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ANDREWS’ Diseases Of The Skin 13 Ed. > CHAPTER 17: HANSEN DISEASE > Flashcards

CHAPTER 17: HANSEN DISEASE Flashcards

1
Q

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

A

5 years- paucibacillary

10 years- multibacillary

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2
Q

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

A

Earlobe
Elbow
Knee

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

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3
Q

Most common outcome after exposure to M. leprae/lepromatosis

A

Spontaneous cure

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4
Q

Earliest sensory changes in Hansen’s

A

Loss of sense of temperature and light touch

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5
Q

First lesion often noted in Hansen’s

A

Solitary poorly defined hypopigmented macule

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6
Q

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?

A

Tuberculoid

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7
Q

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

A

CN 7

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8
Q

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

A

CN 5 and CN 7

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9
Q

Most frequently involved mucous membrane in leprosy

A

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

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10
Q

Every organ can contain leprosy bacilli except for

A

gastrointestinal tract, lungs, and brain,

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11
Q

Most heavily infected organs involved in Hansen’s

A

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

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12
Q

Which T cells predominate in tuberculoid and lepromatous patients?

A

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

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

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13
Q

what stain is optimal for demonstrating M. leprae histologically?

A

fite-faraco stain

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14
Q

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

A

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

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15
Q

The major complication of type 1 reactions is

A

nerve damage

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16
Q

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

A

Type 2 reactions are mediated by immune complexes

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17
Q

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

A

borderline leprosy (BT, BB, BL).

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18
Q

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

A

occur in lepromatous patients (BL, LL).

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19
Q

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

A

reversal reaction

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20
Q

Smaller more numerous erythematous hypopigmented dry scaly patches

Anesthetic hypesthetic and anhidrotic

What type of leprosy?

A

Borderline tuberculoid
BT

21
Q

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

A

Borderline lepromatous
BL

21
Q

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

A

Lepromatous

21
Q

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

A

Histoid leprosy

21
Q

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

A

Borderline borderline
BB

21
Q

Histopathologic landmark of Hansen’s

A

Neural predilection or neurotropism

21
Q

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

A

downgrading reaction

21
Q

Stocking glove peripheral neuropathy occurs in which type of leprosy?

A

Lepromatous

22
Q

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

A

Borderline borderline
BB

22
Q

Smaller more numerous erythematous hypopigmented dry scaly patches

Anesthetic hypesthetic and anhidrotic

What type of leprosy?

A

Borderline tuberculoid
BT

23
Q

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

A

Lepromatous

23
Q

Stocking glove peripheral neuropathy occurs in which type of leprosy?

A

Lepromatous

23
Q

Histopathologic landmark of Hansen’s

A

Neural predilection or neurotropism

24
Q

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

A

Histoid leprosy

25
Q

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

A

Borderline lepromatous
BL

26
Q

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

A

downgrading reaction

27
Q

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

A

Type 1 reactions

28
Q

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

A

Type 2 reactions (erythema nodosum leprosum)

29
Q

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

A

Lucio phenomenon

30
Q

WHO recommended treatment for paucibacillary disease

A

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

31
Q

WHO recommended treatment for multibacillary disease

A

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

32
Q

Management for type 1 reactions in Hansen’s

A

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

33
Q

Treatment of choice for erythema nodosum leprosum

A

Thalidomide 100- 400 mg/ day

CI in pregnant women

34
Q

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

A

false

*should be given

35
Q

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

A

clofazimine and dapsone

*resume MDT regimen once anti-TB tx is completed

36
Q

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

A

6 blister packs; 9 months

37
Q

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

A

12 blister packs; 18months

38
Q

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

A

defaulter

39
Q

diagnosis of leprosy can be documented through

A

slit skin smear at TB DOTS

ANDREWS’ Diseases Of The Skin 13 Ed. (20 decks)

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