Flashcards in Leprosy Deck (12):
What is leprosy?
Caused by Mycobacterium leprae
Affecting skin, peripheral nerves
Mucosa of URT and eye
Affecting all age groups, males>females
2nd most common cause of neuropathic ulcers in Sri Lanka after diabetes mellitus
How is leprosy transmitted?
Nasal droplet inhalation
Prolonged contact with skin abrasions
By multibacillary form
How is leprosy diagnosed?
Clinical features and suspicion
Positive slit skin smears
Lepromin test + (tuberculoid)
What are the important features of Mycobacterium leprae?
Acid fast alcohol fast
Can’t be cultured in vitro
Very slow growth rate (14 day doubling time)
What is the pathophysiology of leprosy?
Infection by nasal droplets
Genetic and immune susceptibility to infection determines host immune response
Immune response is T cell mediated delayed type hypersensitivity
Years long incubation period
Infects Schwann cells, skin, testes, bone
How is leprosy clinically classified?
According to host cell mediated immune response causing different clinical presentations
Ridley and Jopling system
Paucibacillary tuberculoid leprosy if good immunity
Multibacillary lepromatous leprosy if poor immunity
TT BT BB BL LL
What are the clinical features of tuberculoid leprosy?
Single lesion (up to 3) commonly on face
Well demarcated hypopigmented hairless anhydrotic hypoanesthetic macules
Thickened nerves near lesion
What are the clinical features of lepromatous leprosy?
Multiple lesions in Face, limbs, buttocks
Pupules/ nodules/ plaques/ macules not hypoanesthetic
Thickened peripheral nerves with glove and stocking anesthesia, trophic ulcers, paralysis
Nasal crusting, epistaxis, keratitis, infertility
What are the DDx for leprosy?
What is the treatment for leprosy?
Multi drug therapy (MDT)
Tuberculoid 6 months
Rifampicin + dapsone
Lepromatous 12 months
Rifampicin + clofazimine + dapsone
Clofazimine 300mg/month and 50mg/day
Regimens are given for 4 weeks as blister packs
What are lepra reactions?
Acute episodes of inflammation during the chronic course of leprosy
Due to immune reactions on Mycobacterium antigens
Occur at any time(before during after treatment)
Type 1 LR from type IV hypersensitivity
Type 2 LR from type III hypersensitivity
Do not stop MDT
Treat with steroids and NSAIDs