02616nas a2200325   4500000000100000008004100001260001600042653001100058653002300069653001200092653001600104653002500120653001300145653000900158653003000167653001800197653002800215653001300243100001300256700002000269700001400289700001500303700001300318245008400331856005900415300001200474490000800486520178200494022001402276       1983                            d  c1983 Oct 0110aHumans10aImmunity, Cellular10aleprosy10aMacrophages10aMycobacterium leprae10aNecrosis10aSkin10aSkin Diseases, Infectious10aT-Lymphocytes10aTuberculosis, Cutaneous10aVacuoles1 aKaplan G1 aVan Voorhis W C1 aSarno E N1 aNogueira N1 aCohn Z A00aThe cutaneous infiltrates of leprosy. A transmission electron microscopy study.  uhttp://jem.rupress.org/content/jem/158/4/1145.full.pdf  a1145-590 v1583 a<p>The dermal lesions of 18 patients with leprosy have been examined by transmission electron microscopy. The patients exhibited a spectrum of disease from polar lepromatous to polar tuberculoid with intermediate stages in various states of therapy and relapse. The nature and quantities of inflammatory cells and bacteria have been determined by electron microscopy to supplement previous light and fluorescence microscopy studies. Lepromatous leprosy was characterized by many parasitized foam cells containing large, multibacillary vacuoles with intact, osmiophilic Mycobacterium leprae: Bacteria were embedded in an electron-lucent matrix. No extracellular bacteria were evident. Only small numbers of scattered lymphocytes were found. As one approached the borderline state, smaller numbers of bacilli were present as singlets and doublets in small vacuoles of macrophages. The more reactive forms showed increasing bacillary fragmentation, larger numbers of lymphoid cells, and an occasional epithelioid cell. At the tuberculoid end of the spectrum, clear evidence of an exuberant lymphocyte response was evident. Large numbers of T cells with extremely long and complex filipodia were closely associated with epithelioid and multinucleated giant cells. Many of the mononuclear phagocytes appeared nonviable, and areas of necrosis were evident. Bacillary remnants were scarce and the cytoplasm of the epithelioid cells contained occasional dense bodies and many stacks of endoplasmic reticulum and mitochondria. These results suggest that Leu 3a/OKT4 helper cells may be capable of driving the effector function of mononuclear phagocytes. This would lead to a significant microbicidal effect on M. leprae, perhaps through the production of toxic oxygen intermediates.</p>  a0022-1007