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    Leprosy

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    visweswar030406
    The document discusses leprosy (Hansen's disease), including that it is caused by Mycobacterium leprae, can be transmitted through respiratory droplets or skin-to-skin contact, and classifies the disease using the Ridley-Jopling and WHO systems which differentiate based on clinical features, bacillary load, and histopathology. It also describes the various clinical manifestations, classifications, deformities, and methods of diagnosis for leprosy.

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    Leprosy

    Uploaded by

    visweswar030406
    23 views22 pages
    The document discusses leprosy (Hansen's disease), including that it is caused by Mycobacterium leprae, can be transmitted through respiratory droplets or skin-to-skin contact, and classifies the disease using the Ridley-Jopling and WHO systems which differentiate based on clinical features, bacillary load, and histopathology. It also describes the various clinical manifestations, classifications, deformities, and methods of diagnosis for leprosy.

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    Blended learning: leprosy

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    The document discusses leprosy (Hansen's disease), including that it is caused by Mycobacterium leprae, can be transmitted through respiratory droplets or skin-to-skin contact, and classifies the disease using the Ridley-Jopling and WHO systems which differentiate based on clinical features, bacillary load, and histopathology. It also describes the various clinical manifestations, classifications, deformities, and methods of diagnosis for leprosy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    23 views22 pages

    Leprosy

    Uploaded by

    visweswar030406
    The document discusses leprosy (Hansen's disease), including that it is caused by Mycobacterium leprae, can be transmitted through respiratory droplets or skin-to-skin contact, and classifies the disease using the Ridley-Jopling and WHO systems which differentiate based on clinical features, bacillary load, and histopathology. It also describes the various clinical manifestations, classifications, deformities, and methods of diagnosis for leprosy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 22

    BLENDED LEARNING

    ‘LEPROSY’

    DR MUNIRA F
    ASSISTANT PROFESSOR
    DEPARTMENT OF COMMUNITY MEDICINE
    LEARNING OBJECTIVES:
    • Introduction
    • Causative agent
    • Mode of transmission
    • Classification with clinical features
    INTRODUCTION:
    • Also known as Hansen disease.
    • One of the oldest disease.
    • Remains as social stigma.
    • Leprosy is a chronic, granulomatous, slowly progressive, destructive infection
    primarily involving cooler parts of the body like skin and peripheral nerves but
    capable of affecting any tissue or organ.
    CAUSATIVE AGENT:
    • Mycobacterium leprae
    • Mycobacterium lepromatosis (diffuse form of leprosy in Mexico)
    MODE OF TRANSMISSION:
    • Respiratory route (major)
    • Skin to skin contact
    CLASSIFICATION:
    • Ridley and Jopling classification
    Tuberculoid leprosy (TT)
    Borderline tuberculoid (BT)
    Borderline leprosy (BL)
    Borderline lepromatous (BL)
    Lepromatous leprosy (LL)

    • WHO classification
    Paucibacillary leprosy
    Multibacillary leprosy
    WHO CLASSIFICATION:
    PAUCIBACILLARY LEPROSY:
    • A case of leprosy which fulfils all the below criteria:
    1 – 5 skin lesions
    No nerve involvement
    Slit-skin smear negative

    MULTIBACILLARY LEPROSY
    • A case of leprosy which fulfils any of the below criteria:
    >5 sin lesions
    Nerve involvement
    Slit-skin smear positive
    RIDLEY – JOPLING CLASSIFICATION:

    RIDLEY- JOPLING
    CLASSIFICATION

    Bacteriologic Clinical
    Immunologic Histopathologic
    1. Acid fast 1. Skin lesions
    1. CMI 1. Granuloma
    bacilli 2. Nerve
    2. Lepromin involvement 2. Status of
    2. Slit-skin
    test macrophages
    smear
    TRAITS TUBERCULOID LEPROSY LEPROMATOUS LEPROSY

    CMI Good Poor

    Lepromin test Positive Negative

    Acid fast bacilli Few Numerous

    Slit-skin smear Negative Positive

    Skin lesions 1-3, asymmetric with well defined Innumerable, symmetric with ill-
    margins defined margins

