01928nas a2200229   4500000000100000008004100001260001300042653001000055653001100065653001200076653002500088653002500113653001800138653000900156100001500165700001500180245007000195300001100265490000700276520140100283022001401684       1987                            d  c1987 Sep10aAxons10aHumans10aleprosy10aMicroscopy, Electron10aMycobacterium leprae10aSchwann Cells10aSkin1 aChandi S M1 aChacko C J00aAn ultrastructural study of dermal nerves in early human leprosy.  a515-200 v553 a<p>Skin biopsies from the cutaneous lesions of seven patients with indeterminate, BT, BL, and LL leprosy of less than 1 year's duration were examined by light and electron microscopy. Inflammatory cells, which marked the location of Mycobacterium leprae in bacilliferous cases (BL and LL) were most frequently and consistently found in relation to dermal blood vessels, neurovascular bundles, nerves, arrector pili muscles, and skin adnexa. The number of bacilli and inflammatory cells in the epineurium was in great excess of those in the perineurium and endoneurium. Perineurial infiltration by lymphocytes and bacillated macrophages was seen to occur through gaps between the constituent cells of a loosened and sometimes proliferated perineurium. Bacillation of Schwann cells and associated inflammation in the endoneurium was minimal. M. leprae were identified in endothelial cells, arrector pili muscles, macrophages and Schwann cells. At this stage, inflammatory destruction of nerve fibers was not encountered. It is concluded that M. leprae which are extruded from the circulation into the epineurium (or perineurium) may be carried in inflammatory cells across the perineurium which is loosened and rendered permeable to inflammatory cells as a consequence of chronic inflammation in the adjacent epineurium. This is suggested as a very probable route for M. leprae to enter nerves.</p>  a0148-916X