This document discusses leprosy (Hansen's disease), including:
- Gerhard Armauer Hansen discovered Mycobacterium leprae in 1873.
- Clinical features include skin lesions and loss of sensation in fingers and toes.
- Lepromatous leprosy is the most infectious form, characterized by numerous acid-fast bacilli in skin scrapings.
- Diagnosis involves skin smears and biopsies to identify acid-fast bacilli within macrophages.
- Multi-drug therapy (MDT) uses dapsone, rifampicin, and clofazimine to treat paucibacillary and multibacillary forms of the
Scabies is a superficial epidermal infestation by the mite Sarcoptes scabiei var. hominis.
Etiologic Agent:
S. scabiei var. hominis. Thrive and multiply only on human skin, i.e., obligate human parasite.
Transmission
Skin-to-skin contact
Fomites: Mites can remain alive for >2 days on clothing or in bedding; hence, scabies can be acquired without skin-to-skin contact.
intimate personal contact, such as having sexual intercourse
Scabietic (Scabious) Nodule:Inflammatory papule or nodule ;burrow sometimes seen on the surface of a very early lesion.• Distribution : Areola, axillae, scrotum, penis.
Scabies is a superficial epidermal infestation by the mite Sarcoptes scabiei var. hominis.
Etiologic Agent:
S. scabiei var. hominis. Thrive and multiply only on human skin, i.e., obligate human parasite.
Transmission
Skin-to-skin contact
Fomites: Mites can remain alive for >2 days on clothing or in bedding; hence, scabies can be acquired without skin-to-skin contact.
intimate personal contact, such as having sexual intercourse
Scabietic (Scabious) Nodule:Inflammatory papule or nodule ;burrow sometimes seen on the surface of a very early lesion.• Distribution : Areola, axillae, scrotum, penis.
Oldest disease known to mankind
First described in ancient Indian
texts as “Kustha roga” attributed ]
to curse from God
Leper : Greek “scaly”
Hansen’s Disease – 1873 Norwegian Armauer Hansen discovered that leprosy is caused by bacterium - Mycobacterium leprae
Albert Neisser (1879) – stained the organism with fuchsin & gentian violet ( AFB )
Key facts
Leprosy is a chronic infectious disease caused by a type of bacteria, Mycobacterium leprae.
The disease predominantly affects the skin and peripheral nerves. Left untreated, the disease may cause progressive and permanent disabilities.
The bacteria are transmitted via droplets from the nose and mouth during close and frequent contact with untreated cases.
Leprosy is curable with multidrug therapy (MDT).
Leprosy is reported from all the six WHO Regions; the majority of annual new case detections are from South-East Asia.
Overview
Leprosy is an age-old disease and is described in the literature of ancient civilizations. It is a chronic infectious disease which is caused by a type of bacteria called Mycobacterium leprae. The disease affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the eyes. Leprosy is curable and treatment in the early stages can prevent disability. Apart from the physical deformity, persons affected by leprosy also face stigmatization and discrimination.
Scope of the problem
Leprosy is a neglected tropical disease (NTD) which still occurs in more than 120 countries, with more than 200 000 new cases reported every year. Elimination of leprosy as a public health problem globally (defined as prevalence of less than 1 per 10 000 population) was achieved in 2000 (as per World Health Assembly resolution 44.9) and in most countries by 2010. The reduction in the number of new cases has been gradual, both globally and in the WHO regions. As per data of 2019, Brazil, India and Indonesia reported more than 10 000 new cases, while 13 other countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines, Somalia, South Sudan, Sri Lanka and the United Republic of Tanzania) each reported 1000–10 000 new cases. Forty-five countries reported 0 cases and 99 reported fewer than 1000 new cases.
Transmission
The disease is transmitted through droplets from the nose and mouth. Prolonged, close contact over months with someone with untreated leprosy is needed to catch the disease. The disease is not spread through casual contact with a person who has leprosy like shaking hands or hugging, sharing meals or sitting next to each other. Moreover, the patient stops transmitting the disease when they begin treatment.
Diagnosis
The diagnosis of leprosy is done clinically. Laboratory-based services may be required in cases that are difficult to diagnose.
The disease manifests commonly through skin lesion and peripheral nerve involvement. Leprosy is diagnosed by finding at least one of the following cardinal signs: (1) definite loss of sensation in a pale (hypopigmented) or reddish skin patch; (2) thickened or enlarged peripheral nerve, with loss of sensation and/or weakness of the muscles supplied by that nerve; (3) microscopic detection of bacilli in a slit-skin smear.
