159 - Leprosy

Question 1

Besides humans, M. leprae is also found as a zoonotic infection in _____ in the Southern United States, and recently in _____ in the British Isles

Answer 1

Armadillos

Red squirrels

Question 2

More than 805 of all new cases are detected in only 3 countries

Answer 2

India
Brazil
Indonesia

Question 3

Has the highest number of leprosy cases

Answer 3

India

Question 4

Has the highest new case detection rate

Answer 4

Brazil

Question 5

Special self-healing type of tuberculoid leprosy

Can be found as a single nodular lesion, but also as papules or plaques, usually on the face of the child

Answer 5

Infantile nodular leprosy

Question 6

Special type of lepromatous leprosy

Has an ever higher bacillary load than the usual lepromatous leprosy, presenting as diffuse shiny nodules and papules

Answer 6

Histoid leprosy

Question 7

Species in Lucio leprosy

Answer 7

Mycobacterium lepromatosis

Question 8

Mycobacterium lepromatosis is found mainly in

Answer 8

Mexico

Caribbean

Question 9

Triple Lewis response in normal skin

Answer 9

Erythema 5 to 10 seconds after intradermal injection of 1:1000 histamine
Secondary erythema two minutes after caused by capillary dilation
Wheal formation caused by exudation of liquid to the dermis

Question 10

Response of lesional skin tointradermal injection of 1:1000 histamine

Answer 10

Incomplete Lewis response, with the absence of secondary erythema

Question 11

Thinnest monofilament

Answer 11

Green

Question 12

Thickest monofilament

Answer 12

Red

Question 13

Loss of sensation using blue monofilament

Answer 13

Diminished light touch

Question 14

Loss of sensation using purple monofilament

Answer 14

Diminished protective touch

Question 15

Loss of sensation using red monofilament

Answer 15

Profound loss of protective sensation

Question 16

Doubling time of M. leprae

Answer 16

13 days

Question 17

Incubation time between infection and development of clinical disease

Answer 17

Usually between 3 and 7 years, although in some cases up to 20 years

Question 18

Tuberculoid end of the spectrum having a strong Th_____ cell-mediated response whereas those at the lepromatous end have a skewed Th_____ response

Answer 18

1

2

Question 19

TLR-1 and TLR-2 have a higher expression in

Answer 19

Tuberculoid leprosy

Question 20

M. leprae can modulate NF-kappa beta activation in Schwann cells, a function that can be inhibited by

Answer 20

Thalidomide

Question 21

ENL is an immunologic type _____ hypersensitivity response

Answer 21

III

Question 22

Type 1 reaction or reversal reaction is a type _____ hypersensitivity immune response

Answer 22

IV

Question 23

Characterized by sheets of predominantly spindle-shaped cells with nuclear pyknosis and foamy cytoplasm, vacuolated, and arranged in a storiform pattern
Resembles a fibrohistiocytic tumor

Answer 23

Histoid leprosy

Question 24

The predominant lymphocyte present in ENL is the _____, whereas _____ predominate in the lepromatous leprosy

Answer 24

T-helper cell

T-suppressor cells

Question 25

Lucio phenomenon is also knows as

Answer 25

Erythema necrotisans

Question 26

One or a few hypochromic lesions No autonomic alteration No thickened nerves

Answer 26

Indeterminate leprosy

Question 27

One or a few tuberculoid lesions | No more than one thickened nerve

Answer 27

Tuberculoid leprosy

Question 28

One or a few infiltrated lesions | One or more thickened nerves

Answer 28

Borderline tuberculoid leprosy

Question 29

One or many infiltrated lesions, that may be foveolar | Usually, more than one thickened nerve

Answer 29

Borderline leprosy

Question 30

Many infiltrated lesions, associated or not to nodules | Many thickened nerves

Answer 30

Borderline lepromatous leprosy

Question 31

Diffuse infiltration, nodules and autonomic dysfunctions | Many thickened nerves

Answer 31

Lepromatous leprosy

Question 32

Y/N: Reactions never occur in indeterminate patients

Answer 32

Yes

Question 33

Sudden worsening of skin lesions and nerve function impairment, with no apparent systemic involvement

Answer 33

Reversal reaction

Question 34

Majority of the reactional episodes occur in

Answer 34

Borderline forms

Question 35

Aggressive vasculitis with immune complex deposition affecting different organs

Answer 35

ENL

Question 36

Predominant leprosy type in ENL

Answer 36

Lepromatous leprosy

Question 37

Treatment for reversal reaction

Answer 37

Prednisone (1-2 mg/kg/d with slow taper ~3 mo)

Question 38

Treatment for ENL

Answer 38

``` Thalidomide 100-400 mg/d AND Prednisone 1-2 mg/kg/d OR Pentoxifylline 400 mg thrice a day ```

Question 39

The percentage of HIV and other viral infections in leprosy patients is high, indicating that all leprosy patients should be tested for

Answer 39

HIV HBV HCV HTLV-1

Question 40

Reactions vs relapses: | Respond well to treatment with antiinflammatory drugs

Answer 40

Reactions

Question 41

Reactions vs relapses: | Slowly progressing, almost always with resurgence of primary lesions followed by the gradual appearance of new lesions

Answer 41

Relapses

Question 42

3 groups of medications used for treating leprosy

Answer 42

Antibiotics Antiinflammatory or immunosuppressants Analgesic drugs

Question 43

Clinically detected as a violet color on sclera, lips, and the extremities of fingers together with malaise, headache, and dyspnea

Answer 43

Methemoglobinemia

Question 44

Main objection as far as patients are concerned is its affinity to fat tissue and macrophage deposits leading to skin hyperpigmentation

Answer 44

Clofazimine

Question 45

Highly bactericidal Adverse effects include face and neck redness, pruritus and cutaneous rash, loss of appetite, nausea, vomiting, and diarrhea, malaise, purpura, epistaxis

Answer 45

Rifampicin

Question 46

Y/N: Pregnancy and breastfeeding contraindicate the use of multidrug therapy

Answer 46

No - do not contraindicate