159: Leprosy Flashcards

Question

What defines polar lepromatous leprosy and its clinical features?

Answer 1

Polar lepromatous leprosy is defined by: 1. **Complete lack of cell-mediated immunity** 2. **Plentiful nodular lesions**: Disseminated throughout the body. 3. **Diffuse infiltration**: Including the ears and face. 4. **Leonine facies**: Marked facial features resembling a lion's face. 5. **Extensive areas of dryness**: Especially on the legs, with advanced cases leading to madarosis and hair loss.

Answer 2

The three borderline forms of leprosy are: | Form | Characteristics | |--------------------------|----------------------------------------------------------------------------------------------------| | 1. Borderline-tuberculoid | - Clear infiltrative band around the periphery of lesions. - More diffuse infiltrated outer layer compared to tuberculoid leprosy. - Restricted features of dryness of the skin and alopecia. | | 2. Borderline-borderline | - Classical foveolar lesions. - Immunologically unstable. | | 3. Borderline-lepromatous | - Decreased cell-mediated immunity, leading to increased bacilli. - More nodular lesions, often involving the face and ears. - More diffuse features of dryness of the skin and alopecia. |

Answer 3

This is lepromatous leprosy, characterized by a Th2 immune response with high antibody production and defective cell-mediated immunity.

Answer 4

More than 90% of people have a natural immunity, with cell-mediated immunity being most important in preventing disease progression.

Answer 5

They first present with one or a few hypopigmented macules on the skin.

Answer 6

It is at one end of the spectrum with better cell-mediated immunity, presenting well-defined plaques, usually a few in just one segment of the body.

Answer 7

A special self-healing type of tuberculoid leprosy that can be found as a single nodular lesion or as papules or plaques, usually on the face of the child.

Answer 8

It is at the other end of the spectrum with a complete lack of cell-mediated immunity, presenting plentiful nodular lesions disseminated throughout the body.

Answer 9

A special type of lepromatous leprosy that has an even higher bacillary load than usual lepromatous leprosy, presenting diffuse shiny nodules and papules.

Answer 10

They are borderline-tuberculoid, borderline-borderline, and borderline-lepromatous, all of which are immunologically unstable.

Answer 11

Effective cell-mediated immunity decreases, allowing a progressive spread and increase in the number of bacilli.

Answer 12

Th1 cytokines are present in the paucibacillary pole (polar tuberculoid leprosy), while Th2 cytokines are present in the multibacillary pole (lepromatous leprosy).

Answer 13

They are low or negative in paucibacillary leprosy and increase through the multibacillary pole.

Answer 14

Cell-mediated immunity plays a crucial role in preventing the progression of leprosy. In indeterminate leprosy, the outcome may depend on the host's immune response, leading to either a spontaneous cure or progression towards polar or borderline forms of the disease. The effectiveness of this immunity can determine the clinical spectrum of leprosy, influencing whether a patient develops tuberculoid or lepromatous leprosy.

Answer 15

The clinical features of polar tuberculoid leprosy include: - Better cell-mediated immunity - Well-defined plaques, usually few in number, hypochromic or erythematous, sometimes atrophic - Presence of papules or tubercles with no infiltration - Possible dryness of the skin and alopecia restricted to the lesions' territory. In contrast, polar lepromatous leprosy is characterized by: - Complete lack of cell-mediated immunity - Plentiful nodular lesions disseminated throughout the body - Associated with diffuse infiltration, including leonine facies and extensive areas of dryness, especially on the legs.

Answer 16

The three borderline forms of leprosy are: 1. **Borderline-tuberculoid**: - Clear infiltrative band around the lesions - More diffuse infiltrated outer layer compared to tuberculoid leprosy - Restricted features of dryness and alopecia. 2. **Borderline-borderline**: - Classical foveolar lesions - Immunologically unstable with variable features. 3. **Borderline-lepromatous**: - Decreased cell-mediated immunity - Progressive spread and increase in bacilli - More diffuse features of dryness and alopecia, with evolution to more nodular lesions, often involving the face and ears.

Answer 17

Lucio leprosy is characterized by: - Main skin manifestation as infiltration - It poses a diagnostic challenge for less experienced health professionals. - First described by Lucio and Alvarado in 1852, it is associated with Mycobacterium lepromatosis, a newly identified species. - It presents with diffuse shiny nodules and papules, and a higher bacillary load than typical lepromatous leprosy, indicating a more severe form of the disease.

Answer 18

A thorough sensitivity evaluation for leprosy lesions includes the following components: - **Vasomotor reflex** - **Sweating function** - **Thermal sensitivity** - **Pain sensitivity** - **Tactile sensitivity**

Answer 19

The Triple Lewis response is significant in leprosy diagnosis as it assesses nerve integrity through the following phases: 1. **Erythema**: Occurs within 5-10 seconds after histamine injection. 2. **Secondary Erythema**: Develops 2 minutes later, indicating capillary dilation, observed only in normal skin. 3. **Wheal Formation**: The last phase involves exudation of liquid to the dermis, resulting in wheal formation in both normal and lesional skin. The response is incomplete in lesional skin, indicating nerve damage.

Answer 20

The Semmes-Weinstein monofilament test assesses sensory loss in leprosy patients by: - Using monofilaments of varying thickness to apply different amounts of pressure to the skin. - Measuring the patient's ability to feel light touch, with specific colors indicating different levels of sensation: | Thickness | Color | Range | Sensation | |-----------|-------|-------|-----------| | Thinnest | Green | 0.008 - 0.07 g | Normal skin, mosquito landing | | Blue | Blue | 0.16 - 0.4 g | Light touch | | Purple | Purple| 0.6 - 2 g | Protective | | Thickest | Red | 4 - 300 g |

Answer 21

Semmes-Weinstein Monofilaments are used to measure different levels of protective sensation in the skin, indicating nerve damage.

Answer 22

Tuberculoid leprosy may show conspicuous alterations in just one specific peripheral nerve trunk, usually in the same segment as the skin lesion.

Answer 23

Noncutaneous findings include palpation of peripheral nerve trunks, loss of sensation, motor dysfunction, and autonomic alterations.

Answer 24

Perform a sensitivity evaluation, use the Triple Lewis response test, Semmes-Weinstein monofilaments, and conduct a skin biopsy with Fite-Faraco staining.

Answer 25

It indicates nerve damage in the lesional skin.

Answer 26

The diagnosis is based on the detection of hypo- or total anesthesia in the lesions, which may be associated with hypohidrosis and alopecia.

