HANSEN’S DISEASE
DIPLOMA
IN MEDICAL
SCIENCE
SCHOOL OF
ALLIED
SCIENCE
WINDFIELD
INTERNATIONAL
COLLEGE
HANSEN’S
DISEASE
RUTH NAOMI
MANUEL
SARAVANAN
A/L SURESH
SRIRENUKAA A/P
MARIMUTHU
INTRODUCTION
Also known as leprosy
Chronic infection
Caused by Mycobacterium Leprae & Mycobacterium
Lepromatosis
Affects s...
TYPES OF LEPROSY
1-Indeterminate leprosy-
A few hypopigmented macules
can heal spontaneously
2-Tuberculoid leprosy-
A few ...
Borderline
tuberculoid leprosy-
Lesions like
tuberculoid
leprosy but
smaller and
more numerous
with less nerve
Enlargement...
Histoid leprosy
lepromatous
leprosy that
presents with
clusters of
histiocytes
(a type of cell
involved in the
inflammator...
CAUSES
• An intracellular, acid-fast bacterium
• Aerobic & rod-shaped bacterium
• surrounded by the waxy cell
membrane
• d...
Mycobacterium
Leprae
Electron
Micrograph
Acid Fast
Gram
Staining
MODE OF TRANSMISSION
Person to person-
leprosy spread
from person to
• through infected
respiratory
droplets
• Through clo...
PATHOGENECITY (VIRULENCE FACTOR)
Iron
utilization
• Help the pathogen acquire nutrients for growth
• NRAMP proteins
• Allo...
Schwann
cell invasion
Major target of
Mycobacterium leprae
To access the cells,
Mycobacterium leprae gets
into the lymphat...
PATHOGENESIS
Mycobacteri
um leprae
has a
difficult time
replicating
outside of
host cells
It is a very
slowly
replicating
...
CELL BINDING
Bacteria binds to receptors
on the host cell surface
In neural Schwann cells, the phenolic
glycolipid-1 (PGL-...
Once binding has
occurred, M.
leprae is taken
into the host cell
by phagocytosis
and is
encapsulated by a
phagosome
Surviv...
SIGNS & SYMPTOMS
Leprosy symptoms generally appear three to
five years after a person becomes infected with
bacteria
Skin ...
Hypopigmented Macule Deformity
Skin Lesions
EXAMS AND TESTS
Epidemicology Triangle of
Leprosy
Agent-
Mycobacteruim
leprae
Environment-
Transmitted by person
to person contact
Host – ...
Lab
Diagnosis
Skin
lesion
biopsy
CBC
PCR
Liver
blood
Creatinine
blood
Lepromin
skin
Incisional
biopsy
Exicisional
biopsy
Punch
biopsy
Shave
biopsy
Types of Skin
biopsy
Shave Biopsy
least invasive
method.
Your doctor uses a
small blade to remove
the outermost layers
of skin.
The area remove...
Excisional Biopsy
usually done
by a surgeon.
During the
procedure, the
entire lesion is
removed.
Numbing
medicine is
injec...
Incisional
Biopsy
Only a piece
of a large
lesion for
examination.
Numbing
medicine is
injected
into the
area.
A piece of
t...
CBC (
Complete
Blood
Count )
Most
commonly
ordered
blood tests.
The
complete
blood count
is the
calculation
of the
cellula...
PCR (Polymerase
Chain Reaction)
PCR
recombined
DNA
technology
have allowed
for
development
of genes
M.leprae
Used in
biops...
Liver
blood
test.
Most
commonly
performed
blood tests.
Can be used
to assess
liver
functions or
liver injury.
An initial s...
Creatinine
blood test.
If the kidney
become impaired
, the creatinine
level rise due to
poor clearance of
creatinine by th...
Lepromin skin test
Used to determine what type of leprosy a
person has.
A sample of inactivated leprosy-causing bacteria i...
Medication
Surgical
care
Treatment
Dapsone
Bactericidal
Mechanism of action
is the prevention of
formation of folic
acid, inhibiting
bacterial growth
Part of...
Rifampin
For use in combination
with at least 1 other
antituberculous drug.
Inhibits DNA-
dependent bacterial
RNA polymera...
Clofazimine
Inhibits
mycobacterial
growth, binds
preferentially to
mycobacterial DNA.
Has antimicrobial
properties, but
me...
