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Leprosy

Leprosy. Dr. Gerrard Uy. Leprosy. A.k.a. Hansen’s Disease nonfatal, chronic infectious disease caused by Mycobacterium leprae clinical manifestations are largely confined to the skin, peripheral nervous system, upper respiratory tract, eyes, and testes. Etiology. Mycobacterium leprae

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Leprosy

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  1. Leprosy Dr. GerrardUy

  2. Leprosy • A.k.a. Hansen’s Disease • nonfatal, chronic infectious disease caused by Mycobacterium leprae • clinical manifestations are largely confined to the skin, peripheral nervous system, upper respiratory tract, eyes, and testes

  3. Etiology • Mycobacterium leprae • obligate intracellular bacillus • confined to humans, armadillos in certain locales, and sphagnum moss • Acid fast; ideally detected in tissue sections by a modified Fite stain • No known toxins and is well adapted to penetrate macrophages • Known to bind to the basal lamina of Schwann cells

  4. Etiology • Mycobacterium leprae • can be cultivated in mouse footpads • Grows best in cooler tissues (skin, peripheral nerves nerves, anterior chamber of the eye, upper respiratory tract and testes) • almost exclusively a disease of the developing world • associated with poverty and rural residence

  5. Transmission • Remains uncertain • Nasal droplet infection, contact with infected soil, and even insect vectors have been considered the prime candidates • bedbugs and mosquitoes • Skin to skin contact is generally not considered an important route of transmission • ~50% of leprosy patients have a history of intimate contact with an infected person

  6. Disease Spectrum • Incubation period: between 2 and 40 years, although it is generally 5–7 years • polar tuberculoid (TT) • borderline tuberculoid (BT) • mid-borderline (BB, which is rarely encountered) • borderline lepromatous (BL) • polar lepromatous (LL)

  7. Tuberculoid Leprosy • symptoms confined to the skin and peripheral nerves • consist of one or a few hypopigmented macules or plaques • sharply demarcated and hypesthetic, often have erythematous or raised borders, • devoid of the normal skin organs (sweat glands and hair follicles) • dry, scaly, and anhidrotic.

  8. Tuberculoid Leprosy • asymmetric enlargement of one or a few peripheral nerves • most commonly affected are the ulnar, posterior auricular, peroneal, and posterior tibial nerves, with associated hypesthesia and myopathy • Positive Lepromin skin test

  9. Lepromatous Leprosy • symmetrically distributed skin nodules , raised plaques, or diffuse dermal infiltration, which, when on the face, results in leonine facies • loss of eyebrows and eyelashes, pendulous earlobes, and dry scaling skin, particularly on the feet • acral, distal, symmetric peripheral neuropathy and a tendency toward symmetric nerve-trunk enlargement

  10. Lepromatous Leprosy • bacilli are numerous in the skin (as many as 109/g), where they are often found in large clumps (globi), and in peripheral nerves • bacilli are plentiful in circulating blood and in all organ systems except the lungs and the central nervous system • nerve enlargement and damage tend to be symmetric • Negative Lepromin skin test

  11. Complications • Extremities • primarily a consequence of neuropathy leading to insensitivity and myopathy • affects fine touch, pain, and heat receptors but generally spares position and vibration appreciation • ulnar nerve • clawing of the fourth and fifth fingers • loss of sensation • Median Nerve impair thumb opposition and grasp • loss of distal digits in leprosy is a consequence of insensitivity, trauma, secondary infection • Plantar ulceration – most frquent complication of leprous neuropathy

  12. Complications • Nose • chronic nasal congestion and epistaxis • destruction of the nasal cartilage, with consequent saddle-nose deformity or anosmia • Eye • lagophthalmos and corneal insensitivity • uveitis, with consequent cataracts and glaucoma

  13. Complications • Testes • mild to severe testicular dysfunction • decreased testosterone, and aspermia or hypospermia • impotent and infertile • Amyloidosis • Occurs as a complication of LL leprosy • Nerve Abscesses • cellulitic appearance of the skin • affected nerve is swollen and exquisitely tender

  14. Diagnosis • characteristic skin lesions and skin histopathology • associated with diffuse hyperglobulinemia, which may result in false-positive serologic tests (e.g., VDRL, RA, ANA)

  15. Treatment • dapsone (50–100 mg/d), clofazimine (50–100 mg/d, 100 mg three times weekly, or 300 mg monthly), and rifampin (600 mg daily or monthly)

  16. Prevention and Control • Vaccination at birth with bacille Calmette-Guérin (BCG) has proved variably effective in preventing leprosy

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