Infection of peripheral nerve by M. leprae, the histopathologic hallmark of leprosy, is a major factor in this disease, but the route and mechanisms by which bacilli localize to peripheral nerve are unknown. Experimentally infected armadillos have recently been recognized as a model of lepromatous neuritis; the major site of early accumulation of M. leprae is epineurial. To determine the epineurial cells involved, 1 cm. segments of 44 nerves from armadillos were screened for acid-fast bacilli (AFB), and thin sections were examined ultrastructurally. Of 596 blocks containing nerve, 36% contained AFB. Overall, M. leprae were found in endothelial cells in 40% of epineurial blood vessels and 75% of lymphatics, and in 25% of endoneurial vessels.
Comparison of epineurial and endoneurial findings suggested that colonization of epineurial vessels preceded endoneurial infection. Such colonization of epineurial nutrient vessels may greatly increase the risk of endoneurial M. leprae bacteremia, and also enhance the risk of ischemia following even mild increases in inflammation or mechanical stress. These findings also raise the possibility that early, specific mechanisms in the localization of M. leprae to peripheral nerve may involve adhesion events between M. leprae (or M. leprae-parasitized macrophages) and the endothelial cells of the vasa nervorum.

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Since the success of the multiplication of Mycobacterium lepraemurium in cell-free liquid medium by the author in 1972, various factors affecting its growth have been reported. In particular, it was emphasized that the key essential factor for the growth was α-ketoglutaric acid(α-kg) . However, recent data now indicate that the critical factor for the growth of M.lepraemurium is not α-kg, but the optimal pH of the liquid culture medium, quite similar to the condition of egg-yolk solid medium. The recent experimental results clearly indicated that an abundant multiplication of M.lepraemurium took place in an acid liquid medium containing egg-yolk extract, without α-kg. This finding means that the cells of M.lepraemurium can multiply in a liquid medium, if the pH of the medium is adjusted to 6.0-6.2. The reason why the cells of M.lepraemurium multiplied in NC medium, and NC-5 medium, containing α-kg was that the pH of neutral liquid base medium of the NC or NC-5 medium, was adjusted to 6.0-6.2, optimal for the growth of M.lepraemurium by addition of the 10% α-kg ( where 10% α-kg is strongly acidic ; pH:1.22). Other supplements, such as cytochrome c, 1-cysteine, and hemin, which are routinely added to the base medium of NC and NC-5 medium, have shown stimulatory effects on multiplication of M.lepraemurium, rather than a key essential effect.
In addition, recent experimental data have suggested a second key essential component for growth present in egg-yolk extract.

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IgG and/or IgM antibodies against mycobacterial cord factor (trehalose 6, 6'-dimycolate, TDM) in sera of 65 patients of Hansen's disease (21 cases with smear-positive and 44 cases with smear-negative) and 60 healthy individuals were tested by enzyme-linked immunosorbent assay (ELISA) with TDM purified from Mycobacterium tuberculosis H37Rv as an antigen. Of 65 patients with Hansen's disease, 58 cases (89.2%) had positive results (21 samples from 21 patients, 100% with acid-fast bacilli positive in the lesion, and 37 samples from 44 patients, 84.0% with acid-fast bacilli negative Hansen's disease diagnosed clinically). The sensitivity and specificity of anti-cord factor ELISA were higher than those of anti-phenolic glycolipid-I (PGL-I) agglutination test. Among the total, 34 patients were classified clinically into three types of the disease, lepromatous leprosy (LL), borderline lepromatous (BL) and borderline tuberculoid (BT). The antibody titer showed LL > BL > BT, indicating that the elevation of anti-cord factor antibody titers appeared to be parallel with the degree of humoral immune response against M. leprae. By using semisynthetic cord factor consisting of a single subclass of mycolic acid from M. tuberculosis, it was revealed that sera from patients with Hansen's disease were highly reactive against α-mycoloyl cord factor (α-TDM) and less reactive against methoxy mycoloyl TDM (methoxy TDM), differed from sera of tuberculosis patients, which were highly reactive against both methoxy and α-mycoloyl cord factor ( α-TDM). Most of sera from patients with Hansen's disease were more reactive against TMM than TDM, differed from sera of tuberculosis patients which were highly reactive against TDM. ELISA using TDM as an antigen is simple, reproducible and useful for the rapid serodiagnosis of Hansen's disease, especially for smear-negative cases.

