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PubMed2004

[Current management of hand leprosy].

Leprosy, a chronic infectious disease caused by mycobacterium leprae affects an estimated 700,000 persons each year. Clinically, leprosy can be categorized as paucibacillary or multibacillary disease. Leprosy is important largely because of the deformities, disabilities and handicap it causes in a proportion of those affected by the disease. There are surgical procedures and techniques to correct or limit the deterioration of these conditions. In the past these surgical procedures were only performed in special institutions for treating leprosy and their complications. However, with the widespread use of multidrug therapy (PCT) and the consequent reduction in the prevalence of leprosy, there is progressive integration of the care of people affected by leprosy into the general health services. Surgery, as in intervention in the management of leprosy and its complications is used in patients who are already under anti-leprosy treatment, or after the have completed it satisfactorily. Therefore, preventive surgery like nerve decompression and corrective surgery should not be practiced in places where there is no leprosy program. This paper describes the nerve decompression for preventing paralytic deformities. Procedures for correction of claw deformity of finger and thumb resulting from ulnar or combined ulnar and median nerve paralysis, so commonly seen in leprosy-affected persons are given separately. In order to carry out these procedures, many involving tendon transfers with or without tendon grafting, the surgeon has to be well versed in the structural and functional anatomy of the hand and should training in hand surgery. Furthermore, supportive physiotherapy and if possible, occupational therapy services for pre and post-operative management of the hand should be available. If the corrective procedures are carried out in the absence of any of these requirements, the venture is bound to result in failure, worsen the hand disability as well as make any subsequent correction very much more difficult.

Hand↗
PubMed2006

Interactions between HIV infection and leprosy: a paradox.

Early in the HIV epidemic it was feared that the disease would undermine leprosy control, as has occurred with tuberculosis. It was predicted that patients with leprosy and HIV coinfection would have an increased risk of lepromatous disease and a faster clinical evolution, and that the leprosy would be more difficult to treat. None of these concerns have materialised and the interaction between HIV and Mycobacterium leprae seems to be far more subtle than that between HIV and tuberculosis. We review the epidemiological, clinical, and pathological data relating to leprosy/HIV coinfection. The published epidemiological data are limited in quality but show neither an increased HIV prevalence among leprosy cases nor an alteration in clinical spectrum of leprosy among coinfected patients. Some data suggest that immune-mediated reactions that complicate leprosy occur at a higher frequency in coinfected patients. Leprosy has now been reported presenting as immune reconstitution disease among patients commencing highly active antiretroviral treatment. Histopathological observations reveal a normal spectrum of appearances in biopsies of leprosy lesions from coinfected patients, even among those with advanced immunodeficiency. These observations suggest that cell-mediated immune responses to M leprae are preserved at the site of disease despite evidence that these responses are abrogated systemically, by contrast with tuberculosis, in which the host granulomatous response is impaired by HIV coinfection. We speculate that this paradox may relate to differences between the activation state and rates of cell turnover within leprosy and tuberculosis granulomas that differentially affect the susceptibility of the granulomas to HIV. The interactions between leprosy and HIV have been little studied and further research on the clinical, pathological, and management aspects of this coinfection is warranted.

Female↗
PubMed2006

Age is an important risk factor for onset and sequelae of reversal reactions in Vietnamese patients with leprosy.

BACKGROUND: Reversal, or type 1, leprosy reactions (T1Rs) are acute immune episodes that occur in skin and/or nerves and are the leading cause of neurological impairment in patients with leprosy. T1Rs occur mainly in patients with borderline or multibacillary leprosy, but little is known about additional risk factors. METHODS: We enrolled 337 Vietnamese patients with leprosy in our study, including 169 subjects who presented with T1Rs and 168 subjects with no history of T1Rs. A multivariate analysis was used to determine risk factors for T1R occurrence, time to T1R onset after leprosy diagnosis, and T1R sequelae after treatment. RESULTS: Prevalence of T1Rs was estimated to be 29.1%. Multivariate analysis identified 3 clinical features of leprosy associated with T1R occurrence. Borderline leprosy subtype (odds ratio, 6.3 [95% confidence interval, 2.9-13.7] vs. polar subtypes) was the major risk factor; 2 other risk factors were positive bacillary index and presence of > 5 skin lesions. In addition, age at leprosy diagnosis was a strong independent risk factor for T1Rs (odds ratio, 2.4 [95% confidence interval, 1.3-4.4] for patients aged > or = 15 years old vs. < 15 years old). We observed that T1Rs with neuritis occurred significantly earlier than pure skin-related T1Rs. Sequelae were present in 45.1% of patients who experienced T1Rs after treatment. The presence of a motor or sensory deficit at T1R onset was an independent risk factor for sequelae, as was the age at diagnosis of leprosy (odds ratio, 4.4 [95% confidence interval, 1.7-11.6] for patients > or = 20 years old vs. < 20 years old). CONCLUSION: In addition to specific clinical features of leprosy, age is an important risk factor for both T1R occurrence and sequelae after treatment for T1Rs.

