Marked increase in Mitsuda positivity in lepromatous cases with reference to clinical features

1- The nominally high positive rates of the Mitsuda reaction in acses of lepromatous leprosy, 80 per cent and more, were observed in two surveys, made in 1954 and 1957. Clinical analyses have been made of 840 out of some 1,400 cases surveyed in 1954, and of 177 cases that were examined on both occasions. 2- The main cause of the phenomenon is believed to be marked enhancement of the power of resistance against the leprosy infection resulting from modern chemotherapy. 3- It has now become difficult to apply the Mitsuda reaction in the classification of leprosy, so long as either the Madrid or the WHO criterion of positivity is employed. In view of the findings reported, it is proposed that over 7 mm. be made the limit for positive readings. 4 The position of the Mitsuda test in the study of leprosy may be said to be ever more important, because the reaction expresses the state of resistance of the organism against the infection under existing conditions.

Nerve abscess in lepromatous leprosy. Report of a case, with a review of reports of nerve abscess in apan

1- An instance of nerve abscess in a case of lepromatous leprosy is presented. In each of two ulnar antebrachial cutaneous nerves of an 18-year-old boy there occurred an abscess with purulent matter which consisted chiefly of lepra cells, particularly foamy cels, but few leucocytes. Leprosy bacilli were abundant, but there were no bacteria that could be grown in cultures. Histologically there was no resemblance to the socalled "cold abscess". The lesion was not tuberculoid and showed no caseous necrosis; it was definitely lepromatous in nature, with abundant bacilli. 2- Two other cases of lepromatous nerve abscesses recorded in Japan are reviewed briefly. The essential features of all three cases are tabulated. 3- No lepromatous case with an abscess of the cold type has been reported in Japan. There are, however, records of three lepromatous cases in which tuberculoid or caseous lesions were found in nerves at autopsy, in one instance together with lepromatous infiltrations. 4- Reports of 13 cases with cold abscesses have been found in the Japanese literature, and they are summarized in a tabulation. Typical lesions of this kind are rather rare in this country, although caseous lesions of the nerves are often found in cases of tuberculoid or neural leprosy.