17- Hansen

Question 1

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

Answer 1

5 years- paucibacillary

10 yeats- multibacillary

Question 2

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

Answer 2

Earlobe
Elbow
Knee

Question 3

Most common outcome after exposure to M. leprae/lepromatosis

Answer 3

Spontaneous cure

Question 4

Earliest sensory changes in Hansen’s

Answer 4

Loss of sense of temperature and light touch

Question 5

First lesion often noted in Hansen’s

Answer 5

Solitary poorly defined hypopigmented macule

Question 6

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?

Answer 6

Tuberculoid

Question 7

Smaller more numerous erythematous hypopigmented dry scaly patches

Anesthetic hypesthetic and anhidrotic

What type of leprosy?

Answer 7

Borderline tuberculoid

Question 8

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

Answer 8

Borderline borderline BB

Question 9

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

Answer 9

Borderline lepromatous

Question 10

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

Answer 10

Lepromatous

Question 11

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

Answer 11

Histoid leprosy

Question 12

Histopathologic landmark of Hansen’s

Answer 12

Neural predilection or neurotropism

Question 13

Stocking glove peripheral neuropathy occurs in which type of leprosy?

Answer 13

Lepromatous

Question 14

Pattern of sensation loss in Hansen’s

Answer 14

Temperature
Light touch
Pain
Deep touch

Question 15

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

Answer 15

CN 7

Question 16

Most frequently involved mucous membrane in leprosy

Answer 16

Nasal mucosa

Chronic nasal congestion-lepromatous

Question 17

Every organ can contain leprosy bacilli except for

Answer 17

GIT
Lungs
Brain

Question 18

Most heavily infected organs involved in Hansen’s

Answer 18

LN
Bone marrow 
Liver
Spleen
Testicles

Question 19

Which T cells predominate in tuberculoid and lepromatous patients?

Answer 19

Tuberculoid- helper T

Lepromatous- suppressor T

Question 20

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

Answer 20

Cell mediated (Type IV)

Question 21

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

Answer 21

Immune complex (Type 3)

Question 22

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

Answer 22

Borderline

Question 23

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

Answer 23

Lepromatous

Question 24

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

Answer 24

Reversal reaction

Question 25

If a borderline disease shifts toward the lepromatous pole, the reaction is called

Answer 25

Downgrading reaction

Question 26

What type of reactional state?

Inflammation of existing lesions- swelling sometimes tender
No systemic symptoms
Nerve damage- due to inflammation, enlarged and tender

Answer 26

Type 1

Question 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

Answer 27

Erythema nodosum leprosum

Type 2 reaction

Question 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

Answer 28

Lucio’s phenomenon

Question 29

WHO recommended treatment for paucibacillary disease

Answer 29

Rifampicin 600mg 1x a month
Dapsone 100mg OD

X 6 months

Question 30

WHO recommended treatment for multibacillary disease

Answer 30

Rifampicin 600mg + clofazimine 300mg once a month

Dapsone 100mg + clofazimine 50mg OD

X 12 months

Question 31

Management for type 1 reactions in Hansen’s

Answer 31

Prednisone 40-60mg/day

Question 32

Treatment of choice for erythema nodosum leprosum

Answer 32

Thalidomide
up to 400mg/day- if more than 50kg

Others: clofazimine, pentoxifylline