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Recently, Buruli ulcer is emerging from the West and Central African countries. The disease come up with necrotizing and immno-suppressive type ulcer in the skin, subcutaneous tissue and bone, infected by Mycobacterium ulcerans, and shows indolent chronic course as mycobacterial infection, like tuberculosis and Hansen's disease. After the transmission to human, the lesion is usually single and begin as firm, painless, subcutaneous nodule and on any area of human body skin, though most frequently on lower limbs.
In countries of West Africa, it is suspected that the disease should be spreading most widely in Ghana. During April and June 1999, Ghana Health Service pick up the new patients by nation-wide examination.
The author visited Ghana twice at March and September 1999 and made on-the-spot inspections not only at a community and Ga district Health Service Center in Accra region but also at St.Martin's hospital in Agroyesum, Amanse west district, Ashanti region. At the time, the author did see the present state of Buruli ulcer, i.e. health and medical enlightenment.
This report, includes the results due to undergoing nation-wide examination on Buruli ulcer at 2 District in Ghana (List 1 and 2), the present states of the patients and the enlightenment provided by the staffs of Ga district Health Service Center (Photografs 1 ?? 14).
Staffs working for WHO and Ghana Health Service are tackling to Buruli ulcer problems, but conditions of the patiens are very hard because these patients must live in tropical wetlands, poor health, poor medical and poor economic conditions.

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Cell surface expression and release of the tumor necrosis factor receptor (TNFR type I) was analyzed after stimulation of peripheral blood mononuclear cells (PBMC) with Mycobacterium leprae (M. leprae) or lipopolysaccharide (LPS). A transient spontaneous expression of TNFR type I on the surface of PBMC was observed. Two hr after activation with LPS, a significant reduction of TNFR type I expression was detected: Release of TNFR type I by M. leprae or LPS-stimulated PBMC was evaluated with an enzyme-linked immunoabsorbent assay. This release occurred relatively later (20 to 40 hr) than the secretion of TNF alpha which reached high levels between 8 to 20 hr after activation.
Thalidomide, a potent drug for the treatment of erythema nodosum leprosum episodes by inhibiting TNF alpha production, had no influence on the TNFR type I expression. Similar results were obtained with pentoxifylline.
It is concluded that the release of TNFR type I by M. leprae or LPS-stimulated PBMC may counteract the pro-inflammatory activities of TNF alpha, by reducing the systemic toxicity of this cytokine in leprosy.

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A 29 year-old Bengali male case is presented in this paper which was a borderline tuberculoid leprosy (BT) at detection. His father contracted a lepromatous leprosy of G=2 deformity He took anti-leprosy drugs including MDT/MB regimen irregularly and had maculae widely-spread with anesthesia 16 months after being released from treatment (RFT). The histopathology of the maculae unexpectedly showed that of an indeterminate group of leprosy. The recurrent skin lesions were susceptive to a four-week regimen of Rifampicin and Ofloxacin. This case can not be defined as a relapsed case, because slit skin smears were always negative. It would be called a recurrent case after MDT/MB regimen. Though the reason recurrent skin lesions occur is unknown, it is reasonable to assume that the recurrent lesions are caused by dormant persisters which are originally drug sensitive. The recurrent skin lesions can not be classified because the clinical features can not be matched to their histology. Such recurrent cases might occur among the defaulters of MDT in future.

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A case of reconstructive surgery for saddle nose deformity is presented in this paper. A 22 year-old Bengali female who had completed WHO/MB regimen for 27 months underwent reconstructive surgery for saddle nose deformity. Since a saddle nose is one of the symbols of leprosy, it often causes serious psychological and social troubles to patients. This happens more often when the patient is a young unmarried woman. In this case the saddle nose seemed to be very serious. After being discharged from hospital she got married and had a baby. This operation gave the patient great relief to live in the community, because she no longer had serious visible evidence of leprosy on the body. Though the correction of the deformity without any dysfunction does not always have priority over other surgeries at a busy leprosy control project in Bangladesh, it has merit both in patients themselves and in the society around them because it leads to the elimination of the stigma of leprosy.

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