17- Hansen Flashcards
Latency period between exposure and overt signs of hansen’s disease is
5 years- paucibacillary
10 yeats- multibacillary
Smears for dx of hansen’s are taken from which body parts
Earlobe
Elbow
Knee
Most common outcome after exposure to M. leprae/lepromatosis
Spontaneous cure
Earliest sensory changes in Hansen’s
Loss of sense of temperature and light touch
First lesion often noted in Hansen’s
Solitary poorly defined hypopigmented macule
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?
Tuberculoid
Smaller more numerous erythematous hypopigmented dry scaly patches
Anesthetic hypesthetic and anhidrotic
What type of leprosy?
Borderline tuberculoid
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
Borderline borderline BB
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
Borderline lepromatous
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
Lepromatous
Uncommon form of multibacillary Hansen’s where lesions appear as large yellow red shiny papules and nodules in the dermis or subcutaneous tissue
Histoid leprosy
Histopathologic landmark of Hansen’s
Neural predilection or neurotropism
Stocking glove peripheral neuropathy occurs in which type of leprosy?
Lepromatous
Pattern of sensation loss in Hansen’s
Temperature
Light touch
Pain
Deep touch
Corneal erosions, exposure keratitis and ulcerations may result from the involvement of what cranial nerve
CN 7
Most frequently involved mucous membrane in leprosy
Nasal mucosa
Chronic nasal congestion-lepromatous
Every organ can contain leprosy bacilli except for
GIT
Lungs
Brain
Most heavily infected organs involved in Hansen’s
LN Bone marrow Liver Spleen Testicles
Which T cells predominate in tuberculoid and lepromatous patients?
Tuberculoid- helper T
Lepromatous- suppressor T
Type 1 reactional state in Hansen’s is mediated by what type of hypersensitivity reaction
Cell mediated (Type IV)
Type 2 reactional state in Hansen’s is mediated by what type of hypersensitivity reaction?
Immune complex (Type 3)
Type 1 reactions usually occur in what type of Hansen’s
Borderline
Type 2 reactions usually occur in what type of Hansen’s
Lepromatous
If a reaction in Hansen’s occur with antibiotic therapy, it is called
Reversal reaction
If a borderline disease shifts toward the lepromatous pole, the reaction is called
Downgrading reaction
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
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
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
WHO recommended treatment for paucibacillary disease
Rifampicin 600mg 1x a month
Dapsone 100mg OD
X 6 months
WHO recommended treatment for multibacillary disease
Rifampicin 600mg + clofazimine 300mg once a month
Dapsone 100mg + clofazimine 50mg OD
X 12 months
Management for type 1 reactions in Hansen’s
Prednisone 40-60mg/day
Treatment of choice for erythema nodosum leprosum
Thalidomide
up to 400mg/day- if more than 50kg
Others: clofazimine, pentoxifylline