Adolescent↗
PubMed1985

HLA-linked control of predisposition to lepromatous leprosy.

In a study of the relation between HLA and lepromatous leprosy, HLA haplotype segregation was analyzed in 28 families with multiple cases of different types of leprosy. The inheritance of HLA-DR2, HLA-DR3, and HLA-MT1, which had previously been shown to be associated with susceptibility to leprosy or with a leprosy type, was analyzed separately. Segregation occurred in a significantly nonrandom fashion in both polar tuberculoid leprosy and lepromatous leprosy. This finding indicated HLA-encoded control of a predisposition to both of these forms of the disease. In both cases the segregation observed among healthy siblings was random. Thus, susceptibility to leprosy per se is probably not controlled by HLA-linked genes. HLA-DR3 was inherited preferentially by children with polar tuberculoid leprosy rather than lepromatous disease (P = .02), and HLA-MT1 was inherited preferentially by children with lepromatous leprosy (P = .04). The results confirmed the association of these genetic markers with leprosy type.

Female↗
PubMed1994

Infection with human immunodeficiency virus type 1 (HIV-1) and human T cell lymphotropic viruses among leprosy patients and contacts: correlation between HIV-1 cross-reactivity and antibodies to lipoarabinomannan.

To determine the association between leprosy and human retroviral infections, 57 leprosy patients, 39 leprosy contacts, and 500 pregnant women were investigated serologically for antibodies to human immunodeficiency virus type 1 (HIV) and human T cell lymphotropic virus (HTLV) types I and II. Antibodies to Mycobacterium leprae phenolic glycolipid I (PGL-I), and lipoarabinomannan (LAM) were also analyzed. A low prevalence of HIV-1 infection was observed among leprosy patients (3.5%), leprosy contacts (0), and pregnant women (3.6%). Antibodies to HTLV-I but not -II were found more often in leprosy patients (8.7%) and contacts (12.8%) than in pregnant women (0). Sera from leprosy patients and leprosy contacts were often false-positive for HIV-1 by ELISA and were indeterminate by Western blot. LAM IgM and PGL-I IgM antibodies in sera from leprosy patients yielded significant cross-reactivities with HIV-1 pol and gag proteins. These data suggest that mycobacterial cell wall antigens may share common epitopes with HIV. Caution should be exercised when interpreting HIV-1 ELISA and Western blot data from regions where leprosy or other mycobacterial diseases are endemic.

Adult↗
PubMed1994

Anticardiolipin antibodies in infections are heterogenous in their dependency on beta 2-glycoprotein I: analysis of anticardiolipin antibodies in leprosy.

We studied the effect of beta 2-GPI on binding of antibodies in sera from patients with leprosy and patients with the antiphospholipid syndrome (APS) to CL in enzyme-linked immunosorbent assays (ELISAs). Increased levels of IgG aCL were detected in 59 of 61 leprosy patients' sera by the standard aCL-ELISA in the presence of bovine beta 2-GPI and in 60 of the 61 leprosy patients' sera by the modified aCL-ELISA without beta 2-GPI. When tested by both aCL-ELISAs on the same plate, 10/31 leprosy sera and 9/10 APS sera bound better in the standard aCL-ELISA, 16/31 leprosy sera bound better in the modified aCL-ELISA and in five leprosy and one APS sera the difference was not significant. A dose-dependent enhancing effect of beta 2-GPI on the leprosy and APS sera binding to CL was confirmed using purified human beta 2-GPI. Enhanced binding was seen if beta 2-GPI was added either before or together with the test serum. In 11/61 leprosy sera increased levels of IgG antibodies against beta 2-GPI were found by ELISA. Leprosy anti-beta 2-GPI antibodies appear to be a separate antibody population recognizing only beta 2-GPI adsorbed on the ELISA plate. These results demonstrate heterogeneity of leprosy aCL with respect to their beta 2-GPI requirement for binding to CL.

