MICROBIAL DISEASES Height in about three weeks and sometimes ulcerating. It is positive in roughly half It apparently denotes resistance to leprosy. The use of the BCG vaccine to protect susceptible contacts against leprosy is still undergoing extensive experimental testing, and its value is still moot. the lepromin reaction is strongly positive. Recovery (except for residual nerve destruction) is usually completed in a year or two if bacilli were initially few or absent. The sulfones are the major specific chemotherapy of leprosy Diammodiphenylsulfone (DDS, Avlosulfon, dapsone) has preempted the fields.
Many leprologists start with 25 mg. once a week and raise the dose to 100 mg. daily maximum in weekly 25-mg. orally two days a week. The duration of treatment in tuberculosis cases is determined by the clinical response; as bacilli are usually lacking from the start, a clinically satisfactory result is likely to require a year or two. cases, and perhaps as long as six or eight years in heavily involved rases. Patients with a strongly positive reaction to leptin, however, usually remain well indefinitely without maintenance therapy.
Moderate overdosage may cause headache, anorexia, nausea, dizziness, insomnia, or tachycardia. globin determinations weekly and, later, monthly. Toxic psychosis, agranulocytosis, hematuria, or erythema nodosum may be seen with larger doses of any sulfone and require interruption of treat-mentor reduction of the dose.
The dose is 25 mg. a day initially, increased slowly to a maximum of 100 to 150 mg a day, by mouth Dihydrostreptomycin,1.0 gram intramuscularly three times a week, is. much less effective, according to most observers, though controlled studies over short periods in the Philippines and South Africa under (Doull’s direction t1956) suggest that it is almost as good as the sulfones (For discussion of dihydro strep Sumycin toxicity, see Pulmonary Tuberculosis.)
MICROBIAL DISEASES During lepra reactions& bed rest is indicated, and aspirin and antihistaminics may be helpful. The sulfone dosage may have to be reduced, but need not be if symptoms respond well to intra-muscularly injected triamcinolone acetonide (Kenalog IM) suspension. Erythema multiforme. ordinary or haloes or erythema nodosum may be controlled with steroids as a rule., intramuscular triamcinolone Atropiniza tion is indicated for iridocyclitis. require surgical decortication of the nerve involved.
Nerve abscesses, which occur rarely, may require incision and drainage. similar lesions due to other diseases. Prevention. In nonendemic areas, adults are probably as susceptible as children. of sulfone therapy. A recent retrospective study of Hong Kong families by Worth (1968) showed that infection occurred in more than 10 percent of children exposed to an untreated lepromatous.