Which of the following is associated with leprosy: September 2005
Ans. D: All of the above Histologic findings vary according to the type of leprosy. Indeterminate leprosy is characterized by a few cells cuffing the dermal appendages and neurovascular bundles and a few M leprae within cutaneous nerves. In TT leprosy, epithelioid cells, lymphocytes, and perhaps giant cells form noncaseating granulomas. Dermal nerves are destroyed. Normal skin organs (e.g., sweat glands, hair follicles) are lost. Bacilli are frequently absent or difficult to demonstrate. In LL leprosy, the epidermis is normal and the rete flattened. A clear space separates the epidermis from diffuse granulomatous reaction with macrophages; large, foamy histiocytes (Virchow or lepra cells); and many intracellular AFB, which are frequently found in spheroidal masses (i.e., globi). Epithelioid cells and giant cells are not found. Granulomas are most numerous around blood vessels, nerves, and skin appendages. In some cases, many plasma cells are found. Dermal nerves are easily visible. In BT leprosy, granulomas are epithelioid, with a preponderance of lymphocytes. Dermal nerves are mostly destroyed. Bacilli may be scanty or absent. In BB leprosy, granulomas are epithelioid, dermal nerves may be visible, and bacilli are seen more often than in BT leprosy. In BL leprosy, histiocytes form granulomas, dermal nerves are visible, and bacilli are seen in greater numbers than in other types. In a reversal reaction, epithelioid cells and lymphocytes form granulomas. Extracellular edema is noted in the collagen of the dermis with dilated lymphatics or a proliferation of fibrocytes. As reactions clear, lesions heal with reduction or eradication of bacilli. ENL reaction is characterized by a massive influx of polymorphonuclear cells. Complement and immunoglobulin may be deposited in a granular pattern around dermal vessels. Bacilli become more numerous. Histologic studies are not useful for assessing clinical activity because granuloma persists for a long time after clinical activity subsides.
Foamy histocytes
Epitheliod cells
Noncaseating granulomas
All of the above