Leprosy, also known as Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae. It primarily affects the skin and peripheral nerves. Leprosy remains a public health problem in many tropical and subtropical countries. It is classified based on clinical, bacteriological, immunological and histopathological features. Complications can include reactions, peripheral nerve damage leading to numbness and deformities, and eye and bone complications. Treatment involves multidrug therapy to cure the disease and prevent further disability.

1. LEPROSY
Hansen`s Disease

2. :
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3. it is the oldest disease in history and
still worldwide sociomedical and
economic problem, chronic
infectious diseaseas it can lead to
deformities and can leave a crippled
patient burdens on his family and his
society .
It principally affects the skin and
peripheral nerves.
Leprosy (Hansen’s disease(

4. Epidemiology
 It is endemic in tropical and subtropical countries .
It is common and endemic in certain area in upper
Egypt e .g Assiut & Giza
In lower Egypt e.g Sharkeia &
Gharbeia .

5. M. leprae is discovered by Hansen from Norway in 1873
Aetiology
-Mycobacterium leprae .
-discovered by Hansen in Norway 1873
-It is can not be cultured in artificial media .
- it can be growen in mouse footpad and armadillo .

6. BACTERILOGY (cont.(
 . M . Leprae are straight or slightly curved rod like bacteria
 They look like M. tuberculosis stained with Ziehl – Neelsan
stain . But are less acid fast and alcohol fast .
bacteriological index is the density of M leprae in
smear it includes living and dead
bacilli .
morphological index.
is percentage of living bacilli it indicates
if patient is infectious
or not and response to treatment

7. Mode of transmission
 droplet infection is main mode of infection
There is personal susceptibility which decides if a contact will be
infected or not
The majority of human beings have no susceptibiity
 Contact through the skin (rare).
 Arthropod-born infection (rare).
 Through placenta and milk.
Leprosy is not STD or directly inherited.

8. Predisposing or risk factors
Age : in all age groups .Peak of onset is 10-20 years Children
are more susceptible
Sex : male to female ratio in adult was 2 : 1 last years it is
going to be equal .
1.Residence in an endemic area.
2.Having a blood relative with leprosy.
3.Poverty (malnutrition).
4.Contact with affected armadillo.

9. pathogenesis

10. Classification
Based on the clinical, ibacteriologic,immunologic
and histopathologicfeatures
leprosy is classified into main
types
1.Paucibacillaryexample: (Tuberculoidleprosy) (TL) (with
scanty or absent bacilli) -Skin lesions, loss of sensation.
2.Multibacillary(Border line) (with numerous bacilli)---numerous
skin lesions, loss of sensation, can go to
3.Multibacillary(lepromatousleprosy) (LL).Nodules and
plaques, thickened dermis, loss of sensation, neuronal damage,
nasal congestion, epistaxis.

11. Classification & Clinical Presentation
Jopling Classification
Based on Host Immunity
TT BL LL
BT BB BL

12. Classification & Clinical PresentationClassification & Clinical Presentation
WHO Classification
Based on Bacterial Load
Paucibacillary Multibacillary
Slit Skin Smear
PositiveNegative

13. LEPROSY
Paucibacillary (PB( Multibacillary (MB(
Indeterminate Leprosy (IL(
Tuberculoid Leprosy (TL(
Borderline Tuberculoid (BT(
Borderline Borderline (BB(
Borderline Lepromatous(BL(
Lepromatous Leprosy (LL(

14. CLINICAL PICTURE
Indeterminate Leprosy
Tuberculoid Leprosy
Borderline Leprosy
BT BB BL
Lepromatous Leprosy

15. Indeterminate Leprosy (IL(
 Usually single (multiple) macule / patche.
 Hypopigmented or faintly erythematous.
 Sensation normal but sometimes imparied.
 The peripheral nerves normal.
 Slit skin smear negative.

16. Indeterminate leprosy :Hypopigmented patch, sensation normal,
no palpable peripheral nerve and slit skin smear negative.

17. Tuberculoid Leprosy (TL(

Usually single but may be few (<5).
 Hypopigmented / erythematous plaque.
 Well defined borders.
 Sensation markedly imparied.
 Enlarged peripheral nerve.
 Slit skin smear negative

18. Tuberculoid leprosy: Two hypopigmented patches, hypoasthetic
well defined borders, palpable peripheral nerve and SSS negative.

