1. leprosy mailing list - October 2011 - Part I Introduction 1 The diagnosis of leprosy 1 Bernard Naafs, Salvatore Noto and Pieter A M Schreuder Leprosy mailing list, October 2011 Introduction

2. leprosy mailing list - October 2011 - Part I Introduction 2 Definition of leprosy Leprosy is a chronic infectious disease caused by M. leprae. It affects mainly the skin and the peripheral nerves. leprosy mailing list

3. leprosy mailing list - October 2011 - Part I Introduction 33 Protean diseases Leprosy: the great imitator Syphilis: SLE: Sarcoidosis"

4. leprosy mailing list - October 2011 - Part I Introduction 44 Leprosy (TT) Courtesy of S. Noto

5. leprosy mailing list - October 2011 - Part I Introduction 55 Leprosy (TT) Courtesy of S. Noto

6. leprosy mailing list - October 2011 - Part I Introduction 66 Leprosy (BT) Courtesy of S. Noto

7. leprosy mailing list - October 2011 - Part I Introduction 77 Leprosy (borderline) Courtesy of S. Noto

8. leprosy mailing list - October 2011 - Part I Introduction 88 Leprosy (BL) Courtesy of S. Noto

9. leprosy mailing list - October 2011 - Part I Introduction 9 Leprosy, BL reactive after pregnancy Courtesy of B Naafs

10. leprosy mailing list - October 2011 - Part I Introduction 10 Leprosy, BL reactive after pregnancy Courtesy of B Naafs

11. leprosy mailing list - October 2011 - Part I Introduction 11 Leprosy, BL reactive after pregnancy Courtesy of B Naafs

12. leprosy mailing list - October 2011 - Part I Introduction 12 Leprosy (BT-BL) Courtesy of S. Noto

13. leprosy mailing list - October 2011 - Part I Introduction 13 Leprosy (borderline in reversal reaction) Courtesy of S. Noto

14. leprosy mailing list - October 2011 - Part I Introduction 14 Leprosy (LL) Courtesy of S. Noto

15. leprosy mailing list - October 2011 - Part I Introduction 15 Leprosy, sequelae Courtesy of S. Noto

16. leprosy mailing list - October 2011 - Part I Introduction 16 leprosy mailing list Leprosy Courtesy of S. Noto

17. leprosy mailing list - October 2011 - Part I Introduction 17 Leprosy (LL) Courtesy of S. Noto

18. leprosy mailing list - October 2011 - Part I Introduction 18 Slides 15,16 and 17 These patients were all treated with multi-drug therapy. Sequelae in themselves are not an indication to start treatment. These kind of patients need urgently physical and social-economic rehabilitation.

19. leprosy mailing list - October 2011 - Part I Introduction 19 Courtesy of J A da Costa Nery Leprosy in families: father and child

20. leprosy mailing list - October 2011 - Part I Introduction 20 - The 3 cardinal signs of leprosy; - Ridley and Jopling classification; - Reactions and nerve damage. Key concepts in clinical leprosy

21. leprosy mailing list - October 2011 - Part I Introduction 21 The 3 cardinal signs of leprosy 1.Skin patch with loss of sensation; 2.enlarged peripheral nerve; 3.positive slit-skin smear. 21

22. leprosy mailing list - October 2011 - Part I Introduction 22 The leprosy spectrum according to the Ridley and Jopling classification tuberculoid leprosyborderline leprosy lepromatous leprosy TTBTBB BLLL BI- - - -,2+, 3+ 3+, 4+5+, 6+ (1+,2+) BT = borderline tuberculoid leprosy BB = mid borderline leprosy BL = borderrline lepromatous leprosy BI = bacteriological index - - = negative + = degree of positivity

23. leprosy mailing list - October 2011 - Part I Introduction 23 Nerve damage in leprosy 1.dermal nerves; 2.cutaneous nerves; 3.major nerve trunks. Source: B Naafs (1994) in E Nunzi, D Leiker, Manuale di leprologia

24. leprosy mailing list - October 2011 - Part I Introduction 24 Nerve damage in leprosy Most of the nerve damage in leprosy takes place during acute exacerbations of the disease called Reactions.

25. leprosy mailing list - October 2011 - Part I Introduction 25 How to diagnose leprosy history taking; physical assessment; and laboratory investigations. leprosy mailing list25

26. leprosy mailing list - October 2011 - Part I Introduction 26 Slides 27 and 28 show the importance of the source of light in clinical examination

27. leprosy mailing list - October 2011 - Part I Introduction 27 Skin lesions must be examined in a good light BUT NOT direct sunlight Indeterminate leprosy. Compare these photos, same patient, same day, same verandah! B. examined in bright sunlight. Note shadows and that lesion can hardly be identified. A. a well defined edge for part of the lesion, is apparent. It is slightly erythematous, when seen in good light, but not in sun. Appearance of lesion varies with angle of the rays of light. Tangential light is best, as on front of chin. Courtesy of Grace Warren

28. leprosy mailing list - October 2011 - Part I Introduction 28 Courtesy of S Noto Direct sunlight passing trough the foliage of the tree creates false skin lesions!