    Nerve involvement 1 nerve thickened Multiple symmetric nerve


    involvement

    Granuloma Present Absent

    Status of macrophages Epithelioid type Foamy type


    TUBERCULOID LEPROSY:
    • No of skin lesions: 1-3
    • Morphology of lesions: Annular plaque with central clearing and well defined
    raised margin (saucer right way up appearance)
    • Granuloma formation destroys nerves, sweat glands and hair
     Loss of nerve – anaesthesia
     Loss of hair – alopecia
     Loss of sweat glands – anhidrosis
    BORDERLINE TUBERCULOID LEPROSY:
    • Most common type in India
    • No of skin lesions: 3-10.
    • Satellite lesions are seen.
    BORDERLINE LEPROSY:
    • Most unstable form
    • No of skin lesions: 10-30
    • Polymorphic skin lesions (size and shape) geographic map appearance seen
    • Dimorphous skin lesions
     Inner border – punched out (Swiss cheese appearance) (well defined)
     Outer border – sloping outwards (inverted saucer appearance) (ill defined)
    BORDERLINE LEPROMATOUS:
    • Skin lesions: numerous uncountable, bilateral and almost symmetrical
    • Nerve involvement: bilateral asymmetric nerve thickening
    • Onion skin appearance on histology
    • Dimorphous skin lesions
     Inner border – punched out (Swiss cheese appearance) (well defined)
     Outer border – sloping outwards (inverted saucer appearance) (ill defined)
    LEPROMATOUS LEPROSY:
    • Systemic disease with extensive cutaneous, nerve and internal organs involvement
    • Symmetrical bilateral skin lesions consisting of ill-defined macules,
    papulonodules, diffuse infiltration and thickening of skin
    • Symmetrical bilateral nerve thickenings

    EARLIEST FEATURES LATE FEATURES


    • Epistaxis • Leonine facies
    • Nasal crusting • Buddha ears
    • Pedal edema • Saddle nose
    • Gynaecomastia
    • Madrosis
    • Glove and stocking peripheral
    neuropathy
    DEFORMITIES IN LEPROSY:
    • Madrosis
    • Saddle nose deformity
    • Claw hand
    • Foot drop
    • Lagophthalmos
    • Trophic ulcers
    INDETERMINATE LEPROSY:
    • Early form of leprosy
    • CMI – Not yet determined
    • Mostly patients self-heal or can progress to TT, BT, BL, LL
    • Solitary, ill-defined, hypopigmented patch or macule seen
    • Normal sensations
    • Peripheral nerves not enlarged
    • Granuloma is absent
    HISTOID LEPROSY:
    • Type of lepromatous leprosy with dapsone resistance
    • More common in earlier times when only dapsone monotherapy used to be given
    • Shiny papules and nodules with intervening normal skin
    • Skin biopsy shows spindle shaped foamy cells
    PURE NEURITIC DISEASE:
    • Skin lesions are absent
    • Investigation of choice: Nerve biopsy
    Only sensory nerves are biopsied
    Ulnar nerve is never used since it’s a motor nerve
    Upper limb: Radial cutaneous nerve
    Lower limb: Sural nerve
    LEPROSY DIAGNOSIS FOR MCQS:
    TT BT BB BL LL
    • Single lesion • Satellite lesions • Punced out/ • Multiple • Multiple lesions
    • Single thick • Few non- Swiss cheese/ uncountable • Perfectly
    nerve symmetrical inverted saucer lesions symmetrical
    • Well-defined nerve lesions • Almost lesions
    borders thickenings and • Multiple symmetrical • Glove and
    non-symmetrical countable lesions lesions stocking
    patches • Lesions with • Multiple anaesthesia
    well-defined bilaterally • No hypo-
    inner border and thickened nerves pigmentation
    ill-defined outer • Punched out/ • Normal
    border Swiss cheese/ sensations on
    inverted saucer patches in early
    lesions stages
    • Ear lobe
    infiltration
    • Trophic ulcers
    MCQ CORNER:
    • 100% patients have nerve involvement
    • Order of sensation loss- Hot and cold differentiation> cold> hot> light touch>
    pain> deep touch
    • Earliest sensation to loss is temperature
    • Leprosy generally does not involve CNS
    • Commonest nerve involved – Ulnar nerve
    • Proprioception is not affected in leprosy

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