03118nas a2200277   4500000000100000008004100001260001200042653001300054653001200067653001400079100001800093700001700111700001400128700001600142700001600158700001800174700002200192700001400214245010200228856007300330300001300403490000700416050002100423520238100444022001502825       1988                            d  c06/198810aThailand10aleprosy10adiagnosis1 aTheetranont C1 aScollard D M1 aBhoopat L1 aRangdaeng S1 aSuriyanon V1 aThamprasert K1 aMakornkawkeyoon S1 aSmith T C00aDevelopment of an immumoperoxidase test for early diagnosis of acute reactional state in Leprosy.  uhttp://thailand.digitaljournals.org/index.php/CMMJ/article/view/9802  a126–510 v27  aTHEETRANONT 19883 aFluid was obtained on multiple occasions from each patient by aspirating small blisters induced directly over lesions by gentle suction. The cells from the blister fluid were stained with monoclonal antibodies using the immunoperoxidase method.

The T-cell macrophage ratios have been identified in three patterns from low, stable; sharp increase, high in the beginning and drops rapidly. It is not clear whether this is of biological significance. Those patterns have been noted to be similar kenetics in the production of fibrin or fibrinogen in cell mediated immune response.

The numbers and ratio of T lymphocyte subsets in the lesions of two clinical subgroups of ENL reactional state of leprosy were determined and compared with those found in stable, non-reactional patients. In acute and chronic recurrent ENL, the percentages of the helper cells were significantly higher than those found in non-reactional lepromatous lesions, but only chronic recurrent ENL showed remarkable increase in helper/suppressor ratio.

The increase in helper activity with or without reversal of H: S ratio in two clinical subgroups of ENL in contrast to non-reactional lepromatous disease suggests some role of cell mediated immunity in the pathogenesis of ENL.

The cutaneous Tac peptide levels in reversal reaction (RR) were evaluated from the skin blister fluid.After
removing cellular material by filtration, Tac peptide levels were measured by using an ELISA technique emplo
ying two monoclonal antibodies which recognize different epitopes of the IL-2 receptor.

Approximately half of the lesion with RR, the cutaneous Tac peptide levels were significantly higher than the background levels, indicating active immunologic stimulation within these lesions, while Tac peptide levels in the other half of the reacting lesions were within the normal range. This difference may reflect subclinical immunoregulatory events within the tissue lesions, since expression and release of Tac peptid~ from activated cells are transient events which are dependent on the availability of antigen and IL-2.

This study has develop~d the new approach to the early diagnosis of the acute reactional state in leprosy which will more or less lead to the prevention of the tissue damage in leprosy patients either in the form of therapeutic intervention or immunologic measure as well.
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