Answer 27

Common symptoms include paresthesia, burning, numbness, and tickling sensations.

Answer 28

The test assesses the dilation of blood capillaries as a secondary axon reflex erythema, which is dependent on nerve integrity.

Answer 29

Sweating function is assessed using iodine-starch or alizarin red tests, where exercise may be required to induce sweating.

Answer 30

These tests evaluate sweating function by assessing the skin's response to these substances, indicating impaired autonomic nerve function.

Answer 31

Key considerations include understanding the test purpose, proper technique, recording responses, and avoiding simultaneous contact.

Answer 32

Challenges include subtle initial symptoms, delayed presentation, and complexity of nerve involvement.

Answer 33

Signs include nerve inflammation or functional deficit without skin lesions, and a positive acid-fast bacilli result eliminates primary neural leprosy.

Answer 34

Endocrine dysfunctions include hypothyroidism, euthyroid sick syndrome, hypogonadism, sterility, and osteoporosis.

Answer 35

Loss of corneal sensation can lead to wounds, infections, and blindness, along with hypotrophy of palpebral muscles causing lagophthalmos.

Answer 36

It is a noncultivable obligate intracellular pathogen that mainly damages skin and peripheral nerves, leading to a range of skin lesions and peripheral neuropathy.

Answer 37

M. leprae has a doubling time of around 13 days, explaining the long incubation time between infection and clinical disease.

Answer 38

Untreated leprosy can lead to significant complications in the eyes and limbs, including loss of sensation, infections, and severe deformities.

Answer 39

It attaches to Schwann cells, leading to colonization, inflammation, nerve damage, and peripheral neuropathy.

Answer 40

More than 90% of people worldwide have a natural immunity to leprosy, reducing the incidence of the disease.

Answer 41

Leprosy leads to disfigurement and deformity, contributing to the origin of stigma associated with the disease.

Answer 42

Th1 cytokines promote a pro-inflammatory response, while Th2 cytokines downregulate the inflammatory response, affecting disease progression.

Answer 43

Complications include loss of sensation leading to wounds, muscle atrophy, and severe deformities.

Answer 44

The challenge is to diagnose cases early to eliminate disabilities.

Answer 45

4-8% of all leprosy cases; in India, it is about 17%.

Answer 46

Clinical signs, nerve histopathology, electrophysiology, and ultrasonography are used for diagnosis.

Answer 47

It binds to pattern recognition receptors on host cells, triggering an innate immune response.

Answer 48

The long doubling time complicates diagnosis and treatment, as symptoms may not appear for years after infection.

Answer 49

It leads to colonization and inflammation within nerves, causing nerve damage and demyelination.

Answer 50

Th1 cytokines promote a pro-inflammatory response that helps control bacterial growth and prevent dissemination.

Answer 51

Th2 cytokines downregulate the inflammatory response, leading to uncontrolled growth of the bacteria and ineffective antibody responses, which can worsen disease symptoms.

Answer 52

Certain HLA complex genes and SNP differences in genes such as HLA-DR-DQ, RIPK2, TNFSF15, CCDC122, C13orf31, and NOD2.

Answer 53

Twin studies indicate a high concordance (60%-80%) for monozygotic twins developing leprosy, suggesting a genetic component.

Answer 54

1. Naked nerve filaments in the epidermis. 2. Entrance of M. leprae in the epidermis, then to Schwann cells. 3. Phagocytosis of M. leprae by dermal macrophages, which then invade the perineurium. 4. Access through the blood via intraneural capillaries.

Answer 55

M. leprae can dedifferentiate and reprogram adult Schwann cells to stem cell-like cells, promoting dissemination of infection.

Answer 56

| Type of Leprosy | Immune Response | Cytokines Produced | |----------------|----------------|-------------------| | Tuberculoid | Strong Th1 | IL-2, TNF-α, IFN-γ, IL-12 | | Lepromatous | Skewed Th2 | IL-4, IL-5, IL-10, high antibody levels |

Answer 57

A Th1 cytokine-mediated and pro-inflammatory response.

Answer 58

They showed an overwhelming concordance (60%-80%) for monozygotic twin pairs to develop leprosy.

Answer 59

Living in endemic areas, poverty, and poor sanitation.

Answer 60

By inhibiting endocytic maturation, inducing lipid droplet accumulation, and intensifying glucose uptake.

Answer 61

A strong Th1 response with cytokine production including IL-2, TNF-α, and IFN-γ.

Answer 62

A skewed Th2 response with high levels of antibody production.

Answer 63

It may be necessary for the adherence of M. leprae to Schwann cells.

Answer 64

It is involved in anti-apoptotic signaling and nerve regeneration.

Answer 65

The shift from Th1 to Th2 cytokine production in leprosy leads to heightened cell-mediated responses, downregulation of inflammation, and ineffective antibody responses.

Answer 66

Genetic factors influencing susceptibility to leprosy include twin studies, genomewide analyses, SNP differences, and household contacts.

Answer 67

Naked nerve filaments, entrance through the epidermis, phagocytosis by macrophages, and through the blood via intraneural capillaries.

Answer 68

The immune response plays a critical role by initiating at various phases of the interaction, influencing disease progression, inducing antibody production, and exhibiting a dichotomy in immune response.

Answer 69

It is involved in anti-apoptotic signaling, may aid in the survival of infected Schwann cells, and contributes to the maintenance of nerve function despite infection.

Answer 70

| Feature | Tuberculoid Leprosy | Lepromatous Leprosy | |---------|--------------------|--------------------| | Granuloma | Well-organized | Poorly organized, foamy macrophages | | Immune Cells | CD4+ T cells | CD8+ T cells | | Cell-mediated Immunity | Good | Defective | | Antibody Production | None | High titers of antibodies | | Bacilli Presence | None in slit-skin smear | Large numbers of bacilli |

Answer 71

TLR-1 and TLR-2 have higher expression in tuberculoid leprosy, while TLR-4 signaling in macrophages stimulates TNF-α, IL-6, and CXCL10 production.

Answer 72

Insulin-like growth factor I decreases macrophage antimicrobial capacity, inhibiting M. leprae killing.

Answer 73

ENL is characterized by immune complex deposition, upregulation of Th17, IL-6, IL-1β, and neutrophil influx.

Answer 74

Type 1 reaction is caused by a specific increase in cell-mediated immunity against M. leprae, associated with CD4+ T cell infiltration and upregulation of cytokines.

