Diamino-diphenyl-sulfone(DDS)에 의한 나접촉자(癩接觸者)의 화학적인 예방법에 관한 연구

Abstract

[한글]

[영문]

Since G.A.Hansen (1874) discovered M. leprae from leprosy tissue, it has been accepted that leprosy is a chronic contageous disease, and occurs chiefly among poorer people in poverty striken countries. In the treatment of leprosy, although chaulmoogra oil had been used from ancient times, it has now been abandoned. Faget et al. (1943) introduced promin, one of the derivatives of DDS, in the chemotherapy of leprosy and since then many investigators have been interested in chemotherapeutic agents for leprosy. Cochrane et al. (1949), Lowe and Smith (1949), and Lowe(1950) reported that DDS is more potentially active against mycobacteria than promin, and it has been accepted the DDs is the drug of choice in the treatment of leprosy.

However, DDS has still many limitations in the treatment of leprosy. Davey (1964) pointed out its rather strong toxicity, precipitation of hypersensitivity and prolonged period of medication. Therefore, many investigators have attempted to

find an ideal chemotherapeutic agent for leprosy (Buu-Hoi et al, 1955; Schneider et al, 1958; Davey & Hogerzeil, 1959; Lew et al, 1968).

Many leprosy workers believe that leprosy control will be provided not only by effective treatment, but also by effective prophylactic measures.

Fernandez (1939) suggested the possibility of leprosy prevention with BCG vaccination. Numerous clinical and field trials have been carried out in the attempt to prove the effectiveness of BCG vaccination both as a stimulant for lepromin positive conversion, and as a prophylactic measure against leprosy (Azulay, 1949; Convit et al, 1952; souza Campos, 1953; Brown et al, 1968 Bechelli et al, 1968).

As chemoprophylactic agents, chloroquine has been used for malaria (Belding, 1960), penicillin for syphilis (Andrew & Domonkos, 1963), and INH for tuberculosis (Payne, 1957; WHO, 1965). Leprosy is also a chronic disease and has a long incubation period. The idea is to eliminate the causative agent in the host tissue or to interfere with the host parasite relationship during its incubation period by the administration of DDS as a chemoprophylactic measssure in leprosy contacts.

The possibility of chemoprophylaxis of leprosy with DDS has been suggested and reported by some leprosy workers (Lee & Lew, 1960; Lew & Kim, 1966; Dharmendra et al, 1967).

The purpose of this study is to prove the effective chemoprophylactic value of DDS against leprosy contacts and to analyze the epidemiologic factors in leprosy families.

Materials and Methods

1. Children born from leprosy parents: 1752 Children born from leprosy parents in Korea were submitted to this experiments.

These children had very intimate contact with their leprosy parents or other leprosy patients at each respective leprosarium where they grew up before the separation took place.

2. Household contacts in leprosy families: This group consisted of 2461 household contacts from leprosy families at the World Vision Special Skin Clinic in Seoul and in Kangwondo province. The household contacts are living in their own homes where some of their family members are leprosy patients.

3. The children born from leprosy parents and the household contacts were divided into tow groups, an experimental group of children and household contacts, and a control group of children and household contacts. The experimental group were treated regularly with proper oral doses of DDs from 150 mg to 300mg per week according to their ages.

The control groups were not protected with DDS nor with BCG vaccination. Both groups, experimental and control, have been followed and examined periodically with clinical and bacteriological observations for a period of 7 months to 11 years.

Conclusions

1. Among the prophylactic groups, 1195 children born from leprosy parents and 1384 household contacts, two and three of new leprosy cases developed in each group respectively. Among the control groups which had not received DDS prevention, 557

children born from leprosy parents and 1077 household contacts, 33 and 86 cases of new leprosy patients developed respectively. The difference in the incidences of the disease in the both experimental and control groups indicates that chemoprophylaxis with DDS against leprosy contacts is effective.

2. The incidence of new cases of leprosy among the household contacts when the parents are primary cases as sources of infection is higher than other relatives of the families of primary cases. In the relationship between the leprosy types of

primary cases and new cases, the incidence of non-lepromatous types in new cases is higher (75.3%) whether the types of primary cases are lepromatous or non-lepromatous.

3. Most of new cases developing among household contacts had the age of onset between 10 to 20 years and the contact history with the family patient for more than 5 years.