Leprosy

Question 1

Chronic infection of nerves with skin manifestation

Answer 1

Leprosy

also known as Hansen’s disease

Question 2

According to WHO, the following groups are considered to have cases of leprosy

Answer 2

Persons having one or more of the following:

Hypopigmented or reddish skin lesions with loss of sensation

Involvement of peripheral nerves

Skin smear positive for acid fast bacilli

Question 3

Incubation Period of hansen’s disease

Answer 3

5 years (6 months to 20 years)

has a subclinical stage where immunity must weaken before any lesion

Question 4

Mode of transmission for Leprosy:

Answer 4

Droplet transmission

Question 5

Susceptibility in Leprosy

Answer 5

Most people are actually only mildly susceptible

Factors:
Genetic
Repeated exposure

Question 6

Etiology of Hansen’s disease

Answer 6

Mycobacterium leprae

Question 7

Mycobacterium leprae

Answer 7

slow-growing
Doubling time of 2 weeks
Does not grow in culture media
Prefers cooler temp (27-35)

Question 8

The clinical immunologic Spectrum Leprosy

Answer 8

Cell mediated Immunity

Antibody response

Question 9

Cell Mediated Immunity

Answer 9

In the first phase; T cells and macrophages are the ones that respond to the bacteria

The T cells and macrophages are what we need to kill and contain bacteria

The T cells and a granulomatous reaction in the body if the cell-mediated immunity isn;t enough

Question 10

Antibody Response

Answer 10

T cell response weakens and becomes an antibody-dominant response

strong AB response but useless

These AB cannot kill the bacteria therefore, this phase leads to more extreme cases of leprosy

Question 11

Indeterminate Leprosy

Answer 11

some cases may resolve, while some may progress to full term

Patches may have loss sensation and when biopsied may have granulomatous infiltrates

Ill defined patch

Question 12

Single or few, assymetrical, well defined hyppigmented, erythematous or copper colored patches with raised borders

no satellite lesion

Answer 12

Tuberculoid leprosy

Question 13

Few, asymetrical, well demarcated, dry plaques. May be annular with clearly defined outer borders. Surface may be scaly

Answer 13

Bordeline TL

Question 14

More numerous lesions than TL (>3 and <10 lesions)

Asymmetrical, less well demarcated, shiny plaques, often annular with sharply-marginated inner and outer borders

Answer 14

Mid borderline Leprosy

Question 15

Numerous (>5) smaller,, rougly symmetrical, shiny, macules, papules, nodules, and plaques with sloping edges

Annular punched out lesions

Answer 15

Bordeline Lepromatous Leprosy

Question 16

Very numerous, symmetrically distributed, erythematous or sopper colored, shiny macules

Presents with a lot of infiltration on the skin

Answer 16

LL

Question 17

Classifies cases of leprosy bases on clinical features

Answer 17

Ridley Jopling classification

Question 18

WHO classification of leprosy

Answer 18

Multibacillary

Paucibacillary

Question 19

Multibacillary Leprosy

Answer 19

> 5 skin lesions
+ AFB
1 nerve trunk involves

Question 20

Paucibacillary Leprosy

Answer 20

<5 skin lesions
NO AFB in skin smears
0-1 Nerve trunks involved

Question 21

MB - Ripley-jolling

Answer 21

Lepromatous
BL
BT

Question 22

PB- Ripley jopling

Answer 22

BT
T
Indertimate

Question 23

“Leprary reactions”

Answer 23

Cured persons with late reactions

Cured persons with residual disabilities

Question 24

2 nervess usually examined in Leprosy

Answer 24

Ulnar and common peroneal

Question 25

Diagnostic test of leprosy

Answer 25

Slit skin smear | Skin biopsy

Question 26

MDT of Lprosy

Answer 26

Rifampicin Clofazimine Dapsone

Question 27

A leprosy patient becomes non-infectious after taking MDT for _______ month

Answer 27

1 month

Question 28

Treatment for PB leprosy (Indeterminate, TT, BT)

Answer 28

Rifampicin 600mg once a month for 6 months + Dapsone 100 mg daily for 6 months

Question 29

Treatment for MB Leprosy( BT, BB, BL, LL)

Answer 29

Rifampicin 600 mg and Clofazimin 300 mg once a month + Dapsone 100mg and clofazimine 50 mg for 12 months or until skin smears show no more solid staining Bacilli

Question 30

Side effects for treatment of Leprosy

Answer 30

Rifampicin: Reddish urine Clofazimine: Dark brown skin discoloration Dapsone: Hemolytic anemia

Question 31

Medical Management of lepra Reactions

Answer 31

High Risk: MB + nerve impairment Clinical indications Nerve pain Loss of sensation Loss of function

Question 32

management of Mild Lepra reactions (Type 1 and 2)

Answer 32

Features: Mildly swollen skin lesion, Mild fever Mild analgesics Continue MDT Do nerve function assessment every 2 weeks Advise Bed rest

Question 33

Management of Severe Lepra reactions

Answer 33

Prednisolone x 12 weeks and.or clofazzimine x 3months + continue MDT Nerve Fx assessment every 2 weeks Alagesics Refer persistent, non responding reactions

Question 34

Severity grading for Lepra reaction

Answer 34

Mild - only the skin Severe - skin, nerve and systemic

Question 35

Characteristics of Lepra reactions

Answer 35

Type I - reversal reaction Type II -erythema nodosum leprosum

Question 36

Type 1 (Reversal Reaction)

Answer 36

Mostly borderline Associated wih alteration in CMI due to sudden increase inCMI

Question 37

Type 2 (ENL)

Answer 37

Mostly lepromatous Immune-complex syndrome due to precipitation of antigen and antibody complexes in tissues spaces, blood, lymphatics

Question 38

Peripheral nerve inflammation manifests into 2 ways in Leprosy

Answer 38

1. Enlarged and/or very painful | 2. Silent neuritis

Question 39

Impairment, disability and deformity

Answer 39

Claw hand Foot ulcer - posterior tibial nerve Foot drop - Peroneal nerve damage Ocular complications - Facial or trigeminal nerve damage