LEPROSY

Question 1

Mycobacterium leprae infects

Answer 1

• macrophages and

- Schwann cells

Question 2

clumps or globi within macrophages

Answer 2

Lepra cells

Question 3

Obligate, intracellular bacillus, acid-fast staining,

rod-shaped bacterium, never been grown in artificial media

Answer 3

Mycobacterium leprae

Question 4

Temperature required for survival of Mycobacterium leprae

Answer 4

between 27ºC and 30ºC

Question 5

calculated as the percentage of viable bacilli among the total number of bacilli

Answer 5

Morphologic Index

Question 6

(measure of the density of bacilli of all forms found in

the dermis): varying from 0 to 6+; falls an average of 1 log unit/year with multidrug therapy

Answer 6

Bacteriologic Index

Question 7

M. Leprae has (cell)

Answer 7

cytoplasm, plasm membrane, cell wall and capsule.

Question 8

Cell wall of M. Leprae composed of

Answer 8

• Arabinogalactans (which support mycolic acids)

- lipoarabinomannan (LAM)

Question 9

Capsule contains phthiocerol dimycocerosate and ____ - its detection is helpful in serologic diagnosis
of leprosy

Answer 9

phenolic glycolipid (PGL-1)

Question 10

Immunologic components of M. leprae:
Polysaccharide:
Protein:

Answer 10

Polysaccharide: induce mainly a humoral immune response
Protein: both humoral and cell-mediated immune response

Question 11

special type of diffuse lepromatosis known as diffuse leprosy of Lucio and Latapí. Found mainly in Mexico and Central America

Answer 11

Mycobacterium Lepromatosis

Question 12

WHO Leprosy Disability Grading System

Hands and Feet
Grade 0
Grade 1 -
Grade 2 -

Answer 12

Grade 0 - no anesthesia and no visible impairment
Grade 1 - signifies anesthesia but no visible impairment
Grade 2 - visible impairment

Question 13

WHO Leprosy Disability Grading System

Eyes
Grade 0
Grade 1
Grade 2

Answer 13

Grade 0 - no eye problems due to leprosy and no evidence of visual loss
Grade 1 - eye problems due to leprosy without severe effects on vision
Grade 2 - severe visual impairment; includes lagopthalmos, iridocyclitis and corneal opacities

Question 14

Transmission of M. leprae

Answer 14

• Can be shed in large numbers from the mouth and nose of patients with untreated multibacillary leprosy (droplet infection) and sometimes from damaged skin.
• Zoonotic transmission through wild armadillos
• Main route of entry - respiratory tract!!!!
• Wound or tattoos - skin is also possible

Question 15

Reservoir of M. leprae

Answer 15

Humans - main reservoir of infection for M. Leprae!!!!
Armadillos - also a reservoir for human infection
Certain species of monkeys and red squirrels are infected, but there is not evidence of transmission

Question 16

Relatively stable: types of leprosy

Answer 16

• LL

- TT

Question 17

Unstable both clinically and immunologically types of leprosy

Answer 17

• BL,
• BB,
• BT

Question 18

The host tissue’s reaction and related damage due to

Answer 18

delayed hypersensitivity

Question 19

WHO Simplified Clinical Classification of Leprosy

• negative slit-skin smear results at all body sites

Answer 19

Paucibacillary leprosy

Question 20

WHO Simplified Clinical Classification of Leprosy

positive smears at any body site

Answer 20

Multibacillary leprosy

Question 21

Clinical criteria

• one to five skin lesions, and no or only one involved peripheral nerve

Answer 21

Paucibacillary leprosy

Question 22

Clinical criteria

• six or more skin lesions, and/or more than one involved peripheral nerve

Answer 22

Multibacillary leprosy

Question 23

Ridley-Jopling Classification of Leprosy

• Early clinical type manifests are one or few hypopigmented or faintly erythematous, ill-defined to well-defined macular lesions, measuring 1-5 cm in diameter
• Occurs on the external aspects of the limbs, buttocks, and face
• Mild to moderate impairment of touch and/or thermal sensations

Answer 23

Indeterminate Leprosy (IL)

Question 24

Ridley-Jopling Classification of Leprosy

• No thickening of cutaneous and peripheral nerves
• Often, but not always, the first clinical sign of leprosy
• Heals spontaneously or progresses to a determinate form of the disease (TT, BT, BB, BL or LL)

Answer 24

Indeterminate Leprosy (IL)

Question 25

Ridley-Jopling Classification of Leprosy - Presents either as a well-defined, hypopigmented macule or as a raised, erythematous/brown/copper-colored plaque with a well-defined edge - May be found on any part of the skin; characterized by complete loss of fine touch and temperature sensations - Single or few (up to three) in number, can be of any size; seldom measure >10 cm in diameter =Plaque-type lesions: raised clear-cut edge often slopes inward to a flattened and sometimes hypopigmented central area

Answer 25

Tuberculoid (TT) Leprosy

Question 26

Ridley-Jopling Classification of Leprosy - Skin surfaces of the lesion is dry, hairless, and anesthetic because of destruction of underlying superficial cutaneous nerves - Autonomic nerve damage: responsible for surface dryness and loss of sweating - Slit-skin exam: no acid-fast bacilli - Lepromin skin test: strongly positive

