Download LEPROSY (Hansen`s Disease)

LEPROSY (Hansen’s
Disease)
• Causative Organism- Mycobacterium
leprae
• Affects mainly cooler parts of the body
• Skin, mouth, Respiratory Tract, eyes,
Peripheral nerves, Testis, etc
• Earliest --------Skin & Nerves
PATHOGENESIS
 Acid fast, obligate intracellular organism
 Poor growth in culture, but grows in
armadillo, foot pad of mice
 Virulence– cell wall properties
 Cell mediated immunity– Lepromin Test
DIAGNOSIS
Split skin smears & nasal smears
AFB ( Ziehl – Neelson) stain
Fite Faraco Stain
Silver stain
• Bacteriological Index
• Morphological Index
Solid staining – Live
Fragmented / Beaded - Dead
• Paucibacillary – No Bacilli
• Multibacillary – Some or many Bacilli
TRANSMISSION
• ? Inhalation
• Direct Contact
• Maternofetal transmission
Classification
2 Main types ( polar forms);
a) Lepromatous – Low Immunity
b) Tuberculoid – High Immunity
Modified Ridley Jopling’s Classification
• Indeterminate
• TT – Tuberculoid
• BT – Borderline Tuberculoid
• BB – Mid Borderline
• BL – Borderline Lepromatous
• LL -- Lepromatous
FEATURES
Skin Lesions
TT
Asymmetrical
LL
Symmetrical
(Leonine Facies)
Nerve Involvement +, Sensory
disturbance ++
Microscopy
Bacilli load
Immunity
Lepromin Test
Sensory
disturbance
Tubercle, ‘Grenz
Zone’ -ve
‘Globi’ / cigarette
pack
Foam Cells,
‘Grenz Zone’ +
High
Low
+
Few are seen
-
Tuberculoid Leprosy
Tuberculoid Leprosy:
• Skin lesions
• Nerve lesionsAnaesthesia, Skin &
muscle atrophy, Trophic ulcers,
Contractures,etc
• MC – Ulnar, Radial, Common peroneal
• VII Cranial nerve Keratitis, Corneal ulcer
Lepromatous Leprosy:
• Widespread invasion of shwann cells,
neural macrophages
• GlobiAggregates of foam cells filled with
masses of AFB
• Macules, Papules,Nodules Leonine
Facies
• Testes- Extensive destructionSterility
REACTIONS IN LEPROSY
Type I ( Reversal Reaction)
• Upgrading Reaction
• Downgrading Reaction
Type II ( Erythema Nodosum Leprosum)
• Usually after chemotherapy
• Occurs in LL
• Tender nodules, Iridocyclitis, Lymph node
involvement
• Infiltration of neutrophils, Vasculitis
• Responds to Treatment