19. Tuberculoid Leprosy: Annular, erythematous, anasthetic patch with
well defined and raised borders and SSS Negative.

21. Borderline Leprosy (BL)
(BT,BB,BL)
 Few / many asymmetrical patches.
 Partly well-defined borders.
 Sensory impairments range from slight to marked.
 Slit skin smear usually positive.
 P. nerves asymmetrically enlarged.
 Annular plaque in leprosy are most commonly border line with characteristic
punched out internal border and sloping outer border(swiss cheese
appearance)

22. Borderline Tuberculoid Leprosy: Well-defined large anaesthetic patches
with satellite lesions. SSS Negative.

23. Borderline Borderline Leprosy: Less defined, asymmetrically distributed
hypoaesthetic patches. SSS positive.

24. Borderline Lepromatous Leprosy: Numerous, hypoaesthetic almost
symmetrically distributed patches . SSS positive.

25. Lepromatous Leprosy (LL(
 Very numerous ill defined lesions.
(macules, patches, papules,and nodules).
 Symmetrically distributed allover the body
 Loss of eyebrows and eyelashes.
 Leonina facies.
 No sensory impairments in lesions .
 Peripheral nerves symmetrically enlarged.
 Slit skin smear always positive.

28. Lepromatous Leprosy: Leonine Face

29. Mucous membrane
involvement
Very common
Usually epistaxis
Dryness ,rhinorrhea and
obstruction of Nose
Nerve involvement
Bilateral symmetrical
thickening
of all nerves
Nerve fibrosis is very late in
lepromatous leprosy, so loss of
sensation is also very late.
Bilateral Glove and stocking
anasthesia
is present in all advanced cases
of lepromatous leprosy.

30. Diagnosis of Leprosy
1. Clinical Examination.
2. Slit Skin Smear.
3. Skin Biopsy.

31. 1.Clinical examination:
What are the cardinal skin signs of leprosy?
1. Hypopigmented or erythematus patch / plaque
2. Complete / partial loss of sensation.
3. Thickening of peripheral nerves.

32. 1.History
Familial or extrafamilial contact
Parasthesia
Numbness
Epistaxis

33. 2.Clinical examination
I.1(E, Temperature & painxamine all modalities of
sensation in the skin lesion “Touch”
II.2(Examine peripheral nerves for Tenderness,
consistency and size:
III.Head: Supraorbital
IV.Neck: Great auricular n.
V.Elbows: Ulnar n.
VI.Wrists: Superficial radial cut. And median n.
VII.Popliteal fossa: Common peroneal n.
VIII.They may be cord-like, beaded, thinned or may show
abscess formation.

34. 3.Investigations
)1(Nicotinic acid test:
“Professor Dr. El-Arini”
15mg nicotinic acid IM injection Hypopigmented
macule becomes erythematous within 10-15 mins.
*Value:
Quick office test for early detection of hypopigmented
lesions of leprosy.

35. )2(Bacteriological examination:
Nasal smear
Not recommended)?(:
Painful for the patient & may reveal +ve
results in contacts
On treatment, lepra bacilli disappear from
nasal mucus earlier than from skin.
It’s very difficult to prove the bacilli ara M.
Leprae

36. 2.Slit Skin Smear
 Simple and valuable test.
 It is needed for diagnosis.
 Monitor the progress of the treatment.

37. Slit Skin Smear (method(.
 Pinch the site tight.
 Incise.
 Scrape & collect material
 Smear on a slide.
 Air dry & fix.
 Stain (Z-N method)

38. Slit Skin Smear (site(.
 Ear lobe.
 Forehead.
 Gluteal region.
 Active edge of patch.

39. Slit Skin Smear (Reporting the smear(.
Bacteriological indexBacteriological index
00––no bacilli in 100 fieldsno bacilli in 100 fields
11+:+:1-101-10bacilli in 100 fieldsbacilli in 100 fields
22+:+:1-101-10bacilli in 10 fieldsbacilli in 10 fields
33+:+:1-101-10bacilli in 1 fieldbacilli in 1 field
44+:+:10-10010-100bacilli in 1 fieldbacilli in 1 field
55+:+:100-1000100-1000in 1 fieldin 1 field
66+: <+: <10001000bacilli field (globibacilli field (globi(.(.
Morphological indexMorphological index
The percentage of living bacilli to
the total number of bacilli in the
smear.

