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HANSEN’S DISEASE
Epidemiology
• 1.25 cases per 10,000 persons
• India accounts for 80% of cases
• Brazil, Indonesia, Myanmar, Madagascar
and Nepal
• endemic in the coastal southeastern US
and in Hawaii
– related to exposure to armadillos
The Infectious Agent
• Mycobacterium leprae
– a weak acid-fast organism
– It grows best at temperatures (30°) below the
core body temperature of humans
• localization of leprosy lesions to cooler areas of the
body and the sparing of the midline and scalp
– favors intracellular locations
– long generation time of 12-14 days
Diagnosis
• must be considered in any patient with
neurologic and cutaneous lesions
• Smears
– cooler areas of the skin, such as the earlobes,
elbows and knees, and stained with acid-fast
stains
• Skin biopsies from skin or nerve lesions
using Fite-Faraco stain
• Seropositivity
Classification
•
WHO classification
1. Paucibacillary – patients with few organisms
in their tissue
2. Multibacillary - patients with large number of
organisms in their tissue
Classification
•
Ridley and Jopling classification
–
based on clinical, bacteriologic, immunologic and
histopathologic features
1.
2.
3.
4.
5.
6.
Tuberculoid leprosy
Borderline tuberculoid leprosy
Borderline leprosy
Borderline lepromatous leprosy
Lepromatous leprosy
Histoid leprosy
Tuberculoid leprosy
• Paucibacillary
– solitary or few in numbers (usually <5) and
asymmetrical in distribution
– erythematous or hypopigmented plaque with
elevated border that slopes down to a
flattened atrophic center (a saucer right side
up)
– lesions are anesthetic or hypersthetic and
anhydrotic
– face, limb and trunks.
Hypopigmented
Macule
Borderline tuberculoid leprosy
• Multibacillary
– Smaller and more
numerous than
tuberculoid leprosy
– Satellite lesion around
large macules or
plaques
– Bacilli are more
abundant and grenz
zone is present
Borderline leprosy
• Multibacillary
– Numerous but countable
– Red, irregularly shaped plaques
– Small satellite lesions may surround larger
plaques
– Lesions are generalized but assymetrical.
– The edges are not so well define
Borderline lepromatous leprosy
• Multibacillary
– lesions are symmetrical and numerous
(too many to count)
– stocking-glove pattern of nerve
involvement
Lepromatous leprosy
• Multibacillary
– Pale lepromatous macules or infiltrations
– Numerous bacilli
– Lesions are diffusely and symmetrically
Treatment
Leprosy
Paucibacillary
Paucibacillary relapse
Multibacillary
Multibacillary relapse
Treatment
600 mg/d Rifampin + 100 mg/d Dapsone 12 months
Treated with an appropriate regimen for multibacillary disease
100 mg/d Dapsone + 50 mg/d Clofazamine + 600 mg/d
Rifampin for 2 years
Should have a mouse foot pad sensitivity study, multidrug
Adjunctive therapy
• Patient should be offered with occupational
therapy, this include training on how to
avoid injury to insensitive skin of the hands
and feet and special shoes may be
required.
Prevention
• BCG (alone)
– provide about 34% protection against infection
• BCG with heat killed M. leprae
– increases the protection to 64%.
• ICRC vaccination was 65% effective.
• Chemoprophylaxis with once yearly for
hyperendemic regions
– multidrug therapy with single-dose rifampin,
minocycline and clofazamine
Leprosy type
Tuberculoid
Features
* Can be either one large red patch with well-defined raised borders or a large
hypopigmented asymmetrical spot
* Lesions become dry and hairless
* Loss of sensation may occur at site of some lesions
* Tender, thickened nerves with subsequent loss of function are common
* Spontaneous resolution may occur in a few years or it may progress to borderline or
rarely lepromatous types
Borderline tuberculoid
* Similar to tuberculoid type except that lesions are smaller and more numerous
* Disease may stay in this stage or convert back to tuberculoid form, or progress
Borderline borderline
* Numerous, red, irregularly shaped plaques
* Sensory loss is moderate
* Disease may stay in this stage, improve or worsen
Borderline lepromatous
* Numerous lesions of all kinds, plaques, macules, papules and nodules. Lesions
looking like inverted saucers are common
* Hair growth and sensation are usually not impaired over the lesions