Leprosy Flashcards
What is the epidemiology of leprosy?
Most cases occur in India
5% of people in endemic areas are asymptomatic carriers
Young adults
What are the two causative organisms in Leprosy
Mycobacterium leprae
Mycobacterium Lepromatosis
What is the microbiology of Mycobacterium Lepra/lepromatosis
Gram +ve
Acid fast bacilli
Obligate intracellular
What two animal vectors are associated with Leprosy
Armadillos
Red Squirrels
How is Leprosy spread?
Air droplets
Breast milk (rare)
What is the incubation period of leprosy?
3-5 years
What are the 5 types of leprosy?
TT: Tuberculoid Leprosy
BT: Borderline Tuberculois
BB: Mid Borderline
BL: Borderline lepromatous
LL: Lepromatous Leprosy
What is the WHO definition of leprosy
Loss of sensation over hypopigmented lesions
Thickened and enlarged peripheral nerves
AFB on Skin Snip Smear
What are commonly affected nerves in leprosy?
Ulnar Nerve
Radial Nerve
Great Auricular
Radial cutaneous
Common peroneal
Posterior Tibial
What are the 3 immune mediated complications of leprosy (‘Leprosy Emergencies’)
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
Which types of Leprosy are Paucibacillary
Tuberculoid Leprosy
Borderline Tuberculoid
Which types of leprosy are multibacillary
Mid Borderline Leprosy
Borderline Lepromatous
Lepromatous Leprosy
Which types of Leprosy are TH1 mediated?
TT, TB, BB
Which types of leprosy are TH2 mediated?
BL, LL
How do you diagnose leprosy?
Skin snip test (microscopy)
± histology
± PCR (rare; will only be used in BL/LL)
How do you manage Multibacillary TB?
12/12 of:
Rifampicin 600mg PO MONTHLY
+
Clofazimine 50mg PO OD and 300mg MONTHLY
+
Dapsone 100mg OD
How can Leprosy be prevented
BCG Vaccine (better protection against Leprosy than TB)
Rifampicin to close contacts of +ve M.Leprosy
How do you manage Paucibacillary Leprosy?
6/12 of:
Rifampicin 600mg PO Monthly
+
Dapsone 100mg OD
+
Clofazamine 50mg PO OD and 300mg MONTHLY
What are the main Side effects of rifampicin?
– Urine discolouration
– Liver enzyme induction
What are the main side effects of Dapsone?
– Haemolytic anaemia Hb drop 1-2 gm
– Dapsone Hypersensitivity Syndrome
What are the side effects of Clofazimine
– 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.)
What are the main components of leprosy self-care?
