The acute infiltration reaction of lepromatous leprosy

The "acute infiltration" of lepromatous leprosy is an abruptly developing but transitory syndrome which sometimes appears in an early stage of that type, but more often after the case has been for a considerably long time in the prolonged absorption stage. Clinically it presents and appearance of erysipelas0like redness, infiltration and edema and is accompanied by fever (37° to 39°C) and joint pains. It has to be distinguished from a rather similar reactional condition of tuberculoid leprosy called akuter Schub. Histologically, the lesions are like those of reactional tuberculoid leprosy. Lepra bacilli are more numerous than in the lesions of that condition, but much less in number than in the acute lepromatous reactivation (ordinary "lepra reaction"). In this respect the histological findings are quite different from those of any other acute condition that might be confused with acute infiltration. The Mitsuda reaction usually turns positive, and the positivity last for a fairly long time. Some cases have given positive reactions as long as twenty years after the eruptive episode. In many cases this condition is favorable for prognosis, not only temporarily; improvement may be permanent, as if the acute infiltration had been a turning point in the course of the disease. Finally there may be only the condition known as secondary neural. Considering the features enumerated, acute infiltration can be differentiated from the akuter Schub ("reactional tuberculoid leprosy") of the neuro-tuberculoid type, the erythema nodosum leprosum of the lepromatous type, and the acute relapse reaction of that type ("acute lepromatous reactivation").

Leprosy and childbirth

Of 112 leprous women at Aisei-en who have had children, 39 (34.8 per cent) developed the disease during pregnancy or shortly thereafter. In 100 pregnancies that occurred in wommen with leprosy, exacerbation of the disease occured 48 times, the remaining 52 being uneventfull in this respect. Though the initial symptom of leprosy is usually a simple macule, or anesthesia, the symptoms that appear in pregnancy or chilbbirth are usually acute lesions, the so-called "rash", often appearing as numerous active macules and frequently with edematous, erysipelas-like swellings of the face. In the case of abortion there usually is little advance of the disease, though occasionally a case becomes worse in spite of it. It is evident that for women who are in the incubation stage of leprosy, pregnancy and childbirth are liable to precipitate the development of the sisease, and for those who have leprosy childbearing is apt to lead to its exarcebation and extension.