Transcript Leprosy - muhadharaty.com

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
 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
 Skin
lesion are similar to those with
tubercloid but are more numerous
 Damage
 Patient
to peripheral nerve more widespread
are prone to type I reaction
 Widespresd
 Peripheral
small macules
nerve involvement is widespread
 Experience
type I @II reaction
bp2.blogger.com/.../s320/lepromatous_lep
rosy.jpg
Lepromatous vs. Tuberculoid Leprosy
Lepromatous Leprosy (Early/Late Stages)
Lepromatous Leprosy Preand Post-Treatment
 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
 ENL
occurs exclusively in patients near the
lepromatous end of the leprosy spectrum (BLLL),.
 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

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

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
 • 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.

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.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