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The histopathology of lepromatous leprosy in the nose.
J Pathol. 1975 Apr; 115(4):215-26.JP

Abstract

On the basis of clinical, histological and bacteriological assessments, 31 patients in Central India were selected and classified as having active but early lepromatous leprosy and 4 patients as having early borderline leprosy. From the nose of each patient an average of 4 biopsies were taken from particular sites of the septum and turbinates either by punch biopsy or dissection with a scalpel. The nasal tissues from all the lepromatous patients contained many acid-fast bacilli; no bacilli or abnormalities were seen in nasal tissues from the borderline patients. The histopathology of these highly bacilliferous tissues is described. Bacilli were universally seen in macrophages, but they were also seen in blood monocytes and polymorphs, fibroblasts, squamous and pseudo-columnar epithelium, keratin, peri- and endo-neurial cells of tiny nerve bundles, erectile tissue, vascular plain muscle, perivascular histiocytes and frequently and abundantly in the cytoplasm of endothelial lining cells of lymphatics and of small blood vessels and free within the lumina of these vessels. Five basic mechanisms of escape of bacilli from the submucosa on to the surface, and thus into the external environment, are described. Secondary infection, in the presence of an expansile lepromatous infiltrate, together with simple trauma to the surface epithelium, are the main factors in the discharge of bacilli. These histopathological observations are consistent with the findings from other recent studies on the nose in leprosy regarding (1) the large numbers of morphologically intact and viable Myco. leprae excreted in the nasal mucus of lepromatous patients; (2) the clinical changes observed in the nose of such patients, and (3) the similar nasal involvement and excretion of Myco. leprae from the nose of mice inoculated with leprosy bacilli of human origin. Of particular interest was the frequency and intensity of bacilli within the endothelial lining cells of small blood and lymph vessels and the presence of bacilli free within the lumina of these vessels or within monocytes and polymorphs. The possible dynamic significance of these observations in the pathogenesis of leprosy is discussed. The significance of all these observations in relation to (1) the spread of leprosy; (2) local factors in the nose which might favour the growth of Myco. leprae, and (3) the nose as a portal of entry, are discussed.

Authors

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Pub Type(s)

Journal Article

Language

eng

PubMed ID

1099180

Citation

McDougall, A C., et al. "The Histopathology of Lepromatous Leprosy in the Nose." The Journal of Pathology, vol. 115, no. 4, 1975, pp. 215-26.
McDougall AC, Rees RJ, Weddell AG, et al. The histopathology of lepromatous leprosy in the nose. J Pathol. 1975;115(4):215-26.
McDougall, A. C., Rees, R. J., Weddell, A. G., & Kanan, M. W. (1975). The histopathology of lepromatous leprosy in the nose. The Journal of Pathology, 115(4), 215-26.
McDougall AC, et al. The Histopathology of Lepromatous Leprosy in the Nose. J Pathol. 1975;115(4):215-26. PubMed PMID: 1099180.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The histopathology of lepromatous leprosy in the nose. AU - McDougall,A C, AU - Rees,R J, AU - Weddell,A G, AU - Kanan,M W, PY - 1975/4/1/pubmed PY - 1975/4/1/medline PY - 1975/4/1/entrez SP - 215 EP - 26 JF - The Journal of pathology JO - J Pathol VL - 115 IS - 4 N2 - On the basis of clinical, histological and bacteriological assessments, 31 patients in Central India were selected and classified as having active but early lepromatous leprosy and 4 patients as having early borderline leprosy. From the nose of each patient an average of 4 biopsies were taken from particular sites of the septum and turbinates either by punch biopsy or dissection with a scalpel. The nasal tissues from all the lepromatous patients contained many acid-fast bacilli; no bacilli or abnormalities were seen in nasal tissues from the borderline patients. The histopathology of these highly bacilliferous tissues is described. Bacilli were universally seen in macrophages, but they were also seen in blood monocytes and polymorphs, fibroblasts, squamous and pseudo-columnar epithelium, keratin, peri- and endo-neurial cells of tiny nerve bundles, erectile tissue, vascular plain muscle, perivascular histiocytes and frequently and abundantly in the cytoplasm of endothelial lining cells of lymphatics and of small blood vessels and free within the lumina of these vessels. Five basic mechanisms of escape of bacilli from the submucosa on to the surface, and thus into the external environment, are described. Secondary infection, in the presence of an expansile lepromatous infiltrate, together with simple trauma to the surface epithelium, are the main factors in the discharge of bacilli. These histopathological observations are consistent with the findings from other recent studies on the nose in leprosy regarding (1) the large numbers of morphologically intact and viable Myco. leprae excreted in the nasal mucus of lepromatous patients; (2) the clinical changes observed in the nose of such patients, and (3) the similar nasal involvement and excretion of Myco. leprae from the nose of mice inoculated with leprosy bacilli of human origin. Of particular interest was the frequency and intensity of bacilli within the endothelial lining cells of small blood and lymph vessels and the presence of bacilli free within the lumina of these vessels or within monocytes and polymorphs. The possible dynamic significance of these observations in the pathogenesis of leprosy is discussed. The significance of all these observations in relation to (1) the spread of leprosy; (2) local factors in the nose which might favour the growth of Myco. leprae, and (3) the nose as a portal of entry, are discussed. SN - 0022-3417 UR - https://www.unboundmedicine.com/medline/citation/1099180/The_histopathology_of_lepromatous_leprosy_in_the_nose_ L2 - https://doi.org/10.1002/path.1711150406 DB - PRIME DP - Unbound Medicine ER -