- most widely held belief is that the disease is transmitted by contact between cases of leprosy and healthy persons. - Transmission nasal discharges (droplets).

Hansen’s Disease (Leprosy) Flashcards by Angelyka Almeda

is an infectious disease caused by Mycobacterium leprae which involves the skin and peripheral nerves.

leprosy

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Causative agent

Mycobacterium leprae

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Leprosy was recognized in the ancient civilizations of

China, Egypt, and India

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The earliest documented account of leprosy is around

1550 B.C on Egyptian papyrus.

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Through out history, the badly affected have often been hated by their communities and families.

History of Leprosy

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Discovered by

Gerhard Armauer Hansen in 1873

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is a chronic infectious disease caused by an acid-fast, rod-shaped bacillus, Mycobacterium leprae.

Leprosy

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T/ F

Unlike other mycobacteria, it does not grow in artificial media or even in tissue culture.

TRUE

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INCUBATION TIME

multiplies very slowly ( 5 YEARS) average of 3 years

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MOT of leprosy

DROPLETS!!

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T/F
Leprosy is NOT highly infectious

True beh anuna?

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Untreated, leprosy can cause progressive and permanent damage

skin, nerves, limbs and eyes.

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MOT

most widely held belief is that the disease is transmitted by contact between cases of leprosy and
healthy persons.
Transmission nasal discharges (droplets).

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Leprosy is known to occur at all ages ranging from early infancy to very old age.

ALL ages mare, ingat you!

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Risk factors for leprosy

Close contact
People living in Endemic Area
Immunity
Genetic influences
Armadillo Exposure

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Contacts of patients with leprosy have a higher risk of developing leprosy than the general population

Close contact

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People who live in the areas where leprosy is endemic. (Endemic areas are: )

parts of India, China, Japan, Nepal, Egypt, and other areas) and especially those people in constant physical contact with infected people.

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immunocompromised individuals are more susceptible to infection.

Immunity

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There is some evidence that genetic defects in the immune system may cause certain people to be more likely to become infected (region q25 on chromosome 6)

Genetic influences

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Genetic influences region and chromosome?

(region q25 on chromosome 6)

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Leprosy is enzootic in the nine-banded armadillo

Armadillo exposure

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Classification of Leprosy

Skin smear result classification. ( WHO )
Clinical classification. (Ridley Jopling)

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Skin smear result (WHO) classification :

Paucibacillary leprosy (PB) – few Bacilli;
Multibacillary leprosy (MB);

Multibacillary leprosy (MB);

Any form of leprosy in which the patient shows positive smears at any site

Two to five skin lesions with negative skin smear results at all sites.

Paucibacillary leprosy (PB) – few Bacilli;

Clinical (Ridley Jopling) classification

1. Indeterminate leprosy (IL) 2. Tuberculoid leprosy (TT) 3. Lepromatous leprosy (LL) 4. Borderline leprosy (BL) - Borderline tuberculoid leprosy (BT) - Borderline borderline leprosy (BB) - Borderline lepromatous leprosy (BL)

(Skin lesions) One or a few sharply defined annular asymmetric macules or plaques with a tendency toward central clearing, elevated borders

Tuberculoid, (TT,BT) Leprosy

(Nerve Lesions) Skin lesions anesthetic early; nerve near lesions sometimes enlarged; nerve abscesses most common in BT

Tuberculoid, (TT,BT) Leprosy

AFB (0-1+)

Tuberculoid, (TT,BT) Leprosy

Intermediate between BT. and LL-type lesions; ill. defined plaques with an occasional sharp margin; few or many in number

Borderline (BB, BL). Leprosy

Hypesthetic or anesthetic skin lesions; nerve trunk palsies, at times symmetric

Borderline (BB, BL). Leprosy

AFB 3-5+

Borderline (BB, BL). Leprosy

Symmetric, poorly marginated, multiple infitrated nodules and plaques or diffuse infiltration: xanthoma-like or (dermatofibroma papules; leonine faces and eyebrow alopecia

Lepromatous (LL) Leprosy

'Hypesthesia a late sign; nerve palsies /variable; acral, distal, symmetric anesthesia common

Lepromatous (LL) leprosy

AFB 4-6+

Lepromatous (LL) leprosy

CLINICAL FEATURES

1.Skin lesions, usually anaesthetic - Hypopigmented or erythematus patch / plaque . 2.Complete / partial loss of sensation. - Painless wounds or burns on the hands or feet - - - -Paresthesias: tingling or numbness in the hands or feet Diminished sensation or loss of sensation within skin patch(es) 3.Thickening of peripheral nerves. 4.Lumps or swelling on the earlobes or face. 5.Tender, enlarged peripheral nerves

Hypo pigmented patch, sensation normal, no palpable peripheral nerve and slit skin smear negative

Indeterminate Leprosy

Annular, erythematous, anasthetic patch with well defined and raised borders and SSS Negative.

Tuberculoid Leprosy

Two hypopigmented patches, hypoasthetic well defined borders, palpable peripheral nerve and SSS negative.

Tuberculoid leprosy

a well-defined, hypopigmented, anesthetic macule with anhidrosis and a raised granular margin (arrowhead)

Tuberculoid (TT) leprosy

Borderline lepromatous case showing borderline tuberculoid and 'punched- out" mid borderline lesions together with papular and nodular lesions more typical of lepromatous disease.

Borderline lepromatous leprosy (BL/MB)

Hands: signs and symptoms of leprosy

Claw hand due to median andulnar nerve damage

Hands: signs and symptoms of leprosy

hands showing neurotrophic atrophy.

The areas most commonly affected by leprosy are

superficial peripheral nerves , skin, ,mucous membranes of the upper respiratory tract, eyes , and tests

is caused by the degree to which cell-mediated immunity is expressed , the extent of bacillary spread and multiplication , immunologic complication and nerve damage

Tissue damage

an obligate intracellular acid-fast bacillus with unique ability to enter nerves

M. Leprae

Diagnosis of leprosy is most commonly based on the

clinical sign and symptoms

In an endemic country or area, an individual should be regarded as having leprosy if he or she shows ONE of the following cardinal signs : ( 4 signs)

- skin lesion consistent with leprosy - with definite sensory loss - with or without thickened nerves - positive skin smears

If you have a suspicious skin sore, your doctor will remove a small sample of the abnormal skin and send it to a laboratory to be examined

Skin biopsy

If you have a suspicious skin sore, your doctor will remove a small sample of the abnormal skin and send it to a laboratory to be examined

Smear test

Treatment: Common Drugs (CDR)

Dapson Refampicine Clofazimine

The combination of these three drugs Is known as

multi drug therapy (MDT)

6 month regimen for Paucibacillary (PB) Leprosy

Dapson 100 mg (daily) Refampicin 600 mg (monthly)

12 month regimen for Multibacillary (MB) Leprosy

Dapsone 100 mg (daily) Refampicin 600 mg (monthly) Clofazimine 300 mg (monthly) or 50 mg (daily)

Complications include:

disfigurement • hair loss, particularly on the eyebrows and eyelashes • muscle weakness • permanent nerve damage in the arms and legs • inability to use the hands and feet • Nosebleeds • iritis (inflammation of the iris of the eye), glaucoma (an eye disease that causes damage to the optic nerve), and blindness • Infertility • kidney failure