Avaliação baciloscópica na hanseníase virchoviana (estudo de 60 necrópsias)

Abstract

In the literature there are reports that the proliferation of M. leprae in viscera could occur even in the absence of proliferation at neuro-cutaneous level, and this fact could allow reactivation of leprosy. We analyzed 60 necropsies of lepromatous leprosy patients to compare and contrast from several visceral sites with those from skin and peripheral nerves. The necropsies were divided in groups according to results of the last baciloscopy done while the patients were alive: active lepromatous and in progression — 15 necropsies; active lepromatous and in regression — 17 necropsies; inactive lepromatous — 28 necropsies. In some necropsies, the visceral bacillary index overpassed the same index at neuro-cutaneous level, and in 3 necropsies, typical bacilli were found only in viscera (larynx and testicles). These results couldn't be appraised because technical and legal limitation prevented us from collecting skin and peripheral nerve fragments from various sites. Nevertheless, some reports suggest that the baciloscopy of skin drainage lymphonodes can be an estimate of cutaneous baciloscopy. In some of the visceral necropsies examined the bacillary index surpassed the same index in the axillary lymphonodes. Except for the axillary lymphonodes, the highest visceral bacillary indexes were found in the larynx, testicle and pharynx, with predominance of the first site. This may reinforce the relationship between tissue temperature and bacillary proliferation ability, suggesting that the larynx presents conditions of adaptation and proliferation of M. leprae, similar to the nasal mucous, which is the main via of bacillary shedding.