The Continuous Bacteremia of Lepromatous Leprosy

Abstract

Twenty-five of 32 patients with leprosy and high concentrations of acid-fast bacilli (AFB) in the skin had bacteremia of a magnitude that permitted identification of Mycobacterium leprae in smears of peripheral blood. In patients with untreated lepromatous leprosy, AFB are continuously present approximately at a concentration of 10⁵ per milliliter of blood and are unassociated with signs or symptoms of septicemia. AFB are found extracellularly as well as in polymorphonuclear leukocytes, monocytes and large circulating histiocytes. Bacilli appear to enter the bloodstream through invasion of skin arterioles, capillaries and venules. The presence of bacteremia can be predicted from the appearance of skin and liver biopsies. Bacteremia gradually subsides within four months after therapy with diaminodiphenylsulfone is begun, and the disappearance of bacilli from the blood provides an indicator of early response to chemotherapy.