Epidemiology
The number of new
cases of leprosy per
year (incidence) also
fell from
approximately
720,000 in 2000 to
about...
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
Hansen disease medical microbiology presentation by Ruth Naomi Manuel
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Hansen disease medical microbiology presentation by Ruth Naomi Manuel

  1. 1. HANSEN’S DISEASE DIPLOMA IN MEDICAL SCIENCE SCHOOL OF ALLIED SCIENCE WINDFIELD INTERNATIONAL COLLEGE
  2. 2. HANSEN’S DISEASE RUTH NAOMI MANUEL SARAVANAN A/L SURESH SRIRENUKAA A/P MARIMUTHU
  3. 3. INTRODUCTION Also known as leprosy Chronic infection Caused by Mycobacterium Leprae & Mycobacterium Lepromatosis Affects skin, nerves & eyes • Paucibacillary - 5 or less poorly pigmented numb skin patches present • Multibacillary - More than 5 poorly pigmented numb skin patches present Two main types of disease based on the number of bacteria present-
  4. 4. TYPES OF LEPROSY 1-Indeterminate leprosy- A few hypopigmented macules can heal spontaneously 2-Tuberculoid leprosy- A few hypopigmented macules some are large and some become anesthetic (lose pain, tactile and termic sensation) nerves become enlarged; spontaneous resolution
  5. 5. Borderline tuberculoid leprosy- Lesions like tuberculoid leprosy but smaller and more numerous with less nerve Enlargement nerves; this form may persist, revert to Mid-borderline leprosy- Many reddish plaques asymmetrically distributed, moderately anesthetic regional adenopathy (swollen lymph nodes)
  6. 6. Histoid leprosy lepromatous leprosy that presents with clusters of histiocytes (a type of cell involved in the inflammatory response) A grenz zone (an area of collagen separating the lesion from normal tissue) Lepromatous leprosy Early lesions are pale macules ;(flat areas) that are diffuse and symmetric Alopecia (hair loss) ; often patients have no eyebrows nerve involvement leads to anesthetic areas & limb weakness; progression leads to aseptic necrosis (tissue death from lack of blood to area) lepromas (skin nodules) disfigurement of many areas including the face
  7. 7. CAUSES • An intracellular, acid-fast bacterium • Aerobic & rod-shaped bacterium • surrounded by the waxy cell membrane • does not form capsules, flagella, or spores Mycobacterium leprae & Mycobacterium lepromatosis • Are obligate pathogens • Are unculturable in laboratory Due to extensive loss of genes necessary for independent growth ;
  8. 8. Mycobacterium Leprae Electron Micrograph Acid Fast Gram Staining
  9. 9. MODE OF TRANSMISSION Person to person- leprosy spread from person to • through infected respiratory droplets • Through close contact with the affected person Genetics • Parents of someone with leprosy • Children of someone with leprosy The extent of exposure Environmental conditions • Poor hygiene condition
  10. 10. PATHOGENECITY (VIRULENCE FACTOR) Iron utilization • Help the pathogen acquire nutrients for growth • NRAMP proteins • Allow transportation of iron into the macrophage for survival Waxy exterior • Allows intake into the macrophage and into some dendritic cells in which it can survive Macrophage invasion • Prevent phagosome and lysosome fusion to avoid degradation • Bacteria are absorbed into the phagolysosome
  11. 11. Schwann cell invasion Major target of Mycobacterium leprae To access the cells, Mycobacterium leprae gets into the lymphatic system and the blood vessels Mycobacterium leprae binds to the Schwann cell via laminin-binding protein The bacteria will enter through the vascular epithelium into the cell Drug resistance Allow it to continue to survive despite antimicrobial presence
  12. 12. PATHOGENESIS Mycobacteri um leprae has a difficult time replicating outside of host cells It is a very slowly replicating bacteria that can take up to 13 days Leprosy - bacterial replication inside intracellular vesicles • macrophages, Schwann cells, & endothelial cells
  13. 13. CELL BINDING Bacteria binds to receptors on the host cell surface In neural Schwann cells, the phenolic glycolipid-1 (PGL-1) or LBP21 receptor on M. leprae binds to the α-2 side chain of laminin- 2 & α-dystroglycan receptor(1) Presence of the histone-like protein Hlp, secreted by M. leprae, enhances Schwann cell binding Facilitates phagocytosis by the classical complement pathway
  14. 14. Once binding has occurred, M. leprae is taken into the host cell by phagocytosis and is encapsulated by a phagosome Survive phagosome- lysosome fusion & live long enough to replicate Replication will take place
