The document presents an overview of leprosy (Hansen's disease), including its causative organism, Mycobacterium leprae, and its various cultivation techniques. It discusses the incidence, modes of transmission, immunology, classifications, diagnostic methods, and treatment protocols such as multi-drug therapy (MDT) for different forms of leprosy. Key points include the lepromin test for classification, the importance of T-cell immune response, and the geographical prevalence of the disease.

1. LEPROSY
HANSEN’S DISEASE
PRESENTED BY
YASH MEHTA
INSTITUTE OF DENTAL STUDIES AND TECHNOLOGIES (IDST)

2. CONTENTS OVERVIEW
• CAUSITIVE ORGANISM
• CULTIVATION
• TECHNIQUES OF DEMONSTRATION
• INCIDENCES
• MODE OF TRANSMISSION
• IMMUNOLOGY OF LEPROSY
• RIDLEY and JOPLING’s CLASSIFICATION
• REACTIONAL LEPROSY
• LEPROMIN TEST
• DIAGNOSTIC TESTS
• TREATMENT AND DOSAGE

3. CAUSITIVE ORGANISM
• Mycobacterium leprae
• Morphology
• Cylinder / Slightly curved
• Size : 1-8 µm * 0.2-0.5 µm
• Appearance resembles to Cigar bundle
• Found Single or In group attached by glia and
structure known as globus
• Acid fast but less than M.laprae require 5 %
H2SO4 to decolorise after Carbol Fushin dye

4. RESEMBLANCE OF M.laprae

5. CULTIVATION
• No Artificial culture progressed yet
• Nine Banded armadillo ( Dasypus
novemcinctus) highly susceptible

6. Techniques of demonstration
• 1.) Ziehl-Neelsen staining.
• 2.) Fite-Faraco staining.
• 3.) Gomori Methanamine Silver (GMS)
staining
• 4.) Molecular method by PCR
• 5.) IgM antibodies to PGL-1 antigen

7. • STAIN BY Ziehl – Neelsen Method

8. INCIDENCES
• Namely 8 countries have 80% cases
1. INDIA ( 1/3rd cases globally)
2. NEPAL
3. CHINA
4. BRAZIL
5. INDONESIA
6. MAYANMAR (BURMA)
7. MADAGASCAR
8. NIGERIA

9. MODE OF TRANSMISSION
• Direct Contact
• Placental transmission
• By Milk
Incubation Period – 2 to 20 years (avg 3 years)

10. Immunology Of Leprosy
• Antigens of Leprosy Bacilli
Phenolic Glycolipid ( PGL-1)
Lipoarabinomannan (LAMN)
• Genotype of Host
Known as MHC type or HLA type
Host response is different in different
individuals

11. • T Cell response
CD4 + T cell, CD8+T cell both activated
While in tubercular infection CD4+T cells
activated only
In tuberculoid Leprosy high response from
CD4+T Cells ( Helper T cell)
In Lepromatous leprosy high response from
CD8+T Cells (suppressor T cell),
but macrophage and suppressor T cell not
able to destroy bacilli due to CD8+T cell defect

12. • Humoral Response
Even with high level of immunoglobin (IgG,
IgA,IgM) and antibodies, but not have any
significant role in protection against
leprae bacilli

13. Ridley and Jopling’s classification
1.Tuberculoid (TT) – high resistance
2.Boderline Tuberculoid(BT)
3.Mid Borderline(BB)- diamorphic
4.Boderline Lepromatous(BL)
5.Lepromatous(LL)- low resistance

14. According to WHO
• Two types of leprosy
• 1.) Paubacilliary- includes all tuberculoid cases
and some borderline cases
• 2.) Multibacilliary- includes all Lepromatous
cases and some borderline cases

15. Reactional Leprosy
TWO TYPES

16. REVERSAL REACTION
• Polar form leprosy stable
• Borderline form leprosy unstable ,so two types
of reaction occurs
1.) Upgrading
• increased cell mediated immunity
• Case of BL moves towards tuberculoid side
2.) Downgrading
• Cases of BT moves towards Lepromatous side

