a lecture about different types of leprosy with case presentations by Dr/ Ahmad Nofal (Dermatologist, Egypt).

2. By
M.D.

3. It is a chronic 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 prevalent in 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
Although human-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 through the skin (rare).
3-Arthropod-born infection (rare).
4-Through placenta and milk.
Mode of infection

8. 1-Residence in an endemic 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 & Jopling Classification
Based on Host Immunity
TT BL LL
BT BB BL
9
Classification

10. WHO Classification
Based on Bacterial Load
Paucibacillary
1-5 skin lesions
Multibacillary
>6 skin lesions
PositiveNegative

11. LEPROSY
Paucibacillary
(PB)
Multibacillary
(MB)
Indeterminate Leprosy (IL)
Tuberculoid Leprosy (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
Internal organs
Bacteriology
Histopathology
Lepromin test
Course and prognosis
Clinical features

14. 1-Type of leprosy
2-Mechanism
3-Clinical features
4-Histopathology
5-Lepromin test
6-Treatment
Reactions

15. BLBBBT
ManySomeFew(<5)Lesion no.
RoughlyLessWellLesions borders
SlightModerateMarkedSensory
impairment
Roughly
symmetrical
AsymmetricalAsymmetricalDistribution of
skin lesions
Less
asymmetrical
AsymmetricalAsymmetricalPeripheral nerves
MultibacillaryMultibacillaryPaucibacillaryType of leprosy
4+2+ / 3+- / 1+Slit skin smear

16. Diagnosis of Leprosy
Clinical Examination
Slit Skin Smear
Skin Biopsy

17. Pinch the site tight.
Incise.
Scrape & collect material
Smear on a slide.
Air dry & fix.
Stain (Z-N method)
17
Slit Skin Smear

21. 0 – no bacilli 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 calculated by 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 of living bacilli (solid staining
bacilli) to the total number of bacilli
(fragmented and granular) in the smear.
Morphological index

25. Tuberculoid Leprosy

26. Lepromatous leprosy

27. Lepromatous leprosy

29. TT BT BB BL 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 Lepromin Skin 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 detecting antibobies
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

34. TREATMENT

35. Basics about therapy
-MDT will 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 due to 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
6 months
Monthly dose
Rifampicin
600mg
Daily dose
Dapsone 100
mg
40

41. MDT for MB
leprosy
12 months
Monthly dose
Rifampicin 600mg
Clofazimine 300mg
Daily dose
Dapson 100mg
Clofazimine 50 mg
41

42. ADVERVE EFFECT OF ANTI-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 EFFECT OF ANTI-LEPROTIC DRUGS
DISABILITIES & DEFORMITIES
PSYCHO-SOCIAL PROBLEMS
43
Complications

44. DISABILITIES
Causes
1-Late diagnosis and late 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-Loss of 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 :
--Occur as 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 0 Grade 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 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
49

50. 50

51. Clinical applications

53. Indeterminate Leprosy

67. TT: Erythematous plaque

68. Borderline Leprosy

69. Borderline Leprosy

129. Neural Leprosy

130. Neural Leprosy

131. Neural Leprosy

133. Type 1-reaction

134. Type 2 reaction

135. Lucio's phenomenon

144. THANK YOU