Leprosy Flashcards
Most severe form
Lepromatous leprosy
Skin lesions are Symmetric, multiple infiltrated nodules and plaques, xanthoma-like or dermatofibroma papules; leonine facies and eyebrows
Lepromatous leprosy
tuberculous: assymetric with tendency to central clearing
Presence of nerve abscesses and skin lesions are anesthetic early; lesions are usually dry, scay and anhidrotic
Tuberculous leprosy
Hyperesthesia is a late sign
Lepromatous leprosy
AFB usually up to 4-6+
Lepromatous leprosy
Presence of Langerhans giant cells (on H&E stain)
Tuberculous leprosy
Positive lepromin skin test
Tuberculous leprosy
Higher rate of M.leprae PGL-1 antibodies
Lepromatous leprosy
Incubation period
2-40 years
Pathognomonic for leprosy
T cell mediated destruction of Schwann cells
Presence of foam cells
Lepromatous leprosy
Immunologically-mediated inflammatory states that cause considerable morbidity, may precede diagnosis and occur even after initiation of appropriate chemotherapy
Lepta reactions
Type 1 Lepra Reactions
Downgrading and Reversal reactions
borderline forms 50%
Most dramatic manifestation of Type 1 Lepra reactions
Foot drop (Peroneal nerve involvement)
Nerve trunk commonly involved in type 1
Ulnar nerve at the elbow
Tx: GCs
When reactions precede initiation of appropriate antibiotics
Downgrading
When reactions occur after initiation of therapy
Reversal
Most characteristic microscopic feature of type 1 lepra
Edema
Type 2 Lepra Reactions
Erythema Nodosum Leprosum
near the lepromatous end
MC features of type 2
Crops of painful spontaneously resolving but recurring lesions
Tx for recurrent and persistent ENL despite 2 courses of GC therapy
Thalidomide
Unusual reaction seen exclusively in patients from the Carribean and Mexico who have diffuse lepromatosis form of untreated lepromatous leprosy
Lucio’s phenomenon
MC site of nerve abscesses
Ulnar nerve
Most frequent complication of leprous neuropathy
Plantar ulceration (metatarsal heads)
Saddle-nose deformity or anosmia
Lepromatous leprosy
Confirmatoy diagnosis for leprosy
Histopathology
Bactericidal treatment
Rifampin
Treatment which is primarily bacteriostatic
Sulfones (dapsone): mainstay of therapy
Treatment for paucibacillary leprosy
Intensive: Dapsone x 5 years
Dapsone + Rifampin x 6 months
Treatment for multibacillary leprosy
Intensive: Rifampin c 3 years