17. DIFFERNCE IN TT AND LL

18. Histopathology of TT and LL
TUBERCULOID TUBERCULOSIS LEPROMATOUS TUBERCULOSIS

19. LEPROMIN TEST
• Aim : (a) To classify type of leprosy
(b) Assessment of Prognosis
(c) Assessment of Resistance
• Procedure :
Inject 0.1ml lepromin intradermally
• Observations
 Early reaction – Fernandez Reaction, erythema
and induration develop in 24-48 hrs remains for
3-5 days
Histologically- serous exudate and Lymphocytic
infiltration

20. Late reaction- Mitsuda Reactions, after 2-4
week in form of nodule that may be ulcerated
remains for few weeks
 Histologically – Epitheloid cells, lymphocyte
and giant cells
POSTIVE Mistuda – Indicate resistance to
leprosy

21. RESULT
POSITIVE NEGATIVE
CLASSIFICATION OF
LEPRROSY
TUBERCULOID LEPROMATOUS
PROGNOSIS OF
LEPRROSY
GOOD BAD
RESTISTANCE OF
LEPRROSY
HAVING RESISTANCE NO RESISTANCE
NOTE : LEPROMIN TEST IS NOT A DIAGNOSTIC TEST

22. LAB DIAGNOSIS
1.) Specimen collection
Specimen is collected from different places from
body i.e., Buttocks , chin, cheeks, forehead, ear
lobules and also from nose
Skin biopsy from active patches
Nerve biopsy from thickened nerves

23. 2.Acid Fast Staining
• Smear stained by acid fast stain
• Decolorise by 5% H2SO4
• Parallel arranged bacilli with macrophages
confirms Lepromatous tuberculosis
• Grades to smear
• 1-10 Bacilli in 100 field – 1+
• 1-10 Bacilli in 10 field - 2+
• 1-10 Bacilli per field - 3+
• 10-100 Bacilli per field - 4+
• 100-1000 Bacilli per field – 5+
• More than 1000 bacilli, Globus and clumps in every field – 6+

24. BACTERIAL INDEX (BI) :
• MAY DEFINED AS PRESENT IN TISSUE
CALCULATION: total grades divided by total
number of smears e.g.,
Smear A = +2
Smear B = +1
Smear C = +2
Smear D = +3
BI = +2+1+2+3 = 2.
4

25. MORPHOLOGICAL INDEX (MI)
• DEFINED AS Percentage of uniformly stained
layer out of total number of bacilli counted

26. • 3. Skin and nerve biopsy
• 4.Animal inoculation
• 5.lepromin test (not diagnostic test)
• 6.Serological test :Detection of
antiphenolic glycolipid-1 (anti PGL-1) ,latex
agglutination, Mycobacterium Leprae Particle
Agglutination (MLPA), ELISA are some serological
test

27. ANIMAL INOCULATION
• Ground tissue from Lepromatous nodule or
nasal scrapings injected into foot pad of mice
a typical granuloma appears at the site of
inoculation within 6 month
• Then it tested with histological examination
and Acid-fast staining
• Nine banded Armadillo is another choice for
inoculation

28. Rx- Multi Drug Therapy (MDT)
• For Paubacilliary tuberculosis (TT,BT)
 Rifampicin 600mg (supervised) – once a month
 Dapsone 100mg (unsupervised) – daily for 6 month
• Multibacilliary (BB,BL,LL)
 Rifampicin 600mg (supervised) – once a month
 Dapsone 100mg (unsupervised) – daily for 6 month
 Clofazimine 50mg (supervised) – once a month
 Clofazimine 50mg (unsupervised) – daily for a year

30. REFRENCES
HARSH MOHAN TEXTBOOK OF PATHOLOGY- 6TH
EDITION
ROBBIN’S AND CONTRAN PATHOLOGIC BASES OF
DISEASE- 9TH EDITION
DR.CP BAVEJA MICROBIOLOGY FOR DENTAL
STUDENTS – 6TH EDITION
PRESCOTT’S PRINCIPLE OF MICROBIOLOGY
SOME RELATED IMAGES FROM GOOGLE IMAGES