今日の臨床サポート

ハンセン病

著者: 豊川貴生 沖縄県立南部医療センター・こども医療センター 感染症内科

監修: 細川直登 亀田総合病院

著者校正/監修レビュー済:2017/12/25
患者向け説明資料

概要・推奨   

疾患のポイント:
  1. ハンセン病は、抗酸菌の一種であるらい菌(Mycobacterium leprae)による慢性細菌感染症であり、主に皮膚と末梢神経を主病変とし、多彩な皮膚病変、末梢神経障害に伴う感覚・運動障害により変形や機能不全を呈することが特徴である。
  1. 日本では2011年に5例が診断され、うち3例(60%)が外国人であった。患者数が減少したため、日本の医師のほとんどは診療経験がなく、初診から診断までに時間を要することが多い。見落とさないためには、特に高齢者、流行国からの渡航者や在留外国人、流行国にて長期滞在歴のある患者で、診断のつかない皮疹の鑑別に入れることが第一歩である。また、アルマジロがMycobacterium lepraeの自然宿主であり、人畜共通感染症としての感染源になっている可能性が近年指摘されており、鑑別にあげた時点でアルマジロへの曝露歴の確認を行う。
 
診断:
  1. ①知覚の障害を伴う皮疹、②末梢神経の肥厚や運動障害、③らい菌の検出、④病理組織検査――の4点から総合的に診断を行う。
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薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
豊川貴生 : 未申告[2021年]
監修:細川直登 : 未申告[2021年]

病態・疫学・診察

疾患情報(疫学・病態)  
  1. ハンセン病は、抗酸菌の一種であるらい菌(Mycobacterium leprae)による慢性細菌感染症である。
  1. 主に皮膚と末梢神経を主病変とし、末梢神経障害に伴う感覚・運動障害により変形や機能不全を呈することが特徴である。
  1. 感染様式は、主に飛沫による経気道感染と考えられており、一般に感染の成立には、免疫能が完全でない乳幼児期に多量・頻回にらい菌にさらされることが重要と考えられている。潜伏期間はきわめて長く、数年から数十年と考えられている。人の体内に侵入しても、発病することはきわめてまれである。
  1. WHOによると、2015年に全世界で約22万人が新規感染者として登録された[1]。日本では2016年に3例が診断され、うち3例(100%)が外国人であった[2]。日本における新規患者は、外国人患者を除くと60歳以上の症例が多い。
  1. 患者数が減少したため、日本の医師のほとんどは診療経験がなく、初診から診断までに時間を要することが多い。見落とさないためには、特に高齢者、流行国からの渡航者や在留外国人、流行国にて長期滞在歴のある患者で、診断のつかない皮疹の鑑別に入れることが第一歩である。
病型・分類  
WHO分類:
  1. WHOでは、人材や設備の問題により病理検査が困難な国での診断および治療を想定し、皮疹の数および皮膚スメア検査の結果のみをもとにPB(paucibacillary:少菌型、皮膚スメア検査陰性もしくは皮疹が1~5個)か、MB(multibacillary:多菌型、皮膚スメア検査陽性もしくは皮疹が6個以上)への分類を提唱している。
    これは、菌検査および皮疹の数によって治療方針を決定するもので、国内でもこの分類に基づいて治療方針を決定することが推奨されている[3][4]
 
Ridley-Jopling分類:
  1. また、らい菌の数、皮疹の性状や数、神経障害の程度(知覚障害、神経肥厚、運動麻痺など)、病理組織所見などからRidley-Jopling分類(発症初期のindeterminate[I群]、免疫応答の高いtuberculoid[TT]型、まったく反応しないlepromatous(LL)型、これらの中間型のB群(borderline tuberculoid[BT]型、mid-borderline[BB]型、borderline lepromatous[BL]型)も行う。

