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![RIDLEY & JOPLING CLASSIFICATION [1962]
• Tuberculoid tuberculoid(TT)
• Borderline tuberculoid(BT)
• Borderline-borderline(BB)
• Borderline lepromatous(BL)
• Lepromatous leprosy(LL)](https://image.slidesharecdn.com/leprosyugorientation1-250720114330-263e4d18/75/LEPROSY-ug-ORIENTATION-1-pptxhdhdhdhdbdbxb-19-2048.jpg)
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LEPROSY ug ORIENTATION (1).pptxhdhdhdhdbdbxb
- 1. LEPROSY Dr.P.Nirmaladevi M.D., Professor andHOD Department of Dermatology , Venereology and Leprosy Tirunelveli Medical College
- 2. OBJECTIVES • Why leprosyis important – current context • Definition of Leprosy • Pathogenesis and classification of leprosy • Various spectrum of leprosy • Clinical Examination of a Leprosy patient including peripheral nerve examination • Make a clinical diagnosis of leprosy • Differential diagnosis
- 3. Leprosy work isnot merely medical relief ; it is transforming frustration of life into joy of dedication , personal ambition into selfless service -Mahatma Gandhi
- 4. 4 Progressive Disability Occurs in Unattendedand Untreated leprosy affected person Why is leprosy so important? ????? Feared mainly because of the deformities social stigma and discrimination
- 5. Impact and Stigmaof leprosy • Physical • Social • Mental
- 6. DEFINITION • Chronic, communicable,granulomatous, infectious disease, primarily of SKIN & PERIPHERAL NERVES and rarely the organs like Eyes, Testes and RETICULOENDOTHELIAL SYSTEM - Liver, Spleen , Bones etc • Also affects Muscle cells, Endothelial cells, Melanocytes, Chondrocytes except CNS, GIT & lungs • Caused by Mycobacterium Leprae
- 7. DISCOVERY OF LEPRABACILLI • Gerard Henrik Armaur Hansen – entered leprosy work in 1869 (Norwegian) • Took interest after reading a pamphlet in that year by Dutchman in Surinam • Pamphlet declared contagion to be the sole etiology. • In 1873, he discovered bacillus Mycobacterium Leprae • In 1875 he postulated that leprosy is a specific disease caused by the bacillus Mycobacterium Leprae
- 8. MYCOBACTERIUM LEPRAE • Straightor slightly curved Bacilli • Gram+ve , weakly acid fast following stain with carbol-fuchsin
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- 11. ROUTE OF TRANSMISSION Onlyknown source Untreated leprosy patient (BL, LL) Mode of transmission Air (droplet infection )
- 12. INCUBATION PERIOD 3 to5 years
- 13. PREDISPOSING FACTORS • Poverty(low socio economic status) • Over crowding • Lack of personal hygiene • But it may affect persons of any socio economic group • Humidity – viable 9 days in dried nasal secretion 46 days in moist soil at room temperature
- 14. 14 Hypo-pigmented or reddishskin lesion(s) with Definite Sensory Deficit Demonstration of M leprae in the lesions Cardinal Signs Involvement of the peripheral nerves Demonstrated by definite thickening of the nerve with/ without loss of sensation and/or weakness of the muscles of the hands, feet or eyes supplied.
- 15. CLASSIFICATION & CLINICALSPECTRUM
- 16. Classification criteria Based on •Clinical • Immunological • Microbiological • Histopathological
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- 19. RIDLEY & JOPLINGCLASSIFICATION [1962] • Tuberculoid tuberculoid(TT) • Borderline tuberculoid(BT) • Borderline-borderline(BB) • Borderline lepromatous(BL) • Lepromatous leprosy(LL)
- 20. INDIAN CLASSIFICATION • Indeterminatetype • Tuberculoid type • Borderline type(BT,BB,BL) • Lepromatous type • Pure neuritic type
- 21. Observation Tuberculoid Borderline tuberculoid Borderline borderline Borderline lepromatous lepromatous Numberof lesions Single usually Single or few Several Many Very many Size of lesions Variable Variable with satellite lesions Variable Variable Small Surface of lesions Very dry sometimes scaly Dry Slightly shiny Shiny Shiny Sensation in lesions Absent Moderately- markedly diminished Slightly – moderately diminished Slightly diminished Not affected Hair growth in lesions Absent Markedly diminished Moderately diminished Slightly diminished Not affected AFB in lesions Negative 1+ 2 – 3+ 3 to 4+ 4 to 6 + (globi) AFB in nasal smear Nil Nil Nil Usually nil Very many
- 22. Observation Tuberculoid Borderine tuberculoid Borderline borderline Borderline lepromatous lepromatous HPE-granulomaEpithelioid cells Epithelioid cells Mixed cellular Macrophages Macrophages Epithelioid cells ++++ +++ ++ + Absent Langhan’s Giant cells +++ ++++ Absent Absent Absent Foamy Macrophages Absent + ++ +++ ++++ T lymphocytes ++++ +++ ++ ++ + Lepromin test Strongly positive Weakly positive Negative Negative Negative
- 23. CLINICAL PRESENTATION • Patch •Plaque • Nodule • Deformity • Ulcer
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- 33. PURE NEURAL TYPE •Involvement of 1 or more nerves with corresponding area of sensory loss • No skin lesions • Motor deficit+/-
- 34. DIFFERENTIAL DIAGNOSIS OF SKINLESIONS IN LEPROSY
