Leprosy. definition : A chronic infectious disease caused by mycobacterium leprae, With neurologic and cutaneous lesions.

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Presentation transcript:

leprosy

definition : A chronic infectious disease caused by mycobacterium leprae, With neurologic and cutaneous lesions.

leprosy

the infectious agent : mycobacterium leprae stained red with acid-fast stain , contains o-diphenoloxidase breed one generation a 13-14days

M. leprae

M.leprae in nasal secretion of patients , after drying ex vivo→still alive for 2-9 days, Keep alive 3-4 weeks 0 ℃,inactivation after boiled 8' , lose productivity after deposed to sunlight for 2-3h 。

epidemiology : ( 1 ) infectious agent : leper ( lepromatous type ) ( 2 ) route of transmission : damaged skin 、 mucosa , direct contact , droplet spread. ( 3 ) herd suseptibility : natural acquired immunity. ( 4 ) epidemic condition : clustering distrubition , endemic

pathogenesis : Toxicity of M.leprae high:no invasion/autotherapy Organism resistance medium : TT low : Borderline none : LL(infectious) Cytoimmunity hypofunction

pathology : The pathological changes mainly occur in dermis and peripheral nerve. Tuberculoid type : tuberculoid type structure.hair follicle 、 coil gland 、 sebaceous gland 、 blood vessel and nerve damaged. LL : focus of infection contains lepra cell(foam cell) histiocytic infiltrate around vessels.

M.leprae

Clinical features : Incubation:2-5years ( 3moths- 10years ) 1 、 skin lesions : 2 、 peripheral nerve syptoms

1 、 skin lesions : 1.diversification of lesions 2.appendages of the skin involvement:pelage 、 sweat glands 、 sebaceous follicle 3.skin nerve terminal→superficial sensation dysesthesia 4.found M.leprae ( especially LL 、 borderline type )

2 、 peripheral nerves symptoms : Pure neural leprosy spindle-shaped swelling 、 nodules or uniformly enlargement can be found,often felt painful or tenderness. 1 . anesthesia : 2 . dyscinesia , muscular atrophy , palsy ulnar N→little finger and fourth finger contractures , hypothenar … claw hand median N→thenar eminence … ape hand radial N→wrist drop/mallet finger common peroneal N→foot drop facial N→facial paralysis 3. disturbance of trophicity 4. dyshemia

little finger and fourth finger contractures , hypothnar … claw hand

radial N→wrist drop/mallet finger

median N→thenar eminence … ape hand

Facial paralysis

Spectrum classification: 1. Tuberculoid (TT) 2. Borderline tuberculoid (BT) 3. Borderline (BB) 4. Borderline lepromatous ( BL ) 5 . Lepromatous(LL) 6 . Early and indeterminate leprosy

1. tuberculoid(TT): High resistance, the evolution is slow, Without internal organs involvement, lesions are limited 。 bacilli(-),lepromin test(+), Test for cellular immunity shows normal. Typical lesions , superficial sensation disturbance , Nerve trunk is enlarged and stiff 。

Tuberculoid

tuberculoid

tuberculoidtuberculoid

Tuberculoid

tuberculoid

2. Borderline tuberculoid(BT): Numerous lesions, dissymmetric,the edges of lesions are well defined borderline , Peripheral nerve involvement more than TT, fewer internal organs involvement, Bacilli , lepromin test weakly ( + ) - ( - ) in advanced stage, comparatively low cytoimmunity.

BT

3. Borderline(BB): Lesions polymorphism 、 multi- color 、 macule like infiltration and nodules. Lesions are generalized and asymmetrical,internal organs involvement. Bacilli +++→++++ , lepromin test ( - ). Cytoimmunity between TT and BT

B

4. Borderline lepromatous ( BL ): Diffuse infiltration 、 macula 、 plaque/nodule Peripheral nerve trunk involvement , asymmetrical : Nerve enlarged 、 tender , madarosis bacilli , lepromin test ( - ) in advanced stage , cytoimmunity test ( - ).

BLBL

BL

5 . Lepromatous(LL) : very low resistance, developing fast, lesions are numerous,symmetrical. bacilli ( + ).

LL

6 . Indeterminate leprosy : nonage , hypopigmented macule , superficial sensory disturbance , slight peripheral involvement. Usually bacilli (-) or only a few (+) Leromin test most (+) in advanced stage

Reactional leprosy : acute or subacute symptoms abrupt onset in the course of disease , it is an allergic phenomenon.

Lepromin test : lepromin 0.1ML 48h ( nonage 〕 3W ( advanced stage ) pratical value in late phase response : 1 (+)means high resistance 2 Useful to classify a given case

diagnosis and differential diagnosis 1 lesions with superficial sensory disturbance or only anhidrosis , or only an anesthsia area. 2 peripheral nerve trunk or cutaneous nerve enlargement ; 3 lesions or histology section found M.leprae ; 4 Specific changes in histopathology if there are 2 or over 2 items accord with above 4 items, the leprosy can be diagnosed.

treatment : 1 sulfone : dapsone(DDS) acedapsone (DADDS) 2 rifampicin 3 clofazimine 4 protionamide ethinamide drugs above should be used in trigeminy treatment