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We developed a novel gelatin particle agglutination test (MLPA) for the serodiagnosis of leprosy; this test is especially useful for clinical practice and epidemiological surveys of leprosy in countries in which the disease is endemic. The antigen used in the test is the chemically synthesized trisaccharide moiety of Mycobacterium leprae-specific phenolic glycolipid I. MLPA is a simple and easy technique having sensitivity and specificity comparable to those of the conventional indirect enzyme-linked immunosorbent assay. The new technique was found to be useful for monitoring of chemotherapy and predictive diagnosis of high-risk individuals in contact with persons with leprosy and may be useful for the prediction of relapse. We are now preparing to supply a quality-controlled ready-to-use MLPA kit for leprosy control in countries in which leprosy is endemic. Tween 20), peroxidase-conjugated anti-human immunoglobulin G (IgG) or IgM antiserum (Dako Immunoglobulins A/S, Copenhagen, Denmark) was added to the well and incubated Vol. 28,No. 3 on July 15, 2020 by guest

A 35-year-old male with lepromatous leprosy showed significant pro gression of the disease on initial examination. Along with typical lepromatous skin lesions, many scar-forming lesions were present, mainly on his extremities. Some lesions showed erosive surfaces. From clinicopathological findings, these lesions were suspected to be due to the partial excretion of intradermal lepromatous granulomata by 'transepidermal elimination'. Increased local volume, which might be due mainly to rapidly growing lepromatous infiltration before chemotherapy, is suspected of triggering this phenomenon. There is no doubt that many fresh Mycobacterium leprae were included in these excretions. After the initiation of chemotherapy, no new scar-forming lesions were observed.

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Mycobacterium leprae, the etiologic agent of leprosy remains one of the few pathogens that can not be cultivated in vitro. The diagnosis of leprosy is still based upon principles used a century ago: clini cal examination of the patient lesions, demonstra tion of acid-fast bacilli (AFB) in slit-skin smears, and histopathology. Leprosy is most easily diagnosed when Mycobacterium leprae are demonstrable in dis eased tissues, but this is often difficult in the inde terminate and in the tuberculoid types of leprosy in which M. leprae are rarely detected. Such a histo pathological diagnostic procedure is relatively insen sitive and does not give a definitive identification of the infecting organism as M. leprae. Several attempts have been made in recent years to improve the sensi tivity and specficity of the detection of M. leprae