Answer 75

This is tuberculoid leprosy, characterized by a strong Th1 cell-mediated immune response.

Answer 76

Expect massive infiltration of foamy macrophages filled with bacilli, few lymphocytes, and defective cell-mediated immunity.

Answer 77

ENL is characterized by immune complex deposition, upregulation of Th17, IL-6, IL-1β, and neutrophil influx.

Answer 78

This is lepromatous leprosy, with histopathological findings including foamy macrophages filled with bacilli.

Answer 79

| Feature | Tuberculoid Leprosy | Lepromatous Leprosy | |---------|--------------------|--------------------| | Granuloma | Well-organized | Poorly organized, foamy macrophages | | Immune Response | Good cell-mediated immunity | Defective cell-mediated immunity | | T Cells | Predominantly CD4+ T cells | Predominantly CD8+ T cells | | Antibody Production | No antibody production | High titers of antibodies to M. leprae | | Bacilli | No bacilli in slit-skin smear | Large numbers of bacilli |

Answer 80

In lepromatous leprosy, there is a massive infiltration of foamy macrophages filled with bacilli, characterized by defective cell-mediated immunity, leading to a higher bacterial load and more severe disease manifestations.

Answer 81

TLRs such as TLR-1, TLR-2, and TLR-4 mediate monocyte and dendritic cell activation, stimulating cytokine production.

Answer 82

Lepromatous leprosy has a defective cell-mediated immunity with high titers of antibodies and large numbers of bacilli, while tuberculoid leprosy has good cell-mediated immunity and no bacilli found in slit-skin smear.

Answer 83

IL-10 induces phagocytosis by macrophages and differentiates monocytes into foamy macrophages.

Answer 84

Insulin-like growth factor I decreases macrophage antimicrobial capacity and is low in lepromatous leprosy patients.

Answer 85

Metalloproteinases 2 and 9 are upregulated in Schwann cells, macrophages, and endothelial cells in primary neural leprosy nerves.

Answer 86

Th17 cells are increased in tuberculoid leprosy patients, while IL-10 producing Treg cells are more prevalent in lepromatous leprosy.

Answer 87

The clinical spectrum of leprosy shows a range of pathologic manifestations that depend on the host's immune response, complicating diagnosis.

Answer 88

Factors include a reduction in trained leprosy clinicians and laboratory technicians, leading to misdiagnosis or treatment delays.

Answer 89

TLR-1 and TLR-2 have higher expression in tuberculoid leprosy, facilitating monocyte and dendritic cell activation, which stimulates TNF-α and IL-12 production.

Answer 90

TLR-4 signaling can stimulate TNF-α, IL-6, and CXCL10 production in macrophages, contributing to the inflammatory response.

Answer 91

In lepromatous leprosy, TLR signaling is altered, leading to a defective immune response and increased susceptibility to infection.

Answer 92

In patients with erythema nodosum leprosum (ENL), there is an increase in CD4+/CD8+ T cell ratio and high serum levels of TNF-α. ENL is characterized by an influx of neutrophils and upregulation of Th17, IL-6, and IL-1β, indicating a strong inflammatory response. The presence of anti-PGL-1 antibodies and monocyte chemoattractant protein-1 suggests a complex immune interaction that exacerbates the condition. This immune profile highlights the Type III hypersensitivity reaction associated with ENL, leading to significant clinical implications for management.

Answer 93

Laboratory tests that can assist in confirming a diagnosis of leprosy include: 1. Slit-skin smear for bacilli detection. 2. Serological tests for antibodies against M. leprae, such as anti-PGL-1. 3. Skin biopsy to assess histopathological features. 4. PCR tests for M. leprae DNA. 5. Nerve conduction studies to evaluate peripheral nerve involvement.

Answer 94

The standard for laboratory diagnosis in a skin biopsy is the detection of acid-fast bacilli by the Fite-Faraco modification of the carbol fuchsin technique and characteristic cellular histologic patterns detected by hematoxylin-eosin staining.

Answer 95

The Ridley-Jopling classification system divides leprosy into 5 forms based on the number of acid-fast bacilli and the degree of lymphocytic infiltration and organization.

Answer 96

Common findings in indeterminate leprosy include: Nonspecific tissue response, normal epidermis or basal layer of the skin showing melanin reduction, perivascular or perineural, superficial and deep dermal infiltration by few macrophages and lymphocytes, infiltrate surrounds skin appendages, and rarely, there are bacilli in nerves.

Answer 97

Histopathologic characteristics of tuberculoid leprosy include: Epidermis usually normal, absence of subepidermal clear zone, dermis noncaseating dermal granulomatous process composed chiefly of activated macrophages (epithelioid cells), CD4+ T cells in the center of the epithelioid cells, CD8+ T cells in the mantle surrounding the granuloma, and giant cells of the Langhans type. Granulomas may contact the epidermis and are often arranged around nerves and vessels.

Answer 98

Detection of acid-fast bacilli in skin lesions or slit-skin smears automatically places the patient in the multibacillary category, which requires 12 months of multidrug therapy.

Answer 99

Emerging diagnostic methods for leprosy include: Measuring antibody titers to mycobacterial antigens by rapid lateral flow devices, cell-mediated cytokine release assays, amplification of mycobacterial DNA by PCR, use of metabolomics to detect molecular features specific to M. leprae infection in blood or urine, and molecular detection of the M. leprae-specific repetitive RLEP sequence by PCR.

Answer 100

This indicates a high risk of developing leprosy. Conduct a thorough clinical examination for early signs of leprosy and monitor the child closely. Consider household contact screening and preventive measures.

Answer 101

Initiate multidrug therapy with dapsone, clofazimine, and rifampicin for up to 24 months.

Answer 102

This suggests active leprosy with nerve involvement. Initiate multidrug therapy and monitor nerve function closely.

Answer 103

The bacillary index is established through bacilloscopy of multiple skin biopsies or slit-skin smears on a logarithmic scale, ranging from 0 to 6+.

Answer 104

It automatically places the patient in the multibacillary category to receive 12 months of multidrug therapy.

Answer 105

Tests include measuring antibody titers by rapid lateral flow devices, cell-mediated cytokine release assays, amplification of mycobacterial DNA by PCR, and metabolomics.

Answer 106

It is used in lateral flow tests to enhance sensitivity in detecting leprosy patients, even those at the paucibacillary end of the spectrum.

Answer 107

Features include presence of a subepidermal grenz zone, no well-defined granuloma with organized collections of epithelioid cells, reduction in the frequency of lymphocytes, scarce Langhans cells, and rare acid-fast bacilli.

