Search

Out of 2.775 hanseniasis patients Mitsuda tested by one of the authors (R) from 1933 to 1947, 38 were re-examined in 1970/1971. 28 had been treated regularly, 6 did not receive sulfones. Improvement or disappearance of dermatological lesions occurred in 31 (81.5%), independently of reactivity. All eleven bacteriologically positive out of 19 Mitsuda negative patients became bacteriologically negative, which is partly attributed to sulfones. One treated bacillary negative patient became positive. 28 (76,3%) were neurollogically aggravated, independently of reactivity but more evidently among the stronger reactors. As regards classification, all initially "tuberculoid", "Virchowian" and "dimorphous" patients continued in their types or group, but only 7 (41.2%) out of the 17 initially "indetermined" remained so. Four (23.5%) two Mitsuda+ +, two+ changed to reactional tuberculoid, 6 (35,3%) (3 Mitsuda — 2+ and 1+ +) changed to the Virchowian type. These developments according to reactivity confirm the pathogenetic theory postulated in 1937 by one of the authors (R). Mitsuda reactivity remained generally unchanged, rarely increased or decreased. The good prognostic value of the strong Mitsuda test is generally confirmed, but only as regards classification, bacillation and dermatological lesions — not from the neurological and social viewpoints.

B a s e d o n a n ew mo r p h o l o g i c a l c o n c e p t a n d c l a s s i f i c a t i o n o f granulomatous inflammation: the polar granulomas, on the histogenesis of the tuberculoid granuloma of the posi t ive Mi tsuda test and on the relat ionship between the degree of histogenetic differentiation and behaviour of tumors, the Authors concluded that the "benign" or "malignant" behaviour of hanseniasis depends on the degree of tuberculoid differentiation of the lesions. If the lesion is histologically well differentiated toward a polar tuberculoid granuloma (tuberculoid hanseniasis) it will have a "benign" behaviour. On the contrary, if this differentiation is absent (virchowlan hanseniasis) or poor (interpolar bordeline hanseniasis) the behaviour of the lesion will be "malignant".