Leprosy

Question 1

Causative Organism?

Answer 1

M Leprae *Armadillos are the only other known sylvatic reservoir but it makes them very ill

Question 2

3 Cardinal signs

Answer 2

1) Hypopigmented anaesthetic lesions 2) Peripheral nerve thickening 3) Skin smears or biopsy with AAFB

Question 3

Skin lesion dx

Answer 3

Ridley-Jopling classification

Range from LL (lepromatous) to TT (Tuberculoid). Paucibacillary <5 Multibacillary >5

Question 4

Nerves to examine

Answer 4

Head to toe: Great Auricular Lagophtalmos (unable to close eyelids properly) Ulnar Common peroneal

Question 5

Diagnosis

Answer 5

NO SEROLOGY: 1) Skin smear / biopsy 2) Clinically: hx + neuro exam

Question 6

Ocular complications of Leprosy

Answer 6

Lagopthalmos Decreased corneal sensation Acute / chronic iritis Cataract

Question 7

Treatment

Answer 7

Paucibacillary (<5) -

6 months

rifampicin (monthly)

dapsone (daily)

clofazimine

Multibacillary >5 12 months monthly

rifampcin,

daily dapsone

clofazimine

Question 8

Side effects of treatment drugs

Answer 8

Rifampicin: orange tears

Dapsone: Hypersensitivity ; anaemia \

Clofazimine: ichytosis, hyperpigmentation (think harlequin ichytosis!)

Question 9

Treatment Reactions

Answer 9

Type 1:

more common with borderline cases can occur at any stage. flare of inflammation in nerves. can worsen preexisting impairment. requires months of steroids. Relapses common.

Type 2: ENL reactions

more common in LL cases. Erythema nodosum Leprosum. Steroids Thalidomide