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文献 

著者: World Health Organization
雑誌名: World Health Organ Tech Rep Ser. 2012;(968):1-61, 1 p following 61.
Abstract/Text Since the introduction of multidrug therapy for leprosy in 1981, an estimated 15 million patients have been cured of the disease and disabilities have been prevented in some 2-3 million individuals. These remarkable results have been brought about by the synergistic efforts of WHO, governmental and nongovernmental bodies, academia, industry and affected communities throughout the world. Nevertheless, much remains to be done--both to sustain this progress and to effect a further reduction in the impact of leprosy on patients and their families. This report presents the conclusions and recommendations of the WHO Expert Committee on Leprosy, whose eighth meeting reflected the recent shift in emphasis of leprosy elimination to reducing of the impairments and disabilities caused by the disease and ensuring the quality and sustainability of leprosy services. The Committee analysed the global leprosy situation, discussed elements of epidemiology, and reviewed developments in treatment of the disease and management of complications. Sociocultural issues were addressed, as was the need for community care, accessibility of health services, and effective referral systems. Indicators for monitoring and evaluation were outlined and research priorities were set out.

PMID 22970604  World Health Organ Tech Rep Ser. 2012;(968):1-61, 1 p f・・・
著者: Stephen L Walker, Dina N J Lockwood
雑誌名: Clin Dermatol. 2007 Mar-Apr;25(2):165-72. doi: 10.1016/j.clindermatol.2006.05.012.
Abstract/Text Leprosy is a granulomatous disease affecting the skin and nerves caused by Mycobacterium leprae. It continues to be a significant public health problem. Despite multidrug therapy, immunologic reactions continue to occur, leading to disability and deformity due to neuropathy. It is important that dermatologists are aware of the neurologic as well as the skin manifestations of the condition so that nerve involvement can be identified and treated rapidly.

PMID 17350495  Clin Dermatol. 2007 Mar-Apr;25(2):165-72. doi: 10.1016/・・・
著者:
雑誌名: Indian J Lepr. 1995 Jan-Mar;67(1):13-26.
Abstract/Text Until the introduction by WHO of the standard regimens using multidrug therapy (MDT) for the treatment of leprosy, there was a general unwillingness to release patients from treatment. This was mainly due to the high risk of relapse after dapsone monotherapy. After almost a decade of MDT implementation and after releasing more than 4 million patients, it was necessary for WHO to review the risk of relapse following WHO-recommended MDT. The results of this study, carried out on more than 20,000 MB and 50,000 PB patients, revealed that the risk of relapse is very low, 0.77% for MB and 1.07% for PB, nine years after stopping MDT. In comparison to dapsone monotherapy, the risk is 10-times lower. Thus, over the last decade, MDT implementation has probably prevented close to half-a-million relapses.

PMID 7622926  Indian J Lepr. 1995 Jan-Mar;67(1):13-26.
著者: Diana Nj Lockwood
雑誌名: BMJ Clin Evid. 2007 Apr 1;2007. Epub 2007 Apr 1.
Abstract/Text INTRODUCTION: The World Health Organization field leprosy classification is based on the number of skin lesions: single-lesion leprosy (1 lesion), paucibacillary leprosy (2-5 skin lesions), and multibacillary leprosy (more than 5 skin lesions). Worldwide, about 720,000 new cases of leprosy are reported each year, and about 2 million people have leprosy-related disabilities.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent leprosy? What are the effects of treatments for leprosy? We searched: Medline, Embase, The Cochrane Library and other important databases up to March 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 20 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: Bacillus Calmette Guerin (BCG) plus killed Mycobacterium leprae vaccine; BCG vaccine; ICRC vaccine; multidrug treatment; multiple-dose treatment; mycobacterium w vaccine; single-dose treatment.

