L. donovani specific antibodies present in the test sera. Direct readings can be obtained after signal enhancement through a photomultiplier tube within 5 min. The system, when tested on 12 positive sera, did not show any false negative result. Also, no false positive result was obtained with serum samples of patients infected with leprosy, tuberculosis, typhoid and malaria, showing the specificity of the sensor and efficacy of the technique.
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PMID:Evanescent wave fibre optic sensor for detection of L. donovani specific antibodies in sera of kala azar patients. 925 53

A total of 734 serum specimens from various clinical disorders along with 100 control samples from healthy subjects were processed for estimation of serum IgG, IgA and IgM employing single radial immunodiffusion procedure. Immunoglobulin deficiency, either selective or combined was noted in 31 males and 24 females in all age groups. Of the 55 cases encountered it was secondary immunoglobulin deficiency which was seen on a larger scale and encountered in patients with Multiple myeloma (16 out of 32) followed by Leprosy (14 out of 250), Lymphoma (5 out of 43), Malaria (4 out of 137), Burns (4 out of 52), Rheumatoid arthritis (2 out of 69) and non lymphoreticular malignancies (1 out of 41) in decreasing order of frequency. Primary immunoglobulin deficiency was observed in nine cases comprising of six belonging to Idiopathic late onset immunoglobulin deficiency, two of dysgammaglobulineamia and a solitary case of Ataxia telangiectasia. Panimmunoglobulin deficiency was observed in six cases, 11 had a dual deficiency while 38 showed deficiency of an isolated class with selective IgA deficiency in 20 cases. Furthermore, one patient each had total absence of IgG or IgA while IgM was not detectable in seven patients. A high suspicion index along with a regular rapport between the clinician and the laboratory personnel is necessary in the diagnostic set up of immunoglobulin deficiency states.
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PMID:Analysis of immunoglobulin deficiency cases: a five year study. 935 99

Dapsone (DDS) is useful in the treatment of a number of inflammatory conditions which are characterized by neutrophil infiltration. It is the drug of choice for the treatment of leprosy and prophylaxis of malaria. Haematological side effects of methaemoglobinaemia and haemolysis have been long recognized. However, the frequency and severity of these side effects in patients already treated with DDS as a single drug or as part of a multidrug therapy (MDT) have not been well documented. We report herein an investigation of the effect of dapsone long-term treatment on the haematological and biochemical alterations in leprosy patients undergoing dapsone as a single drug (DDS group) or as part of a multidrug therapy in combination with rifampin and clofazimine (MDT group). Methaemoglobinaemia and haemolytic anaemia were the principal side effects observed. Reticulocytes were found to be elevated (> 1.5%) in 90% of the patients. Heinz bodies were also detected (6.6% of the patients). The osmotic fragility test showed a reduction in cell resistance and in the evaluation of white cells a severe eosinophilia was found. Hepatic, pancreatic and renal evaluation by the determination of biochemical parameters showed rare and occasional changes of no apparent clinical significance. We conclude that haematological side effects of dapsone are significant even at doses currently used to treat leprosy (100 mg/day) and that rifampin and clofazimine do not increase the incidence of these effects during long-term treatment.
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PMID:Haematological and biochemical alterations in leprosy patients already treated with dapsone and MDT. 937 43


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