Organisation and Practice in Tuberculosis Bacteriology

Abstract

This chapter discusses leprosy. Mycobacterium leprae, unlike other mycobacteria that cause disease in man, is not isolated or identified in the tuberculosis laboratory as it has never been convincingly cultured in vitro. Nevertheless, it is possible to obtain a limited growth of the bacillus in mouse footpads. By incorporating various antileprosy drugs in the diet of such mice, sensitivity testing may be performed. Such investigations, however, lie outside the province of all but a few research or reference centers. Routine bacteriological studies on leprosy are, of necessity, confined to a microscopical detection of acid-fast bacilli in skin, nasal mucosa, and nasal discharges. Owing to technical similarities, such investigations are well suited to the tuberculosis laboratory. Leprosy is, after tuberculosis, the most prevalent mycobacterial infection. It is estimated by the World Health Organization that there are, at present, about 11 million sufferers of the disease throughout the world, though many regard this as being a conservative estimate. Leprosy is complicated by the occurrence of the two types of tissue-damaging reactions known as Jopling types I and II. The first of these—erythema nodosum leprosum (ENL)—occurs in patients at or near to the lepromatous pole of the spectrum, and is almost certainly because of complexes formed between antibody and antigens liberated by the bacilli.