Leprosy

Question 1

What is the epidemiology of leprosy?

Answer 1

Most cases occur in India
5% of people in endemic areas are asymptomatic carriers
Young adults

Question 2

What are the two causative organisms in Leprosy

Answer 2

Mycobacterium leprae
Mycobacterium Lepromatosis

Question 3

What is the microbiology of Mycobacterium Lepra/lepromatosis

Answer 3

Gram +ve
Acid fast bacilli
Obligate intracellular

Question 4

What two animal vectors are associated with Leprosy

Answer 4

Armadillos
Red Squirrels

Question 5

How is Leprosy spread?

Answer 5

Air droplets
Breast milk (rare)

Question 6

What is the incubation period of leprosy?

Answer 6

3-5 years

Question 7

What are the 5 types of leprosy?

Answer 7

TT: Tuberculoid Leprosy
BT: Borderline Tuberculois
BB: Mid Borderline
BL: Borderline lepromatous
LL: Lepromatous Leprosy

Question 8

What is the WHO definition of leprosy

Answer 8

Loss of sensation over hypopigmented lesions
Thickened and enlarged peripheral nerves
AFB on Skin Snip Smear

Question 9

What are commonly affected nerves in leprosy?

Answer 9

Ulnar Nerve
Radial Nerve
Great Auricular
Radial cutaneous
Common peroneal
Posterior Tibial

Question 10

What are the 3 immune mediated complications of leprosy (‘Leprosy Emergencies’)

Answer 10

Type 1 Reaction: Local reaction –> spontaneous worsening of existing lesions ( odematous and erythematous) and pain/loss of nerve function acutely!!!!!!)

Type 2 Reaction: Systemic Reaction –> General systemic inflammatory response; malaise, fever, fatigue, anorexia

Lucio’s Phenomenon: Occurs in M. Lepromatosis
Haemorrhagic rash

Question 11

Which types of Leprosy are Paucibacillary

Answer 11

Tuberculoid Leprosy
Borderline Tuberculoid

Question 12

Which types of leprosy are multibacillary

Answer 12

Mid Borderline Leprosy
Borderline Lepromatous
Lepromatous Leprosy

Question 13

Which types of Leprosy are TH1 mediated?

Answer 13

TT, TB, BB

Question 14

Which types of leprosy are TH2 mediated?

Answer 14

BL, LL

Question 15

How do you diagnose leprosy?

Answer 15

Skin snip test (microscopy)
± histology
± PCR (rare; will only be used in BL/LL)

Question 16

How do you manage Multibacillary TB?

Answer 16

12/12 of:
Rifampicin 600mg PO MONTHLY
+
Clofazimine 50mg PO OD and 300mg MONTHLY
+
Dapsone 100mg OD

Question 17

How can Leprosy be prevented

Answer 17

BCG Vaccine (better protection against Leprosy than TB)
Rifampicin to close contacts of +ve M.Leprosy

Question 18

How do you manage Paucibacillary Leprosy?

Answer 18

6/12 of:
Rifampicin 600mg PO Monthly
+
Dapsone 100mg OD
+
Clofazamine 50mg PO OD and 300mg MONTHLY

Question 19

What are the main Side effects of rifampicin?

Answer 19

– Urine discolouration
– Liver enzyme induction

Question 20

What are the main side effects of Dapsone?

Answer 20

– Haemolytic anaemia Hb drop 1-2 gm
– Dapsone Hypersensitivity Syndrome

Question 21

What are the side effects of Clofazimine

Answer 21

– Skin pigmentation-
– Lesions and normal skin
– Icthyosis (Ichthyosis is a condition that causes widespread and persistent thick, dry, “fish-scale” skin. The skin of a person with ichthyosis is rough, dry and scaly and needs to be regularly moisturised.)

Question 22

What are the main components of leprosy self-care?

Answer 22