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    Leprosy

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    Luqman Al-Bashir Fauzi
    Leprosy, also known as Hansen's disease, is a chronic infection caused by the bacterium Mycobacterium leprae. It primarily affects the nerves, skin, and lining of the nose. The disease has been documented as far back as 600 BC in India. It is transmitted through droplets from the nose of infected individuals. There are tuberculoid and lepromatous clinical forms depending on the immune response. Diagnosis involves skin smears, biopsy, and skin tests. Treatment is multidrug therapy with dapsone, rifampin, and clofazimine.

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    Leprosy

    Uploaded by

    Luqman Al-Bashir Fauzi
    105 views6 pages
    Leprosy, also known as Hansen's disease, is a chronic infection caused by the bacterium Mycobacterium leprae. It primarily affects the nerves, skin, and lining of the nose. The disease has been documented as far back as 600 BC in India. It is transmitted through droplets from the nose of infected individuals. There are tuberculoid and lepromatous clinical forms depending on the immune response. Diagnosis involves skin smears, biopsy, and skin tests. Treatment is multidrug therapy with dapsone, rifampin, and clofazimine.

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    Leprosy, also known as Hansen's disease, is a chronic infection caused by the bacterium Mycobacterium leprae. It primarily affects the nerves, skin, and lining of the nose. The disease has been documented as far back as 600 BC in India. It is transmitted through droplets from the nose of infected individuals. There are tuberculoid and lepromatous clinical forms depending on the immune response. Diagnosis involves skin smears, biopsy, and skin tests. Treatment is multidrug therapy with dapsone, rifampin, and clofazimine.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    105 views6 pages

    Leprosy

    Uploaded by

    Luqman Al-Bashir Fauzi
    Leprosy, also known as Hansen's disease, is a chronic infection caused by the bacterium Mycobacterium leprae. It primarily affects the nerves, skin, and lining of the nose. The disease has been documented as far back as 600 BC in India. It is transmitted through droplets from the nose of infected individuals. There are tuberculoid and lepromatous clinical forms depending on the immune response. Diagnosis involves skin smears, biopsy, and skin tests. Treatment is multidrug therapy with dapsone, rifampin, and clofazimine.

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    Leprosy

    (Morbus Hansen [MH])

    (Hansen’s disease)

    Definition: A chronic mycobacterial disease primarily affecting the peripheral nervous system and
    secondarily involving skin and other tissues.

    History
     600 B.C – written records in India
     150 B.C – written records in China
     2nd century BC – Egyptian mummies
     From Egypt -> Europe (150 AD: Greece)
     Then -> Americas & other parts of the world
     1983: WHO -> Estimated total in world – 10.5 million
     1996 (Multiple drug treatment) -> 1.3 million
     Malaysia –Common Orang Asli & Foreign workers

    Etiology
    Mycobacterium Leprae [unculturable in lab] (Armauer Hansen 1874)

    Grown in:

    - mouse footpad
    - 9 banded armadillos (discovered because of Armauer Hansen’s wife)

    Man – only significant reservoir

    Transmission:

    - via nasal secretions by droplets


    - Skin
    Pathogenesis
    Principal target cell = Schwann cells

    Nerve damage

    - Anaesthesia
    - Muscle paralysis

    Skin -> usually first sign/symptom

    - Non-specific lesions with pigmentary changes (hypopigmented) – anaesthesia /


    hypoaesthesia (Whether the patient still feels pain at the area. Use a needle to prick)
    - Often heals spontaneuously

    Clinical manifestations depend on immune status of patient

    Range TUBERCULOID -> LEPROMATOUS

    TUBERCULOID LEPROMATOUS
    Hyperactive immune response Anergy
    Few localized skin lesions with few bacilli Numerous skin lesions – often confluent
    (paucibacillary)
    Intense granulomatous response -> Damage Bacilli ++++ (multicacillary)
    major nerves (hardening)
    Immune response greatly weakened (anergy)
    Ear lones – bacilli ++++

