Mycobacterium leprae in deep organs in fifteen quiescent and arrested cases of leprosy that gave negative smears at necrospy

ABSTRACT

It was previously reported (1) that in 15 (36 per cent) out of 42 necropsies on "quiescent" and "arrested" cases of leprosy the bacillus was not demonstrated by direct smears from the deeper organs. Histological study of these cases is now reported. In 12 of these 15 cases the bacillus was found in association with foammy cells. Of the remaining 3 cases, in one neither foamy cells nor bacilli were found, in another a very few foamy cells one bacillus, and in the third a few bacilli without foamy cells. The three cases last mentioned are looked upon as instances in which the infection had probably been almost or quite overcome. Foamy cells were found in the nerve trunks in three cases, in the liver in 5 out of 14 cases, in the adrenal in 2 out of 9 cases, and in the testes in 5 out of 9 cases. Tuberculoid lesions were found in the nerve trunks in three cases, never in the lymph nodes or visceral organs. Absorbed globules of the injected drug were found in some or the lymph nodes examined, never in the nerve trunks. The histological evidence indicates that the bacilli found within the foamy cells were undergoing intracellular digestion. When the microorganisms are very scarce in the tissue, demonstration is probably influenced by chance when the "scraped-incision" method of obtaining smears is used. The necessity of a regular, systematic and continuous follow-up of all paroled cases, in order to determine the permanences of "arrest", is emphasized.