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Leprosy lecture
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, primarily affecting the peripheral nerves, skin, and mucous membranes, with higher prevalence in Africa, Southeast Asia, and Latin America. Transmission occurs mainly through droplet infection, human contact, and occasionally from other animal carriers; early diagnosis and treatment with multi-drug therapy (MDT) are crucial for preventing complications and disabilities. Clinical classifications are based on bacterial load and host immunity, with leprosy presenting various forms and requiring specific therapeutic regimens.
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Leprosy lecture
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- 3. It is achronic infectious disease characterized by lesions of the peripheral nerve, skin, and mucus membrane of the nasal mucosa and internal organs. World's oldest recorded disease 3 Definition
- 4. More prevalentin Africa, South east Asia and Latin America. Commonest in India. Incidence now: 1/10000 Males twice as females Children are more prone Two peaks: 10-15 and 35-45 Epidemiology
- 5. Acid fast bacillus Staining:Z-N stain Growth :Culture and Inoculation Incubation period Multiplication: very slow (Ms-ys) 5 Ateiology
- 6. Mode of infection Althoughhuman-to-human transmission is the primary source of infection, three other species can carry and (rarely) transfer M. leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos.
- 7. 1-Droplet infection 2-Contact throughthe skin (rare). 3-Arthropod-born infection (rare). 4-Through placenta and milk. Mode of infection
- 8. 1-Residence in anendemic area. 2-Poverty (malnutrition). 3-Contact with affected armadillo. 4-Genetic :DR2 &3 in TT, DQW in LL 5-Low immunity. Predisposing factors
- 9. Ridley & JoplingClassification Based on Host Immunity TT BL LL BT BB BL 9 Classification
- 10. WHO Classification Based onBacterial Load Paucibacillary 1-5 skin lesions Multibacillary >6 skin lesions PositiveNegative
- 11. LEPROSY Paucibacillary (PB) Multibacillary (MB) Indeterminate Leprosy (IL) TuberculoidLeprosy (TL) Borderline Tuberculoid (BT) Borderline Borderline (BB) Borderline Lepromatous(BL) Lepromatous Leprosy (LL) 11
- 12. In Tuberculoid leprosy 1-T-Cells: CD4 predominate 2- Humoral immunity: low antibody titer 3-Lepromin test: +ve In Lepromatous leprosy 1-T-Cells : CD8 predominate 2- Humoral immunity: high antibody titer 3-Lepromin test: -ve Immunology
- 13. Skin lesions Peripheral nerves Internalorgans Bacteriology Histopathology Lepromin test Course and prognosis Clinical features
- 14. 1-Type of leprosy 2-Mechanism 3-Clinicalfeatures 4-Histopathology 5-Lepromin test 6-Treatment Reactions
- 15. BLBBBT ManySomeFew(<5)Lesion no. RoughlyLessWellLesions borders SlightModerateMarkedSensory impairment Roughly symmetrical AsymmetricalAsymmetricalDistributionof skin lesions Less asymmetrical AsymmetricalAsymmetricalPeripheral nerves MultibacillaryMultibacillaryPaucibacillaryType of leprosy 4+2+ / 3+- / 1+Slit skin smear
- 16. Diagnosis of Leprosy ClinicalExamination Slit Skin Smear Skin Biopsy
- 17. Pinch the sitetight. Incise. Scrape & collect material Smear on a slide. Air dry & fix. Stain (Z-N method) 17 Slit Skin Smear
- 21. 0 – nobacilli in 100 fields 1+: 1-10 bacilli in 100 fields 2+: 1-10 bacilli in 10 fields 3+: 1-10 bacilli in 1 field 4+: 10-100 bacilli in 1 field 5+: 100-1000 in 1 field 6+: >1000 bacilli field (globi). Bacteriological Index
- 22. BI is calculatedby adding up the index from site examined and dividing by the total number TT:-ve +BT:0-2 LL & BL:5+ or 6+
