CHAPTER 17: HANSEN DISEASE Flashcards
Latency period between exposure and overt signs of hansen’s disease is
5 years- paucibacillary
10 years- multibacillary
Smears for dx of hansen’s are taken from which body parts
Earlobe
Elbow
Knee
bec. M. leprae grows best at temperatures (30°C) below the core body tem
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 ( “ a saucer right side up”)
Palpable induration and neuro findings
What type of leprosy?
Tuberculoid
Corneal erosions, exposure keratitis and ulcerations may result from the involvement of what cranial nerve
CN 7
Ptosis, ectro- pion, and a masklike appearance occur from damage to what cranial nerve
CN 5 and CN 7
Most frequently involved mucous membrane in leprosy
nasal mucosa is most frequently involved, and lepromatous patients frequently complain of chronic nasal congestion
Every organ can contain leprosy bacilli except for
gastrointestinal tract, lungs, and brain,
Most heavily infected organs involved in Hansen’s
lymph nodes, bone marrow, liver, spleen, and testicles are most heavily infected
Which T cells predominate in tuberculoid and lepromatous patients?
Tubercu- loid patients make well-formed granulomas that contain HELPER T cells
lepromatous patients have poorly formed granulomas, and SUPPRESSOR T cells predominate.
what stain is optimal for demonstrating M. leprae histologically?
fite-faraco stain
Type 1 reactional state in Hansen’s is mediated by what type of hypersensitivity reaction
Type 1 reactions represent an enhanced cell-mediated immune response to M. leprae and usually occur after treatment is initiated
The major complication of type 1 reactions is
nerve damage
Type 2 reactional state in Hansen’s is mediated by what type of hypersensitivity reaction?
Type 2 reactions are mediated by immune complexes
Type 1 reactions usually occur in what type of Hansen’s
borderline leprosy (BT, BB, BL).
Type 2 reactions usually occur in what type of Hansen’s
occur in lepromatous patients (BL, LL).
If a reaction in Hansen’s occur with antibiotic therapy, it is called
reversal reaction
Smaller more numerous erythematous hypopigmented dry scaly patches
Anesthetic hypesthetic and anhidrotic
What type of leprosy?
Borderline tuberculoid
BT
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
BL
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, then 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
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
Histopathologic landmark of Hansen’s
Neural predilection or neurotropism
If a borderline disease shifts toward the lepromatous pole, the reaction is called
downgrading reaction
Stocking glove peripheral neuropathy occurs in which type of leprosy?
Lepromatous
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
Smaller more numerous erythematous hypopigmented dry scaly patches
Anesthetic hypesthetic and anhidrotic
What type of leprosy?
Borderline tuberculoid
BT
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, then body hair
Lepromatous
Stocking glove peripheral neuropathy occurs in which type of leprosy?
Lepromatous
Histopathologic landmark of Hansen’s
Neural predilection or neurotropism
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
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
BL
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, simulating cellulitis
No systemic symptoms
Nerve damage- due to inflammation, enlarged and tender
occurs in PB and MB
Type 1 reactions
what type of Rxn?
Occurs in 50% borderline lepromatous or lepromatous
Within a few years of antibiotic tx or during pregnancy
With Systemic sx ( fever and pain)
Lesions: widespread erythematous subcutaneous and dermal nodules that do not occur on the site of lesions
Favor extensor arms and medial thighs
occurs in MB only
Type 2 reactions (erythema nodosum leprosum)
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 phenomenon
WHO recommended treatment for paucibacillary disease
paucibacillary disease (TT and BT):
1. dapsone 100 mg OD x 12 months
2. rifampicin 600 mg OD x 12 months
WHO recommended treatment for multibacillary disease
Multibacillary (LL,BL,BB)
1. dapsone 100 mg OD x 24 months
2. rifampicin 600 mg OD x 24 months
3. clofazimine 50 mg OD x 14 months
Management for type 1 reactions in Hansen’s
systemic corticosteroids: Prednisone is given orally, starting at a dose of 40–60 mg/day.
Neuritis and eye lesions are urgent indications for systemic steroid the
Treatment of choice for erythema nodosum leprosum
Thalidomide 100- 400 mg/ day
CI in pregnant women
MDT is contraindicated in pregnancy and lactating mothers? true or false
false
*should be given
what leprosy drugs are given in addition to anti-TB tx for px with tuberculosis?
clofazimine and dapsone
*resume MDT regimen once anti-TB tx is completed
PB regimen should take ____ blister packs to be completed for _____ months
6 blister packs; 9 months
MB regimen should take ____ blister packs to be completed for _____ months
12 blister packs; 18months
a _____ is a px who has started regimen and who has not collected MDT drugs for 3 consecutive months
defaulter
diagnosis of leprosy can be documented through
slit skin smear at TB DOTS
