Cured tuberculoid patients have a greater life expectancy than cured lepromatous patients in Japan1

International Journal of Leprosy and Other Mycobacterial Diseases, Jun 2003 by Goto, Masamichi, Kitajima, Shinichi, Nomoto, Mitsuharu, Et al

ABSTRACT

Leprosy patients lack specific cellular immunity against Mycobacterium leprae, but other immunological functions are thought to be preserved. However, in a leprosy sanatorium in South Japan between 1982 and 2000, we found that the average age at death of cured lepromatous leprosy patients was about 5 yrs younger than that of cured tuberculoid patients; [male/lepromatous, 76.0 or - 10.0 yrs old vs. male/tuberculoid, 79.7 or - 9.4 yrs old, p = 0.026], and [female/lepromatous, 78.0 or - 10.5 vs. female/tuberculoid, 85.3 or - 9.8, p = 0.0001]. This trend was also observed in autopsy records of two other leprosy sanatoria in Japan. In a prospective study based on their age in 1982, among females in the age group between 60 and 69, lepromatous patients (75.3 or - 6.0 yrs) died earlier than tuberculoid patients (81.0 or - 5.1 yrs) (p

RESUME

Les patients souffrant de la lepre sont demunis d'une immunite a mediation cellulaire specifiquement contre Mycobaderium leprae, alors que le reste des fonctions immunologiques sont considerees comme preservees. Cependant, nous avons observe que, entre 1982 et 2000, au sein d'un sanatorium de lepre du Japon meridional, l'age moyen de deces des patients lepromateux gueris etait d'environ 5 annees de moins que celui de patients tuberculoides gueris ; (patients masculins lepromateux, 76,0 or - 10,0 ans versus patients masculins tuberculoides 79,7 or - 9,4 ans, p = 0,026) et (patientes lepromateuses, 78,0 or - 10,5 versus patientes tuberculoides 85,3 or - 9,8 ans, p = 0,0001). Cette tendance etait aussi presente a l'examen de comptes rendus d'autopsie de deux autres sanatoriums japonais. Dans une etude prospective basee sur des patientes agees de 60 a 69 ans en 1982, les patientes lepromateuses ont decede plus tot (75,3 or - 6,0 ans) que les patientes tuberculoides (81,0 or - 5,1 ans) (p

RESUMEN

Los pacientes con lepra carecen de inmunidad celular especifica contra Mycobacterium leprae pero otras funciones inmunologicas se mantienen preservadas. Sin embargo, en un estudio realizado en un sanatorio para lepra en el sur de Japon entre 1982 y 2000, encontramos que la edad promedio de muerte de los pacientes con lepra lepromatosa curada fue aproximadamente 5 anos menor que la de los pacientes con lepra tuberculoide curada [hombres lepromatosos, 76.0 or - 10 anos vs hombres tuberculoides, 79.7 or - 9.4 anos, p = 0.026], y [mujeres lepromatosas, 78.0 or - 10.5 vs mujeres tuberculoides, 85.3 or - 9.8, p = 0.0001]. Esta tendencia tambien se observo en los registres de autopsia en otros dos sanatorios de la lepra en Japon. En otro estudio prospectivo realizado en mujeres de 60 a 69 anos en 1982, se encontro que las pacientes con lepra lepromatosa (75.3 or - 6.0 anos) murieron mas tempranamente que las pacientes con lepra tuberculoide de la misma edad (81.0 or - 5.1 ano) (p

In Japan, after the introduction of diaphenylsulfone (dapsone) monotherapy in 1940's and WHO/MDT regimens in 1980's (1), most leprosy patients were clinically cured. However, many of them have sequelae, such as deformities of extremities or face and/or blindness (2), and most of them are still living in Hansen's disease hospitals/sanatoria. Patients having active lesions are extremely rare today.

Leprosy patients show low immunological response to eliminate Mycobacterium leprae, but other immunological responses are considered to be well preserved. Ridley and Jopling classified leprosy into five types (3). Lepromatous patients present Th2 dominant response, and have many bacterial loads, many skin eruptions, and wide damage of peripheral nerves in the skin. Tuberculoid patients show Th1 dominant T cell response and have relatively stronger protective immunity to M. leprae (4), and have less skin eruptions and limited areas of nerve damage. Leprosy is basically a nonlethal disease in both disease types; however, while analyzing the causes of death in a leprosy sanatorium (Hoshizuka-Keiaien), we found that the average age at death is younger in cured lepromatous patients than that of cured tuberculoid patients. In this study, we tried to reveal the reason for this difference.

MATERIALS AND METHODS

Until the abolition of the Leprosy Segregation Act in 1996, many leprosy patients were obliged to stay in national sanatoria in Japan, but several patients were allowed to be discharged during that time. Medical records of inpatients of the National Sanatorium Hoshizuka-Keiaien in Kanoya, Kagoshima, located in the southern part of Japan, were reviewed and a basic computer database was established in 1982. In 1982, there were 751 patients. They were followed up until 2000, and their death records were analyzed. Age at 1982, age at admission, age at death (between 1982 and 2002), gender, type of the disease, blindness, and Mitsuda's skin reaction were analyzed. In this study, types of leprosy were simply classified as lepromatous or tuberculoid, the former includes polar lepromatous (LL), borderline lepromatous (BL), and mid-borderline lepromatous (BB) while the latter includes borderline tuberculoid (BT) and polar tuberculoid (TT), according to the Ridley and Jopling classification (1). A small number of cases were classified as borderline type not otherwise specified.