- 23. The percentage ofliving bacilli (solid staining bacilli) to the total number of bacilli (fragmented and granular) in the smear. Morphological index
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- 29. TT BT BBBL LL Skin Lesions No. of Bacilli Slit skin test Immunity Clinical spectrum of leprosy
- 30. Other tests: Histamine test:for the diagnosis of indeterminate leprosy Immunological tests Test for detecting CMI Test for detecting antibobies
- 31. Lepromin skin test: To differentiate the two different forms of leprosy apart, but it is not used to diagnose the disease Because: false negative and false positive Test for detecting CMI
- 32. Procedure to LeprominSkin Test A tiny sample (0.1) of leprosy antigen is injected under the skin, usually in the forearm. The site of the injection is marked, and is examined for reaction, first after 3 days(early reaction- Fernandez reaction:-redness and induration) and then again after 21 days(late reaction-Mitsuda reaction:-nodule>5mm). Lepromin Skin Test
- 33. Test for detectingantibobies 1-Fluorescent leprosy antibody absorption test(FLA-ABS test):-Screening 92.3% Sensitive & 100% specific 2-Monoclonal antibodies 3-ELISA 4-Radioimmunoassay: cell wall AG -7
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- 35. Basics about therapy -MDTwill cure you completely -MDT is free of cost -MDT is available in all health centres -MDT should be taken as advised (regular, full course)
- 36. 1-Skin discoloration dueto clofazimine 2-Urine discoloration due to rifampicin 3-In case of fever, pain in the nerves, 4-muscle weakness, joint pains they must return immediately to the health centre 5-Appearance of new skin patches Basics about therapy
- 40. MDT for PB leprosy 6months Monthly dose Rifampicin 600mg Daily dose Dapsone 100 mg 40
- 41. MDT for MB leprosy 12months Monthly dose Rifampicin 600mg Clofazimine 300mg Daily dose Dapson 100mg Clofazimine 50 mg 41
- 42. ADVERVE EFFECT OFANTI-LEPROTIC DRUGS DRUGS MINOR MAJOR RIFAMPICIN RED URINE JAUNDICE GIT UPSET HEPATITIS FLU LIKE SYNDROME SHOCK DAPSONE GIT UPSET DAPSONE SYNDROME DRUG RASH AGRANULOCYTOSIS ANAEMIA HEMOLYTIC ANAEMIA CLOFAZIMINE GIT UPSET ACUTE PAIN ABDOMEN DISCOLOURATION OF SKIN ICHTHYOSIS 42
- 43. LEPRA REACTION ADVERSE EFFECTOF ANTI-LEPROTIC DRUGS DISABILITIES & DEFORMITIES PSYCHO-SOCIAL PROBLEMS 43 Complications
- 44. DISABILITIES Causes 1-Late diagnosis andlate treatment with MDT 2-Advanced disease (MB leprosy) 3-Leprosy reactions which involve nerves 4-Lack of information on how to protect insensitive parts 5-Only about 10-15% of leprosy affected person develop significant deformities and disabilities.
- 45. 1: 1-Leonine facies 2-Nasal deformity 3-Lossof outer third of eyebrow 45 1) Specific deformities
- 46. 2) Paralytic deformities: -result from damage to motor nerve. -seen most often in the hand(claw finger), less often in the feet & occasionally in the face(lagopthalomos,facial palsy 46
- 47. 3)Anesthetic deformity : --Occuras a consequence of neglected injuries in part rendered insensitive because of damage to sensory nerve. - Found most often on the feet and hand(ulceration, scar contracture, shortening of digits & skeletal disorganization of foot) 47
- 48. WHO Grade 0Grade 1 Grade 2 EYES Normal vision,lid gap,blinking. Corneal reflex weak Reduced vision,lagophtha lmos. HANDS Normal sensation & m.power. Loss of feeling in the palm Visible damage:wounds, claw hand,loss of tissue etc. FEET Normal sensation & m.power. Loss of feeling in the sole Visible damage:wound,f oot drop,loss of tissue. 48
- 49. Peripheral nerves Sensory MotorAutonomic 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 49
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