||International Jorunal oí Leprosy !17
Vol 12 1944
JACINTO CONVIT, RUBEN D. AzUL.I\Y, DI~GO BERMUD~,
and I:1¡F.RRSEA L(,AOO*
Opinions vary a:s to the nature of th~ lepromin reaction. Some workers
eonsider that it.representa an allergi( rcsponse, indicating hypersensitivity to
8Ome component of MycobQ,('terilLm t~'Prae. The failure to react of patients
with active lepromatous lepros} is. explained by assuming that anergy has
*n produced by overwhehlúng d()sage. Others regard the reaction as nonspecinc,
atttibutable to irrit2ti(,n of the tissues by a foreign substance,
Assuming the responsl;' t(> be al1érgic and specific it should be rarely
encountered in areas wher(' lel)rosy is ra¡"e. Several workers, however, have
demonstrated high proportlon$ of positives in such areas. As a result, thl"
~ry of specificity has been broadened by the assumption that lepromin
~tains a protein identical or closely similar to tuberculo-protein. In other
~ds, positive results m noll-endemic areas are to be explained by prior
iDfection, not with M. teprae but with Mycobacteri1f;m t1LberC1l.los-is.
Certain studies carried out in non-endemic areas may be mentioned.
Cwn~ and Williams (1) in England found 6 positives amon~ 25 mental
~~tS, or 21 per cent, us¡r\g lt~promin diluted five times. Tbey note that
.n patients showed po5itiv(. tul)(,rculi11 tests. DuboL" .(2) in Belgium found
t~of 29 pe!'$0n5 t() be react(.rs, ' r 51 per cent. if a reading of 3 mm. or more
is~ccePted as po~itive. BoJ¡,m."I\i (3) in Italy reported 22 positives among
" patients with various demjat(J~f'. lJr 50 per cent. Six of his patie11ts suf~
fered ~ tubercul06is \,f the skin. Femández (4) in P-aris found 33 reat;..
tors among 42 patients with various dermatoses, or 79 ~er cent. Elevel"l of
his patientshad tubercul(lSis of the skin.
Radn8 (5) adduced evidence pointing direcily to non-specificity of the
l~fomin test and to a lack of correlation \vith the tuberculin test. He tested
100 healthy persons, all negative to tuberculin, belonging to an area vThere
l~rosy is very rare, and found that 94 reacted t(j l~promin. He tested a1so
25 pe~S ~th cachexia causro by infestation wíth intestinal parasites and
||#39;nal Journal of Leprosy 1944
TABLE I. Reactions to lepromin and tuberculin in 13 patients with variO'U$
---I~~ positivereact~1l ~ -
Diagnosis Lepromin }lantoux
4í I [-4-
The second group studied comprised 108 patients at Seaview Hospital,
New York, 70 of whom were Negroes. ~ Of the group, 42 were under 6 years
of age, 32 from 6 to 1l years, 27 from 11 to 20 years, and 7 over 20 years. A1l
had pulmonary tuberculosjs, for the most part of the primary type and all of
the remainder were sputum-negative. This group is especially interesting
~use of the large proportion of children. In table 2, comparison is made
between the 1ate reactions obtained at Seaview and those obtained by Dharmendra
and Jaikaria (6) .
TA8LE 2. C~O" ()f Mit.st«la reacti1m8 in tuberculoU8 patients at Seaview HO8-
~tGl, N. Y., IIJith thc.~e fo'tRd in We8t Bengal and the Punja'., India.
=-= := ==-===-
I Healtby penom UI ~ l¡'.n- I IIe:~:;h~ persons in the I Tuberculous.patients
pl (hlght) en~~I~r",. ) -I'ul~~a¡. :::-t'~d~~!- -a.t seavlew
I i I
I Num~r Per t ~nt "' llml...¡ Numt¡er !Pt'r Cent l Number I Number iPer Cent
'Poaiti".«" P08it,ve Tf!st~1 ¡ PO&itive ' P08itive Tested , PO&itive Positive
-I ! -
13 : 21 \ 51) ; 7 J ' 14 42
29 I 3( 4! ¡ 9 II 32
48 -¡ --7-1 ! '
1.--~ -.::.- !~
í 4~i I.":. j2 1- 211 101 i
The data of table 2 shov. t11..t i[\ Th(&a}p»#39;: Indian areas studied, the proportions
w~th.POSitive Mitsuda increa.,;e w.th age. Also the proportion positive in each
.group is much higher in t:he f!n~n',ic than in the non-endemic area. Among
tuberculous patients at Seaview tht' proportions positive in the two younger
age groups are much higher ti,~n iD the corresponding age groups in the
endemic area of w. Bengal. In thl Cg1e group from 11 to 20 years tlle pro-
~on positive among the Sea:vi~ patients is higher than in the Punjah bltt
much lower than in the West Beng,ll area.
A possible explanation is that there actually exis~ an allergic ('f'r'4't¡,Jr:
||nto tuberculosis and lepro~J All the Seaview patient5 wf:r ,,1)t'r.
cU1ú1-'P06itivew, hich according t(} this theory would lead to a high \'.~,.r
12 Convit, et al: Lepromin Test in Tuberculous 63
tion of lepromin-positives even in the younge.r ages. The rt"Sults of the
tuberculin tests are not given for the West Bengal area, but it may ~ that
tuberculosis is likewise much more prevalent there than in the Punjab.
In table 3 a comparison is made ~tween the. Fernández and the Mitsuda
phenomenon for the 108 patients tested a.t Seaview.
TABLE 3. ¡...ernández and Mitsuda phenomena in tubt'rCIdin-positive ~tients.
Type of reaction
.H of th"se reactions .howed berros;..
, 1. Of ten patients, with various dermatoses, attending the outpatient
clinic at New York Skin and Cancer Hospital, a1l reacted positively to tubercul-
iri. Of this group 9 showed early and 8 ]ate positive reactions to lepror."
.2. Oí íour patients with Boeck's sarcoid, three r('ticted negatively to
tubEirculin and to lepromin. The fourth was weak!y p\Jsitive to tuberctJ.lin.
~ p Number Number Per cent
tested -~--., ~~~
InternatiO'r!;aL JO1LT1Wl O! Lepro$1j
neg.tiv(: to iepromin on the early reading but did develop a positiv~ Mitsuda
rea('t3io. n. Of 108 tuberculous patients at Seaview Hospital, 70.4 per cent were
pOI.itive to lepromin on the early reading and 46.2 on the late reading. This
high proportion of Fernández positivcs may be due to the fact that all indivíduals
were tuberculin p~itives. If so, comparative figures for Mitsuda
~itives wou1d indicate that the Mitsuda reaction is less affected by cosensitiz.
ation with M. tttbeTculosis tJlan is ihe r'ernández reaction.
The authors wish to thank PrÑess..,r G(,orge MacKec, Dr. llarry Ke11, tmd (Ither
mI~mbers of the staff of the Skjn and Cancer Hospital of New York post-Graduate
Medjcal Scl1ool and Hospjtal, Prof,-,ssor Bret Ratncr, Djrector of the Pediatrjc Divisjün
of Seaview Hospita1, New y ,}rk. al1d l)r. HJ)ldah Bancroft of Western Reserve
University for their assistance il1 the "ludy.