The mouth in 40 consecutive, unselected bacilliferous leprosy patients has been examined. The fr equency and various types of lesion are reported. Twenty-three patients showed lesions inside the mouth. Although all parts of the mouth were found. to be affected in a varying percentage of patients, the hard palate was involved in ali 23 patients. Further, of these 23 patients, 21 showed acid-fast bacilli on the surface of mouth as judged by surface smears and mouthwash. A review of the literature concerning oral lesions in lepromatous' leprosy is also presented.

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Very little is known in leprosy regarding the transmission of the infection from the source to the susceptible host. One of the important fa ctors which governs the transmission of the disease is the viability of My cobacterium leprae outside the human body. In this study M. leprae obtained from untreated patients have been subjected to several adverse conditions. Their viability was verified by their multiplication in the fo otpads of normal mice. After drying in the shade the organisms were viable up to 5 months. On wet soil, they remained alive for 46 days. Kept in saline at room temperature, the organisms lived for 60 days. Surprisingly on exposure to direct sunlight for 3 hours a day the bacteria survived for 7 days. On refrigeration at 4°e, the bacteria could be preserved for 60 days. On the other hand, keeping at-70De, the bacteria could be maintained in a living condition for only 28 days. On exposure to antiseptics like Savlon (R) and alcohol, the bacteria were rapidly killed. These results indicate the survival outside the human body of M. leprae under different environmental conditions in India where the disease is endemic. Transmission of infection by indirect contact and occurrence of new cases in the absences of any known source, are consistent with M. leprae being viable outside the human body for varying periods of time. The findings could also be pointers to understand the epidemiology of leprosy.

Bacilli were purified from the 23 cases of multi bacillary type of leprosy. The ATP content of these bacilli was assayed by a firefly bioluminescent technique which is capable of detecting a very small number of cultivable mycobacteria as assessed by colony counts. The A TP content was compared with morphological index (MI) and FDA-EB staining of bacilli from the same specimens. It was observed that when MI was I % or more, the A TP content/solid bacillus was fairly constant in 15 cases studied. It ranged from 2•02 x 10-1 5 g to 5•60 X-I S g/solid bacillus (mean 3•46 x 10-1 5 g) and was in the same range as A TP content of viable cultivable mycobacteria. In the same IS cases, when the green-staining bacilli was considered as 'supposedly viable bacilli', ATP content/green-staining bacillus varied up to 9-fold (0•22-1 5 x g to 1•98 X 10-15 g/green-staining bacillus) and this did not correlate. The percentage of green-staining bacilli (FDA-EB) and solid staining bacilli (MI) was different in all the cases. In 2 cases with 0% MI in which ATP levels were also zero, 7•5% and 21•5% green-staining bacilli were present which implies that the enzymes responsible for green-staining character may persist for some time after death. Three cases with 0% MI had also 0% green staining bacilli and zero A TP levels, whereas in another 3 cases with zero MI significantly high levels of A TP were detected. It is inferred that solid-staining bacilli may be the viable bacilli but when MI is 0% (I % or less) sampling error or clumping may be responsible for missing out the solid bacilli in some cases. It is concluded that the ATP content of M. /eprae appears to be an easy, rapid and sensitive tool for determining the viability fo r monitoring the therapy. On the other hand MI and FDA-EB staining appear to have their limitations. As My cobacterium /eprae can not be cultivated in in vitro systems, there is a strong need to develop other rapid screening methods for monitoring the effect of therapy as growth in the mouse fo otpad

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