PMID 19454067  BMJ Clin Evid. 2007 Apr 1;2007. Epub 2007 Apr 1.
著者: Richard W Truman, Pushpendra Singh, Rahul Sharma, Philippe Busso, Jacques Rougemont, Alberto Paniz-Mondolfi, Adamandia Kapopoulou, Sylvain Brisse, David M Scollard, Thomas P Gillis, Stewart T Cole
雑誌名: N Engl J Med. 2011 Apr 28;364(17):1626-33. doi: 10.1056/NEJMoa1010536.
Abstract/Text BACKGROUND: In the southern region of the United States, such as in Louisiana and Texas, there are autochthonous cases of leprosy among native-born Americans with no history of foreign exposure. In the same region, as well as in Mexico, wild armadillos are infected with Mycobacterium leprae.
METHODS: Whole-genome resequencing of M. leprae from one wild armadillo and three U.S. patients with leprosy revealed that the infective strains were essentially identical. Comparative genomic analysis of these strains and M. leprae strains from Asia and Brazil identified 51 single-nucleotide polymorphisms and an 11-bp insertion-deletion. We genotyped these polymorphic sites, in combination with 10 variable-number tandem repeats, in M. leprae strains obtained from 33 wild armadillos from five southern states, 50 U.S. outpatients seen at a clinic in Louisiana, and 64 Venezuelan patients, as well as in four foreign reference strains.
RESULTS: The M. leprae genotype of patients with foreign exposure generally reflected their country of origin or travel history. However, a unique M. leprae genotype (3I-2-v1) was found in 28 of the 33 wild armadillos and 25 of the 39 U.S. patients who resided in areas where exposure to armadillo-borne M. leprae was possible. This genotype has not been reported elsewhere in the world.
CONCLUSIONS: Wild armadillos and many patients with leprosy in the southern United States are infected with the same strain of M. leprae. Armadillos are a large natural reservoir for M. leprae, and leprosy may be a zoonosis in the region. (Funded by the National Institute of Allergy and Infectious Diseases and others.).

PMID 21524213  N Engl J Med. 2011 Apr 28;364(17):1626-33. doi: 10.1056・・・
著者: S Bruce, T L Schroeder, K Ellner, H Rubin, T Williams, J E Wolf
雑誌名: J Am Acad Dermatol. 2000 Aug;43(2 Pt 1):223-8. doi: 10.1067/mjd.2000.106368.
Abstract/Text BACKGROUND: Naturally occurring leprosy has been demonstrated in wild nine-banded armadillos (Dasypus novemcinctus ). This suggests a possible mode of transmission of human leprosy in regions where armadillo contact is prevalent.
OBJECTIVE: Our purpose was to study the possible relationship between armadillo exposure and Hansen's disease.
METHOD: One hundred one patients (67 men, 34 women) with established Hansen's disease seen in the Hansen's Disease Clinic in Houston, Texas, were questioned about their exposure to armadillos. These patients were divided into two groups: Asian (n = 32) and non-Asian (n = 69).
RESULTS: Seventy-one percent of the non-Asian patients surveyed reported either direct or indirect armadillo exposure. None of the Asian patients reported armadillo exposure (P <.001). Of the non-Asian patients, 75.4% had lepromatous disease versus 50.0% of the Asian patients (P <.001). The average age at diagnosis for the non-Asian group with Hansen's disease in this study was 51 versus 38 years for the Asian group (P <.001).
CONCLUSION: Although it is yet to be determined whether direct transmission from the armadillo to human occurs, it is likely based on the high incidence of armadillo exposure in non-Asian patients with Hansen's disease in our study population that this animal acts as a reservoir for human disease. However, the Asian patients reporting no known armadillo exposure likely obtained the disease from person-to-person contact in their respective countries of origin where Hansen's disease has a much higher prevalence.

PMID 10906642  J Am Acad Dermatol. 2000 Aug;43(2 Pt 1):223-8. doi: 10.・・・
著者: Brychan M Clark, Clinton K Murray, Lynn L Horvath, Gregory A Deye, Mark S Rasnake, Robert N Longfield
雑誌名: Am J Trop Med Hyg. 2008 Jun;78(6):962-7.
Abstract/Text Hansen's disease (HD) continues to have worldwide impact despite efforts to eradicate the disease. Although a definitive transmission mode has not been identified, data supports an association between HD and contact with the nine-banded armadillo. We conducted a case-control study of 28 HD patients to determine if there is an association between armadillo exposure and HD. There was no association between HD and place of birth or having hunted, consumed, or had direct or indirect contact with deer, birds, or squirrels. Univariate analysis showed that residence in Mexico (P = 0.001), hunting rabbits (P = 0.04), cleaning rabbits (P < 0.001), and armadillo exposure from hunting (P = 0.005), cleaning (P = 0.004), consuming (P = 0.002) them, or having direct armadillo contact (P = 0.017) were associated with HD. Multivariate analysis showed that eating armadillos (P = 0.039, odds ratio [OR] = 3.65, 95% confidence interval [CI] = 1.07-12.4), cleaning rabbits (P = 0.018, OR = 4.08, 95% CI = 1.27-13.1), and having lived in Mexico (P = 0.006, OR = 24.9, 95% CI = 2.52-245) were associated with HD.