- 35. DD for Patch •Pityriasis alba • Nevus achromicus/ anemicus • Vitiligo • Acquired hypomelanosis • Pityriasis versicolor • Polymorphic light eruption • Post-kala-azar dermal leishmaniasis
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- 45. DD for Plaque •Psoriasis • Dermatophytosis • Secondary syphilis • PMLE • Morphea • Pityriasis roseae • Nummular eczema • Sarcoidosis • Granuloma annulare
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- 53. DD for Nodule •Neurofibromatosis • Tuberous sclerosis • Papulonodular lesions of PKDL
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- 56. PAPULONODULAR LESIONS OFLEISHMANIASIS
- 57. DD FOR PURENEURITIC LEPROSY • Diabetis • Congenital • Toxicity • Deficiency
- 58. DD FOR MADAROSIS •Hypothyroidism • Follicular mucinosis • Alopecia areata :
- 59. DEFORMITY Visible consequence ofimpairment inside the body
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- 61. DEFORMITIES OF FACE SPECIFICPARALYTIC • Loss of eyebrows • Premature senility • Sunken Nose • Rat bitten ears • Buddha ears • Lagophthalmos • Facial palsy • Leprous stare
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- 65. DEFORMITIES OF HANDS SPECIFICPARALYTIC ANAESTHETIC • Banana fingers • Nonparalytic clawing • Swan neck deformity • Twisted finger • Claw hand • Drop wrist • Paralytic thumb • Shortening of fingers • Mutilation of hand • Disorganization of wrist
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- 67. WRIST DROP BANANAOR SAUSAGE FINGERS
- 68. DEFORMITIES OF FEET SPECIFICPARALYTIC ANAESTHETIC • Reaction foot • Claw toes • Foot Drop • Disorganization of foot • Plantar ulcers
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- 73. LEPRA REACTION • Suddenappearance of symptoms and signs of inflammation in the skin of a person with leprosy in the forms of redness, swelling, pain, and sometimes tenderness of the skin lesion • New skin lesions can also appear • It can occur before, during and after completion of treatment
- 74. REACTIONS IN LEPROSY •Immunologically mediated • Episodes of acute or subacute inflammation • Interrupt the relatively uneventful chronic course of the disease • Affecting mainly skin ,nerves ,mucous membrane and also other sites • Occur in any type except indeterminate type
- 75. SEQUELAE • Risk ofnerve damage • Mental upset to the patients on regular Rx • Create feeling of worsening of the disease , incurability of the disease in spite of regular treatment • Repeated attacks affects drug compliance
- 76. TYPES OF REACTION •2 types • Type1 - type 4 HSN reaction • Type2 - type 3 HSN reaction
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- 81. GENERAL PHYSICAL EXAMINATION •Thorough physical examination • Pallor , Edema & Lymphadenopathy • Pulse & BP • Generalised edema • Fever , Arthralgia & Prostration
- 82. CUTANEOUS EXAMINATION • Morphology •Border: well defined, raised/flat, sloping & punched out • Sparseness of hair • Lesional tenderness
- 83. TESTING SENSATIONS • Lesionalskin should be tested for Temperature Touch Pain • Should proceed from uninvolved to involved skin
- 85. ALSO LOOK FOR •Trophic changes • Blisters & callosities • Inspection of vulnerable pressure points • Trophic ulcers : pus discharge, foul smell , slough & granulation tissue • Ichthyosis
- 86. NERVE EXAMINATION To lookfor • Symmetricity • Thickening • Number of nerves involved • Regularity/ Uniformity ( granuloma or abscess) • Tenderness
- 87. COMMONLY AFFECTED NERVEWITH MOTOR FUNCTION Facial Ulnar Median Radial Lateral popliteal Posterior tibial
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- 97. MOTOR SYSTEM To lookfor • Deformity • Wasting • Shortening • Paralysis
- 98. TESTING OF MEDIANNERVE
- 99. TESTING OF ULNARNERVE
- 100. TESTING OF RADIALNERVE
- 101. CRANIAL NERVE EXAMINATION •Affected nerves : Facial > olfactory > trigeminal • Trigeminal
- 102. EXTERNAL GENITAL EXAMINATION Inmales , testes palpated to look for • Size & consistency • Testicular sensation • Tenderness
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- 108. WHO VISION OFLEPROSY: • Zero infection and disease • Zero disability • Zero stigma and discrimination and • The elimination of leprosy
- 109. WHO GLOBAL TARGETSOF LEPROSY FOR 2030 • 120 countries reporting zero new autochthonous cases • 70% reduction* in annual number of new cases detected • 90% reduction* in rate per million population of new cases with G2D • 90% reduction* in rate per million children of new child cases with leprosy
- 110. National Leprosy EliminationProgramme (NLEP)
- 111. National Strategic Plan(NSP) to leprosy
- 113. SUMMARY • Leprosy isa chronic , debilitating disease caused by Mycobacterium Leprae • It is spread through Respiratory droplets • It mainly affects the skin and nerves • Through proper clinical examination one can accurately diagnose leprosy and the spectrum to which it belongs • Hence a structured examination of Leprosy patient is a must to derive at the right diagnosis
- 114. WHO THEME OFWORLD LEPROSY DAY-2024 “BEAT LEPROSY”
- 115. SLOGAN FOR THISYEAR 2024-NLEP “ENDING STIGMA, EMBRACING DIGNITY!”