Leprosy

Question 1

What organism causes leprosy?

Answer 1

Mycobacterium leprae and mycobacterium lepromatosis (new species)

Question 2

Which parts of the body does leprosy affect?

Answer 2

Nerves - predominantly
Skin
Eyes, muscles, URT,
Multiplies best in cooler parts of the body

Question 3

Incubation period for leprosy?

Answer 3

3-5 years
Bimodal peaks - 10-15 yrs and >35 yrs
Transmission - unclear, probably respiratory

Question 4

Spectrum of leprosy?

Answer 4

1. Tuberculoid - 1 macule, shiny thick skin
2. Borderline tuberculoid -5-25 macules or plaques
3. Mid borderline - punched out donut lesions, sensation decreased
4. Borderline lepromatous - lots of small plaques
5. Lepromatous - diffuse erythematous. Lots of plaques.

Unstable - borderline types
As go down - more bacilli seen.

Question 5

Clinical manifestations of disease?

Answer 5

Cutaneous nerves: paraestheisa, thickening, no pain
Skin lesions: macules, places, infiltrated, nodules and papule

Question 6

Diagnosis of leprosy?

Answer 6

Fite faraco skin biopsy - see granulomas, histiocytes
May see bacilli depending on type

Question 7

Treatment of leprosy?

Answer 7

Dapsone, rifampicin and clofazimine for 6 months for pauci bacillary and 12 months for multi bacillary.

Question 8

What reactions can patients with leprosy get?

Answer 8

Type IV cell mediated hypersensitive reactions - lesions swell and become erythematous - Rx with prednisolone
Type III reaction - antibody antigen complexes - causes erythema nodosum

Question 9

What is Lucio phenomenon caused by mycobacterium lepromatosis?

Answer 9

Symmetrical erythematous painful lesions caused by vasculitis - treated with corticosteroids

Question 10

What is the difference between multi bacillary and pauci bacillary leprosy?

Answer 10

Multi - AFB bacteria seen
Pauci - AFB bacteria not seen

Note - if more than 5 skin lesions, Rx as multi.

Difference in Rx length.