1. leprosy

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

3. leprosy

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

6. M. leprae

7. 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 。

8. 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

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

10. 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.

11. M.leprae

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

13. 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 ）

14. 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

15. little finger and fourth finger contractures ， hypothnar … claw hand

16. radial N→wrist drop/mallet finger

17. median N→thenar eminence … ape hand

18. Facial paralysis

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

20. 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 。

21. Tuberculoid

22. tuberculoid

24. tuberculoidtuberculoid

26. Tuberculoid

27. tuberculoid

28. 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.

29. BT

32. 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

33. B

34. 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 （ - ）.

35. BLBL

36. BL

37. 5 ． Lepromatous(LL) ： very low resistance, developing fast, lesions are numerous,symmetrical. bacilli （ + ）.

38. LL

41. 6 ． Indeterminate leprosy ： nonage ， hypopigmented macule ， superficial sensory disturbance ， slight peripheral involvement. Usually bacilli （－） or only a few （＋） Leromin test most （＋） in advanced stage

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

47. 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

48. 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.

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