Clinico-histopathological findings of Buruli ulcer.

Here, we report the clinico-pathological findings of Buruli ulcer. The patients were 2 females, 9 and 23 years of age and one male, 47 years of age from the Ashanti Country of Ghana. Clinically, cutaneous lesions were classified as nodular, ulcero-nodular and ulcerative. Histopathologically, lesions involved cutaneous and subcutaneous tissue, which showed lympho-epithelioid cell proliferation and panniculitis with characteristic fat necrotic changes. Vascular inflammation, with the nerve tissue involvement, are prominent features on the chronological spectrum of the 3 cases. In all but the early case, Mycobacterium ulcerans could be visualized from the mid dermal area to the subcutis by Fite-Faraco and Harada stain. The ulcerated lesions were also immunoreactive to phenolic glycolipid-1 (PGL-1). These findings suggest Mycobacterium ulcerans infection with lesions of different ages. Further, we also show the need to identify distinct characteristics for differential diagnosis with lesions caused by other mycobacteria.

Comparison of polymerase chain reaction, immunohistochemistry and conventional histopathology in the diagnosis of early leprosy in Sichuan Province of China.

46 formalin-fixed, paraffin-embedded skin biopsy specimens, which were clinically suspected or diagnosed as early leprosy, were retrieved from the files of Sichuan, China from 1997 to 1999. All of them were examined by polymerase chain reaction (PCR) using the primers amplifying the 130 base-pair fragment of the gene from the 16S ribosomal RNA of Mycobacterium leprae, hematoxylin and eosin (H&E) staining, modified Fite-Faraco technique for M. leprae and immunostaining with the antiserum against the PGL-1, LAM-B, S-100 protein using ABC method. PCR was positive for 27 (58.7%) of 46 specimens. In 13 (28.3%) among them, only PCR signals were positive for M. leprae and all other test were negative. AFB was positive for 7 (15.2%) of 46, PGL-1 was positive for 17 (36.9%) of 46, LAM-B was positive for 10 (21.7%) of 46. Early epithelioid cells granuloma was detected in 4 (8.7%) patients (TT 3, BT 1), macrophage granuloma was detected in 1 (2.2%) patient (BL), S-100 protein staining showed early nerve granuloma for 4 (8.7%) of 46, peripheral nerve inflammatory infiltration for 11 (23.9%) of 46. Comparison PCR with other method showed statistically significant difference. PCR have an advantage over microscopic examination in detecting M. leprae in biopsy specimens negative for acid-fast bacilli.

Brief survey of leprosy situation in Congo: sero-epidemiologic profile in correlation with some emerging viral infections.

The Democratic Republic of Congo (DRC, former Zaire) in central Africa remains the foremost country for leprosy in Africa, with a total of 4877 registered cases, of which 4573 are new cases since 1997. These numbers are well above the regional average. About 94% of these patients are under multidrug therapy (MDT) coverage in the Congo, which ranks 8th in coverage rate among the surrounding nine nations. Available data on anatomo-clinical profile and bacillarity are provided, with reservations on the use of these data drwn due to relatively small sample sizes. The seroprofile of the disease was reviewed with regard to the association of other immunity impairing infections like HBV infection and the recently highly incident retroviral epidemics (HIV-1, HTLV-1, and HTLV-2). The leading role of non-governmental organizations is cited for improving leprosy patient conditions and also for future prospects, where the necessity of coordinated strategies with the government is emphasized. Recommendations for new trends and steps relevant to improving existing and future leprosy control strategies are put into perspective.

[Pathological findings of the liver in Hansen's disease].

In leprosy patients, granulomatous lesion are often observed, not only in skin and nerve, but also other visceral organs such as liver, kidney, spleen and cardiovascular system. But for the development of drug therapy, there are very few cases we can see the acid-fast bacilli in the lesion these days. We have reviewed the histopathological lesions in the liver of leprosy patients who had been treated for long term, based on autopsy findings of 31 cases, including 24 cases with lepromatous leprosy (LL) and 7 cases with tuberculoid leprosy (TL). Except one case of LL with progressive stage, most of them diagnosed as retrogressive or quiescent stage. Morphologically, acid-fast bacilli and granuloma were seen in a few cases of Hansen's disease. In addition, no suggestive changes of drug and virus induced liver injury were recognized. However, sclerotic change of portal vein was remarkably encountered in the tuberculoid leprosy.

[Pathology of the heart and blood vessels in Hansen's disease].

There are few reports on the cardiovascular changes accompanying Hansen's disease, and many aspects remain unclear. We performed macroscopic and histologic examinations on the cardiovascular system in autopsy (47 cases of L type, 2 cases of B type and 14 cases of T type) and biopsy cases of Hansen's disease. The changes in small blood vessels and capillaries were also observed using electron microscopy. Cardiac changes such as atrophy, hypertrophy, fibrosis and endocarditis, epicarditis and coronary sclerosis, were observed, and severe fibrosis was significantly more common in the T type cases. The heart weight tended to decrease with age in the T type cases, but such tendency was not observed in the L type cases, with some cases showing an increased heart weight. Marked atrophy, fibrosis, swelling and hyperplasia were observed in the peripheral nerves around the arteries in the epicardial adipose tissue and arterioles in the myocardium. These changes were caused by ageing of the vessels feeding the peripheral nerves, together with changes due to Hansen's disease, such as circulatory disturbance in vessels feeding the peripheral nerves, augmentation of vascular permeability and ischemic changes due to over-stratification of the basement membrane. Because these peripheral nerves were distributed around the arteries in the epicardial adipose tissue and they were probably vasomotor nerves. These results suggest that paralytic arterial changes may promote the ischemic cardiac disease or fibrosis.

