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

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.

Mycobacterium leprae M. lepra

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.

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.

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 Mycobacterium lepra

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 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.

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 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 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 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

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.