Answer 108

Characterized by aggregates of epithelioid cells, scarce dispersed lymphocytes, no Langhans multinucleated giant cells, and increasing numbers of acid-fast bacilli.

Answer 109

Findings include presence of a subepidermal grenz zone, aggregates of macrophages, occasional epithelioid cells with abundant cytoplasm, some foamy cells, and a great number of bacilli and some globi.

Answer 110

Features include normal to flattened epidermis, subepidermal grenz zone, aggregates and sheets of foamy macrophages admixed with predominantly CD8+ lymphocytes and plasma cells throughout the dermis and into the subcutaneous fat, and huge numbers of acid-fast bacilli and globi found within foamy macrophages (Virchow cells), nerves, arrectores pilorum muscle, follicular epithelium, and sweat glands.

Answer 111

It helps in early detection of cases by following up on household contacts of diagnosed children.

Answer 112

To diagnose leprosy early and facilitate breaking the lines of transmission to eventually reach the goal of leprosy elimination.

Answer 113

Indeterminate leprosy: Nonspecific tissue response, normal epidermis or basal layer of the skin shows melanin reduction, perivascular or perineural infiltration, superficial and deep dermal infiltration by few macrophages and lymphocytes, infiltrate surrounds skin appendages, and rarely, there are bacilli in nerves. Tuberculoid leprosy: Epidermis usually normal, subepidermal clear zone absent, dermis noncaseating dermal granulomatous process composed chiefly of activated macrophages (epithelioid cells), CD4+ T cells in the center of the epithelioid cells, CD8+ T cells in the mantle surrounding the granuloma, and giant cells of the Langhans type.

Answer 114

The Ridley-Jopling classification system categorizes leprosy into five forms based on the number of acid-fast bacilli present and the degree of lymphocytic infiltration and organization. This classification aids in determining the type of leprosy, which is crucial for accurate diagnosis, appropriate treatment regimen, and understanding the immunological response and potential disease progression.

Answer 115

The detection of anti-PGL-I titers and RLEP PCR positivity in individuals living in hyperendemic areas indicates a high risk of developing leprosy, supports the need for targeted surveillance and early intervention strategies, and highlights the importance of monitoring asymptomatic individuals who may progress to symptomatic disease.

Answer 116

Recent advancements in laboratory testing for leprosy include lateral flow devices for measuring antibody titers to mycobacterial antigens, cytokine release assays to detect immune responses, PCR amplification of mycobacterial DNA, metabolomics to identify molecular features specific to M. leprae infection, and use of LID-1 protein antigen and synthetic disaccharides of PGL-I to enhance sensitivity in detecting leprosy patients.

Answer 117

1. Epidermal atrophy 2. Subepidermal grenz zone 3. Dermis showing sheets of predominantly spindle-shaped cells with nuclear pyknosis and foamy cytoplasm, vacuolated, and arranged in a storiform pattern 4. Some polygonal-shaped cells, macrophages, and inflammatory cells are present 5. Some may show a pseudocapsule 6. Lesion resembles a fibrohistiocytic tumor 7. Fit-Foraco stain: large number of acid-fast bacilli, mostly as rafts or globi 8. Bacilli can be located in nerves, Schwann cells, eccrine glands, and in the vascular endothelium 9. CD68-positive macrophages and spindle cells are present

Answer 118

This is lepromatous leprosy.

Answer 119

This is histoid leprosy.

Answer 120

No acid-fast bacilli or they are rare, found more frequently within peripheral nerves, arrectores pilorum muscle, or granulomas.

Answer 121

It indicates the presence of a subepidermal grenz zone without well-defined granulomas.

Answer 122

There are scarce dispersed lymphocytes and increasing numbers of acid-fast bacilli.

Answer 123

Presence of a subepidermal grenz zone, aggregates of macrophages, and a great number of bacilli and some globi.

Answer 124

Huge numbers of acid-fast bacilli and globi are found within foamy macrophages (Virchow cells).

Answer 125

Sheets of predominantly spindle-shaped cells with nuclear pyknosis and foamy cytoplasm arranged in a storiform pattern.

Answer 126

It suggests the presence of macrophages and spindle cells in the lesion.

Answer 127

A large number of acid-fast bacilli, mostly as rafts or globi.

Answer 128

- Presence of a **subepidermal grenz zone** - No well-defined **granuloma** with organized collections of **epithelioid cells** - Reduction in the frequency of **lymphocytes** - Scarce **Langerhans cells** - Rare **acid-fast bacilli**

Answer 129

- **Borderline-borderline leprosy** shows: - Aggregates of **epithelioid cells** - Scarce dispersed **lymphocytes** - No **Langerhans multinucleated giant cells** - **Increasing numbers of acid-fast bacilli**

Answer 130

- **Normal to flattened epidermis** - Presence of a **subepidermal grenz zone** - Aggregates and sheets of **foamy macrophages**

Answer 131

Aggregates and sheets of foam macrophages with predominantly CD8+ lymphocytes and plasma cells.

Answer 132

Huge numbers of acid-fast bacilli and globi found within foamy macrophages (Virchow cells), nerves, arrectores pilorum muscle, follicular epithelium, and sweat glands.

Answer 133

Epidermal atrophy.

Answer 134

Presence of a subepidermal grenz zone.

Answer 135

Sheets of predominantly spindle-shaped cells with nuclear pyknosis and foamy cytoplasm, arranged in a storiform pattern.

Answer 136

Presence of polygonal-shaped cells, macrophages, and inflammatory cells.

Answer 137

Some lesions may show a pseudocapsule.

Answer 138

Resembles a fibrohistiocytic tumor.

Answer 139

Reveals a large number of acid-fast bacilli, mostly as rafts or globi.

Answer 140

Edema both extracellular as in epithelioid cell granulomas.

Answer 141

Increased number of lymphocytes and Langhans giant cells in the infiltrate.

Answer 142

Small collections of epithelioid cells.

Answer 143

Poorly organized granuloma.

Answer 144

Fibrinoid necrosis in severe cases of reversal reaction.

Answer 145

Bacilli in macrophages and nerves.

Answer 146

The predominant lymphocyte present in ENL is the T-helper cell, whereas T-suppressor cells predominate in lepromatous leprosy.

Answer 147

Commonly affected sites include: 1. Elbow for the ulnar nerve 2. Carpal tunnel for the median nerve 3. Fibula head for the fibular nerve 4. Tarsal tunnel for the posterior tibial nerve.