PMID 18541777  Am J Trop Med Hyg. 2008 Jun;78(6):962-7.
著者: G A Filice, R N Greenberg, D W Fraser
雑誌名: Am J Trop Med Hyg. 1977 Jan;26(1):137-9.
Abstract/Text In 1971 it was discovered that the nine-banded armadillo (Dasypus novemcinctus) could be infected in the laboratory with Mycobacterium leprae, and would manifest disease similar to the lepromatous form of leprosy in man. In 1975 several wild armadillos captured in Louisiana were found to have a disease identical to the M. laprae infection in laboratory animals. To determine if there is a significant association between contact with armadillos and presence of leprosy in humans, the armadillo contact of persons with indigenous leprosy in Louisiana was compared to the contact of matched controls. No difference in the nature or frequency of contact was found. If this infection of wild armadillos is of recent onset, an association with human leprosy in enzootic areas may not be detectable for several years.

PMID 557294  Am J Trop Med Hyg. 1977 Jan;26(1):137-9.
著者: D A Thomas, J S Mines, D C Thomas, T M Mack, T H Rea
雑誌名: J Infect Dis. 1987 Dec;156(6):990-2.
Abstract/Text
PMID 3680998  J Infect Dis. 1987 Dec;156(6):990-2.
著者: B Kumar, R Sinha, S Sehgal
雑誌名: J Dermatol. 1998 Apr;25(4):238-41.
Abstract/Text Purified phenolic glycolipid (PGL-1) from Mycobacterium leprae was used to detect IgG antibodies against PGL-1 in leprosy patients in an enzyme-linked immunosorbent assay (ELISA). A total of 698 sera were screened; they came from patients suffering from leprosy, autoimmune disease, myeloma, tuberculosis and sexually transmitted diseases (STDs). Cases with miscellaneous diseases and persons undergoing AIDS screening were also included. Sera from lepromatous and tuberculoid leprosy patients gave positivity rates of 60.5% and 41.7%, respectively. In non-leprosy cases, the PGL-1 ELISA showed an overall positivity rate of 6.9%; this was greatest in patients with tuberculosis (43.8%) followed by autoimmune diseases (40.9%) and miscellaneous cases including liver diseases (37.9%). This study emphasizes that PGL-1 ELISA has a low predictive value for diagnosis of active infection by Mycobacterium leprae. Positive reactions in a significant percentage of patients with autoimmune disease are intriguing and need indepth study.

PMID 9609981  J Dermatol. 1998 Apr;25(4):238-41.
著者: D M Scollard, L B Adams, T P Gillis, J L Krahenbuhl, R W Truman, D L Williams
雑誌名: Clin Microbiol Rev. 2006 Apr;19(2):338-81. doi: 10.1128/CMR.19.2.338-381.2006.
Abstract/Text Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world, publicity to the contrary notwithstanding. Mycobacterium leprae remains noncultivable, and for over a century leprosy has presented major challenges in the fields of microbiology, pathology, immunology, and genetics; it continues to do so today. This review focuses on recent advances in our understanding of M. leprae and the host response to it, especially concerning molecular identification of M. leprae, knowledge of its genome, transcriptome, and proteome, its mechanisms of microbial resistance, and recognition of strains by variable-number tandem repeat analysis. Advances in experimental models include studies in gene knockout mice and the development of molecular techniques to explore the armadillo model. In clinical studies, notable progress has been made concerning the immunology and immunopathology of leprosy, the genetics of human resistance, mechanisms of nerve injury, and chemotherapy. In nearly all of these areas, however, leprosy remains poorly understood compared to other major bacterial diseases.

