Waters M F, Ridley D S
Hospital for Tropical Diseases, London.
Lepr Rev. 1990 Dec;61(4):353-65. doi: 10.5935/0305-7518.19900033.
It is commonly accepted that the attainment of bacteriological negativity fails to restore the immune state of leprosy patients who have downgraded to lepromatous. We report six patients who had been lepromatous (LLs), and who, after many years of chemotherapy and bacteriological negativity, were found upon relapse to have upgraded to borderline-tuberculoid (BT). Five had become Mitsuda lepromin positive. The relapses could be accounted for by proven or suspected dapsone resistance. The upgrading was associated with minimal signs of reaction, which was attributed to the low level of antigen in the almost resolved lesions. The manner of development of the new high immune lesions resembled the onset of a primary infection, clinically and histologically. The development of a positive Mitsuda reaction in longstanding LL leprosy is not necessarily an indication of cure.
人们普遍认为，细菌学转阴并不能恢复已降级为瘤型的麻风患者的免疫状态。我们报告了6例曾为瘤型（LL）的患者，他们在经过多年化疗且细菌学转阴后，复发时被发现已升级为边缘结核样型（BT）。其中5例已成为麻风菌素 Mitsuda 试验阳性。复发可能是由已证实或疑似的氨苯砜耐药引起的。病情升级与轻微的反应迹象相关，这归因于几乎消退的皮损中抗原水平较低。从临床和组织学上看，新的高免疫性皮损的发展方式类似于原发性感染的发作。在长期瘤型麻风病中出现阳性的 Mitsuda 反应不一定表明已治愈。
