Leprosy

Cytokines, eg, interferons, interleukins, tumor necrosis factor (TNF), and certain growth factors, could have antitumor activity directiy, or may modulate cellular mechanisms of antitumor activity (2). Cytokines may be used to influence the proliferation and differentiation of T-ceUs, B-ceUs, macrophage—monocyte, myeloid, or other hematopoietic cells. Alternatively, the induction of interferon release may represent an important approach for synthetic—medicinal chemistry, to search for effective antiinflammatory and antifibrotic agents. Inducers of interferon release may also be useful for lepromatous leprosy and chronic granulomatous disease. The potential cytokine and cytokine-related therapeutic approaches to treatment of disease are summarized in Table 4. A combination of cytokines is a feasible modaUty for treatment of immunologically related diseases however, there are dangers inherent in such an approach, as shown by the induction of lethal disserninated intravascular coagulation in mice adrninistered TNF-a and IFN-y. 

The sulfas also remain clinically useful in the treatment of chancroid, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, and the fungus-related nocardiosis (7). In combination with pyrimethamine, they are recommended for toxoplasmosis (8) and have been used for chloroquine-resistant falciparium malaria (4,9). There has also been some use of sulfas for the prophylaxis of rheumatic fever. The sulfone, dapsone, remains an accepted treatment for all forms of leprosy (4). 

During the most active period of investigation of sulfanilamide derivatives, 1935—1944, for systemic bacterial infections, the antimycobacterial activity of 4,4 -dianainodiphenylsulfone [80-08-8] (DDS, dapsone) was discovered (14). Although neither this compound nor its derivatives proved to be clinically usehil for human tuberculosis, it did evolve into the most important type of compound for leprosy (15). The diacetyl derivative has also... 

Antituberculin Agents. Rifampin [13292-46-17, a semisynthetic derivative of rifamycin SV, is a most valuable dmg for treatment of tuberculosis, an infection caused by mycobacteria, leprosy, and an expanding range of other infections (23). Cycloserine [64-41-7] has been used to a limited extent for treatment of tuberculosis as a reserve dmg. Although cycloserine inhibits bacteria by interfering with their cell wall biosynthesis, it has toxic side effects in humans in the form of neurotoxicity. Capreomycin [11003-38-6] and to a much lesser extent viomycin [32988-50-4] both of which are peptides, have also been used for treatment of this disease. 

Rifampicin has also shown antiviral activity but at levels 500—1000 times greater than required for antibacterial activity (130,140—142). Rifampicin shows promise in the treatment of leprosy (130,143). A large number of rifampicinlike derivatives are potent inhibitors of reverse transcriptase (123,144-148). 

Rifamycia B is not biologically active but is spontaneously converted in aqueous solution to the active rifamycias O, S, and SV. Rifamycia SV was chosen for further studies because of its good in vivo activity, low toxicity, and solubiUty properties. Rifamycia SV is effective against a variety of infections as well as being active against tuberculosis and leprosy (168). Rifamycia P is the most active of the naturally occurring rifamycias (174). 

Some naturally occurring fatty acids have ahcycHc substituents such as the cyclopentenyl-containing chauJmoogra acids (1), notable for thek use ki treatkig leprosy (see Antiparasitic agents, antimycotics), and the cyclopropenyl (2) or stercuhc acids (Table 6). 

According to a review by Biichi of work done in Japan during the war, promising results have been obtained by the use of the alkaloid cepharanthine (p. 357) in tuberculosis and leprosy. 

Compounds closely related to the sulfonamide antibiotics proved to be the first drugs effective against Mycobacterium leprae, the causative agent of the disease known since antiquity, leprosy. These drugs are at least partly responsible for the decline of I hose horror spots, the leper colonies. 

Aussalzung, /. salting out (iSoap) graining. Aussatz, m. display (of wares) leprosy scurf, aussauem, v.t. deprive of acid, deacidify treat with acid. 

Leprosy is a chronic, communicable disease spread by prolonged, intimate contact with an infected person. Peripheral nerves are affected, and skin involvement is present. Lesions may be confined to a few isolated areas or may be fairly widespread over the entire body. Treatment with the leprostatic drugs provides a good prospect for controlling the disease and preventing complications. 

Leprosy, also referred to as Hansen s disease, is caused by the bacterium Mycobacterium leprae. Although rare in colder climates, this disease may be seen in tropical and subtropical zones. Dapsone and clofazimine (Lamprene) are the two drags currently used to treat leprosy. The leprostatic drugs are listed in the Summaiy Drug Table Leprostatic Dragp. 

Clofazimine is primarily bactericidal against M. leprae. The exact mode of action of this drug is unknown. Clofazimine is used to treat leprosy. 

Mr. Winters is very anxious about his newly diagnosed leprosy and his treatment regimen with dapsone. Discuss what you could do to decrease his anxiety. Determine what information you would include when educating Mr. Winters about the treatment regimen. 

Mr. York has been prescribed clofazimine daily to manage his leprosy. Discuss what preadministration assessments the nurse should make. Explain what information you would include in a teaching plan for Mr. York. 

A patient with leprosy is prescribed clofazimine 100 mg daily PO. The drug is available in 200-mg tablets. The nurse administers. ... 

Young, D., Lathigra, R., Hendrix, R., Sweetser, D., Young, R.A. (1988). Stress proteins are immune targets in leprosy and tuberculosis. Proc. Natl. Acad. Sci. USA 85,4267-4270. 

Dapsone (diaminodiphenylsulphone Fig. 5.16F) is used specifically in the treatment of leprosy. However, because resistance to dapsone is unfortunately now well known, it is recommended that dapsone be used in conjunction with rifampicin and clofazimine. 

Mycobacteria consist of a fairly diverse group of acid-fast bacteria. The best-known members areM tuberculosis andM leprae, the causative agents of tuberculosis and leprosy, respectively. Other mycobacteria can also cause serious irrfection, e.g. members of the MAI group, and there are many opportunistic species. 

Since the causative organism of leprosy, one of the world s six major diseases, Mycobacterium leprae, is closely related to Mycobacterium tuberculosis, thio-semicarbazones have also been used as second-line drugs in the chemotherapy of leprosy [38]. The most widely used in leprosy treatment has been thiacetazone, and structure-activity relationships for it are similar to those observed for antitubercular thiosemicarbazones [39, 40]. 

McGeer, P.L., Harada, N., Kimura, H., McGeer, E.G. and Schulzer, M. (1992). Prevalence of dementia amongst elderly Japanese with leprosy apparent effect of chronic drug therapy. Dementia 3, 146-149. 

Namba, Y., Kawatsu, K., Izumi, S., Ueki, A. and Ikeda, K. (1992). Neurofibrillary tangles and senile plaques in brain of elderly leprosy patients. Lancet 340, 978. 

B-Lactamase inhibitors, 31 (1994) 297 Leprosy, chemotherapy, 20 (1983) 1 Leukocyte elastase inhibition, 31 (1994) 59 Leukotriene D4 antagonists, 38 (2001) 249 Ligand-receptor binding, 23 (1986) 41 Linear free energy, 10 (1974) 205... 

Other diseases that formerly required long-term hospitalization or complete isolation include tuberculosis and the dreaded leprosy. Only a generation or two ago, for patients to be told that they had such diseases... 

Until the development of the antibacterial sulfones, Hanson s Disease (leprosy) remained a potentially horrible affliction, treated with largely ineffective ancient remedies. The antibacterial sulfonamides do not do well against this disease and, interestingly, the, sulfones which are effective, are not very useful... 

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