CHAPTER 17: HANSEN DISEASE

Question 1

Latency period between exposure and overt signs of hansen’s disease is

Answer 1

5 years- paucibacillary

10 years- multibacillary

Question 2

Smears for dx of hansen’s are taken from which body parts

Answer 2

Earlobe
Elbow
Knee

bec. M. leprae grows best at temperatures (30°C) below the core body tem

Question 3

Most common outcome after exposure to M. leprae/lepromatosis

Answer 3

Spontaneous cure

Question 4

Earliest sensory changes in Hansen’s

Answer 4

Loss of sense of temperature and light touch

Question 5

First lesion often noted in Hansen’s

Answer 5

Solitary poorly defined hypopigmented macule

Question 6

Solitary or few lesions, asymmetrical

Large erythematous plaque with a sharply defined and elevated border and flattened atrophic center ( “ a saucer right side up”)

Palpable induration and neuro findings

What type of leprosy?

Answer 6

Tuberculoid

Question 7

Corneal erosions, exposure keratitis and ulcerations may result from the involvement of what cranial nerve

Answer 7

CN 7

Question 8

Ptosis, ectro- pion, and a masklike appearance occur from damage to what cranial nerve

Answer 8

CN 5 and CN 7

Question 9

Most frequently involved mucous membrane in leprosy

Answer 9

nasal mucosa is most frequently involved, and lepromatous patients frequently complain of chronic nasal congestion

Question 10

Every organ can contain leprosy bacilli except for

Answer 10

gastrointestinal tract, lungs, and brain,

Question 11

Most heavily infected organs involved in Hansen’s

Answer 11

lymph nodes, bone marrow, liver, spleen, and testicles are most heavily infected

Question 12

Which T cells predominate in tuberculoid and lepromatous patients?

Answer 12

Tubercu- loid patients make well-formed granulomas that contain HELPER T cells

lepromatous patients have poorly formed granulomas, and SUPPRESSOR T cells predominate.

Question 13

what stain is optimal for demonstrating M. leprae histologically?

Answer 13

fite-faraco stain

Question 14

Type 1 reactional state in Hansen’s is mediated by what type of hypersensitivity reaction

Answer 14

Type 1 reactions represent an enhanced cell-mediated immune response to M. leprae and usually occur after treatment is initiated

Question 15

The major complication of type 1 reactions is

Answer 15

nerve damage

Question 16

Type 2 reactional state in Hansen’s is mediated by what type of hypersensitivity reaction?

Answer 16

Type 2 reactions are mediated by immune complexes

Question 17

Type 1 reactions usually occur in what type of Hansen’s

Answer 17

borderline leprosy (BT, BB, BL).

Question 18

Type 2 reactions usually occur in what type of Hansen’s

Answer 18

occur in lepromatous patients (BL, LL).

Question 19

If a reaction in Hansen’s occur with antibiotic therapy, it is called

Answer 19

reversal reaction

Question 20

Smaller more numerous erythematous hypopigmented dry scaly patches

Anesthetic hypesthetic and anhidrotic

What type of leprosy?

Answer 20

Borderline tuberculoid
BT

Question 21

What type of leprosy?

Symmetric and numerous (too many to count) macules, papules plaques or nodules

Smaller lesions outnumber the large ones
Nerve involvement appears later
Sensation and sweating normal

Answer 21

Borderline lepromatous
BL

Question 21

What type of leprosy?

Pale macules or diffuse infiltration of skin
Symmetrically distributed all over
Poorly defined, no change in texture, blend with surrounding skin
Minimal or no loss of sensation
Slow, progressive loss of outer 1/3 eyebrow, then body hair

Answer 21

Lepromatous

Question 21

Uncommon form of multibacillary Hansen’s where lesions appear as large yellow red shiny papules and nodules in the dermis or subcutaneous tissue

Answer 21

Histoid leprosy

Question 21

What type of leprosy?
Countable numerous lesions in leprosy

Red irregularly shaped plaques
Small satellite lesions may surround larger plaques

Generalized but asymmetric, edges not as well defined, moderate anesthesia

Answer 21

Borderline borderline
BB

Question 21

Histopathologic landmark of Hansen’s

Answer 21

Neural predilection or neurotropism

Question 21

If a borderline disease shifts toward the lepromatous pole, the reaction is called

Answer 21

downgrading reaction

Question 21

Stocking glove peripheral neuropathy occurs in which type of leprosy?