  15. 15. SIGNS & SYMPTOMS Leprosy symptoms generally appear three to five years after a person becomes infected with bacteria Skin lesions that are lighter than your normal skin color; lesions have decreased sensation to touch, heat, or pain and lesions do not heal after several weeks to months Numbness or absent sensation in the hands, arms, feet, and legs Muscle weakness Eye problems Skin rash Skin stiffness
  16. 16. Hypopigmented Macule Deformity Skin Lesions
  17. 17. EXAMS AND TESTS
  18. 18. Epidemicology Triangle of Leprosy Agent- Mycobacteruim leprae Environment- Transmitted by person to person contact Host – Infected to human
  19. 19. Lab Diagnosis Skin lesion biopsy CBC PCR Liver blood Creatinine blood Lepromin skin
  20. 20. Incisional biopsy Exicisional biopsy Punch biopsy Shave biopsy Types of Skin biopsy
  21. 21. Shave Biopsy least invasive method. Your doctor uses a small blade to remove the outermost layers of skin. The area removed includes all or part of the lesion. Do not need stitches. At the end of the procedure, medicine is applied to the area to stop any bleeding.
  22. 22. Excisional Biopsy usually done by a surgeon. During the procedure, the entire lesion is removed. Numbing medicine is injected into the area. The entire lesion is removed, going as deep as needed to get the whole area. The area is closed with stitches. If a large area is biopsied, a skin graft or flap of normal skin may be used to replace the skin that was removed.
  23. 23. Incisional Biopsy Only a piece of a large lesion for examination. Numbing medicine is injected into the area. A piece of the growth is cut and sent to the lab for examination. You may have stitches, if needed. The rest of the growth can be treated after the diagnosis is made.
  24. 24. CBC ( Complete Blood Count ) Most commonly ordered blood tests. The complete blood count is the calculation of the cellular (formed elements) of blood. Determined by special machines that analyze the different component s of blood in less than a minute. To measure of the concentrati on of white blood cells, red blood cells, and platelets in the blood.
  25. 25. PCR (Polymerase Chain Reaction) PCR recombined DNA technology have allowed for development of genes M.leprae Used in biopsy samples , blood and tissue section
  26. 26. Liver blood test. Most commonly performed blood tests. Can be used to assess liver functions or liver injury. An initial step is a simple blood test to determine the level of certain liver enzymes (proteins) in the blood. But when the liver is injured for any reason, these enzymes are spilled into the blood stream.
  27. 27. Creatinine blood test. If the kidney become impaired , the creatinine level rise due to poor clearance of creatinine by the kidney. Found to be a fairly reliable indicator of kidney function. Elevated creatinine level signifies impaired kidney function.
  28. 28. Lepromin skin test Used to determine what type of leprosy a person has. A sample of inactivated leprosy-causing bacteria is injected just under the skin, usually on the forearm, so that a small lump pushes the skin up. The lump indicates that the antigen has been injected at the correct depth. The injection site is labelled and examined 3 days, and again 28 days, later to see if there is a reaction.
  29. 29. Medication Surgical care Treatment
  30. 30. Dapsone Bactericidal Mechanism of action is the prevention of formation of folic acid, inhibiting bacterial growth Part of a 2-drug regimen for treatment of paucibacillary leprosy; part of a 3-drug regimen for treatment of multibacillary leprosy
  31. 31. Rifampin For use in combination with at least 1 other antituberculous drug. Inhibits DNA- dependent bacterial RNA polymerase. Cross-resistance may occur. Treat for 6-9 months or until 6 months have elapsed from time of negative sputum test.
  32. 32. Clofazimine Inhibits mycobacterial growth, binds preferentially to mycobacterial DNA. Has antimicrobial properties, but mechanism of action is unknown. Part of 3- drug regimen for treatment of multibacillary leprosy.
  33. 33. Epidemiology The number of new cases of leprosy per year (incidence) also fell from approximately 720,000 in 2000 to about 300,000 in 2005 Since then this has stabilised, with an estimated 230,000 new cases reported in 2010. The highest numbers of new cases in 2010 were reported from India, Brazil, Indonesia, the Democratic Republic of Congo, and Ethiopia

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