Job C K, Jayakumar J, Aschhoff M, Mathan M M
Department of Leprosy, St. Thomas Hospital and Leprosy Center, Chettupattu, Tamil Nadu, India.
Int J Lepr Other Mycobact Dis. 1996 Mar;64(1):44-50.
The pathological changes, bacterial load, and viability of Mycobacterium leprae in the skin and nerves of nine lepromatous leprosy patients who had undergone 2 years of multidrug therapy (MDT) were studied. M. leprae and varying amounts of their remnants were present in the nerves and skin of all but one patient. M. leprae isolated from skin biopsies of six patients and nerve biopsies of nine patients were inoculated into mouse foot pads. No growth was obtained from any one of them. During the electron-microscopic examination of three nerve biopsies, only one specimen showed a small number of solid-staining M. leprae. These findings would explain the low relapse rate in patients treated with 2 years of fix-duration MDT. Results of a long-term follow up of patients is awaited with interest. The possibility of nerve paralysis due to intraneural microreaction and fibrosis consequent to the continued presence of dead bacterial remnants should be seriously considered.
对9例接受了2年多药联合化疗（MDT）的瘤型麻风患者的皮肤和神经中麻风分枝杆菌的病理变化、细菌载量及活力进行了研究。除1例患者外，所有患者的神经和皮肤中均存在麻风分枝杆菌及其不同数量的残余物。从6例患者的皮肤活检标本和9例患者的神经活检标本中分离出的麻风分枝杆菌接种到小鼠足垫中。所有接种均未生长。在对3例神经活检标本进行电子显微镜检查时，仅1个标本显示有少量呈固态染色的麻风分枝杆菌。这些发现可以解释接受2年固定疗程MDT治疗的患者复发率较低的原因。人们期待着对患者进行长期随访的结果。应认真考虑因神经内微反应以及死亡细菌残余物持续存在导致的纤维化而引起神经麻痹的可能性。
