zoonoses and communicable diseases common to ... - PAHO/WHO

LEPROSY 155was used to detect a high percentage of multibacillary patients (Burgess et al.,1988). A variation of this test is the use of the synthetic disaccharide epitope ofPGL-1 as an antigen (Brett et al., 1986).Control: Control is based on early detection and chemotherapy. Given the multipleconfirmed cases of resistance to dapsone, combination of this medication withrifampicin is presently recommended for paucibacillary leprosy, and the same twomedications in combination with clofazimine are recommended for multibacillaryleprosy. Rifampicin has a rapid bactericidal effect and eliminates contagion inpatients in one to two weeks. To achieve the objective of eliminating leprosy, allpatients should receive polychemotherapy. This treatment has been successful inreducing general prevalence from 5.4 million in 1986 to 3.7 million in 1990.Widespread testing began in 1992 on a new oral treatment that was developed overthe preceding five years and combines two antibiotics, rifampicin and ofloxacin.Ofloxacin inhibits an enzyme that controls the way that DNA coils inside the bacterium.It is hoped that this combination will be able to cure leprosy in the course ofone month. If testing is successful, all patients should have access to this medication(WHO, 1992). The isolation of patients in leprosariums is no longer necessary, sincemedication is effective in suppressing infectiousness and thus interrupts transmissionof the disease.BibliographyAmezcua, M.E., A. Escobar-Gutierrez, E.E. Storrs, et al. Wild Mexican armadillo with leprosy-likeinfection [letter]. Int J Lepr Other Mycobact Dis 52:254–255, 1984.Bechelli, L.M., V. Martínez Domínguez. Further information on the leprosy problem in theworld. Bull World Health Organ 46:523–536, 1972. Cited in: Bullock, W.E. Mycobacteriumleprae (Leprosy). In: Mandell, G.L., R.G. Douglas, Jr., J.E. Bennett, eds. Principles andPractice of Infectious Diseases. 3rd ed. New York: Churchill Livingstone, Inc.; 1990.Binford, C.H., W.M. Meyers, G.P. Walsh. Leprosy. JAMA 247:2283–2292, 1982.Binford, C.H., W.M. Meyers, G.P. Walsh, E.E. Storrs, H.L. Brown. Naturally acquired leprosy-likedisease in the nine-banded armadillo (Dasypus novemcinctus): Histopathologic andmicrobiologic studies of tissues. J Reticuloendothel Soc 22:377–388, 1977.Brett, S.J., S.N. Payne, J. Gigg, et al. Use of synthetic glycoconjugates containing theMycobacterium leprae specific and immunodominant epitope of phenolic glycolipid I in theserology of leprosy. Clin Experim Immunol 64:476–483, 1986.Brubaker, M. Leprosy Control in the Americas. Part I: General Considerations. In: Bolivar’sBicentennial Seminar on Leprosy Control: Report: Caracas 12–14 September 1983. PanAmerican Health Organization, 1983. (PNSP/84–05).Bullock, W.E. Leprosy (Hansen’s disease). In:Wyngaarden, J.B., L.H. Smith, Jr., eds. CecilTextbook of Medicine. 16th ed. Philadelphia: W.B. Saunders; 1982.Bullock, W.E. Mycobacterium leprae (Leprosy). In: Mandell, G.L., R.G. Douglas, Jr., J.E.Bennett, eds. Principles and Practice of Infectious Diseases. 3rd ed. New York: ChurchillLivingstone, Inc.; 1990.Burgess, P.J., P.E. Fine, J.M. Ponnighaus, C. Draper. Serological tests in leprosy. Thesensitivity, specificity and predictive value of ELISA tests based on phenolic glycolipid antigens,and the implications for their use in epidemiological studies. Epidemiol Infect101:159–171, 1988.Clark, K.A., S.H. Kim, L.F. Boening, et al. Leprosy in armadillos (Dasypus novemcinctus)from Texas. J Wildl Dis 220–224, 1987.