Answer 21

Lepromatous

Question 22

What type of leprosy? Countable numerous lesions in leprosy Red irregularly shaped plaques Small satellite lesions may surround larger plaques Generalized but asymmetric, edges not as well defined, moderate anesthesia

Answer 22

Borderline borderline BB

Question 22

Smaller more numerous erythematous hypopigmented dry scaly patches Anesthetic hypesthetic and anhidrotic What type of leprosy?

Answer 22

Borderline tuberculoid BT

Question 23

What type of leprosy? Pale macules or diffuse infiltration of skin Symmetrically distributed all over Poorly defined, no change in texture, blend with surrounding skin Minimal or no loss of sensation Slow, progressive loss of outer 1/3 eyebrow, then body hair

Answer 23

Lepromatous

Question 23

Stocking glove peripheral neuropathy occurs in which type of leprosy?

Answer 23

Lepromatous

Question 23

Histopathologic landmark of Hansen’s

Answer 23

Neural predilection or neurotropism

Question 24

Uncommon form of multibacillary Hansen’s where lesions appear as large yellow red shiny papules and nodules in the dermis or subcutaneous tissue

Answer 24

Histoid leprosy

Question 25

What type of leprosy? Symmetric and numerous (too many to count) macules, papules plaques or nodules Smaller lesions outnumber the large ones Nerve involvement appears later Sensation and sweating normal

Answer 25

Borderline lepromatous BL

Question 26

If a borderline disease shifts toward the lepromatous pole, the reaction is called

Answer 26

downgrading reaction

Question 27

What type of reactional state? Inflammation of existing lesions- **swelling,** sometimes tender, simulating cellulitis No systemic symptoms Nerve damage- due to inflammation, enlarged and tender occurs in PB and MB

Answer 27

Type 1 reactions

Question 28

what type of Rxn? Occurs in 50% borderline lepromatous or lepromatous Within a few years of antibiotic tx or during pregnancy With **Systemic sx** ( fever and pain) Lesions: widespread erythematous subcutaneous and **dermal nodules** that do not occur on the site of lesions Favor extensor arms and medial thighs occurs in MB only

Answer 28

Type 2 reactions (erythema nodosum leprosum)

Question 29

Purpuric macules—bullous lesions that ulcerate especially below the knees Occurs in px with diffuse lepromatous type, no systemic symptoms Numerous bacilli in the dermis and BV walls that lead to cutaneous infarctions

Answer 29

Lucio phenomenon

Question 30

WHO recommended treatment for paucibacillary disease

Answer 30

paucibacillary disease (TT and BT): 1. dapsone 100 mg OD x 12 months 2. rifampicin 600 mg OD x 12 months

Question 31

WHO recommended treatment for multibacillary disease

Answer 31

Multibacillary (LL,BL,BB) 1. dapsone 100 mg OD x 24 months 2. rifampicin 600 mg OD x 24 months 3. clofazimine 50 mg OD x 14 months

Question 32

Management for type 1 reactions in Hansen’s

Answer 32

systemic corticosteroids: Prednisone is given orally, starting at a dose of 40–60 mg/day. | Neuritis and eye lesions are urgent indications for systemic steroid the

Question 33

Treatment of choice for erythema nodosum leprosum

Answer 33

Thalidomide 100- 400 mg/ day | CI in pregnant women

Question 34

MDT is contraindicated in pregnancy and lactating mothers? true or false

Answer 34

false *should be given

Question 35

what leprosy drugs are given in addition to anti-TB tx for px with tuberculosis?

Answer 35

clofazimine and dapsone *resume MDT regimen once anti-TB tx is completed

Question 36

PB regimen should take ____ blister packs to be completed for _____ months

Answer 36

6 blister packs; 9 months

Question 37

MB regimen should take ____ blister packs to be completed for _____ months

Answer 37

12 blister packs; 18months

Question 38

a _____ is a px who has started regimen and who has not collected MDT drugs for 3 consecutive months

Answer 38

defaulter

Question 39

diagnosis of leprosy can be documented through

Answer 39

slit skin smear at TB DOTS