RESUMO
Selective infection of peripheral nerves is a unique property of Mycobacterium leprae that results in serious injury, but its basis is unexplained. Recent evidence from infected armadillos suggests that endothelial cells of peripheral nerve vasculature may be the gatekeepers by which M. leprae infects nerves. The pathogenesis of neuropathy in leprosy may thus entail a dynamic sequence of adhesion, immunologic, and inflammatory processes involving peripheral nerve endothelial cells.
Assuntos
Endotélio Vascular/microbiologia , Hanseníase/microbiologia , Mycobacterium leprae/isolamento & purificação , Neurite (Inflamação)/microbiologia , Nervos Periféricos/microbiologia , Animais , Tatus/microbiologia , Modelos Animais de Doenças , Endotélio Vascular/citologia , História do Século XIX , História do Século XX , Humanos , Hanseníase/história , Neurite (Inflamação)/história , Nervos Periféricos/irrigação sanguíneaAssuntos
Animais , Endotélio Vascular/cirurgia , Endotélio Vascular/microbiologia , Hanseníase/história , Hanseníase/microbiologia , História do Século XIX , História do Século XX , Mycobacterium leprae/isolamento & purificação , Nervos Periféricos/irrigação sanguínea , Nervos Periféricos/microbiologia , Neuritos/história , Neuritos/microbiologiaRESUMO
Ultrathin sections of nerves of tuberculoid and lepromatous leprosy were examined in an electron microscope for changes in endoneural blood vessels. In the tuberculoid nerves, hypertrophy of endothelial cells was the most prominent feature. This was to such an extent that the lumen of blood vessel was often closed. Endoneural blood vessels showed multilayers separated by collagen and ground substances. In contrast, in the lepromatous nerves, there was no hypertrophy of endothelial cells in the blood vessels and the lumen of the vessels was open. M. leprae were seen within the endothelial cells and these organisms were intact and probably viable. These observations suggest a possible involvement of endoneural blood vessels which may contribute to nerve damage in leprosy.
Assuntos
Endotélio Vascular/ultraestrutura , Hanseníase/patologia , Nervos Periféricos/irrigação sanguínea , Humanos , Microscopia EletrônicaRESUMO
The recent progress were focused on: the identification of the general immunological mechanism of the hansenian neuritis, demonstrated by endoneural biopsies; the different pathology of the two categories of neuritis; the pathophysiologic derangements, inducing hypoxia or anoxia in the truncular involved segment. The adjuvant role of the canals is important; the clinical differences of the two categories of neuritis and the cases we shall treat by emergency; the importance of antireactionnal treatment and of the notation by tests for the study of the results. The goals are the hemodynamic decompression, useful in the first stage of ENL neuritis, the mechanical decompression of neural fasciculus and the urgent exeresis of necroses or evacuation of febrile abscess. Three technics a re studied: Extraneural and epineural decompression fascicular endoneural necrosis, neurolysis and complex neurolysis for evaluated ENL neuritis and for endoneural necrosis. The different indication according to the two categories: medico-surgical treatment for ENL neuritis, and according the precocity and the delay of the antireactional treatment, and also the absolute emergency of the necrosis and febrile abscess. The results of the treatment of 258 cases of recent neuritis are presented.