Topic I/12) Leprosy and Leishmaniasis, clinical forms and therapy

Question 1

leprosy(hensen disease):

Answer 1

a chronic granulomatous disease caused by Mycobacterium leprae, principally aquired during childhood/young adulthood. The incubation period is 2-40 years (average: 5-7yrs). The bacterium prefers cooler temperatures and thus skin, peripheral nervous system, upper resp. tract, eyes and testes are the major sites of involvement.

Question 2

Clinical forms:

Answer 2

1.Tuberculoid leprosy
well-defined, hypopigmented (or erythematous) macules/plaques with raised, erythematous edges and varying sizes (a few mm’s to very large lesions). These lesions enlarge peripherally, with atrophy of the center. Advanced lesions are anesthetic (no pain felt) with abscence of both sweat glands (dry surface) and hair follicles. Nerves may be enlarged and palpable.
treatment: dapsone for 5 years

2. Lepromatous leprosy –
   generalized involvement including the skin
   upper respiratory mucus membranes
   the reticuloendothelial system, adrenal glands and testes.
   It presents with multiple inflammatory (and hypopigmented) papules, plaques and nodules.
   Loss of the eyebrows („madarosis”) and nasal stuffiness is common.
   Skin thickening and severe disfigurement („lion’s face”) may follow; the lesions enlarge, new lesions occur and coalesce.

Treatment: Rifampin (600mg/month) for 3 years + Dapsone indefinitely

Borderline (dimorphic) leprosy
esions are intermediate between tuberculous and lepromatous type and are composed of macules, papules and plaques
Anesthesia and decreased sweating is are prominent in the lesions.
Indeterminate/transitional forms
he most common clinical type, especially in children. Presents as hypopigmented or erythematous circular maculeswith occasional midl anesthesia and scaling

Question 3

Leischmaniasis

Answer 3

Leischmaniae are insect-transmitted protozoa (parasites; hemoflagellates) which infect blood and tissues

1. leischmania tropica
2. leishmania braziliensis
3. leischmania donovani

Question 4

Cutaneous Leischmaniasis

Answer 4

single or multiple cutaneous papules at the site of a sandfly bite, often evolving into intensely pruritic nodules and ulcers, which heal spontaneously with a depressed scar

Question 5

Treatment of cutaneous Leischmaniasis:

Answer 5

Stibogluconate (Pentostam – a pentavalent antimonial) Fluconazole, and Miltefosine

Question 6

● Mucocutaneous Leischmaniasis

Answer 6

Characterized by nasopharyngeal mucosal involvement, a metatstatic complication of cutaneous Leischmaniasis
Edema and inflammatory changes lead to epistaxis and coryzal symptoms (nasal congestion, loss of smell
the nasal septum, floor of mouth and tonsillar areas are destroyed by the development of painful ulcerations which leads to marked disfigurement

Treatment of mucocutaneous Leischmaniasis:
Stibogluconate
Amphotericin B