A suspicion of tuberculosis leprosy can be Nasal scrapings, though they will show acid-either to confirm or to ex-Claude the diagnosis. Nonpathogenic acid-fast cases of diphtheria bacilli indistinguishable and lymph is obtained. Blood does not interfere with ser-piously.
The carbolfuchsin should be used cold, not warm, for fifteen minutes. The preparation should not be subjected to a depolarization to long because M. deprave is much less acid-fast than M. tuberculosis. A count of bacilli may be made in high-power fields per bacillus (or bacilli per high-power field) for comparison with future counts. The standard Ziehl-Neelsen staining procedure is not sensitive enough to be used on paraffin section of tissue if bacilli are at all scarce.
Wade’s modification of the Fite Faraco stains (Amer. In the •absence of bacilli, a suspicion of leprosy needs confirmation by the demonstration of nerve damage. Such damage may consist of anesthesia or anhidrosis (usually coextensive with a skin lesion in tuberculin cases, often on feet or hands in lepromatous disease), thickening of superficial nerves, muscular weakness or atrophy, especially in the face and hands, ay histology changes in a biopsy specimen.
Each should be tested separately. Palpation of the great auricular nerves where they cross the sternocleidomastoid muscles, of the ulna nerves just above and behind the internal humeral epicondyles, or of the pert Teal nerves behind the heads of the fibulas may reveal thickening, modularity, stiff-news, or tenderness, any or all of which cause suspicion of leprous neuritis. Drooping of one or both lepromatous leprosy in a young boy. Note symmetrical involvement and predilection for cooler sacral parts: brows, ears, nose, cheeks, chin, and fingers. Of interest also are kinds of macaroni (loss of eyebrows) and the burn scar on his anesthetic left hand.
(From Arnold, H. L, Jr.: Modern Concepts of Leprosy. Spring-field, Illinois,-Charles C Thomas, 1953.)lower eyelids or oral commissars, or weakness of elevation of one eyebrow may disclose the patchy weakness of facial muscles, which Monad Krogh has said is the most distinctive single neurologic sign of leprosy. Contracture of a fifth finger, or f l attention of a hyposthenia or tenor eminence, or the grooving produced by atrophy of the interosseous muscles of the hands, May is not possible. Shortening of digits or of the whole foot. Rarely, “Dropping off” of digits is a myth.
Painless trophy plantar ulceration, identical with that seen in takes dorsal is and in syringe-Morelia, may also occur. Such ulcers are not prim-Marilyn leprous and no bacteriologic or histology evidence of leprosy is to be found in them. They often lead to osteomyelitis of metatarsal bones. Lepromin Test. The Jerome test is performed by the intradermal injection of 0.1 ml. of a boiled or autoclaved, gauze-filtered suspension