Answer 148

- Cutaneous or subcutis necrotizing vasculitis - Fibrinoid necrosis of small and medium-sized vessels - Necrosis of epidermis and superficial dermis - Micro-abscess formation - Angiogenesis - Endothelial swelling - Vascular occlusion caused by luminal thrombi - Deposits of fibrin in small blood vessel walls of the dermis and subcutis

Answer 149

- Used for peripheral nerve evaluation and established procedure - Evaluates nerve function impairment in leprosy neuropathy - Assesses echogenicity, vascularity, and nerve thickening - Can detect nerve abscesses and entrapment early - Its utilization for leprosy neuropathy evaluation is still evolving but promising

Answer 150

The likely diagnosis is Lucio phenomenon.

Answer 151

This is ENL (Type 2 reaction).

Answer 152

Increased number of lymphocytes and Langhans giant cells in the infiltrate.

Answer 153

The T-helper cell.

Answer 154

Cutaneous or subcutis necrotizing vasculitis and fibrinoid necrosis of small and medium-sized vessels.

Answer 155

Asymmetric focal or multi-focal neuropathy.

Answer 156

Asymmetric focal or multifocal lesions, mononeuropathy or mononeuritis multiplex.

Answer 157

It is used for nerve function assessment at diagnosis and for patient follow-up to detect and characterize new lesions.

Answer 158

Nerve palpation and pain evaluation.

Answer 159

High-resolution ultrasound.

Answer 160

The elbow for the ulnar nerve, carpal tunnel for the median nerve, fibula head for the fibular nerve, and tarsal tunnel for the posterior tibial nerve.

Answer 161

Entrapment of the enlarged nerves may require surgical intervention to decompress the nerve.

Answer 162

Worsening of nerve abnormalities was found independent of leprosy classification or presence of reactions.

Answer 163

**Leprosy Reversal Reaction:** - Edema both extracellular in epithelioid cell granulomas. - Increased number of lymphocytes and Langhans giant cells in the infiltrate. - Small collections of epithelioid cells. - Poorly organized granuloma. - Fibrinoid necrosis in severe cases. - Bacilli present in macrophages and nerves. **ENL or Type 2 Reaction:** - Edema and a mixed inflammatory infiltrate in the dermis and subcutis, predominantly neutrophils with eosinophils.

Answer 164

Predominantly neutrophils with eosinophils and lymphocytes.

Answer 165

Aggregates of foamy macrophages, plasma cells, and mast cells.

Answer 166

Vasculitis and mixed lobular and septal panniculitis in most cases.

Answer 167

Bacilli in large numbers, usually granular in appearance.

Answer 168

Asymmetric focal or multifocal lesions.

Answer 169

Mononeuropathy or mononeuritis multiplex.

Answer 170

Caused by direct damage of nerves by M. leprae or an inflammatory immune response of the host.

Answer 171

Chronic neuropathy with acute exacerbations from reversal reaction or ENL.

Answer 172

1. Nerve palpation 2. Pain evaluation 3. Sensory assessment 4. Muscle power measurement 5. Autonomic examination 6. Electroneuromyography for nerve function assessment and follow-up.

Answer 173

High-resolution ultrasound.

Answer 174

Used for peripheral nerve evaluation and established procedure for nerve function impairment in leprosy neuropathy. ## Footnote Evaluates echogenicity, vascularity, and nerve thickening.

Answer 175

Can detect nerve abscesses and entrapment early.

Answer 176

Its utilization for leprosy neuropathy evaluation is evolving but promising.

Answer 177

Clinical examination of nerve enlargement may be difficult, and robust parameters for follow-up are lacking.

Answer 178

Linked to poor outcomes if echogenicity abnormalities are present or if intraneural Doppler shows areas above normal limits with less than 30.

Answer 179

Areas above normal limits with less than 30% reduction.

Answer 180

Macules and patches, popular or nodular lesions, plaques, polymorphous vesiculobullous eruption, and annular lesions.

Answer 181

Hypopigmentation of pityriasis alba, indeterminate leprosy.

Answer 182

Dermatomyositis, histiocytosis, lymphoma, sarcoidosis, neurofibromatosis, syphilis, leprosy, etc.

Answer 183

Erythematous plaques, confusion with fungal infections, hypopigmented plaques mimicking other conditions.

Answer 184

Dermal/epidermal separation, may be seen in ENL.

Answer 185

May mimic leprosy, annular erythemas, sarcoidosis, syphilis, or tinea.

Answer 186

Infacts and ulcers.

Answer 187

Seen in Lucio phenomenon and ENL, may mimic septic infarcts.

Answer 188

Occur due to vascular occlusion, can be neuropathic or due to venous insufficiency.

Answer 189

Systemic lupus erythematosus-like changes and vasculitis.

Answer 190

May present with false positive syphilis tests, antiphospholipid antibodies, and anemia.

Answer 191

Can mimic ENL and Lucio phenomenon, leading to misdiagnosis.

Answer 192

Infarcts and ulcers, which may mimic septic infarcts and occur due to vascular occlusion.

Answer 193

They may be misdiagnosed as 'vasculitis.'

Answer 194

Erythematous plaques may mimic conditions like fungal infections or sarcoidosis.

Answer 195

Systemic symptoms may include erythema nodosum, false positive syphilis tests, and autoimmune conditions.

Answer 196

Primary lesions that can mimic leprosy include: | Lesion Type | Description | Differentiation | |-------------|-------------|----------------| | Macules and patches | Hypopigmentation of ptyriasis alba and indeterminate leprosy | Neurological or histological examination may help distinguish them | | Popular or nodular lesions | May mimic or be mimicked by various conditions | Requires careful clinical evaluation and possibly biopsy | | Plaques | Erythematous plaques may resemble leprosy | Appearance and histological features can aid in differentiation | | Polymorphic vesiculobullous eruptions | May occur in ENL | Histological examination is necessary for diagnosis | | Annular lesions | May mimic leprosy | Clinical features and history are important for differentiation |

Answer 197

Secondary lesions associated with leprosy include: | Lesion Type | Description | Clinical Presentation | |-------------|-------------|---------------------|

Answer 198

Infarcts occur in Lucio phenomenon and ENL. They present as necrotic lesions or septic infarcts.

Answer 199

Ulcers result from vascular occlusion. They are seen on plantar surfaces and may be neuropathic or due to venous insufficiency.