40. 3.Skin biopsy
- TO verify the diagnosis & classification
- The biopsy must be deep enough to include dermis

45. It’s a sudden change in the clinical picture of the disease because
of conflict between the bacilli and the immune system of the host.
What are the precipitating factors ?
1.1. Effective treatment.Effective treatment.
2.2. Intercurrent infection.Intercurrent infection.
3.3. Physical stress.Physical stress.
4.4. Surgical operation.Surgical operation.
5.5. Pregnancy.Pregnancy.
6.6. Sometimes spontaneously.Sometimes spontaneously.
LEPROSY REACTIONLEPROSY REACTION

46. TYPES OF LEPRA REACTIONS
Type I
•Change in host CMI
•Seen in borderlines
•Skin and nerve lesions
Type II
•Antigen antibody
•Seen in LL & BL leprosy
•Skin, nerve & systemic
involvement

47. Type I Lepra Reaction
(Reversal Reaction(
 Seen in BT, BB & BL.
 Sudden onset.
 Eythematous & odematous changes in old lesions.
 Appearing of new lesions.
 Tenderness & swelling of peripheral nerves.
Treatment of type I Reaction:
1. Continue MDT.
2. NSAID.
3. Systemic corticosteroid.

48. Type II Lepra Reaction (ENL(
 Acute onset of constitutional symptoms.
 Appearance of ENL-like skin lesions.
 Visceral manifestations includes :-
Iridocyclitis, hepato-splenomegaly, epididmo-
orchitis, nephritis, pleuritis, lymphadenitis &
neuritis.
Treatment of type II Reaction:
1. Continue MDT.
2. NSAID
3. Thalidoamide ( clofazimine, corticosteroid )

49. Lucio phenomena
Unusual reaction seen exclusively in patien from
Mexico
Having diffusue leprometus form of leprometus leprosy
,who left untreated
•Patient develop recurrent crops of large and sharply
marginal ulcerative lesion (lower extremities(

50. COMLICATIONS
OF
LEPROSY

51. COMLICATIONS OF LEPROSY
1. Reactions.
2. Complications of peripheral nerves.
3. Complications of eyes
4. Complication of bones

52. COMPLICATIONS
OF
PERIPHERAL NERVES

53. Peripheral nerves
Sensory Motor Autonomic
Hypoaestesia / anaestesia Muscle paralysis Lack of sweating & sebum
Ulcers Ulnar nerve Claw hand
Radial nerve Wrist drop
Lt. popliteal Foot drop
Post. tibial Claw toes
Facial lagophthalmous
Dry skin
Cracked skin
Ulcers

57. COMPLICATIONS
OF
EYE

58. Involvment of the ophthalmic division of the (5th
.) trigeminal nerve
Corneal sensation imparment
Patients ignore injuries
keratitis, conjunctivitis and ulcers
Involvment of zygomatic & temporal braches of the (7th
.) facial nerve.
Lagophthalmos
Unable to close the eye (unbliking stare)

61. Complications Of Bones
Bone damage in Leprosy is confined to bones of hand , feet &
skull.

62. In the skull two pathognomonic changes occurs
1-Atrophy of anterior nasal spine.
Nasal collapse
2-Atrophy of maxillary alveolar process.
Loss of upper central incisors
These two skull changes known as “facies leprosa”

65. TREATMENT

66. LEPROSY IS A CURABLE DISEASE
 Leprosy treatment is simple, & the drugs are
supplied in backs
 All you have to do is decide which course of
treatment the patient needs and make sure that
he take it regularly.

67. Drugs used in Leprosy treatment
What are the three commonly used drugs?
1. Dapson.
2. Rifampicine.
3. Clofazimine.
The combination of these three drugs is
known as Multi Drug Therapy (MDT)

68.  Rifampicin is highly bactericidal 99.999% of bacilli will be killed within 3
monthly doses.
 Dapsone & clofazimine are weekly bactericidal, but in combination
will
kill 99.999% of bacilli within 3 months.
 MDT (Chemotherapy) renders Leprosy patients non-infectious.

69. MDT for PB leprosy
6 months
Monthly dose
Rifampicin 600mg
Dapsone 100 mg
Daily dose
Dapsone 100 mg

70. Multidrug Therapy (MDT) for Paucibacillary Leprosy (PB)

71. MDT for MB leprosy
24 months
Monthly dose
Rifampicin 600mg
Clofazimine 300 mg
Dapsone 100 mg
Daily dose
Dapsone 100mg
Clofazimine 50 mg

72. Multidrug Therapy (MDT) for Multibacillary Leprosy (MB)

73. Multi Drug TherapyMulti Drug Therapy
24 months
6 months

74. “
”
Prophylaxis
1-BCG Vaccine : it has protective effect as it can
help until a vaccine becomes available.
3-small dose of Dapsone can be used as
prophylactic for contacts at risk , though it is
liable to give chance for dapsone resistance . But
now it is the only available prophylactic measure
for contacts at risk.
2- Armadillo Derived Vaccine (heat killed M.lepra) + BCG and
vaccines derived from cultivable mycobacteria are now under trials .

75. thanks