leporsy disease

1. DR SUBODH KUMAR SHAH

2.  Etiology
 Mycobacterium leprae (M. leprae), an acid fast organism.
 Route of infection : respiratory transmission.(droplets infection)

3. 1.Ridley–Jopling classification:
 Tuberculoid leprosy (TT)
 Borderline tuberculoid (BT)
 Mid borderline (BB)
 Borderline lepromatous (BL) leprosy
 Lepromatous leprosy (LL)
2.Skin smear result (WHO) classification :
 • 1- Paucibacillary leprosy (PB) – few Bacilli; • Two to five skin lesions with
negative skin smear results at all sites. •
 2. Multibacillary leprosy (MB); • Any form of leprosy in which the patient shows
positive smears at any site

5.  Prototype skin lesion: atrophic, hypopigmented, an(hypo)esthetic macules or plaques
(with papules and nodules seen in lepromatous end of spectrum) with loss of
appendages (so absent hair and sweating).
 Depending on number, size, symmetry, morphology and degree of sensory deficit in skin
lesions and numbers of nerves affected, classified as:
 Indeterminate leprosy: Ill-defined macule(always a macule) ± sensory impairment on
face of children.
 Tuberculoid leprosy (TT): Single (or few),well-defined anesthetic lesion(s). Regional
nerve(s)thickened.

6.  . Borderline tuberculoid (BT): Few, welldefined,hypoesthetic lesions with satellite
lesions.Few nerves involved.
 Borderline (BB): Multiple, bilateral(not symmetrical) annular plaques (inverted saucer
appearance) with hypoesthesia. Few nerves involved.
 Borderline lepromatous (BL): Multiple (with tendency to symmetry), minimally
hypoesthetic illdefined lesions. Many nerves (bilateral, tendency to symmetry) involved.
 Lepromatous leprosy (LL):Widespread symmetrical normoesthetic macules,papules,
nodules, and infiltration. Symmetrical nerve involvement with glove and stocking
sensory impairment.
Systemic involvement common:
 Lymphadenopathy.
 Hepatosplenomegaly.
 Ocular involvement.
 Testicular atrophy.

7. Indeterminate leprosy: ill-defined,
hypopigmented,
hypoesthetic lesion on the face; the lesion
is
always macule.
Tuberculoid leprosy: well-defined
hypopigmented,
hypoesthetic plaque. Note the feeder
nerve

8. Borderline tuberculoid leprosy:
A: welldefined,hypoesthetic,
erythematous plaque
Borderline lepromatous leprosy:
A: multiple plaques present almost
symmetrically

9. A: diffuse infiltration
of face.
B: infiltration of ear lobule.

11. nasal deformity
and supraciliary madarosis

12. lepromatous nodules on infiltrated
skin on chin.
histoid nodules on normal skin

14.  Cardinal signs
 According to WHO, in an endemic area, an individual should be regarded as
having leprosy if he or she shows ONE of the following cardinal signs:
 Skin lesion(s) consistent with leprosy with definite sensory loss, with or without
thickened nerves.
 Skin smears positive for acid fast bacilli.
 A person presenting with skin lesions or with symptoms suggestive of nerve
damage, in whom the cardinal signs are absent or doubtful, should be called a
‘suspect case’ in absence of an obvious alternate diagnosis..

15.  Such individuals should be counselled and advised to follow up if signs persist for
more than 6 months or if there is any worsening.
 Suspect cases may be also sent to referral clinics with more facilities for diagnosis

16.  Thickened peripheral nerves is typical.
Apart from larger nerve trunks, a feeder
nerve to the skin lesion may be
thickened.
 In distal extremities—glove and stocking
anesthesia (in BL, LL) and weakness of
muscles supplied by the affected nerve.

17.  Two types of reactions occur in leprosy—type 1 and type 2 reactions
 Type 1 lepra reaction:
 Occurs in borderline leprosy (the unstable varieties—BT, BB and BL).
Pathogenesis: Is due to alteration in the host’s CMI,
Manifestations: Characterized by:
 Erythema, edema, and scaling of the preexisting lesions
 Appearance of new lesions.
 Neuritis, clinically manifesting as nerve tenderness, and appearance of increasing new
areasof sensory impairment and motor deficits.

18.  Leprosy in type 1 reaction: erythema,
edema and scaling of pre-existing
lesions.

19.  Occurs most commonly in LL and sometimes in BL leprosy.
Pathogenesis: Immune complex reaction.
Manifestations: Characterized by:
 ENL: appearance of several tender, evanescent (quickly fading or
disappearing),erythematous nodules on face, flexures ,and legs; sometimes these
lesions may become pustular and ulcerate.
 Neuritis.
 Arthralgia, orchitis, and iridocyclitis.

20. evanescent,
tender, erythematous nodules.
necrotic ENL.

21.  Positive skin smears:Slit smear
 Smears are taken from skin lesions, ear lobules,eye brows, and sometimes dorsae
of fingers.on Zeihl–Neelsen staining, rod-shaped, red-stained leprosy bacilli may
be seen.
 Tests to confirm diagnosis of leprosy
 Biopsy:

22. Tests to evaluate systemic involvement:
 Hematological parameters:
 Anemia:
 Leucocytosis:
 Renal function tests
 Chest X-ray: Ruling out concomitant pulmonary tuberculosis is important

23. General measures:
 Reassuring patient.
 Education regarding low contagiousness.
 Advice regarding sensory impairment especially with regard to hands and feet.
 Care of hands, feet, and eyes.
 Counseling regarding regularity of treatment.

26.  • disfigurement
 • hair loss, particularly on the eyebrows and eyelashes
 • muscle weakness
 • permanent nerve damage in the arms and legs
 • inability to use the hands and feet
 • Nosebleeds
 • iritis (inflammation of the iris of the eye), glaucoma (an eye disease that causes
damage to the optic nerve), and blindness
 • Infertility
 • kidney failure