Leprosy

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

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Lepromatous vs. Tuberculoid Leprosy

Lepromatous Leprosy (Early/Late Stages)

Lepromatous Leprosy Pre- and Post-Treatment

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.

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