    - Those with the better immune system will suffer from the tuberculoid form.
    - Those with the lepromatous form will have a negative tuberculin test.
    - The safest area to wear earings/studs is at the ear lobes. Anywhere else, then it will easily
    affect the ear cartilage. It could lead to cauliflower ear. (Pak Nasa’s story)

    More WHO criteria:

    - Borderline tuberculoid (BT)


    - Mid-Borderline (BB)
    - Borderline Lepromatous (BL)

    Other signs & Symptoms


    Eye

    - Uveitis
    - Corneal infection secondary to eyelid paralysis
    - The 2 symptoms above might lead the person to suffer from blindness

    Bone resorbtion

    - Collapse of nasal bone


    - Shortening of fingers & toes (autoamputation)

    Neuritis

    Orchitis

    Immune-Complex Nephritis

    Facial skin may become crumpled and look like a lion (Facies leonina)

    DIAGNOSIS
    History & physical examination

    Slit-skin smear and punch biopsy (AFB)

    - Ear lobe
    - Nasal secretion
    - Nasal mucosa
    Histology – granuloma + caseation

    Skin test

    - Lepromin test (only guide)


    - Fernandez (early) Rx 1-2/7
    - Mutsida (late) Rx 7/7 (Usually negative in Lepromatous Leprosy)

    Most cases of Lepromatous Leprosy cases in Malaysia are among the Chinese

    Split-skin smear - Acid fast staining


    Record # of bacteria/high power

    1+ : 1-10 per 100 fields

    2+ : 1-10 per 10 fields

    3+ : 1-10 per field

    4+ : 10-100 per field

    5+ : 100-1000 per field

    6+ : >1000 per field

    = Bacillary Index (BI)

    Acid Fast Bacilli:

    - if viable -> stains strongly and evenly


    - Dead when stains unevenly & weakly

    Morphological Index (MI):

     Percentage (%) of regularly stained (viable)


     Increase MI – Active disease
     MI decreases with chemotherapy

    Other Diagnosis methods:

    - α-PGL
    - Polymerase Chain Reaction (PCR)

    Treatment:

    Dapsone (diaminophenyl sulphone –DDS)

    - Before 1982 – Standard monotherapy for all forms

    DDS – Resistance -> MDT


    Add

    - Rifampin
    - Clofazimine (side effect: Skin discolouration)

    Other drugs

    - Prothionamide
    - Ofloxacin
    - Minocycline

    WHO

    Paucibacillary

    - Rifampin
    - Dapsone
    - (Give these for 6 months)

    Multibacillary

    - Rifampin
    - Dapsone
    - Clofazimine
    - (Given for 2 years or more)

    Reactions:

    Lepra/Jopling’s Type I:

    - Delayed Type Hypersensitivity


    - Vasculitis (Type II HS)

    Lepra/Jopling’s Type II

    - Erythema Nodosum
    - Leprosum

    Infections by environmental (Opportunistic) mycobacteria (Pak Nasa said this part is not important)

    Runyon’s classification

    a) Photochromogens (Group I)
    - M. Kansasii
    - M. Marinum
    - M. Simiae
    b) Scotochromogens (Group II)
    - M. Scrofulaceum
    - M. gordonae
    - M. szulgai
    c) Non-Chromogens (Group III)
    - M. avium
    - M. intercellulare
    - M. malmoense
    - M. xenopi
    - M. ulcerans
    - M. terrae
    d) Rapid Growers (Group IV)
    - M. chelonae

    Principal types of opportunistic mycobacterial infections in man

    Lymphadenopathy

    - M. Avium complex
    - M. Scrofulaceum

    Skin lesions

    a) Post-trauma abscesses
    - M. Chelonae
    - M. Fortuitum
    - M. Terrae
    b) Swimming Pool Granuloma
    - M. Marinum
    c) Buruli ulcer
    - M. Ulcerans

    Pulmonary Disease

    - M. Avium complex
    - M. Kansasii
    - M. Xenopi
    - M. Malmoeure

    Disseminated Disease

    a) AIDS related
    - M. Avium complex
    - M. Genevense
    b) Non-AIDS related
    - M. Avium complex
    - M. Chelonae

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