Antibodies, Anticardiolipin↗
PubMedDate not supplied

Comparison of two systems of classification of leprosy based on number of skin lesions and number of body areas involved--a clinicopathological concordance study.

BACKGROUND AND AIMS: WHO guidelines classify leprosy patients for therapeutic purposes into paucibacillary (PB) and multibacillary (MB) leprosy based on the number of skin lesions. An alternative system of classification has been in practice in Nepal from 1985 onwards, based on the number of body areas involved in patients of leprosy. We attempted a clinicopathological approach for comparison of these two systems of classification in leprosy patients for their ability to demarcate patients into groups of PB and MB leprosy. MATERIALS AND METHODS: The study included 108 leprosy patients (80 males and 28 females). Complete clinical examination and body charting was carried out in each patient noting the count of skin lesions and the number of body areas involved. Slit skin smears and skin biopsies were taken from an active skin lesion in all patients. RESULTS: On analysis, it was observed that there was good clinicopathological correlation between patients with 5 or < 5 skin lesions and 2 or < 2 body areas involved. (Clinical 95% and histological 96%) A similar correlation was also observed in the other group of patients with > 5 skin lesions and > 2 body areas involved, (Clinical 94% and histological 96%). There were almost identical numbers of patients represented in these two groups of classification. CONCLUSIONS: Our findings suggest that patients with involvement of 2 or less body areas can be classified as PB leprosy and those with more than 2 body areas involved can be classified as MB leprosy for the purposes of therapy. The study of areas of involvement in leprosy patients not only provides additional patient information but also adds another parameter as a basis for the study of leprosy patients.

Female↗
PubMedDate not supplied

Evaluation of leprosy patients with 1 to 5 skin lesions with relevance to their grouping into paucibacillary or multibacillary disease.

BACKGROUND: Patients with 1 to 5 skin lesions are arbitrarily categorized as belonging to the paucibacillary (PB) group for treatment purposes. With the decreasing prevalence of leprosy in India and modifications in leprosy program, the relevance of this grouping needs further study. AIMS: To study a group of leprosy patients with 1 to 5 skin lesions and compare the clinical parameters with histopathological findings and bacteriological status of the skin and nerve to evaluate the relevance of this grouping. METHODS: Seventy seven patients of leprosy with 1 to 5 skin lesions were included in the study. The number of skin lesions was recorded. Slit skin smears (SSS) and skin biopsies were taken in all patients and nerve biopsy was performed in 19 of them. The biopsies were evaluated for the type of pathology and AFB status. RESULTS: In these 77 patients (single skin lesions, 42; two lesions, 18; three lesions, 10; four lesions, 5; and five lesions, 2 patients) the clinical classification was indeterminate leprosy (IL) in 4, tuberculoid leprosy (TT) in 4 patients and borderline tuberculoid leprosy (BT) in 69 patients. Skin smears were positive only in 1 patient. The histological diagnoses in the skin were IL in 13, TT in 3, BT in 48 and borderline lepromatous (BL) in 4 patients. Acid-fast bacilli (AFB) were found in 14 out of 77 skin biopsies. Of the 19 nerve biopsies, 17 showed histological features of BT leprosy; of these, 12 demonstrated AFB on Fite staining. The bacillary index of granuloma (BIG) ranged from 1+ to 2+. The clinico-histopathogical correlation was 63% in the BT group, with 4 patients of this group showing features of BL on histopathology. When the presence of AFB was assessed, the percentage of positivity was 1.3% in SSS, 18% in skin biopsies and 63% in nerve biopsies. CONCLUSION: Our results point to the non-homogeneous nature of this group of leprosy patients with 1 to 5 skin lesions, with varied bacteriological and histopathological features. The significance of MB type findings on histopathology in patients grouped as PB leprosy should be resolved so that these patients may be given the drug therapy and the duration of therapy they warrant.

Biopsy↗
PubMed2000

Three cases of pure neuritic (PN) leprosy at detection in which skin lesions became visible during their course.

