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Macrophages phagocytose Mycobacterium leprae but this bacteria can neutralise its lysosomes and continue to survive intracellularly inside the macrophage. This is when macrophages trigger the Th1 response and activate cell-mediated immunity (cytotoxic-T cell / CD8+ response) to kill the macrophage itself. If the immune system fails to do this - the mycobacterium continues to survive and accumulate within the macrophage cell to form leprematous lesions. It remains hidden from circulating antibodies. One of the side effects of taking Dapsone is erythema nodusum leprosum - there is acute inflamation at leprematous lesion sites because the mycobacterium is killed by the antibiotic and its antigens escape extracellularly out of the macrophages to then react with circulating antibodies to cause this acute reaction.