The influence of antimycobacterial chemotherapy on delayed hypersensitivity skin-test reactions in leprosy patients

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Abstract
Skin tests using purified protein derivative (PPD) and Rees'' skin test antigen (RSTA), a soluble extract of Mycobacterium leprae, were performed in 53 treated leprosy patients, 52 newly diagnosed untreated leprosy patients and 78 household contacts of untreated leprosy patients in northern Bangladesh. In addition, a small group of 20 leprosy hospital workers and a further group of 50 indigenous subjects with no known exposure to leprosy were studied. Untreated paucibacillary and multibacillary patients showed significantly fewer positive reactions than comparable groups of treated patients to both PPD and RSTA. It appears from these results that treatment of leprosy patients is associated with enhanced ability to produce a delayed-type hypersensitivity response to mycobacterial antigens. The mechanisms underlying this phenomenon may include both general and specific suppression of antimycobacterial delayed-type hypersensitivity. The household contacts and indigenous subjects showed similar skin test responsiveness, but virtually all of the hospital workers responded to both PPD and RSTA. The implications of these results for studies of immunity in leprosy patients are discussed.

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