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IM INFECTIOUS > LEPROSY > Flashcards

LEPROSY Flashcards

1
Q

Mycobacterium leprae infects

A
  • macrophages and

- Schwann cells

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2
Q

clumps or globi within macrophages

A

Lepra cells

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3
Q

Obligate, intracellular bacillus, acid-fast staining,

rod-shaped bacterium, never been grown in artificial media

A

Mycobacterium leprae

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4
Q

Temperature required for survival of Mycobacterium leprae

A

between 27ºC and 30ºC

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5
Q

calculated as the percentage of viable bacilli among the total number of bacilli

A

Morphologic Index

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6
Q

(measure of the density of bacilli of all forms found in

the dermis): varying from 0 to 6+; falls an average of 1 log unit/year with multidrug therapy

A

Bacteriologic Index

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7
Q

M. Leprae has (cell)

A

cytoplasm, plasm membrane, cell wall and capsule.

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8
Q

Cell wall of M. Leprae composed of

A
  • Arabinogalactans (which support mycolic acids)

- lipoarabinomannan (LAM)

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9
Q

Capsule contains phthiocerol dimycocerosate and ____ - its detection is helpful in serologic diagnosis
of leprosy

A

phenolic glycolipid (PGL-1)

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10
Q

Immunologic components of M. leprae:
Polysaccharide:
Protein:

A

Polysaccharide: induce mainly a humoral immune response
Protein: both humoral and cell-mediated immune response

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11
Q

special type of diffuse lepromatosis known as diffuse leprosy of Lucio and Latapí. Found mainly in Mexico and Central America

A

Mycobacterium Lepromatosis

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12
Q

WHO Leprosy Disability Grading System

Hands and Feet
Grade 0
Grade 1 -
Grade 2 -

A

Grade 0 - no anesthesia and no visible impairment
Grade 1 - signifies anesthesia but no visible impairment
Grade 2 - visible impairment

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13
Q

WHO Leprosy Disability Grading System

Eyes
Grade 0
Grade 1
Grade 2

A

Grade 0 - no eye problems due to leprosy and no evidence of visual loss
Grade 1 - eye problems due to leprosy without severe effects on vision
Grade 2 - severe visual impairment; includes lagopthalmos, iridocyclitis and corneal opacities

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14
Q

Transmission of M. leprae

A
  • Can be shed in large numbers from the mouth and nose of patients with untreated multibacillary leprosy (droplet infection) and sometimes from damaged skin.
  • Zoonotic transmission through wild armadillos
  • Main route of entry - respiratory tract!!!!
  • Wound or tattoos - skin is also possible
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15
Q

Reservoir of M. leprae

A

Humans - main reservoir of infection for M. Leprae!!!!
Armadillos - also a reservoir for human infection
Certain species of monkeys and red squirrels are infected, but there is not evidence of transmission

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16
Q

Relatively stable: types of leprosy

A
  • LL

- TT

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17
Q

Unstable both clinically and immunologically types of leprosy

A
  • BL,
  • BB,
  • BT
18
Q

The host tissue’s reaction and related damage due to

A

delayed hypersensitivity

19
Q

WHO Simplified Clinical Classification of Leprosy

  • negative slit-skin smear results at all body sites
A

Paucibacillary leprosy

20
Q

WHO Simplified Clinical Classification of Leprosy

positive smears at any body site

A

Multibacillary leprosy

21
Q

Clinical criteria

  • one to five skin lesions, and no or only one involved peripheral nerve
A

Paucibacillary leprosy

22
Q

Clinical criteria

  • six or more skin lesions, and/or more than one involved peripheral nerve
A

Multibacillary leprosy

23
Q

Ridley-Jopling Classification of Leprosy

  • Early clinical type manifests are one or few hypopigmented or faintly erythematous, ill-defined to well-defined macular lesions, measuring 1-5 cm in diameter
  • Occurs on the external aspects of the limbs, buttocks, and face
  • Mild to moderate impairment of touch and/or thermal sensations
A

Indeterminate Leprosy (IL)

24
Q

Ridley-Jopling Classification of Leprosy

  • No thickening of cutaneous and peripheral nerves
  • Often, but not always, the first clinical sign of leprosy
  • Heals spontaneously or progresses to a determinate form of the disease (TT, BT, BB, BL or LL)
A

Indeterminate Leprosy (IL)

25
Q

Ridley-Jopling Classification of Leprosy

  • Presents either as a well-defined, hypopigmented macule or as a raised, erythematous/brown/copper-colored plaque with a well-defined edge
  • May be found on any part of the skin; characterized by complete loss of fine touch and temperature sensations
  • Single or few (up to three) in number, can be of any size; seldom measure >10 cm in diameter
    =Plaque-type lesions: raised clear-cut edge often slopes inward to a flattened and sometimes hypopigmented central area
A

Tuberculoid (TT) Leprosy

26
Q

Ridley-Jopling Classification of Leprosy

  • Skin surfaces of the lesion is dry, hairless, and anesthetic because of destruction of underlying superficial cutaneous nerves
  • Autonomic nerve damage: responsible for surface dryness and loss of sweating
  • Slit-skin exam: no acid-fast bacilli
  • Lepromin skin test: strongly positive
A

Tuberculoid (TT) Leprosy

27
Q

Ridley-Jopling Classification of Leprosy

  • Characterized by either macular or plaque-type lesions numbering three to nine or more; asymmetrically located on any part of the body
  • Margins of the lesions: poorly defined to well-defined, sometimes both forms are seen
  • Smaller satellite lesions around a larger one: indicates downgrading of the lesion from TT to BT leprosy
A

