الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
Leprosy is a chronic inflammatory disease of man caused by intra-cellular Mycobacterium leprae, which displays a wide clinical spectrum related to host ability to develop and sustain specific cell-mediated immunity.
The aim of this study was to characterize the subpopulation of T-lymphocytes, Langerhans’ cells and monocytes I macrophages in different clinical variants of leprosy to determine the role of cell-mediated immunity in the pathogenesis of the disease. To achieve the purpose of this work, 40 cases covering the spectrum of leprosy were
studied.
All the cases were taken from El-Kalaa Outpatient Clinic of Leprosy and they
were subjected to the following:
.Complete history taking and clinical examination.
.Bacteriological examination of a skin slit smear and a skin biopsy using Ziel-Neelsen stain.
.Histopathological examination of a skin biopsy.
.Investigation by the indirect immunofluorescence technique and BMA series of monoclonal antibody to define T-lymphocyte subsets, Langerhans’ cells and monocytes I macrophages infiltrating the lesions.
To supplement the immunofluorescence study, skin biopsies from 3 different cases :1 lepromatous (LQ, 1 borderline (BB) and 1 tuberculoid (TT) were investigated
by the aid of the electron microscope.
SUMMARY AND CONCLUSION 205
Of the 40 patients studied, 26 (65%) were males, while 14 (35%) were females. The age of the patients ranged between 10 and 60 years with an average age of 26.6 years. The duration of disease ranged between 1 month and 36 months with an average duration of 11.25 months. The duration of treatment ranged between 0.0 and 36.0 months with an average duration of 7.13 months.
According to the clinical, bacteriological, and histopathological examinations, patients were classified into three groups:
Group I (tuberculoid group): this group consisted of 11 patients (6 It 5 BT). Group II (borderline group): this group consisted of 7 borderline patients (BB). Group III (lepromatous group): consisted of 22 patients (16 LL, 6 BL).
Lesions of the different types of the disease were biopsied and examined to determine the relative importance of each subset of the inflammatory cells in the different types of the disease. It was observed that BMA 030 positive cells (pan T-lymphocytes) were the dominant mononuclear cells infiltrating the lesions in most of the sections examined with more predominance in the tuberculoid group of cases than the borderline and the lepromatous group. Mean values were 2.91, 2.00 & 1.80 respectively with a statistically significant difference between the tuberculoid and the lepromatous group and insignificant differences between the borderline group and the other two groups.
SUMMARY AND CONCLUSION 206
As regards BMA 040 (help eI ri nducer) and BMA 081 (suppressor I cytotoxic) monoclonal antibodies, positive results were obtained in the different types of lep-rosy with variable intensity staining. While BMA 040 positive cells (helper 1 inducer) were predominant in the tuberculoid group (mean value 2.05) with statistically insignificant differences between the three groups, BMA 081 positive cells (suppr-essor I cytoto:dc) were predominant in the lepromatous group (mean value: 1.75) with statistically significant difference between the lepromatous and the tuberculoid group and insignificant differences between the borderline group and the other two groups. These data demonstrated the presence of a depression of cell-mediated im-munity in the lepromatous group more than in the tuberculoid group.
Ki-M1 (monocyte I macrophage) monoclonal antibody stained the highest proportion of cells in the lepromatous group and the lowest proportion in the tuber-culoid group (mean values: 2.07, 1.14 respectively) with insignificant differences between the three groups. These findings indicated that the mere presence of mono-cytes in the leprotic lesions does not have an important effect on the cell-mediated immune response. Their function and activity have a more significant effiect.
BMA 060 positive cells (Langerhans’ cells) were predominant in the epider-mis and dermis of the tuberculoid group, the epidermis of the borderline group and were scanty in the epidermis of the lepromatous group and very rare in the dermis. These data may explain the importance of Langerhans’ cells in the irnmuno-regulatory mechanisms in leprosy.
SUMMARY AND CONCLUSION 207
By classifying the studied groups into subgroups according to the duration of disease and according to the duration of antileprotic therapy, it was observed that early cases with a duration of disease less than 6 months showed the lowest inten-sity of fluorescence in all sections examined and with the all monoclonal antibodies studied, specially if the cases were untreated. This denotes that cell-mediated immunity is suppressed in all leprotic patients even those of the localized tuber-culoid type. With prolongation of the duration of treatment, marked cellular in-filtrate was observed in all patients covering the spectrum of leprosy, giving the highest intensity with a duration of treatment between 6 and 12 months. This clea-rly denotes that antileprotic chemotherapy ameliorate the cell-mediated immune response of leprotic patients. Cases treated more than 12 months showed again a gradual decline in the intensity of cellular infiltrate either due to resolution of the disease or due to destruction of the T-cell dependent area of lymph nodes as a res-ult of prolongation of the disease process.
The electron microscopic study supported the previous studies by finding that lymphocytes and epithelioid cells were more predominant in the tuberculoid case than the borderline and the lepromatous cases denoting a higher level of immune response in the tuberculoid case while the vacuolated macrophages, which were laden with mycobacteria were more predominant in the lepromatous case than the borderline one and were absent in the tuberculoid case illustrating also a higher level of immune response in the tuberculoid case. The existence of large numbers of macrophages together with large numbers of M.leprae denoted that these macro-phages were malfunctioning. The detection of Langerhans’ cells in the tuberculoid case only provided a strong evidence that Langerhans’ cells must have an impor-tant role in the immunoregulatory mechanisms in leprosy.
SUMMARY AND CONCLUSION 208
Conclusion
The data obtained from the study of mononuclear cell infiltrate in leprotic lesions by their specific monoclonal antibodies in different groups of leprotic pat-ients demonstrated the presence a suppression of cell-medieted immune response in the lepromatous group of patients which was more evident than in the borderline and the tuberculoid groups. These results were shown by the significant decrease in pan T-lymphocytes, relative decrease in T-helper cells, significant increase in sup-pressor T-lymphocytes and the highly significant decrease in LCs. The electron microscopic study demonstrated that the relative increase in cumber of macro-phages in the lepromatous group did not clearly ameliorate the cell-mediated im-mune response of lepromatons patients as they were less active than those of the borderline and the tuberculoid patients.
Also, it was clearly observsed from our study that antileprotic chemotherapy improves the cell-mediated immune response of leprotic patients.