Pure neuritic leprosy (PN leprosy) is a type of leprosy with nerve involvement, but without obvious skin lesions. It is not uncommon in the south of Bangladesh, but its nature is less recognized than that in other types of leprosy. Male is dominant on its occurrence with higher disability grading. The histopathological study shows that the entire spectrum can be observed in nerves of PN leprosy. There was no relation among clinical parameters, such as the number and distribution of affected nerves, the immune response and its histopathology. Therefore the treatment of PN leprosy is not well-established at field level. Out of 1,741 newly detected cases by Dhanjuri Leprosy Project--Khulna Branch (PIME Sisters) in Khulna, the south of Bangladesh from 1994 to 1998, 141, or 8.10% were diagnosed as PN leprosy. 6 cases out of 1,741, or 0.34% were canceled afterwards because of wrong diagnosis, of which one misdiagnosed as PN leprosy. Three cases out of 140 of primary neuritic leprosy proved to have obvious skin lesions some time after their treatment started. The details of the three cases are described in this paper.

Adult↗
PubMed2006

[Leprosy and medicine I--proposal of an isolation policy and its background].

The leprosy policy of Japan began from when the government enacted "law No. 11 (The leprosy prevention act)" in 1907 (Meiji 40) and several leprosy sanatoriums were built and the patient who wanders about was received. Then, in rise of totalitarianism, the isolation policy of Japan gained national support under a slogan "Patient Relief", and it would become the big factor to which enactment of "Leprosy Prevention Law" in 1931 (Showa 6) and leprosy policy changed to segregation which aimed at internment of all leprosy patients. From today's research on the leprosy policy of Japan, it is internment of all leprosy patients, whole life isolation, social defense and neglect of patients' human-rights and led to many tragedy of patient. However, there is little research which can reply clearly to the question of whether the leprosy policy of Japan was really original and what the factors of led to the formation of the segregation policy. This paper focuses on the relation between leprosy policy and medicine, and from this, I make clear the similarity, or peculiarity of the isolation policy between Japan and the vest of the world, and clarify the factors of progress of the absolute isolation policy. The processes are historical and medical historical the verification of the relation between the formation of the national medicine and the progress of the isolation policy of Meiji Era, the proposal of the isolation policy by Dr. Keizo Dohi, Dr. Shibasaburo Kitasato, and Dr. Masatsugu Yamane, and the application by Dr. Kensuke Mitsuda, the decision to enact this policy and its support by the Health and Medical Bureau and the Department of the Interior, as well as many factors.

Health Policy↗
PubMed1993

Long-term active surveillance of leprosy suspects--what are the likely returns?

Data are presented from the Karonga District in Northern Malaŵi on the long-term follow up of 277 leprosy suspects who were not given antileprosy treatment or kept on active surveillance. Individuals who were started on antileprosy treatment within a year after leprosy was first suspected, usually on the basis of histopathology results, are excluded from this analysis, because their active surveillance would not usually cause an organizational or financial problem for leprosy control projects. After an average follow-up period of 4.5 years 35 of the 277 suspects included in the analysis (13%) were diagnosed with what we consider to be 'unequivocal' leprosy, and 3 of the 35 had developed disabilities. In 211/277 (76%) all signs of leprosy had disappeared completely. Comparing clinical certainties at first and last examinations and comparing clinical with histopathological certainties at last examinations it is estimated that up to 50% of the 35 cases of unequivocal leprosy which 'arose' in this group were attributable to misdiagnosis at the 1st or 2nd examination rather than to genuine progression of the disease. This estimate is compatible with an overall sensitivity of 90% and an overall specificity of 95% at each examination. Leprosy suspects with 1 cardinal sign of leprosy, either a typical lesion without loss of sensation, or loss of sensation in an otherwise untypical lesion, should be considered a high-risk group in that approximately 25% of such suspects (19/78) were later found with unequivocal leprosy. Policies towards such suspects should be formulated by leprosy control projects.

Humans↗
PubMed1998

Explanatory models and help-seeking behaviour of leprosy patients in Adamawa State, Nigeria.

In northern Nigeria 60 leprosy patients, 49 outpatients and 11 in-patients, were interviewed about their help-seeking behaviour and explanatory models before their first contact with the leprosy services. Most patients showed a delay of more than 1 year. After leprosy was provisionally diagnosed by lay persons, 27% of patients found their way to the leprosy services within 3 months. Chemists (popular sector) and the professional sector frequently missed the diagnosis. If early case finding is to be improved, it is important to involve them in case finding activities and to train them in adequate diagnostic skills. No significant correlations were found between total delay and sex, age, religion or leprosy classification, except with visible deformity at the time of the interview and illiteracy. Consultation of folk healers was the major reason for delay. Most patients consulted folk healers, who, although they claimed to have a positive attitude towards modern medicine in the case of leprosy, never referred patients to the leprosy services. While many patients held a variety of causes responsible for leprosy, most patients explained the disease in traditional terms (58%), while only a minority used modern concepts (20%). This emphasizes the need for continuous attention for health education of diagnosed patients and their families. No significant difference was found between male and female patients concerning their concept of leprosy. Denial of the leprosy diagnosis was rare.