Answer 200

Vasculitis may occur in ENL and Lucio phenomenon. Clinically, it resembles other forms of vasculitis, requiring careful diagnosis.

Answer 201

Answer 202

1. **Type 1 (Reversal Reaction)**: Involves mainly peripheral nerves and skin, characterized by a sudden worsening of skin lesions and nerve function impairment without systemic involvement. 2. **Type 2 (Erythema Nodosum Leprosum - ENL)**: May present with localized or systemic symptoms, including severe cutaneous reactions and systemic symptoms such as fever and malaise.

Answer 203

Factors include: - **Neuropathy** present at the time of diagnosis - **Multibacillary leprosy** - **Extent of the disease**

Answer 204

A form of leprosy characterized by multiple lesions and significant nerve involvement.

Answer 205

Features include the extent of the disease and the presence of lesions overlying peripheral nerve trunks.

Answer 206

Reversal reactions can occur in up to 30% of patients, leading to sudden worsening of skin lesions and nerve function impairment.

Answer 207

Immediate intervention is required to prevent nerve impairment and permanent disabilities.

Answer 208

ENL is characterized by systemic symptoms such as fever, edema, and malaise.

Answer 209

A severe form of leprosy characterized by aggressive vasculitis with immune complex deposition affecting various organs.

Answer 210

Reversal reactions and ENL may occur together in some patients, particularly those with borderline forms of leprosy, leading to increased severity of symptoms and complications.

Answer 211

The patient is likely experiencing a reversal reaction. Immediate intervention with corticosteroids, such as prednisolone, is required to prevent nerve impairment and permanent disabilities.

Answer 212

This is likely an Erythema Nodosum Leprosum (Type 2 reaction). Management includes anti-inflammatory drugs like thalidomide or corticosteroids to control inflammation and systemic symptoms.

Answer 213

The patient is likely experiencing a reversal reaction. ## Footnote Treatment with corticosteroids like prednisolone in a regressive scheme.

Answer 214

The likely reaction is a reversal reaction. ## Footnote Treatment with corticosteroids like prednisolone.

Answer 215

Immune response against M. leprae antigens.

Answer 216

Type 1 (reversal reaction) and Type 2 (ENL).

Answer 217

It may be considered a type of reaction.

Answer 218

Neuropathy at diagnosis, multibacillary leprosy, extent of disease, and lesions overlying peripheral nerve trunks.

Answer 219

They can occur in up to 30% of patients and require immediate intervention to prevent nerve impairment and permanent disabilities.

Answer 220

An aggressive vasculitis with immune complex deposition affecting different organs.

Answer 221

Fever, edema, malaise, and various organ involvements such as neuritis and glomerulonephritis.

Answer 222

A high bacillary index and diffuse skin infiltration are important risk factors, with 65% of cases having more than one episode of ENL.

Answer 223

Type 1 (reversal reaction) and Type 2 (ENL) differ in their immune response and clinical manifestations.

Answer 224

1. Type 1 (Reversal Reaction) 2. Type 2 (Erythema Nodosum Leprosum - ENL)

Answer 225

Involves mainly peripheral nerves and skin. Symptoms include sudden worsening of skin lesions and nerve function impairment without systemic involvement.

Answer 226

May have localized or systemic symptoms. Associated with vasculitis and can affect multiple organs, leading to symptoms such as fever, edema, and malaise.

Answer 227

1. Neuropathy present at the time of diagnosis. 2. Multibacillary leprosy. 3. Extent of the disease. 4. Presence of lesions overlying peripheral nerve trunks.

Answer 228

Reversal reactions can occur in up to 30% of patients, particularly in borderline forms of leprosy. They start with a sudden worsening of skin lesions and nerve function impairment, which can lead to nerve impairment and permanent disabilities if not addressed promptly.

Answer 229

Immediate intervention is required to prevent long-term complications.

Answer 230

ENL is characterized by aggressive vasculitis with immune complex deposition.

Answer 231

Symptoms may include neuritis, panniculitis, glomerulonephritis, arthralgia, epididymitis, orchitis, and eye inflammation.

Answer 232

The main skin manifestation is **erythema nodosum**, which is more palpable than visible. It may be accompanied by **erythema polymorphous** or **severe cutaneous necrotizing vasculitis** (Lucio phenomenon).

Answer 233

Systemic symptoms such as **fever**, **edema**, and **malaise** are common.

Answer 234

A high bacillary index and diffuse skin infiltration are important risk factors, with **65%** of cases experiencing more than one episode of ENL.

Answer 235

Immunologic disorders, such as **HIV** and **HTLV** infections, as well as the use of **immunosuppressive drugs** or **immunobiological medications**, can interfere with the resolution of leprosy.

Answer 236

All leprosy patients should be tested for **HIV**, **HBV**, **HCV**, and **HTLV-1** because viral coinfection decreases the survival of leprosy patients and increases rates of **neuritis**, **nerve function impairment**, and **leprosy relapses**.

Answer 237

Reactions are usually **acute**, with a rapid appearance of new lesions and infiltration of old ones, responding well to treatment with **anti-inflammatory drugs**. In contrast, relapses are generally **slowly progressing**, with a resurgence of primary lesions and new lesions, and do not respond to anti-inflammatory drugs.

Answer 238

The three groups of medications used for treating leprosy are: 1. **Antibiotics**

Answer 239

1. **Antibiotics**: WHO Multidrug Therapy regimen (rifampicin, dapsone, with or without clofazimine) 2. **Anti-inflammatory or immunosuppressants**: control leprosy reactions (prednisone, thalidomide) 3. **Analgesic drugs**: control neuropathic pain.

Answer 240

Potential side effects of Dapsone include: - **Dapsone hypersensitivity syndrome**: presents with fever and cutaneous rash, potentially involving internal organs. - **G6PD deficiency**: can lead to serious hemolytic events and life-threatening hemolytic anemia.

Answer 241

Clofazimine is a pigment with **anti-inflammatory properties** and an unknown antibiotic mechanism. It can cause **skin hyperpigmentation** and **skin dryness** as side effects. It is administered at a dose of **300 mg once a month** and **50 mg per day** in multibacillary patients.

Answer 242

Adverse effects of Rifampicin include: - **Face and neck redness** - **Pruritus and cutaneous rash** - **Loss of appetite** - **Nausea, vomiting** - **Diarrhea** - **Malaise** - **Purpura** - **Epistaxis** - **Flulike syndrome** characterized by fever, myalgia, and headache.

