The Pathogenesis of the Neuropathy in Dimorphous Leprosy: Electron Microscopic and Cytochemical Studies

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Abstract
The lesions and the distribution of mycobacteria were studied in sural nerve biopsies from patients with dimorphous (borderline) leprosy. Schwann cell infection led to extensive focal myelin breakdown and fibrosis, which occurred while patients were as yet relatively asymptomatic. Axonal loss was gradual, and accompanied by more severe fibrosis, until replacement of nerve by densely packed, poorly cellular collagen made regeneration impossible. The bacteria tended to proliferate at one site within the nerve and there was no evidence of significant bacterial transport within nerve fibres or in the extracellular space. The distribution of intraneural bacteria in early lesions was compatible with blood-borne dissemination of the infection.

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