Borderline Tuberculoid (BT) Leprosy

28
Q

Ridley-Jopling Classification of Leprosy

  • Susceptibility to a Type 1 leprosy reaction, that exacerbates skin lesions and/or peripheral nerves
  • If not diagnosed and treated early - tends to downgrade across the spectrum to BB, BL or LL leprosy
  • Slit skin smears: negative to 1+
A

Borderline Tuberculoid (BT) Leprosy

29
Q

Ridley-Jopling Classification of Leprosy

  • Unstable form of leprosy; downgrade toward BL and LL disease (especially if not treated)
  • Multiple plaque lesions, not infrequently, macular lesions; various shapes and sizes, bilateral and usually occur in a more or less symmetrical distribution
    = Moderately shiny and the central area looks pale
A

Mid-Borderline (BB) Leprosy

30
Q

Ridley-Jopling Classification of Leprosy

  • Minimal loss of sensation over the lesions
  • Nerve damage: variable; many nerves may be thickened, asymmetrical
  • Not commonly observed and rapidly changes its spectrum
  • Lepromin test: negative
  • Slit-skin smears: moderate number of AFB (2+ to 3+)
A

Mid-Borderline (BB) Leprosy

31
Q

Ridley-Jopling Classification of Leprosy

  • Numerous bilateral, round or oval, macular, diffusely infiltrated, erythematous or hypopigmented lesions with moderately defined borders
    = Usually 2-3 cm in diameter, may have a coppery hue, tend to become symmetrical
  • Some loss of sensation, particularly over older lesions
  • Untreated patients - new ill-defined skin lesions continue to develop
A

Borderline Lepromatous (BL) Leprosy

32
Q

Ridley-Jopling Classification of Leprosy

  • Widespread but asymmetrical thickening of peripheral nerves, with or without tenderness, leads to sensory and motor deficits
  • Lepromin test: negative results
  • Slit-skin examination: bacteriologic index varying from 3+ to 4+
A

Borderline Lepromatous (BL) Leprosy

33
Q

Ridley-Jopling Classification of Leprosy

  • Presents with innumerable bilateral, symmetrically distributed, diffusely indurated, erythematous, copper-colored or skin-colored patches or plaques
  • No loss of sensation over these lesions; smooth, shiny surface
  • Lesions spread over the face, earlobes, ears, extensor aspects of the upper and lower extremities, back and buttocks
A

Lepromatous (LL) Leprosy

34
Q

Ridley-Jopling Classification of Leprosy

  • Bilateral earlobe thickening and eyebrow loss occurs
    = “Lion face” - coarse induration on the face resulting in gross skin folds, particularly when associated with loss of eyebrows and thickening of earlobes
  • Polar type (LLp): 10-15% from the time of onset, with sensory loss in a “glove-and-stocking” distribution
  • Slit-skin smear exam: 4+ to 6+ with globi
A

Lepromatous (LL) Leprosy

35
Q

Clinical Manifestation: Lepromatous Leprosy

Systemic Involvement: AFB Involvement of testes:

A

first to sterility and then gynecomastia and impotence

36
Q

Clinical Manifestation: Lepromatous Leprosy

Systemic Involvement: AFB Eye involvement:

A
  • corneal anesthesia,
  • episcleritis,
  • iridocyclitis,
  • iris atrophy,
  • cataract and glaucoma,
  • lagophthalmos,
  • corneal ulceration and perforation
  • blindness
37
Q

Clinical Manifestation: Lepromatous Leprosy

Systemic Involvement: AFB Nose: portal of entry

A
  • earliest site of involvement in LL leprosy;
  • chronic rhinitis with loss of smell sensation
  • Saddle perforation due to bone destruction “Saddle-nose disfigurement”, common in advanced LL disease
38
Q

Clinical Manifestation: Lepromatous Leprosy

Histoid Leprosy:

A
  • Rare form of LL leprosy
  • Waxy, shiny, firm, symmetrical or asymmetrical nodules and plaques observed over normal-looking skin
  • Histologic examination: specific spindle-cell granulomas
  • Slit-skin smear examination: high bacteriologic and microbiologic indices without globi in most cases
39
Q

Clinical Manifestation: Lepromatous Leprosy

  • Rare form of non-nodular LL leprosy occurring in Mexico and Central America
  • Characterized by diffuse shiny infiltration of the skin and widespread sensory loss
  • Complicated by an unusual reaction known as Lucio’s phenomenon
A

Diffuse leprosy of Lucio and Latapi

40
Q

skin looks shiny and has a shiny appearance, with obvious diffuse induration of the earlobes and forehead, loss of eyebrows, sometimes eyelashes and not infrequently all
body hair

A

“Lepra bonita” (beautiful leprosy)

41
Q
  • Some countries (India and Nepal), observed in 2-10% of all leprosy cases
  • Only peripheral nerve involvement and no skin lesions
  • Nerve thickening and sensory loss occurs in the affected area, with or without a motor deficit
  • Can manifest at different points along the disease spectrum
  • Classified as paucibacillary or multibacillary on the basis of the absence or presence of AFB in nerve biopsy section or the number of thickened nerves (single or multiple)
A

Primary Neurotic Leprosy

IM INFECTIOUS (13 decks)

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