DISCUSSION on hansens diseases HANSEN'S.pptx

DISCUSSION on hansens diseases HANSEN'S.pptx

1. DISCUSSION

2. History Dr Gerhard Henrik Armauer Hansen first described M.leprae to be the causative organism in 1873. Synonyms: Hansen’s disease, ‘ Kusht rog’

3. Global & National Scenario of Leprosy Prevalence in India (2020) : 0.57/10,000 Global prevalence (2018) : 0.2/10,000

4. Mycobacterium Leprae Obligate, non motile, nonspore forming microaerophilic intracellular, acid-fast bacillus that forms curved or straight rods Affinity for skin, nerves Closely resembles M. Tuberculosis , but less acid-fast Non cultivable

5. Transmission of Leprosy Respiratory route: inhalation of bacilli-laden droplets Cutaneous : skin to skin contact GIT : ingestion of food In utero transmission Transmission through breast milk Intradermal : inoculation by tattoos Incubation period: 5-7 years (on average ) Not Yet Proven

6. Epidemiological Factors Occurs at all age groups Peak age of onset : Between 20-30 years Males > Females (M:F: 2:1) Genetic susceptibility reported Overcrowding, lack of personal hygiene, humidity favor disease transmission

7. Immunopathogenesis of leprosy Entry of M.Leprae in the body via nose Invasion Multiplication in dermal lymphatics and vascular endothelial cells Hematogenous spread Invasion of M.Leprae into nerves Immunological response

8. Immunity and Leprosy Host resistance Clinical manifestation Excellent No infection Good Subclinical, spontaneous regression Fair Indeterminate, pure neuritis, tuberculoid Poor Borderline Very poor Lepromatous

9. Classification Ridley Jopling classification Tuberculoid Borderline- tuberculoid Mid-borderline B orderline- lepromatous Lepromatous Indian Classification Lepromatous Tuberculoid Maculoanesthetic Borderline Pure neuritic Indeterminate NLEP Classification Nonlepromatous Tuberculoid Maculoanesthetic Polyneuritic Indeterminate Borderline Indeterminate Lepromatous Lepromatous

10. Diagnosis Cardinal signs of leprosy Hypoesthetic /Anesthetic skin lesions Nerve involvement Demonstration of M.Leprae Only one of these three features needed to make diagnosis

11. Clinical Examination General physical examination Cutaneous examination Peripheral nerve examination Sensory examination Musculoskeletal system examination

12. Cutaneous Examination Number of skin lesions Distribution Size Colour : Hypopigmented / erythematous / coppery Morphology : Macule / patch / plaque / papule / nodule Margin : Well / ill defined, raised / flat , sloping / punched out Surface : dry, scaly, smooth, shiny, edematous, ulcerated

13. Ear infiltration in lepromatous leprosy

14. Peripheral nerve examination Supra/ infraorbital Greater auricular Ulnar Median Radial Lateral popliteal Anterior/posterior tibial Sural Cutaneous branch of radial nerve

15. Peripheral nerve examination Check for enlargement, tenderness , nodularity and abscess and scoring system Scoring system for enlarged nerves Normal 0 Enlarged + Moderately enlarged ++ Very much enlarged +++

16. Sensory examination

17. Sensory examination

18. Sensory examination

19. Musculoskeletal examination

20. Musculoskeletal examination

21. Musculoskeletal examination

22. Musculoskeletal examination

23. Musculoskeletal examination

24. Musculoskeletal examination

25. Musculoskeletal examination

26. Investigations for M. Leprae Slit skin smear Histopathological examination Nerve biopsy

27. Treatment MDT-WHO Paucibacillary leprosy (6 months) Cap. Rifampicin (600 mg) monthly, supervised Tab. Dapsone (100 mg) daily Multibacillary leprosy (1 year) Cap. Rifampicin (600mg) monthly, supervised Cap. Clofazimine (300mg) monthly, supervised Tab. Dapsone (100mg) daily Cap. Clofazimine (50mg) daily

28. Blister Packets

29. Lepra Reactions Acute episodes or bouts of exacerbations occurring in course of chronic disease It is a sudden tissue response resulting from liberation of bacilli or their products into the tissues, manifestations of which are local or systemic Sudden increase in activity of existing lesions, appearance of fresh lesions with or without constitutional symptoms

30. Lepra Reactions Type I reaction - All borderline cases (BT, BB,BL) Type II reaction - LL and sometimes BL cases

31. TAKE HOME MESSAGE Early case detection and initiation of Rx Case holding Health education of public and patients

32. A 15 year old boy presented with multiple asymptomatic lesions with asymmetric enlarged ulnar nerve. What is the likely diagnosis? Photo quiz

33. A 4 year old girl presented with aysmptomatic non scaly, whitish patch with intact sensations. What is the likely differential diagnosis? Photo Quiz

34. Photo Quiz A 25 yr old lady with asymptomatic hypopigmented lesion since childhood

35. Thank You