Leprosy Hansen’s Disease types Causes of leprosy sign and Symptoms With Treatment

 Leprosy (Hansen’s Disease) Causes, Symptoms, Signs, Diagnosis With Treatment

Leprosy sd
Leprosy(Hansen’s Disease) types Causes of leprosy sign and Symptoms

Leprosy is a chronic infective disease, also called Hansen’s disease.

  • It is caused by Mycobacterium leprae.
  • Clinical manifestations are seen in skin, peripheral nervous system, upper respiratory tract, eyes, and testes.
  • The main involvement is of the peripheral nerve from large trunks to small dermal nerves.
  • The disease is transmitted from person to person.
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Mycobacterium leprae M. lepra
M lepraeu
M. lepra


Etiology:

  • M. leprae is an obligate intracellular bacillus.
  • The bacteriologic index is a measure of infection with 4+ to 6+ denoting severe infection.
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Epidemiology Mycobacterium leprae


Epidemiology Mycobacterium leprae:

  • It is a disease of the developing nations.
  • It is found in poor people, rural people and patients of AIDS.
  • Common in second and third decades. s more common in f1lllP.
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Transmission Epidemiology Mycobacterium lepra


Transmission  Mycobacterium leprae

  • Nasal droplet infection
  • Contact with infected soil
  • Aerosol – like a sneeze
  • Insect vectors
  • Dermal inoculation like tattoo
  • Intimate contact with infected person.
  • Caring for a leprosy patient by nurse and doctors does not give them infection.
Clinical features lfv
Clinical features Mycobacterium lepra
Clinical features l
Clinical features Mycobacterium lepra

 

Clinical features Mycobacterium lepra

  • · Incubation period 2 – years.
  • · The disease may be tuberculoid, borderline tu­berculoid, mid borderline, borderline lepromatous and lepromatous leprosy.
  • · This spectrum of presentation from tuberculoid to lepromatous is a change from asymmetric, localized macules and plaques to nodular, hard, symmetric and generalized skin lesions, an in­creasing bacterial load and decreasing immunity.
TUBERCULOID LEPROSY d
TUBERCULOID LEPROSYFeatures

 

TUBERCULOID LEPROSY Features are:

  • · Hypopigmented macules or plaques, sharply de­marcated, red, hypoesthetic, dry, scaly and an­hidrotic.
  • · A few peripheral nerves show asymmetric en­largement like the ulnar, posterior auricular, pero­neal, posterior tibial nerves.
  • · It is the most common form of disease.
  • · Lepromin skin test is positive.
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LEPROMATOUS LEPROSY

 

LEPROMATOUS LEPROSY

  • There are symmetrical skin nodules, raised plaques, leonine faeces.
  • Loss of eyebrows (specially lateral one-third), eye­lashes. ~ry scaly skin._
  • Leprabacilli are numerous on the skin and peripheral nerves.
  • Nerve enlargement and damage is  mmetrical. There is symmetrical peripheral neuropathy with nerve trunk enlargergment.
  • Upper respiratory tract, anterior chamber of eye and testes are involved .
  • Lepromin skin test is negative.

LEPRA REACTIONS

  • Leprosy may present with lepra reactions.
  • Lepra reactions may also occur after start of chemo­therapy.
Type 1 lepra reaction
Type 1 leprareaction


Type 1 lepra reaction —

  • It is common in borderline cases.
  • There are signs of inflammation over skin lesions. There is neuritis, low grade fever.
  • The ulnar nerve is very painful.
  • Nerve damage resulting in foot-drop may occur. Down grading reactions are lepra reactions before start of antimicrobial therapy.
  • Reversal reactions are leprareaction after start of therapy.
Type 2 Lepra reaction
Type 2Lepra reaction


Type 2 Lepra reaction —

  • It is also called erythema nodosum leproticum. It occurs within 2 years of start of therapy. There are painful red papules, malaise, high fever, neuritis, uvei­tis, lymphadenitis, orchitis, glomerulonephritis.
  • It may end in death.

LUCIO’S HENO ENON It is found in Mexico.

  • It is seen in diffuse lepromatous leprosy.
  • There are large ulcerated lesions on lower extremi­ties.
Complications of Leprosy Extremities
Complications ofLeprosyExtremities


Complications of Leprosy Extremities–
  • There is loss of fine touch, pain and heat sensation but position and vibration is spared.
  • There is clawing of hands due to ulnar and median nerve damage.
  • There is foot drop due to peroneal nerve palsy. There may be ulcers on the hands and feet.
  • Fingers and toes are lost due to osteolytic process and injury.

Nose:

  • · Chronic nasal congestion
  • · Epistaxis
  • ·Destruction of nasal cartilage with saddle-nose deformity and anosmia

Eye:

  • · Corneal insensitivity
  • · Uveitis
  • · Cataract
  • · Glaucoma
  • ·Blindness

Testes:

  • · Orchitis
  • · Aspermia
  • · Impotence

Amyloidosis:

  • · Secondary amyloidosis affecting liver and kid­ney

Nerves:

 

  • • Abscess
TUBERCULOID LEPROSY er
Diagnosis lepromatous leprosy Biopsyofskin

 

Diagnosis Biopsy of skin:

  • In lepromatous leprosy even normal skin will show the bacilli.
  • In tuberculoid leprosy biopsy must be taken from the lesion.
  • Scraping the skin and examining under the micro­scope may show the bacilli.

 

IgM antibodies

  • PGL 1 (phenolic glycolipid) are found in untreated patients.

Treatment lepromatous lepros

  • Tuberculoid leprosy – Dapsone 100 mg/day for 5 years.
  • Lepromatous leprosy – Rifampin 600 mg/day for 3 years + Dapsone 100 mg /day for a long time.
  • Treatment of reactions – Glucocorticoids ­Prednisone 40-60 mg/day gradually tapered and continued for 3 months.
  • Clofazimine 200 to 300 mg/d is less efficacious than steroids.

Treatment of ENL (erythema nodosum leprosum)

  • – Glucocorticoids.

Prevention lepromatous lepros

  • · Vaccination at birth with BCG.
  • · Dapsone reduces incidence of tuberculoid lep­rosy.