Adult↗
PubMed2002

Social stigma: a comparative qualitative study of integrated and vertical care approaches to leprosy.

Integration of leprosy into the general health system is very much emphasized by health care planners. One prime reason stated for this is to reduce stigma attached to this disease. This study was conducted in the state of Maharashtra, India, to compare the level of social stigma towards leprosy in communities with a vertical and an integrated programme. The data were collected in three areas of five villages each. The first two areas were in an integrated programme to test for internal consistency and the third in a vertical programme. All the leprosy patients with visible deformities in these villages were enrolled in the study, and an in-depth stigma measurement scale was administered. In addition, focus group discussions were conducted among the family members of leprosy patients and participative rural appraisal was done in the communities. The data were analysed using qualitative methods. A total of 24 leprosy patients with visible deformities participated in the in-depth stigma measurement exercise from 15 villages. Fifteen focus group discussions were conducted with families of leprosy patients and an equal number of participatory rural appraisals with communities were done. The results show that social stigma was virtually non-existent among the communities with the integrated approach and minimally experienced by leprosy patients in this model. However, a high level of self-stigmatization among leprosy patients was observed in the vertical approach and equally a high level of social stigma was found in their communities, which led to reduced interaction between the leprosy patients and their communities. The integrated approach to community-based primary health care is effective in reducing leprosy stigma in society.

Attitude to Health↗
PubMed2002

Is beggary a chosen profession among people living in a 'leprosy colony'?

Leprosy is a highly stigmatized disease that apart from the physical ailments and the deformities causes psycho-socio-economic problems to the people affected. As a result of social rejection, leprosy colonies were formed inhabited by the leprosy-affected families. With inadequate socioeconomic support and help, these people often have resorted to beggary as a way to earn their living. This study is an attempt to look into the lives of the leprosy-affected people living in the leprosy colony in Ambala City, Haryana, north-west State of India and who have accepted beggary as their source of income. The psychosocial impact of leprosy and the subjects' attitude towards beggary has been studied. The study comprised 21 families, including, 22 men, 21 women and 40 children. Seventy-one percent of the families came from Southern India. All the men and nine of the women were leprosy-affected. The proportion of people with deformity was 89%. Prior to contracting leprosy, all of the men were employed, mainly in agriculture and physical labour. At present, all are beggars. Of the 20 who were interviewed, 65% of those who beg and 83% of other adults were illiterate. Fifty percent of the children were in need of education. Due to leprosy, the social interaction of 85% of the interviewees was limited to within the colony and of 88% to only other leprosy-affected people. Through their own organized efforts, they raised welfare services and housing for themselves. None of them liked begging to start with but have accepted it as a source of income. If given a chance and support, 80% said they were ready to quit begging. They were concerned about the education of their children. The study highlighted the need to develop alternate avenues of income generation utilizing the existing desires and potential of the inhabitants.

Adult↗
PubMed2003

Epidemiology of leprosy. Molecular, biological, and immunological approach.

Leprosy is an infectious disease for which humans are considered the only source of infection. The major hindrance in leprosy control and thus in reaching the elimination goal is that numerous leprosy cases remain undetected for a long time. Many of these patients are a continuous source of infection and, and hence perpetuate transmission. The goal of the World Health Organization (WHO) is to eliminate leprosy as a public problem by the year 2000; that is, to reach as a global prevalence of <1 per 10,000 people. The epidemiological data generated routinely by health services are greatly influenced by their policies and activities. The data do not, however necessarily reflect the true situation in the field. Information on the magnitude of the leprosy problem in any one area is important for the health services with regard to their planning, monitoring and evaluation of leprosy control activities. Our studies have suggested that the high prevalence of antibodies in children may be indicative of the active transmission of M. leprae in their surroundings. The prevalence of these antibodies may also be important for leprosy control programs in order to detect new patients as early as possible and in an effective and sustainable manner. Based on PCR data, it seems that the environment also plays an important role in the transmission of leprosy in endemic areas. The results of our study show that contact with a leprosy patient is the major determinant in the incidence of leprosy and that this concept shows similarities with the "stone-in-the-pond" principle of tuberculosis transmission in concentric circle around patients.

Antibodies↗
PubMed2005

[Study on the living condition of people affected by leprosy in Guizhou province].