PMID 16614253  Clin Microbiol Rev. 2006 Apr;19(2):338-81. doi: 10.1128・・・
著者: Bhushan Kumar, Sunil Dogra, Inderjeet Kaur
雑誌名: Int J Lepr Other Mycobact Dis. 2004 Jun;72(2):125-33. doi: 10.1489/1544-581X(2004)072<0125:ECOLRY>2.0.CO;2.
Abstract/Text A retrospective analysis of patient's leprosy clinic records at PGIMER, Chandigarh, India for the period 1983 to 1998 was undertaken to study the frequency, time of onset, and risk factors for leprosy reactions. Of the 2600 cases analyzed, 1494 were multibacillary and 1106 had paucibacillary disease. Presentation with reaction was common with 30.9% of our patients having reactions at the time of first visit. The incidence of reversal reaction (RR) was highest during 6 to 12 months after starting multi-drug therapy (MDT), thereafter declining gradually. Late RR occurred in 9.5% of all cases and was noted up to 7 years after treatment. Female gender, widespread disease, and multibacillary disease were identified as risk factors for RR. Erythema nodosum leprosum (ENL) reactions were noted to occur mostly during second or third year after starting MDT. Of the total number of patients who experienced ENL, 64.3% had recurrent episodes which continued for up to 8 years after the start of treatment. Lepromatous leprosy, female gender, and high Bacterial Index (>/=3) were recognized as risk factors for developing ENL. Occurrence of recurrent and late reactions, even though of mild severity, highlights the importance of recognizing and treating them promptly to prevent or reduce morbidity, complications, and further deterioration in the disability status. Although it is hoped that leprosy will have been eliminated at all levels by 2005, the recognition and management of these reactions will continue to be the most essential/significant task in the post elimination era.

PMID 15301592  Int J Lepr Other Mycobact Dis. 2004 Jun;72(2):125-33. d・・・
著者: Stephen L Walker, Diana N J Lockwood
雑誌名: Lepr Rev. 2008 Dec;79(4):372-86.
Abstract/Text The type of leprosy that affects an individual depends on the immune response mounted against the organism. This leads to a spectrum of disease which may be complicated by immunological phenomena called reactions. Antimicrobial chemotherapy is effective in treating the Mycobacterium leprae infection but up to 30% of individuals with borderline disease experience Type 1 reactions (T1Rs). T1Rs are immunologically mediated episodes, localised in skin and nerves, which are a major cause of nerve function impairment. Nerve function impairment may result in disability and deformity. We review the frequency and features of Type 1 reactions. The data from the limited number of randomised controlled trials of treatment are discussed. These four randomised controlled trials were all conducted in south Asia. The accepted treatment of T1Rs is with oral corticosteroids but there is no consensus about the dose or duration of treatment due to the lack of data. One randomised controlled trial showed that patients treated with a 5 month course of prednisolone (total dose 2.31 g) were less likely to need additional prednisolone than those treated with a 3 month course of prednisolone (total dose 2.94 g). This study did not use nerve function as an outcome measure. The improvement in nerve function impairment with steroid treatment is highly variable, with 33-73% of nerves recovering fully. Optimal steroid regimes and alternative treatments need to be identified if the disability associated with leprosy is to be minimised. Search strategy Papers for this review were identified by repeated searches of the Cochrane Clinical Trials Register, PubMed and LILACS with various combinations of the following search terms 'leprosy', 'lepra', 'reaction', 'steroids', 'corticosteroids', 'reversal', 'Type 1', 'Hansen*'. Searches were complete to the end of November 2008.

PMID 19274984  Lepr Rev. 2008 Dec;79(4):372-86.
著者: E H Bernink, J E Voskens
雑誌名: Lepr Rev. 1997 Sep;68(3):225-32.
Abstract/Text This paper presents a retrospective study on the detection of the treatment of leprosy reactions in a field situation, and the effect of prednisone on the various affected nerves. Two patient cohorts were analysed. The leprosy control programme in the testing area is not backed up by a specialized referral leprosy hospital, but patients are treated on an ambulatory basis at peripheral health centres by trained multipurpose health workers supervised by the health centre doctors. For operational purposes the guidelines and procedures for reaction management in the field were adjusted and partially simplified. In both studies it appeared that the time of the occurrence of severe reactions was the same: 80% or more of the severe reactions occurred in the first year of treatment, the majority in the first few months after the start of the multidrug (MDT) treatment. One third of all reaction patients suffered from a silent neuritis. Well-instructed fieldworkers proved to be competent in detecting and treating leprosy reactions. Treatment of severe reactions with prednisone in the field situation can preserve or considerably improve the functions of the affected nerves. It is interesting that often the motor function of a nerve was found to be impaired without any loss in sensibility, which was tested using the ballpoint pen method.

