Leprosy

What causes it? Rod Shaped Humans and Armadillos are only known natural reservoir for mycobacterium leprare

Mycobacterium leprare multiplies very slowly Symptoms can take as long as 20 years to appear Organism cant distinguish microscopically from other mycobacterium

What are the types of leprosy? Lepromatous: damages respiration, eyes, and skin Tuberculoid: affects nerves in fingers and toes, and surrounding skin Borderline: has effects of both types

Tuberculoid vs. Lepromatous Leprosy Clinical Manifestations and Immunogenicity

Borderline tubercloid Skin lesion are similar to those with tubercloid but are more numerous Damage to peripheral nerve more widespread Patient are prone to type I reaction

Borderline lepromatous Widespresd small macules Peripheral nerve involvement is widespread Experience type I @II reaction

bp2.blogger.com/.../s320/lepromatous_leprosy.jpg

Lepromatous vs. Tuberculoid Leprosy

Lepromatous Leprosy (Early/Late Stages)

Lepromatous Leprosy Pre- and Post-Treatment

peripheral nerve become tender and painful and sudden loss of function TYPE 1 LEPRA REACTIONS These reactions occur in almost half of patients with borderline forms of leprosy (BT,BL,BB) Manifestations include classic signs of inflammation within previously involved macules, papules, and plaques and, on occasion peripheral nerve become tender and painful and sudden loss of function fever—generally low-grade

TYPE 2 LEPRA REACTIONS (ERYTHEMA NODOSUM LEPROTICUM, ENL ENL occurs exclusively in patients near the lepromatous end of the leprosy spectrum (BL- LL),. Immun complex deposition Although ENL may precede leprosy diagnosis and initiation of therapy and in 90% of cases it follows the institution of chemotherapy, crops of painful erythematous papules or nodule that resolve spontaneously in a few days to a week it may recur

malaise; and fever that can be profound Acute neuritis Iritis and episcleritis are common Acute neuritis ,lymphadenitis,orchitis,bone pain,dactylitis ,arthrits

DIAGNOSIS: Biopsy the advancing edge of a skin lesion in TT. In LL, biopsy even of normal-appearing skin often yields positive results. Presence of acid fast bacilli in slit skin smear or typical histopathalogy

Complications: Extremities: Neuropathy results in insensitivity and affects fine touch, pain, and heat receptors. Ulcerations, trauma, secondary infections, and (at times) a profound osteolytic process can take place. • Nose: chronic nasal congestion and epistaxis, destruction of cartilage with saddle-nose deformity or anosmia. • Eye: trauma, secondary infection, corneal ulcerations, opacities, uveitis, cataracts, glaucoma, sometimes blindness. • Testes: orchitis, aspermia, impotence, infertility

TREATMENT: • Rifampin (daily or monthly) is the only bactericidal M. leprae agent. Clofazimine ( 3 times per week, or monthly). clofazimine is weakly active against M. leprae.

2. Daily self adminstered: Dapson (100 mg) daily for 6 months. Regimens • Paucibacillary disease in adults (<6 skin lesions): 1.monthly supervised: rifampin (600 mg monthly) for 6 months 2. Daily self adminstered: Dapson (100 mg) daily for 6 months.

Multibacillary disease in adults (>6 skin lesions): 1 Multibacillary disease in adults (>6 skin lesions): 1.monthly supervised: rifampin (600 mg monthly) plus clofazimine (300 mg monthly) supervised for 1 year. 2. Daily adminstration:Clofazimine 50 mg+ dapsone (100 mg/d) for 1 year

Reactional states: 1. Mild reactions: glucocorticoids (40–60 mg/d for at least 3 months). 2. If ENL is present and persists despite two courses of steroids, thalidomide (100– 300 mg nightly) should be given