Answer 26

Tuberculoid (TT) Leprosy

Question 27

Ridley-Jopling Classification of Leprosy - Characterized by either macular or plaque-type lesions numbering three to nine or more; asymmetrically located on any part of the body - Margins of the lesions: poorly defined to well-defined, sometimes both forms are seen - Smaller satellite lesions around a larger one: indicates downgrading of the lesion from TT to BT leprosy

Answer 27

Borderline Tuberculoid (BT) Leprosy

Question 28

Ridley-Jopling Classification of Leprosy - Susceptibility to a Type 1 leprosy reaction, that exacerbates skin lesions and/or peripheral nerves - If not diagnosed and treated early - tends to downgrade across the spectrum to BB, BL or LL leprosy - Slit skin smears: negative to 1+

Answer 28

Borderline Tuberculoid (BT) Leprosy

Question 29

Ridley-Jopling Classification of Leprosy - Unstable form of leprosy; downgrade toward BL and LL disease (especially if not treated) - Multiple plaque lesions, not infrequently, macular lesions; various shapes and sizes, bilateral and usually occur in a more or less symmetrical distribution = Moderately shiny and the central area looks pale

Answer 29

Mid-Borderline (BB) Leprosy

Question 30

Ridley-Jopling Classification of Leprosy - Minimal loss of sensation over the lesions - Nerve damage: variable; many nerves may be thickened, asymmetrical - Not commonly observed and rapidly changes its spectrum - Lepromin test: negative - Slit-skin smears: moderate number of AFB (2+ to 3+)

Answer 30

Mid-Borderline (BB) Leprosy

Question 31

Ridley-Jopling Classification of Leprosy - Numerous bilateral, round or oval, macular, diffusely infiltrated, erythematous or hypopigmented lesions with moderately defined borders = Usually 2-3 cm in diameter, may have a coppery hue, tend to become symmetrical - Some loss of sensation, particularly over older lesions - Untreated patients - new ill-defined skin lesions continue to develop

Answer 31

Borderline Lepromatous (BL) Leprosy

Question 32

Ridley-Jopling Classification of Leprosy - Widespread but asymmetrical thickening of peripheral nerves, with or without tenderness, leads to sensory and motor deficits - Lepromin test: negative results - Slit-skin examination: bacteriologic index varying from 3+ to 4+

Answer 32

Borderline Lepromatous (BL) Leprosy

Question 33

Ridley-Jopling Classification of Leprosy - Presents with innumerable bilateral, symmetrically distributed, diffusely indurated, erythematous, copper-colored or skin-colored patches or plaques - No loss of sensation over these lesions; smooth, shiny surface - Lesions spread over the face, earlobes, ears, extensor aspects of the upper and lower extremities, back and buttocks

Answer 33

Lepromatous (LL) Leprosy

Question 34

Ridley-Jopling Classification of Leprosy - Bilateral earlobe thickening and eyebrow loss occurs = “Lion face” - coarse induration on the face resulting in gross skin folds, particularly when associated with loss of eyebrows and thickening of earlobes - Polar type (LLp): 10-15% from the time of onset, with sensory loss in a “glove-and-stocking” distribution - Slit-skin smear exam: 4+ to 6+ with globi

Answer 34

Lepromatous (LL) Leprosy

Question 35

Clinical Manifestation: Lepromatous Leprosy Systemic Involvement: AFB Involvement of testes:

Answer 35

first to sterility and then gynecomastia and impotence

Question 36

Clinical Manifestation: Lepromatous Leprosy Systemic Involvement: AFB Eye involvement:

Answer 36

- corneal anesthesia, - episcleritis, - iridocyclitis, - iris atrophy, - cataract and glaucoma, - lagophthalmos, - corneal ulceration and perforation - blindness

Question 37

Clinical Manifestation: Lepromatous Leprosy Systemic Involvement: AFB Nose: portal of entry

Answer 37

- earliest site of involvement in LL leprosy; - chronic rhinitis with loss of smell sensation - Saddle perforation due to bone destruction “Saddle-nose disfigurement”, common in advanced LL disease

Question 38

Clinical Manifestation: Lepromatous Leprosy | Histoid Leprosy:

Answer 38

- Rare form of LL leprosy - Waxy, shiny, firm, symmetrical or asymmetrical nodules and plaques observed over normal-looking skin - Histologic examination: specific spindle-cell granulomas - Slit-skin smear examination: high bacteriologic and microbiologic indices without globi in most cases

Question 39

Clinical Manifestation: Lepromatous Leprosy - Rare form of non-nodular LL leprosy occurring in Mexico and Central America - Characterized by diffuse shiny infiltration of the skin and widespread sensory loss - Complicated by an unusual reaction known as Lucio’s phenomenon

Answer 39

Diffuse leprosy of Lucio and Latapi

Question 40

skin looks shiny and has a shiny appearance, with obvious diffuse induration of the earlobes and forehead, loss of eyebrows, sometimes eyelashes and not infrequently all body hair

Answer 40

“Lepra bonita” (beautiful leprosy)

Question 41

- Some countries (India and Nepal), observed in 2-10% of all leprosy cases - Only peripheral nerve involvement and no skin lesions - Nerve thickening and sensory loss occurs in the affected area, with or without a motor deficit - Can manifest at different points along the disease spectrum - Classified as paucibacillary or multibacillary on the basis of the absence or presence of AFB in nerve biopsy section or the number of thickened nerves (single or multiple)

Answer 41

Primary Neurotic Leprosy