Regenerative changes in median nerve defects using various rabbit skeletal muscles.

We examined the morphological changes of median nerve regeneration which situated to pass through degenerative latissimus dorsi and brachial triceps muscles in rabbits. Morphological observation was performed at 7, 14, 28, 45, 60 and 180 days after the creation of defect of the bilateral median nerves. Regenerative nerve fibers were observed in the residual tubes of left degenerative muscle bridges. In this respect the regenerative effect of the latissimus dorsi was better than that of the brachial triceps. These results suggest that regular and longer muscle fibers as those of latissimus dorsi may contribute to the effective regeneration of nerve.

[The dermal connective tissue of long quiescent leprosy patients. Part 2. Comparison of the volumes of collagen with those of elastic fibers].

We studied dermal connective tissue of leprosy patients(Pa) in inactive condition. The dermal thickness(D) and the volumes of collagen and elastic fibers were measured utilizing automated computerized image analyzer. The length of each elastic fibers(E) in lower legs were also measured. The E in upper dermis of forearms were observed microscopically. All these were compared with age-matched control(Co). We got the following results accordingly. There was a relative increase of E in Pa's limb skin in spite of greatly decreased dermal thickness and fibrous components. The influence of sun exposure could not be recognized in this result. Each elastic fibers of Pa were longer than that of Co. The increased E in upper dermis was evident in Co's forearms, but not in Pa's. From our results, it is conceivable that the Pa's E either outlast or are overproduced exceedingly the collagen fibers. The factors that may account for these results are remained to be clarified.

[Intraepidermal mass of M. leprae in a case of seborrheic keratosis due to Hansen's disease (LLs)].

A 67-year-old patient has had exanthema in the lower right limb since 51 years ago (16 years old at onset), which underwent repeated remission and recurrence. At present, he has bilateral symmetrical widespread infiltrating exanthema and asymmetrical marked neuralhypertrophy, and has been diagnosed typical LLs (His father had the same disease). The exanthema recurred several years ago, and the patient is being treated for Hansen's disease. He had a dark brown flat elevation with a rough surface and the size of a small finger tip in his right abdominal skin for approximately 20 years. A biopsy was performed, and the specimen was fixed in 10% formalin and paraffin sections were prepared for histopathologic examination. A part of the specimen was processed forscanning electron microscopic examination. Seborrheic keratosis was diagnosed by H & E staining. Acid-fast (FITE) staining, immunohistochemical staining (keratin, S-100 protein, anti-PGL antibody and anti-BCG antibody) and scanning electron microscopy revealed the presence of bacteria (M. leprae) in the dermal foam cells, the matrix with a banded structure and the squamous epithelial cells which normally lack phagocytosis function. Compared to the basal cells of normal epidermis, the basal cells located adjacent to the dermis affected with seborrheic keratosis showed increased proliferation and more marked characteristics of a germinative cell. The degree of differentiation of the basal cells appeared regressed, and they probably possessed augmented phagocytic activity. The phagocytosed bacteria were probably carried by the epidermal cell cycle toward the surface layer. However, bacteria could not be found in the stratum corneum, probably due to an association with the lysosome.

[The dermal connective tissue of leprosy patients. Part 1. The elastic fibers and the skin appendages].

Leprosy patients who are keeping long quiescent conditions show some characteristic changes clinically on their skins. The elastic fibers and skin appendages are important factors for the peculiar skin characters. We calculated the collagen and elastic fibers in the limbs and redundant facial skins of leprosy patients by automated computerized image analyser. Histopathological studies of these samples were also done. All cases were over sixty years old and many of them were in quiescent conditions. The control cases were taken from the same parts of age matched normal skins. We found the dermal thickness of lower legs of patients was significantly lower than that of controls. The amount of collagen fibers had tendensy of decrease accompanied with decreased dermal thickness, but the elastic fibers of leprosy patients did not show the same tendensy. In the patients' skin, the elastic fibers arranged irregularly, sometimes fragmented and focally coagressed. Skin appendages were greatly decreased and intraepidermal pores of sweat ducts were almost disappeared, but many sweat glands have survived. Of the facial skins, only 1 case showed a compatible feature with solar elastosis. We concluded that the dermal elastic fibers of leprosy patients had characteristic features. The types of leprosy, duration periods of active condition, destructed dermal structures, all these factors were suspected to have some relations with these phenomena.

Ultrastructural observations of small blood vessels in leprosy patients.

In lepromatous leprosy, blood vessels revealed the luminal protrusions of endothelial cells containing M. leprae and thickening of the basement membrane of endothelial and smooth cells. Endothelial projections with increased pinocytotic vesicles were more often encountered in lepromatous leprosy than in the other types of leprosy. On the other hand, in tuberculoid leprosy, the extensive rough endoplasmic reticulum suggesting protein synthesis was observed in the endothelial cells compared with the other types of leprosy and non-specific lesions. It seems that the blood vessels associated with hyperfunction and proliferation in the endothelium could aggravate the degenerative changes in peripheral nerve fibers including the Schwann cells.