Studies of Clinical Course and Prognosis of Hansen's Disease during Chemotherapy
1. Mode of Decrease of Bacterial Index in Lepromatours Leprosy
1974 Volume 43 Issue 4 Pages 275-283
Details
1974 Volume 43 Issue 4 Pages 275-283
The skin lesions in the lepromatous leprosy during chemotherapy showed distinct improvement serveral years before acid fast bacilli disappeared from the lesions. Conse-quently an indicator called Bacterial Clearance Time (BCT) was chosen to represent the clinical course and prognosis of each case of lepromatous leprosy. BCT is the period of time from the start of treatment until skin smears from the skin lesions become negative. Negativity of bacilli is defined here as negative skin smears over a twelve month period with no clinical evidence of activity.
This study concerns the 56 patients for whom a diagnosis of lepromatous leprosy was made in our clinic between 1952 and 1964, whose records were relatively complete, and were followed more than 5 years. In addition, 123 lepromatous patients admitted to Tama-Zenshon Leprosarium in Tokyo between 1957 and 1963, were studied to know whether the differnt results in these two institutions were observed.
There was no significant difference in the BCT distribution of lepromatous case in the two institutions. The cummulative ogive of BCT showed the sigmoid curve. A BCT of 4.5 and 7.5 years can be roughly regarded as inflexion points of this sigmoid curve. The following three groups were defined in the relation to the above inflexion points :
(1) Rapid decrease group (RA group) …… BCT _??_4.5(years)
(2) Standard decrease group (ST group) …… 4.5<BCT _??_7.5
(3) Slow decrease group (SL grou) ……7.5<BCT
Four and a half to 7.5 years chemotherapy was necessary to gain the bacterial nega-tivity in standard lepromatous leprosy. In RA group, some were the cases with Acute Infiltration reaction (Tajiri) in their clinical course. Some other cases in this group had a history of previous treatment or showed near lepromatous leprosy. The skin lesions in the RA group were localized type and were not so extensive. One of main causes in the SL group was irregular treatment due to ENL or other reasons.
