Studies towards the standardization of lepromin. Progress and prospects

Because of the wide range of concentrations of Mycobacterium leprae in existing lepromins the authors studied methods of producing a standardizable lepromin containing 160 million bacilli/ml. The effects of using different dilutions of lepromin on the incidence of false-positive reactions were also studied.Progress reported includes a convenient method for preparing large batches of non-sedimenting lepromin, which is directly suitable for microscopic counting of Myco. leprae cells; and a validation of current methods for microscopic enumeration of Myco. leprae. Skin tests with diluted lepromins have demonstrated that dilutions up to 1:16 increase progressively the ability to distinguish between lepromatous and tuberculoid leprosy. This work has provided further evidence that 20 million bacilli/ml (a 1:8 dilution of the initial lepromin) should produce adequate Mitsuda reactions in general populations, provided that 3-mm reactions are taken as the criterion for 1+ positivity. The net effect of these findings is equivalent to expanding the world supply of lepromin by 8 times.Recommendations for further research are proposed.