Answer 243

For multibacillary cases, the recommended treatment duration is up to **24 months** with dapsone, clofazimine, and rifampicin. For paucibacillary patients, the treatment duration is **6 months** with dapsone and rifampicin.

Answer 244

The patient likely has G6PD deficiency leading to hemolytic anemia due to dapsone. ## Footnote Discontinue dapsone and switch to an alternative medication.

Answer 245

The diagnosis is ENL (Type 2 reaction). ## Footnote Recommended medications include thalidomide (if not contraindicated) and corticosteroids.

Answer 246

The condition is likely Lucio phenomenon. ## Footnote Management includes aggressive anti-inflammatory treatment and supportive care.

Answer 247

The flu-like syndrome is an immunologic side effect of rifampicin. ## Footnote Discontinue the drug and consider alternative antibiotics if necessary.

Answer 248

Test for HBV, HCV, and HTLV-1, as viral coinfections can worsen leprosy outcomes and increase neuritis and nerve function impairment.

Answer 249

Test for G6PD deficiency, as it can lead to hemolytic anemia when using dapsone.

Answer 250

The flu-like syndrome is an immunologic side effect of rifampicin. ## Footnote Discontinue the drug and consider alternative antibiotics if necessary.

Answer 251

Tests for HBV, HCV, and HTLV-1 should be performed, as viral coinfections can worsen leprosy outcomes and increase neuritis and nerve function impairment.

Answer 252

Erythema nodosum, which may be accompanied by erythema polymorphous or severe cutaneous necrotizing vasculitis (Lucio phenomenon).

Answer 253

Immunologic disorders, such as HIV and HTLV infections, immunosuppressive drugs, or immunobiological medications.

Answer 254

All leprosy patients should be tested due to the high percentage of HIV and other viral infections in leprosy patients, which can decrease survival and increase rates of neuritis and relapses.

Answer 255

Reactions are usually acute with rapid appearance of new lesions and systemic involvement, while relapses are slow progressing with resurgence of primary lesions and no response to anti-inflammatory drugs.

Answer 256

1) Antibiotics (WHO Multidrug Therapy), 2) Anti-inflammatory or immunosuppressants, 3) Analgesic drugs.

Answer 257

Dapsone is a simple, low-cost, highly effective drug used in a daily dose of 100 mg or 1 to 2 mg/kg, absorbed by the GI tract and eliminated through the kidneys.

Answer 258

Dapsone is absorbed by the gastrointestinal (GI) tract and eliminated through the kidneys.

Answer 259

Dapsone hypersensitivity syndrome, which can present with fever and cutaneous rash, and may involve internal organs, especially the lungs.

Answer 260

Rifampicin is administered once per month with supervision, at a dose of 450 mg for children and 600 mg for adults.

Answer 261

G6PD deficiency can lead to serious hemolytic events by oxidative stress, affecting a significant number of people worldwide.

Answer 262

Dapsone, clofazimine, and rifampicin prescribed for up to 24 months.

Answer 263

Reactions in leprosy are typically acute, characterized by a rapid appearance of new lesions and deterioration of neural function, responding well to anti-inflammatory drugs. In contrast, relapses are slow-progressing, often with a resurgence of primary lesions and new lesions, and do not respond to anti-inflammatory drugs.

Answer 264

A full course of treatment must be confirmed, and histopathology can be useful to differentiate between a reaction and a relapse.

Answer 265

Dapsone can lead to serious hemolytic events in patients with G6PD deficiency, which is common in tropical areas. Complications include: 1. **Methhemoglobinemia** - Clinically detected as a violet color on sclera, lips, and extremities, along with malaise, headache, and dyspnea. 2. **Severe hemolytic anemia** - Life-threatening condition requiring medication change.

Answer 266

Dapsone hypersensitivity syndrome - A rare but potentially fatal event presenting with fever, cutaneous rash, and possible involvement of internal organs, especially the lungs, leading to eosinophilic infiltrates and pneumonia.

Answer 267

Clofazimine is used in leprosy treatment for its antibiotic and anti-inflammatory properties. Notable effects include:

Answer 268

Due to its affinity for fat tissue and macrophage deposits, leading to noticeable pigmentation in lesions.

Answer 269

Contributes to a xerodermic appearance of the skin.

Answer 270

Administered at 300 mg once a month and 50 mg per day in multibacillary patients.

Answer 271

These side effects can significantly impact patient quality of life and adherence to treatment.

Answer 272

Rifampicin, while highly bactericidal, has several adverse effects that can impact patient management, including:

Answer 273

An adverse effect associated with Rifampicin.

Answer 274

An adverse effect associated with Rifampicin.

Answer 275

Adverse effects associated with Rifampicin.

Answer 276

May require cessation of the drug.

Answer 277

Adverse effects associated with Rifampicin.

Answer 278

Characterized by fever, myalgia, and headache, which may lead to discontinuation of treatment.

Answer 279

These side effects necessitate careful monitoring and may require adjustments in therapy to ensure patient safety and treatment efficacy.

Answer 280

Details not provided in the text.

Answer 281

**Prednisone** at doses of **1 to 2 mg/kg/d** in a regressive scheme, diminishing **10% to 15%** of the dose every **15 days**, with a complete cycle lasting up to **3 months**. If the clinical situation worsens, it may be necessary to revert to a higher dose for **30 to 45 days** before tapering off again.

Answer 282

- **Glaucoma** - **Cataracts** - **Moon face** - **Striae** - **Adrenal gland atrophy** - **Osteoporosis** - **Infectious diseases** such as systemic fungal infections and tuberculosis - **Strongyloides stercoralis hyperinfection**

Answer 283

Counseling is a key process in leprosy patient management, addressing: - **Nerve damage** and its management - **Harm reduction** - Combating **stigma** associated with leprosy - Providing support for patients and their families - Encouraging **self-care groups** that are inclusive and supportive

Answer 284

Preventive measures include: 1. **Massage and hydration** of the skin of hands and feet to avoid fissures and ulcers. 2. Use of **special boot soles** or customized shoes for feet with loss of sensation. 3. **Self-examination** for early detection and immediate treatment of trauma. 4. **Adduction, abduction, and opposition movements** to maintain muscle health. 5. Use of **lubricating** agents.

Answer 285

Contact examination is crucial for leprosy prevention as it should be a mandatory part of leprosy programs in endemic countries. It identifies household contacts who have a 5- to 8-fold higher risk of contracting leprosy, helps in early detection of cases, and raises awareness in the community to diminish stigma and increase detection of early cases.