PMID 9364823  Lepr Rev. 1997 Sep;68(3):225-32.
著者: W J Britton
雑誌名: Lepr Rev. 1998 Sep;69(3):225-34.
Abstract/Text
PMID 9805878  Lepr Rev. 1998 Sep;69(3):225-34.
著者: Natasja H J van Veen, Peter G Nicholls, W Cairns S Smith, Jan Hendrik Richardus
雑誌名: Lepr Rev. 2008 Dec;79(4):361-71.
Abstract/Text OBJECTIVE: Corticosteroids are commonly used for treating nerve damage in leprosy. We assessed the effectiveness of corticosteroids for treating nerve damage due to leprosy.
METHODS: A systematic search was undertaken to identify randomised controlled trials (RCTs) comparing corticosteroids with placebo or with no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised.
RESULTS: Three RCTs involving 513 people were found. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than 6 months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined nerve function improvement 12 months from the start of treatment, but found no significant difference between the two groups. The third trial compared three corticosteroid regimens for severe type 1 reactions. After 12 months, a significantly higher proportion of individuals on a 3 month course required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of 5 months duration. Diabetes and peptic or infected ulcers were not significantly more often reported in the corticosteroid compared to the placebo group.
CONCLUSIONS: Evidence from RCTs does not show a significant long-term effect for either long-standing nerve function impairment or mild sensory impairment. A 5 month corticosteroid regimen was significantly more beneficial than a 3 month corticosteroid regimen. Further RCTs are needed to establish the effectiveness and optimal regimens of corticosteroids and to examine new therapies.

PMID 19274983  Lepr Rev. 2008 Dec;79(4):361-71.
著者: J SHESKIN
雑誌名: Clin Pharmacol Ther. 1965 May-Jun;6:303-6.
Abstract/Text
PMID 14296027  Clin Pharmacol Ther. 1965 May-Jun;6:303-6.
著者: M Hogeweg
雑誌名: Int J Lepr Other Mycobact Dis. 2001 Jun;69(2 Suppl):S30-5.
Abstract/Text
PMID 11757176  Int J Lepr Other Mycobact Dis. 2001 Jun;69(2 Suppl):S30・・・
著者: T J Ffytche
雑誌名: Indian J Lepr. 1998 Jan-Mar;70(1):49-59.
Abstract/Text A world-wide study on the ocular complications of leprosy has been carried out over the past ten years. The data from 4772 patients, designed to give baseline information for a five-year incidence study, have been analysed. Blindness due to leprosy was seen in 3.2% of the sample and 7.1% had Grade 2 visual disability. The causes of visual impairment in the disease are discussed and it is emphasized that a high proportion of these are preventable, particularly through the early use of multidrug therapy. The active participation of ophthalmologists in the management of the disease is still required since many of the blinding complications respond well to surgery.

PMID 9598405  Indian J Lepr. 1998 Jan-Mar;70(1):49-59.
著者: M Matsuoka, Y Kashiwabara, M Namisato
雑誌名: Int J Lepr Other Mycobact Dis. 2000 Dec;68(4):452-5.
Abstract/Text Mycobacterium leprae were isolated from a Japanese patient, and susceptibility to antileprosy drugs was examined by the mouse foot pad method. The isolate was susceptible to clofazimine and clarithromycin, and resistant to dapsone, rifampin, ofloxacin and sparfloxacin. Mutations were identified in the genes associated with resistance to these drugs. The risk of the emergence of leprosy with multidrug resistance is emphasized.

PMID 11332288  Int J Lepr Other Mycobact Dis. 2000 Dec;68(4):452-5.
著者: S Maeda, M Matsuoka, N Nakata, M Kai, Y Maeda, K Hashimoto, H Kimura, K Kobayashi, Y Kashiwabara
雑誌名: Antimicrob Agents Chemother. 2001 Dec;45(12):3635-9. doi: 10.1128/AAC.45.12.3635-3639.2001.
Abstract/Text Sequences of the folP1, rpoB, and gyrA genes were analyzed for 88 isolates of Mycobacterium leprae from leprosy patients in Japan, Haiti, Indonesia, Pakistan, and the Philippines. Thirteen isolates (14.8%) showed representative mutations in more than two genes, suggesting the emergence of multidrug-resistant M. leprae.

PMID 11709358  Antimicrob Agents Chemother. 2001 Dec;45(12):3635-9. do・・・

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