17- Hansen Flashcards

1
Q

Latency period between exposure and overt signs of hansen’s disease is

A

5 years- paucibacillary

10 yeats- multibacillary

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2
Q

Smears for dx of hansen’s are taken from which body parts

A

Earlobe
Elbow
Knee

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3
Q

Most common outcome after exposure to M. leprae/lepromatosis

A

Spontaneous cure

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4
Q

Earliest sensory changes in Hansen’s

A

Loss of sense of temperature and light touch

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5
Q

First lesion often noted in Hansen’s

A

Solitary poorly defined hypopigmented macule

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6
Q

Solitary or few lesions, asymmetrical

Large erythematous plaque with a sharply defined and elevated border and flattened atrophic center

Palpable induration and neuro findings

What type of leprosy?

A

Tuberculoid

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7
Q

Smaller more numerous erythematous hypopigmented dry scaly patches

Anesthetic hypesthetic and anhidrotic

What type of leprosy?

A

Borderline tuberculoid

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8
Q

What type of leprosy?
Countable numerous lesions in leprosy

Red irregularly shaped plaques
Small satellite lesions may surround larger plaques

Generalized but asymmetric, edges not as well defined, moderate anesthesia

A

Borderline borderline BB

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9
Q

What type of leprosy?

Symmetric and numerous (too many to count) macules, papules plaques or nodules

Smaller lesions outnumber the large ones
Nerve involvement appears later
Sensation and sweating normal

A

Borderline lepromatous

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10
Q

What type of leprosy?

Pale macules or diffuse infiltration of skin
Symmetrically distributed all over
Poorly defined, no change in texture, blend with surrounding skin
Minimal or no loss of sensation
Slow, progressive loss of outer 1/3 eyebrow—body hair

A

Lepromatous

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11
Q

Uncommon form of multibacillary Hansen’s where lesions appear as large yellow red shiny papules and nodules in the dermis or subcutaneous tissue

A

Histoid leprosy

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12
Q

Histopathologic landmark of Hansen’s

A

Neural predilection or neurotropism

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13
Q

Stocking glove peripheral neuropathy occurs in which type of leprosy?

A

Lepromatous

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14
Q

Pattern of sensation loss in Hansen’s

A

Temperature
Light touch
Pain
Deep touch

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15
Q

Corneal erosions, exposure keratitis and ulcerations may result from the involvement of what cranial nerve

A

CN 7

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16
Q

Most frequently involved mucous membrane in leprosy

A

Nasal mucosa

Chronic nasal congestion-lepromatous

17
Q

Every organ can contain leprosy bacilli except for

A

GIT
Lungs
Brain

18
Q

Most heavily infected organs involved in Hansen’s

A
LN
Bone marrow 
Liver
Spleen
Testicles
19
Q

Which T cells predominate in tuberculoid and lepromatous patients?

A

Tuberculoid- helper T

Lepromatous- suppressor T

20
Q

Type 1 reactional state in Hansen’s is mediated by what type of hypersensitivity reaction

A

Cell mediated (Type IV)

21
Q

Type 2 reactional state in Hansen’s is mediated by what type of hypersensitivity reaction?

A

Immune complex (Type 3)

22
Q

Type 1 reactions usually occur in what type of Hansen’s

A

Borderline

23
Q

Type 2 reactions usually occur in what type of Hansen’s

A

Lepromatous

24
Q

If a reaction in Hansen’s occur with antibiotic therapy, it is called

A

Reversal reaction

25
If a borderline disease shifts toward the lepromatous pole, the reaction is called
Downgrading reaction
26
What type of reactional state? Inflammation of existing lesions- swelling sometimes tender No systemic symptoms Nerve damage- due to inflammation, enlarged and tender
Type 1
27
Occurs in 50% borderline lepromatous or lepromatous Within a few years of antibiotic tx or during pregnancy With Systemic sx Lesions: widespread erythematous subcutaneous and dermal nodules that do not occur on the site of lesions Favor extensor arms and medial thighs
Erythema nodosum leprosum | Type 2 reaction
28
Purpuric macules—bullous lesions that ulcerate especially below the knees Occurs in px with diffuse lepromatous type, no systemic symptoms Numerous bacilli in the dermis and BV walls that lead to cutaneous infarctions
Lucio’s phenomenon
29
WHO recommended treatment for paucibacillary disease
Rifampicin 600mg 1x a month Dapsone 100mg OD X 6 months
30
WHO recommended treatment for multibacillary disease
Rifampicin 600mg + clofazimine 300mg once a month Dapsone 100mg + clofazimine 50mg OD X 12 months
31
Management for type 1 reactions in Hansen’s
Prednisone 40-60mg/day
32
Treatment of choice for erythema nodosum leprosum
Thalidomide up to 400mg/day- if more than 50kg Others: clofazimine, pentoxifylline