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LEPROSY

( MORBUS HANSEN )

dr. Uun Khusnul Khotimah, SpKK


DEFINITION :
Chronic infection disease
Mainly affects the skin, peripheral
nerves, mucosa upper respiratory
tract, reticulo endothelial system, eye,
bone , testis, except central nervous
system.
AETIOLOGY :
Mycobacterium leprae
Curved rod shaped
Acid Fast Bacilli
Gram positive
1 8 long, 0,2 0,5
Intracellular
Prefer a growth temperature of less than 37
C
Can not be cultured
EPIDEMIOLOGY :

Africa / Central Asia ---- World


All ages ranging : early infancy to very old
age
15 25 years old >>

Both sex : Males : Females = 2 : 1

Very long period : 3 5 years

1990 : 7 / 10,000 ----- 2000 : 1 / 10,000


TRANSMISSION :
Contact person
- Respiratory tract
- Skin

- Immunity
- Virulence
- Physical
- Environment : - Biological
- Social
THE MICROBIOLOGY OF LEPROSY :
M. leprae can not be cultured

Bacteriological examination :
1. Diagnosis

2. To get a cross spectrum

3. Evaluations

4. Prognosis
MATERIAL :
Skin lession

Ear lobe

Nasal secretions / Nose blows


DIAGNOSIS OF LEPROSY :
If shown one or more of the following cardinal
signs :
1. Hipopigmented or reddish skin lession with
definite loss of sensation
2. Involvement of the peripheral nerves, as
demonstrated by definite enlargement /
thickening peripheral nerves with loss of
sensation
3. Skin smear positive for Acid Fast Bacilli

Not Yet ----- Observation for 3 6 months


Measurement of the Bacterial Index :
1. Diagnosis
2. To get a cross the spectrum
3. Therapy evaluation
SCORING THE B I :
Average Number of Bacterial Index
Acid Fast Bacilli (BI)
1000 / field 6+
100 1000 / field 5+
10 100 / field 4+
1 10 / field 3+
1 10 / 10 fields 2+
1 10 / 100 fields 1+
0 / 100 fields 0
MORPHOLOGICAL INDEX :
The proportion or percentage of regularly
stained bacteria of the total scored
Ridley ( 1971 ) :
- Regularly stained bacteria = Solidly
bacteria
- Irregularly stained bacteria = Fragmented
+ Granular bacteria
M I WILL BE A GUIDE IN DETERMINING :

1. Response to treatment
2. Drug resistance

3. Determining the infectiousness of a

patient

Treatment --- M I quickly


B I slowly
IF M I AND THEN : POSSIBILITY

Irregularly

Malabsorbtion

Drug resistance
THE AIM OF CLASSIFICATION OF LEPROSY :

1. Infectious / Non infectious


2. Possible infectious
3. Possible Disability
4. Duration of treatment
CLASSIFICATION
SPECTRUM

Ridley & TT BT BB BL LL
Jopling

MADRID Indeter- Tuber- Border- Lepromatous


minate culoid line

WHO Paucy Bacillar Multi Bacillar


( 1988 ) Leprosy Leprosy
CLINICAL LEPROSY

Indeter- TT BT BB BL LL
minate
Infectious Infectious Infectious Infectious Infectious Infectious
(-) (-) (-)

Children 23 Satelit Punch Out


lesion lesion
Hipopig- Macules Macules : Dimor- Symetrical Symetri-
mented / hipopig- hipopig- phous papul, cal papul,
pink : Face, mented mented / features nodules nodules
back, reddish and tend
buttock symmetry
CLINICAL LEPROSY
Indeter- TT BT BB BL LL
minate
Loss of (+) (+) (+) Sensory Stocking
sensation loss, and gloves
(-) decreases anesthesia
sweating and
hair growth
Nerve (+) (+) (+) Nerve Nerve
swollen (-) damaged damaged

Lepromin (+) 4 (+) 3 (+) 1 -2 (-) (-)


(-)
Acid Fast (-) (+) / (+) 3 (+) 3 - 4 (+) 5 - 6
Bacilli (-) (-)
TREATMENT OF LEPROSY :

Multi Drug Therapy :


- Prevention & treatment of resistance
- As short a period of time for treatment
- To interrupt the transmission of the
infection
W H O ( 1997 ) :

Paucibacillary Single Lesion Leprosy


(one lesion)
Paucibacillary Leprosy (2-5 skin lesion)

Multibacillary Leprosy (More than 5 skin lesion)


I. P B SINGLE LESION

CHILD ADULT

Rifampicin 300 mg Rifampicin 600 mg

Ofloxacin 200 mg Ofloxacin 400 mg

Minocycline 50 mg Minocycline 100 mg

Dosage : Single Dose R O M


II. P B 2 5 SKIN LESION
CHILD ADULT
Monthly Treatment : Monthly Treatment :
Day 1 : Day 1 :
Rifampicin 450 mg Rifampicin 600 mg
Dapsone 50 mg Dapsone 100 mg

Daily : Daily :
Day 2 28 Day 2 28
Dapsone 50 mg/daily Dapsone 100 mg/daily
Duration of treatment : 6 - 9 Months
III. M B :
CHILD ADULT
Monthly treatment Monthly treatment
Day 1 : Day 1 :
Rifampicin 450 mg Rifampicin 600 mg
Clofazimine 150 mg Clofazimine 300 mg
Dapsone 50 mg Dapsone 100 mg

Daily 2 28 : Daily 2 28 :
Clofazimine 50 mg / daily Clofazimine 50 mg / daily
Dapsone 50 mg / daily Dapsone 100 mg / daily
Duration of treatment : 12 18 months
LEPROSY REACTIONS :

Type 1 reaction : Reversal reaction


Type 2 reaction : Erythema Nodosum
Leprosum
( E N L reactions )
MANIFESTATION OF :
1. Reversal reaction
Mild Severe
Skin - Lesion become reddish - Same & rarely new skin lesion
& swollen - Fever, malaise
Nerve - Enlarge, painfull (-) - Enlarge, painfull (+)
- Nerve damage (-) - Nerve damage, loss sensation
- < 6 weeks - > 6 weeks
Skin & - Lesion become reddish - Same
Nerve - Painful on peripheral - Ulceration
nerves - Swollen on hand & foot
- < 6 weeks - Nerve enlarge
-- > 6 weeks
2. E N L REACTION
MILD SEVERE
Skin Skin nodules : Skin nodules >>
- Tender reddish - Painful
- Ulceration - Ulceration
- Fever & malaise
Nerve Enlarge Enlarge
Painful (-) Painful & swollen
Nerve damage (-) Nerve damage
Eye Not involvement Painful
Visual impairment
Testis Swollen, Painful (-) Painful, Enlarge
Skin, nerve, Same - Same
eye, testis - Very painful
- Fever
TREATMENT OF REACTION :
Prednisone : 30 80 mg / daily and then tappering
off
Continued M D T without interruption
MILD REACTION :
- Immobilization
- Rest
SEVERE REACTION :
Reffered to the nearest hospital
MH TIPE BB
MH TIPE BL
MH TIPE BT
MH INDETERMINATE
MH TIPE TT
MH TIPE LL
MH TIPE LL
ERITEMA NODUSUM LEPROSUM(ENL)
Lepromatous leprosy. Note the diffuse infiltration of the face with
leonine facies and madarosis.
Sequele of leprosy. The patient has madurosis, a saddle nose and
blindness in the left eye. Courtesy of Evangeline Handog, M.D.