Based on the above, the cases are classified into two types for treatment
This ppt contains all the information about the Epidemiology of leprosy. It is useful for students of the medical field learning Preventive and social medicine, Swasthavritta (Ayurved), and everyone who is interested in knowing about it
Mycobacterium is a genus of Actinobacteria, given its own family, the Mycobacteriaceae. Over 190 species are recognized in this genus. This genus includes pathogens known to cause serious diseases in mammals, including tuberculosis (Mycobacterium tuberculosis) and leprosy (Mycobacterium leprae) in humans.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
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The four main behavioral effects of AUD are impaired control over
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the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
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4. 2. What is the generation time of
Mycobacterium laprae
a. 20 minutes
b. 20 hours
c. 12-13 days
d. 20 weeks
5. 3. A 40-year-old woman who has lived in southwest Louisiana all
her life presents to the emergency room. She has strange-
looking, raised areas on her face, arms, and legs. She also
complains that she is losing feeling in her fingers and toes. She
says that when she cuts or burns herself, she does not feel it
and that makes the injury even greater because she does not
know to pull away from the injuring source. A Gram stain of
scrapings from the raised areas on her skin shows thin bacterial
rods that do not take up the stain. However, an acid fast stain
of the same material shows numerous bacilli. What disease is
the woman most likely to have?
a. Borderline tuberculoid leprosy
b. Lepromatous leprosy
c. Scrofula
d. Tuberculoid leprosy
6. • Lady Windermere syndrome is caused by M. avium-
complex, usually in elderly female nonsmokers, resulting in
a very serious lung infection with this organism.
• Scrofula is a term usually reserved for tuberculosis of the
neck, but the disease is really a cervical lymphadenopathy
caused by Mycobacterium tuberculosis.
• The woman obviously has leprosy due to the presence of
acid-fast staining bacilli in the skin scrapings and the loss of
feeling in her fingers and toes. This is caused by the
bacterium infecting and destroying nervous tissue in these
areas. Leprosy is also known as Hansen disease, after the
discoverer of the causative organism of the disease,
Mycobacterium leprae.
• Tuberculoid leprosy (also called paucibacillary Hansen
disease) is the mild form of the disease with few organisms
observed in skin scrapings.
• Lepromatous leprosy is the fulminant form of the disease
with numerous bacilli seen in skin scrapings.
7. 4. Single skin lesion is seen in which type
of Leprosy:
a. LL
b. TT
c. BL
d. BT
8. 5. The most infectious type of leprosy
is:
a. Lepromatous leprosy
b. Tuberculoid leprosy
c. Borderline-tubercoloid leprosy
d. None of the above
9. 6. Lepromatous leprosy is observed in
patients with:
a. Deficient cell mediated immunity
b. Adequate cell mediated immunity
c. Adequate humoral immunity
d. None of the above
10. 7. Which type of hypersensitivity reaction
is involved in lepromin test?
a. Type I
b. Type II
c. Type III
d. Type IV
11. 8. The following test is not used
for diagnosis of leprosy :
a. Lepromin test
b. Slit skin smear
c. Fine needle aspiration cytology
d. Skin biopsy
12. 9. The characteristic finding in a case
of leprosy is:
a. Culture test is positive in 2-3 months in
LJ media
b. Long contact with tuberculoid leprosy
can transmit the disease
c. CMI is seen in Lepromatous leprosy
d. Macule lesion heals spontaneous
13. 10. Exacerbation of lesions in patients of
borderline leprosy is seen in :
a. ENL (erythema nodosum leprosum)
b. Lepra reaction type 1
c. Jarisch-Herxheimer reaction
d. Both a & b.
14. 11.The following drug is not used for the
treatment of type II lepra reaction :
a. Chloroquin
b. Thalidomide
c. Cyclosporine
d. Corticosteroids
15.
16. 12. Lepra cells found in lepromatous leprosy are
:
b. Neutophils
c. Lymphocytes
d. Macrophages
e. Plasma cells
17. 13. Globi is :
a. Histocyte containing acid-fast bacillus
b. Lymphocyte containing acid-fast bacillus
c. Nutrophill containing acid-fast bacillus
d. Large lymphocyte containing acid-fast bacillus
19. Key facts about LEPROSY -
Leprosy is a chronic infectious
disease caused by an acid-fast,
rod-shaped bacillus,
Mycobacterium leprae.
Not cultivable: M. leprae is not
cultivable either in artificial
culture media or in tissue
culture; (does not follow the
Koch's postulates).
can be maintained in animal-
nine banded armadillo (Dasypus
noverncinctus) and foot pad of
mice (kept at a low temperature,
200C).
.
20.
21. M. leprae
Intracellular: Lepra bacilli are obligately intracellular and
strict aerobe.
Less acid fast: Compared to tubercle bacilli, they are less
acid fast and can resist up to 5% sulfuric acid.
Appearance: In smears made from skin lesions, they appear
in groups, called cigar-like bundles of bacilli(globi) present
inside lipid laden macrophages called virchow's lepra cells.
multiplies very slowly
incubation period – about 3 to 5 years.
Lepromarous cases have longer incubation period than
tuberculoid cases.
22. not highly infectious.
transmitted via droplets, from the nose
and mouth, during close and frequent
contacts with untreated cases.
Untreated, leprosy can cause progressive
and permanent damage to the skin,
nerves, limbs and eyes.
23. Transmission
• not highly infectious
• The exact mechanism of transmission of
leprosy is not known
• transmitted via droplets, from the nose and
mouth, during close and frequent contacts
with untreated cases.
• occur at all ages (ranging from early infancy
to very old age).