Answer 286

Use lubricating eye drops to prevent keratitis. In severe cases, refer the patient for surgical correction to prevent infection and blindness.

Answer 287

Treatment options include tricyclic antidepressants (e.g., amitriptyline), anticonvulsants (e.g., gabapentin), and corticosteroids for acute episodes. Physical therapy and counseling may also help.

Answer 288

Reconstructive surgery can help recover functional aspects of the hand. Physical therapy and adaptive tools may also improve functionality.

Answer 289

Perform abscess drainage and send the content to the laboratory for investigation.

Answer 290

Preventive measures should be taken to address the risk of osteoporosis, although specific measures are not detailed in the provided text.

Answer 291

Recommend calcium intake of 1200-1500 mg/day and vitamin D supplements. Monitor bone health regularly.

Answer 292

Consider alternative antibiotics like ofloxacin, minocycline, or clarithromycin.

Answer 293

Surgical correction of lagophthalmos can prevent keratitis, infection, and blindness.

Answer 294

Perform abscess drainage and send the content to the laboratory for investigation.

Answer 295

Recommend calcium intake of 1200-1500 mg/day and vitamin D supplements. Monitor bone health regularly.

Answer 296

Prednisone at doses of 1 to 2 mg/kg/day in a regressive scheme, diminishing 10% to 15% of the dose every 15 days.

Answer 297

Glucose levels and blood pressure.

Answer 298

Glaucoma, cataracts, moon face, striae, adrenal gland atrophy, osteoporosis, and systemic fungal infections.

Answer 299

Thalidomide may be used to treat ENL (erythema nodosum leprosum) with doses of 100 to 400 mg/day, but it is teratogenic and requires pregnancy testing and contraceptive methods.

Answer 300

Massage and hydration of the skin of hands and feet to avoid fissures, ulcers, and fixed claw formation.

Answer 301

It is mandatory for early detection and immediate treatment of trauma.

Answer 302

Counseling is essential for managing nerve damage and reducing stigma associated with leprosy.

Answer 303

Household contacts should be examined as they have a 5- to 8-fold higher risk of contracting leprosy.

Answer 304

There is no current official recommendation to use chemoprophylaxis in leprosy contacts due to lack of significant long-term protection.

Answer 305

BCG revaccination is recommended for all household contacts to provide protection against leprosy.

Answer 306

Reversal reactions can be treated with **prednisone** at doses of **1 to 2 mg/kg/d** in a regressive scheme, reducing the dose by **10% to 15%** every 15 days for up to **3 months**. Monitoring of **glucose levels** and **blood pressure** is necessary during corticosteroid use to manage potential side effects such as **glaucoma**, **cataracts**, and **osteoporosis**.

Answer 307

Long-term use of corticosteroids can lead to various side effects, including **glaucoma**, **cataracts**, and **osteoporosis**.

Answer 308

Long-term use of corticosteroids in leprosy treatment may lead to several side effects, including: 1. **Glaucoma** 2. **Cataracts** 3. **Moon face** 4. **Striae** 5. **Adrenal gland atrophy** 6. **Osteoporosis** 7. **Infectious diseases** such as systemic fungal infections and tuberculosis 8. **Strongyloides stercoralis hyperinfection**

Answer 309

Thalidomide is a **teratogenic drug**, which means it can cause birth defects. Therefore, it is mandatory for women of childbearing age to undergo **pregnancy testing** and to use **two contraceptive methods** before starting therapy with thalidomide to prevent potential harm to a fetus.

Answer 310

Counseling is a key process in leprosy patient management, focusing on: - Addressing **nerve damage** and its management - Providing **harm reduction** strategies - Combating **stigma** associated with leprosy - Supporting **reintegration** into society - Offering resources for **self-care** and disability management

Answer 311

Preventive measures for leprosy patients include: 1. **Massage** and **hydration** of the skin of hands and feet to avoid fissures and ulcers. 2. Use of **special boot soles** or **customized shoes** for feet with loss of sensation. 3. **Self-examination**.

Answer 312

Self-examination is for early detection of trauma.

Answer 313

Performing adduction, abduction, and opposition movements helps maintain muscle health.

Answer 314

Using lubricating eye drops prevents keratitis in cases of lagophthalmos.

Answer 315

Referral to specialized centers is for complex cases requiring a multiprofessional team.

Answer 316

Cell-mediated immunity is crucial in preventing disease progression in leprosy.

Answer 317

Patients with primary neural leprosy typically present with 1 or a few hypopigmented macules on the skin.

Answer 318

Individuals with close contact to untreated leprosy patients or those with compromised immune systems are at the highest risk.

Answer 319

Lepromatous leprosy is characterized by infiltration as the main skin manifestation.

Answer 320

Lepromatous leprosy with higher bacillary load is associated with more severe symptoms and a greater risk of transmission.

Answer 321

Multidrug therapy for leprosy typically includes a combination of rifampicin, dapsone, and clofazimine, with alternative drugs available for specific cases.

Answer 322

Treatment for lepra reactions often involves corticosteroids to reduce inflammation and manage symptoms effectively.

Answer 323

Cell-mediated immunity.

Answer 324

Hypopigmented macules.

Answer 325

Individuals with certain risk factors, such as close contact with untreated leprosy patients.

Answer 326

Lepromatous leprosy.

Answer 327

To effectively treat leprosy and prevent resistance.

Answer 328

Corticosteroids and other immunosuppressive therapies.

Answer 329

Cell-mediated immunity is crucial in preventing disease progression in leprosy, as it helps control the infection and limits the severity of the disease.

Answer 330

Patients with primary neural leprosy typically present with one or a few hypopigmented macules on the skin.

Answer 331

Individuals with close contact to untreated leprosy patients, those with compromised immune systems, and individuals living in endemic areas are at the highest risk of developing leprosy.

Answer 332

Lepromatous leprosy is characterized by infiltration as its main skin manifestation.

Answer 333

Lepromatous leprosy with a higher bacillary load.

Answer 334

A higher bacillary load is associated with more severe symptoms and a greater risk of transmission due to the increased number of bacteria present in the skin and other tissues.

Answer 335

Multidrug therapy for leprosy typically includes a combination of rifampicin, dapsone, and clofazimine, which work synergistically to eliminate the Mycobacterium leprae bacteria.

Answer 336

The treatment for leprosy reactions often includes corticosteroids to reduce inflammation and manage symptoms, along with supportive care and monitoring for complications.