الفهرس 
AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Leprosy is a chronic granulomatous disease affecting skin and nerve. There is a range of clinical and immunological responses to infection with Mycobacterium leprae and the disease manifests as a spectrum. Mycobacterium leprae, has a predilection for Schwann cells, where the organism multiplies unimpeded by organism-specific host immunity, resulting in destruction of myelin, secondary inflammatory changes, and destruction of the nerve architecture.
Although leprosy may have a protracted onset and be difficult to recognize, cure is achievable with appropriate multidrug therapy. Because untreated leprosy can result in permanent, irreversible nerve damage and secondary transmission, early diagnosis and treatment are essential to minimize morbidity.
Anti neural antibodies are known to play a role in the immunopathogenesis of nerve damage in leprosy. Ceramide is a glycosphingolipid that is expressed as a surface determinant of myelin, antibodies to ceramide or related neural components of the myelin sheath may be associated with nerve damage.
The present study was undertaken to identify antibodies to ceramide in the sera of leprosy patients, and healthy subjects using enzyme linked immunosorbant assay (ELISA), to evaluate the possible role of anti-ceramide antibodies (ACA) as a marker in the assessment of nerve damage.
This study included 25 patients with MB leprosy, 25with PB leprosy without previous treatment and 50 healthy controls. Studied individuals were subjected to history taking as: name, sex, age, residence, occupation, contact numbers and duration of the disease.
Clinical examination including: type of leprosy (PB or MB), sites and morphology of skin lesions, nerve examination; tenderness and enlargement, disability; examine eyes for any problem due to leprosy, and examine hands & feet for anesthesia and visible deformity or damage.
Histopathological report soft skin biopsies was used for diagnosing paucibacillary (PB) and multibacillary (MB) leprosy cases. Leprosy patients were classified broadly as PB or MB according to World Health Organization (WHO) guidelines for the treatment purposes without taking into account the size and extent of lesions or the number of nerves involved.
Venous blood samples (5 ml each) were collected from both leprosy patients and healthy controls under sterile conditions. Leprosy patients on drug therapy, immunosuppressive therapy such as corticosteroids, regular analgesics and/or with a history of inflammatory, autoimmune disease or any other systemic illness were excluded from the study. Anti-ceramide antibody titre was estimated by indirect ELISA, and correlated the ACA levels with type of leprosy, duration, nerve damage and disabilities in paucibacillary and multibacillary leprosy patients.
Results were reported as mean ± SD and data was analyzed statistically by Chi square test, with the level of significance set at p < 0.05. Statistical analysis was performed using SPSS windows version 16 software.
The result of this work showed the following:
1. There was no difference in age and sex between both patients groups and control group.
2. No difference was found in the duration of leprosy between two patients groups.
3. No correlation was found between serum anti-ceramide antibody level and age.
4. No relation was found between serum anti-ceramide antibody level and the gender.
5. Serum anti-ceramide antibody level was significantly higher in MB than its level in PB and than its level in controls, also it was significantly higher in PB than its level in control group.
6. The level of serum anti-ceramide antibody among the studied cases of leprosy was normal in 20% of PB and 4% of MB with less nerve affection and short duration of the disease.
7. There was a positive correlation between serum anti-ceramide antibody level and duration of disease.
8. There was a positive correlation between nerve enlargement & tenderness and serum anti-ceramide antibody level.
9. Disability of eye and hand grade 2 was higher with MB than PB, while disability of feet, and other grades in eye & hand have no statistically significant difference between both groups.
10. There was positive correlation between anti-ceramide antibody level and grades of disabilities among both groups of leprosy for all relations (eyes, hands, feet).
11. ROC curve could diagnose nerve damage in MB cases, at cut off value (0.610 OD) of serum anti-ceramide antibody, with sensitivity 80%, specificity 80%, accuracy 85.3% and area under curve was 0.85.
12. ROC curve could diagnose nerve damage in PB cases, at cut off value (0.323 OD) of serum anti-ceramide antibody, with sensitivity 91.7%, specificity 85%, accuracy 96.8% and area under curve was 0.97.
In conclusion, antibodies to ceramide are important molecules in the pathogenesis of nerve damage in leprosy patients. The nerve damage is the most serious aspect of this disease as nerve damage leads to progressive impairment and disability. It is important to identify markers of nerve damage so that preventive measures can be taken. Anti-ceramide antibodies can be one such biomarker.