24. Risk Factors -
• Close contact — Contacts of patients with leprosy have a higher risk
of developing leprosy than the general population
• People who live in the areas where leprosy is endemic
parts of India, China, Japan, Nepal, Egypt, and other areas
especially those people in constant physical contact with
infected people.
• Immunity – immunocompromised individuals are more
susceptible to infection.
• Genetic influences - There is some evidence that genetic defects
in the immune system may cause certain people to be more likely
to become infected (region q25 on chromosome 6).
• Armadillo exposure — Leprosy is enzootic in the nine-banded
armadillo
25. Classification
• Two types of classification :
▫ Skin smear result classification. ( WHO )
▫ Clinical classification. (Ridley Jopling)
26. Classification -
▫ Skin smear result (WHO) classification :
1. Paucibacillary leprosy (PB) – few Bacilli;
• Two to five skin lesions with
• Negative skin smear results at all sites.
2. Multibacillary leprosy (MB);
• Any form of leprosy in which the patient shows positive
smears at any site
32. Clinical features -
1. Skin lesions, usually anaesthetic
Hypopigmented or erythematus patch / plaque .
2. Complete / partial loss of sensation.
Painless wounds or burns on the hands or feet
Paresthesias: tingling or numbness in the hands or feet
Diminished sensation or loss of sensation within skin patch(es)
3. Thickening of peripheral nerves.
4. Lumps / swelling on the earlobes or face.
5. Tender, enlarged peripheral nerves.
33. Symptoms-
• Paucibacillary (PB) :
– Well defined skin lesions that are numb
• Multibacillary (MB) :
Chronically stuffy nose and
many skin lesions and
nodules on both sides of the body
34. Sings -
• Large bumps on the skin that
do not feel pain
do not heal for weeks or months
• Muscle weakness
• Disappearance of eyebrows or eyelashes
38. Tuberculoid leprosy: Two hypopigmented patches, hypoasthetic well
defined borders, palpable peripheral nerve and SSS negative.
39. Borderline lepromatous leprosy
(BL/MB)
Borderline lepromatous case showing borderline tuberculoid and
"punched- out" mid borderline lesions together with papular and
nodular lesions more typical of lepromatous disease.
40. A -Claw hand due to median
and ulnar nerve damage.
B- hands showing neurotrophic
atrophy.
41. Pathogenesis
• M. leprae is an obligate intracellular acid-fast bacillus with
unique ability to enter nerves
• The areas most commonly affected are- superficial
peripheral nerves , skin, mucous membranes of the upper
respiratory tract, eyes , and tests
• 95% of people who are exposed do not develop disease
• Tissue damage is depend upon -
the degree to which cell-mediated immunity is expressed
the extent of bacillary spread and multiplication
immunologic complication and
nerve damage
42. Diagnosis
• Diagnosis of leprosy- most commonly based
on the clinical sign and symptoms.
• In an endemic country or area, an individual
should be regarded as having leprosy if shows
one of the following cardinal signs :
skin lesion consistent with leprosy and with
definite sensory loss, with or without
thickened nerves
positive skin smears
43. Smear Microscopy
• Smear microscopy is done to demonstrate the
bacilli in the lesions.
• Specimen Collection-
Total 6 samples are collected;
4 from skin (forehead, cheek, chin and bunock)
1 from ear lobe and nasal mucosa by nasal
blow/scraping.
• With paucibacillary leprosy, no bacteria will be
detected.
44. Silt skin smear
• Silt skin smear prepared- from the skin and ear lobe
specimens.
• The edge of the lesion is the preferred site.
• Lesion is cleaned with spirit, then is pinched up light to
minimize bleeding.
• A 5 mm long incision is made with a scalpel, deep
enough to get into the infiltrated layers.
• After wiping off blood or lymph that may have exuded,
the scalpel blade is rotated transversely to scrape the
sides and base of the incision so as to obtain a tissue
pulp from below the epidermis- which is smeared
uniformly over an area of 8 mm diameter on a slide.
46. Nasal specimens
• Nasal blow: Early morning mucus material is
collected by blowing the nose on a clean
cellophane sheet
• Nasal scraping: By using a mucosal scraper to
scrape the nasal septum sufficiently so as to
remove a piece of mucous membrane ,
transferred onto a slide to make a uniform
smear.
47. • Biopsy from the thickened nerves and nodular
lesions may be necessary in some cases.
48. DIAGNOSIS OF LEPROSY
• Hypopigmented or reddish skin
lesion(s) with definite loss of sensation
• Damage to the peripheral nerves, as
demonstated by loss of sensation
• Weakness of the muscles of hands, feet
or face
• Positive skin smear
49. Treatment
• Common drugs
1. Dapson
2. Refampicine
3. Clofazimine
The combination of these three drugs
Is known as multi drug therapy (MDT)
52. Complication -
• disfigurement
• hair loss (particularly on the eyebrows and eyelashes)
• muscle weakness
• permanent nerve damage in the arms and legs
• inability to use the hands and feet
• Nosebleeds
• iritis (inflammation of the iris of the eye), glaucoma
(an eye disease that causes damage to the optic
nerve), and blindness
• Infertility
• kidney failure