OBJECTIVE: To study the marriage status, labour ability, income and other living condition of people affected by leprosy, and to provide information on prevention, cure and salvation programs from the government. METHODS: Based on the standardized national criteria and method, all registered people affected by leprosy in the whole province were asked to fill in a nationally standardized Form. RESULTS: Out of the 13,034 cases, 91.19% were farmers and only 13.01% of the teenagers were at school. On 12,816 patients at age for marriage, there were more unmarried males than females, more living in the leprosy villages than those living outside of the leprosy village (P < 0.01). Disability rate in leprosy villages was seen more than outside of the leprosy village. Per capita average annual income for the people affected by leprosy was only half of the average individual income in the whole province and 1/4 of the individual income in the nation. CONCLUSION: The living condition of those leprosy-affected people, particularly living in leprosy villages, called for special attention and the government should take comprehensive prevention to publicize the knowledge on leprosy to reduce fear and discrimination against them.

Activities of Daily Living↗
PubMed2005

Leprosy in the Department of Dermatology, Chang Gung Memorial Hospital at Kaohsiung from 1988 to 2004: a clinical and histopathologic study of 13 cases.

BACKGROUND: Leprosy has long been in Taiwan, but it has never been eradicated. Incidental cases are easily overlooked nowadays because most younger dermatologists are unfamiliar with this disease. METHODS: We review and analyze 13 cases diagnosed as leprosy at the Department of Dermatology, Chang Gung Memorial Hospital at Kaohsiung from 1988 to 2004, all of which were histopathologically proven. RESULTS: The ages of the 13 recruited patients ranged from 31 to 73 (mean, 58.6) years, without a gender preference (male: female, 7:6). Two male patients were under 40 years old; one was a foreign worker from Thailand and the other was a local person in Penghu working as the chief officer on a fishing boat. The most-common clinical subtype was lepromatous leprosy (5/13), followed by borderline lepromatous leprosy, borderline tuberculoid leprosy, and tuberculoid leprosy (each 2/13), and then borderline leprosy and indeterminate leprosy (each 1/13). The initial clinical impression before the histopathological diagnosis included granuloma annulare, generalized eczema, lymphoma, syphilis, papular urticaria, cutaneous tuberculous infection, Sweet's syndrome, erythema annulare centrifugum, and hematoma. Most of these patients only received irregular treatment after the diagnosis was made and were soon lost to follow-up. CONCLUSIONS: With increasing numbers of foreign workers and immigrants living in Taiwan in recent years, leprosy seems to have become a challenging diagnosis for younger dermatologists. Dermatologists should keep this ancient disease in mind and not overlook it. Because of the necessity of prolonged medication, complete treatment and long-term follow-up of leprosy cases will remain a major problem in public health.

Adult↗
PubMed1975

Leprosy--histopathologic aspects of nerve involvement.

The most striking single feature of the clinical manifestations of leprosy is the very wide range of appearances shown by the skin lesions. These include the vague, hypopigmented macules of indeterminate leprosy; the large, sharply defined hypopigmented anaesthetic lesions of tuberculoid leprosy; the nodules and diffuse infiltration of lepromatous leprosy; and a wide range of plaques and annular lesions of the intermediate (borderline or dimorphous) types of disease. From superficial appearances it would be impossible to say that these were manifestations of the same infection. Moreover, histologically there is a similar wide range of appearances, including minimal lymphocyte infiltration around the neurovascular bundles in indeterminate leprosy; epithelioid granulomata with Langhans' giant cells and virtually no bacilli to be seen in tuberculoid cases; and in lepromatous leprosy, histiocytic infiltration occupying the whole thickness of the dermis, with massive parasitisation by Mycobacterium leprae, of which there may be up to 10-9 per gram of tissue. Strain differences have been recognised, but appear not to be responsible for this remarkable range of manifestations; they are caused by variations in the soil, not in the seed. Leprosy is almost unique among infectious diseases in the importance that host factors play in its development. The different clinical appearances shown by different types of leprosy can be graded into a continuous series, forming a spectrum from the single or scanty lesions of tuberculoid leprosy to the total body involvement o lepromatous; and the patient with leprosy can indeed truly be said to wear his skin lesions like medals displaying his capacity to resist Myco. leprate. The histopathologic features of the developed disease have a similar spectrum, from an epithelioid granuloma to infiltration with histiocytes that are full of bacilli and are ultimately converted to foam cells (Virchow cells)...

Adrenal Cortex Hormones↗