Distinct patterns of microvasculature in the cutaneous lesions of leprosy

This work is an investigation on the microvasculature of the cutaneous infiltrates of leprosy with the immunohistochemical staining of endothelial cells in cutaneous biopsies. Anti-Factor VIII-related antigen antibody (anti-FVIII-ra) and Ulex Europaeus-1 lectin (UEA-1) binding were utilized as endothelial cell markers. Thirty-nine patients grouped according to the Ridley-Jopling classification (14 borderline tuberculoid, 18 borderline lepromatous, 6 lepromatous, and 1 indeterminate leprosy) were selected for this study. Two microvascular architectural patterns could be clearly distinguished: lepromatous lesions presented a dense and tortuous mesh of microvessels among the Mycobacterium leprae-glutted macrophages; whereas the microvessels in the tuberculoid lesions were restricted to the periphery of the granulomas and were not seen among the central epithelioid cells. We were able to distinguish three basic morphological kinds of infiltrate distribution related to the microvessels: micronodules, cords and macronodules. Intensifications of the FVIII-ra immunoreactivity and UEA-1 binding capacity were observed in the endothelial cells of microvessels involved by the inflammatory infiltrate. A distinct cytokine expression profile at the leprosy poles and the role of mast cells in angiogenesis were speculated as factors contributing to these distinct patterns. Growth of the lesion and systemic dissemination of M. leprae in the bipolar spectrum of leprosy may hypothetically be influenced by the vascular-infiltrate relationship. The detection of angiogenesis in the cutaneous lesions of leprosy may bring about alternate and/or additional strategies for leprosy treatment.

Dermal extracellular matrix in cutaneous leprosy lesions

Thirty-eight biopsies of cutaneous lesions from leprosy patients [borderline tuberculoid (BT) 14, borderline lepromatous (BL) 18, lepromatous (LL) 6] were processed for staining of some extracellular matrix (ECM) components (collagen, proteoglycans, elastic fibers and fibronectin). Specific histological staining and the indirect immunofluorescence method with antibodies to collagen and fibronectin were utilized. The ECM of the normal dermis was strikingly modified in the inflammatory infiltrate. By Gomori's reticulin and anti-fibronectin immunostaining, replacement of the dense interlaced collagen fibers with a reticular mesh was observed in the infiltrate. The immunoreactivity obtained with anti-type I and anti-type III collagens showed positive fibrils and a lumpy pattern in the lepromatous and tuberculoid lesions with a higher amount in the lepromatous lesions. The lack of clear-cut boundaries between the normal dermis and the inflammatory infiltrate in the lepromatous (BL, LL) lesions was correlated with the blurred limits of the clinical lesions of this pole of the leprosy spectrum. Absence of elastic fibers in the infiltrate was a constant finding, and fuchsin-positive microfibrils were found in some infiltrates. The clear zone of lepromatous lesions was devoid of oxytalan fibers. Elaunin fiber rings around sweat gland acini were present even when the leprosy infiltrate was seen enveloping them. The original ECM is replaced by a newly assembled one, which is suited for the dynamic nature of the inflammatory process. The trophic effects of the ECM upon the cutaneous epithelial structures are modified so that atrophy and late degeneration ensues. These ECM modifications contribute, therefore, to the biological alterations of the skin functions in leprosy.

Ultrastructural study of the dermal nerves in the cutaneous macular lesions of patients with early leprosy

Thirteen biopsies of macular lesions of early leprosy patients were studied ultrastructurally with transmission electron microscopy (TEM). All of the biopsies displayed at least one dermal nerve partially or completely encircled by mononuclear cells in the conventional histopathological study with light microscopy. The patients'diagnosis varied from indeterminate leprosy to borderline tuberculoide (BT). In the ultrastructural study, twenty-seven dermal nerve branches were found in the thirteen biopsies. Twenty dermal nerve branches in eleven biopsies were found to display no inflammatory involvement. Seven nerves in seven biopsies were morphologically associated with mononuclear leukocytic cells. Four biopsies exhibited nerves with and without inflammatory involvement concomitantly. Three nerves showed morphological evidence of endoneurial fibrosis, not morphologically associated with the inflammatory process at least in the sections examined. No detectable axional and Schwann cell ultra strutural changes even in the twenty-seven nerves were found. The sensorial loss exhibited by the patients before the institution of treatment was completely reversed in eight patients after the end of multidrug therapy regimen. These findings suggest that sensory loss in the early stages of leprosy may be caused by reversible pathological mechanisms, rather than anatomical damage. It is also possible, concerning the mechanisms of nerve damage in leprosy, to speculate on the existence of a pathological process which may precede the inflammation.

Multidrogaterapia em hansenianos classificados como paucibacilares / Multidrug therapy in leprosy classified as paucibacillary

Trabalho realizado na Fundaçäo Oswaldo Cruz (Rio de Janeiro) apresenta os resultados observados em 70 pacientes hansenianos classificados como paucibacilares. O esquema terapêutico administrado consistiu de Rifampicina 600 mg/mês supervisionado associado com Dapsona 100mg/dia auto-administado por seis meses. Nenhum paciente tinha recebido medicaçäo específica anterior, e apresentaram IB = 0. Foram submetidos antes e após o tratamento ao exame dermatológico, histopatologia, avaliaçäo neuromotora e teste de Mitsuda. Este último näo foi utilizado como critério diagnóstico, foram incluídos 44 pacientes com mitsuda negativo ou com nódulo menor que 5mm. Após o término do tratamento os pacientes continuaram sob supervisäo semestral. A média do período de observaçäo é de 11,9% meses; durante este período dois casos apresentaram reaçäo do tipo I

Neurite hanseniana tuberculóide com caseificaçäo e ulceraçäo: presença de globias na secreçäo das lesöes / Tuberculoid leprosy with necrotizing neuritis and numerous bacilli in the fistulae

Apresentamos o caso de uma paciente com neurite hanseniana tuberculóide do ciático-poplíteo externo de evoluçäo arrastada e diagnóstico tardio, que evoluiu para fistulizaçao e ulceraçäo: globias foram notadas na secreçäo de uma das fístulas e bacilos em todas

Indices bacteriológico e morfológico no auxílio ao diagnóstico e tratametno dos pacientes hansenianos / Bacteriologic and morphologic index in the diagnosis and treatment of patients with leprosy

Pela evidenciaçäo dos índices bacteriológico e morfológico em esfregaços do muco nasal e linfa dos lóbulos auriculares e cotovelos de pacientes hansenianos, observou-se uma maior positividade do IB e IM nos esfregaços da linfa e, entre estes, valor mais alto naqueles oriundos da linfa auricular. A importância do IM reside no fato de possibilitar a avaliaçäo da resposta terapêutica em menor tempo do que o IB

Estudos dos dermatóglifos digitais em comunicantes de hansenianos / Digital dermatoglyphics in leprosy contacts

Foram analisadas as impressöes digitais de 184 comunicantes de hansenianos controlados no Ambulatório Souza Araújo (FIOCRUZ) e pertencentes às diferentes formas clínicas da doença. E, 27% dos comunicantes, foram observadas alteraçöes nas impressöes digitais semelhantes às encontradas em hansenianos, tendo uma das comunicantes sob suspeita apresentado sinais e sintomas clínicos da doença 125 dias após a tomada de impressöes. Em 56% as alteraçöes eram menos acentuadas, e finalmente, em 17%, näo havia alteraçäo nas impressöes digitais. Os resultados obtidos permitem-nos indicar o grupo com alteraçöes nos desenhos digitais como alvo de maior vigilância