LEPROSY

This presentation is made by Dr Ashok Jaisingani for study purpose if any one like this than please give your comments.

1. Leprosy Leprosy
Dr. Ashok Jaisingani Dr. Ashok Jaisingani

2. Introduction Introduction
►Leprosy is also called as “Hansen's disease”Leprosy is also called as “Hansen's disease”
►It is chronic curable infectious disease caused by It is chronic curable infectious disease caused by
mycobacterium leprae. mycobacterium leprae.
►It occurs mainly in tropical regions and developing It occurs mainly in tropical regions and developing
countries.countries.
►The majority of the cases are located in Indian The majority of the cases are located in Indian
subcontinents subcontinents
►Patient suffer not only from the primary affect of Patient suffer not only from the primary affect of
disease but also from the social discrimination, disease but also from the social discrimination,
sadly compounded by inappropriate term ‘leper’ sadly compounded by inappropriate term ‘leper’
for one who afflicted with that disease. for one who afflicted with that disease.

3. Pathology Pathology
►The transmission occurs through nasal secretionThe transmission occurs through nasal secretion
►It is attributed to poor hygiene and unsanitary It is attributed to poor hygiene and unsanitary
conditions conditions
►The incubation period is several years The incubation period is several years
►The disease present with skin, upper respiratory The disease present with skin, upper respiratory
and neurological symptomsand neurological symptoms
►The infection occur in childhood or early The infection occur in childhood or early
adolescence adolescence
►The bacillus is acid fast but so weakly when The bacillus is acid fast but so weakly when
compared with mycobacterium tuberculosis. compared with mycobacterium tuberculosis.

4. Classification Of Disease Classification Of Disease
►The disease is broadly classified into two The disease is broadly classified into two
groups. groups.
1- Lepromatous 1- Lepromatous
2- Tuberculoid 2- Tuberculoid

5. Lepromatous Leprosy Lepromatous Leprosy
►In lepromatous leprosy there is wide spread In lepromatous leprosy there is wide spread
dissemination of abundant bacilli in the dissemination of abundant bacilli in the
tissues with the macrophages and a few tissues with the macrophages and a few
lymphocytes. lymphocytes.
►This denote a poor host immune reaction.This denote a poor host immune reaction.

6. Tuberculoid Leprosy Tuberculoid Leprosy
►In tuberculoid leprosy the pts show strong In tuberculoid leprosy the pts show strong
immune response with scant bacilli in immune response with scant bacilli in
tissues, epithelioid granuloma, numerous tissues, epithelioid granuloma, numerous
lymphocytes and giant cells. lymphocytes and giant cells.
►Thus that condition occurs when host Thus that condition occurs when host
resistance is stronger than virulence of resistance is stronger than virulence of
organisms. organisms.

7. Clinical Features Clinical Features
►Disease is slowly progressive affecting skin, upper Disease is slowly progressive affecting skin, upper
respiratory tract and peripheral nerves. respiratory tract and peripheral nerves.
►Tuberculoid Leprosy:Tuberculoid Leprosy: There is damage to tissues occurs There is damage to tissues occurs
early and is localized to one part of the body, which limited early and is localized to one part of the body, which limited
deformity of that organ. deformity of that organ.
►Neural involvement is characterized by thickening of the Neural involvement is characterized by thickening of the
nerves which are tenders.nerves which are tenders.
►There may be asymmetrical well defined anesthetic There may be asymmetrical well defined anesthetic
hypopigmented or erythamatous macules with elevated hypopigmented or erythamatous macules with elevated
edges and dry and rough surface lesion called “leprids”. edges and dry and rough surface lesion called “leprids”.
►Lepromatous Leprosy:Lepromatous Leprosy: There is disease is symmetrical There is disease is symmetrical
and extensive. Cutanous involvement occurs in the form of and extensive. Cutanous involvement occurs in the form of
the several pale macules that form plaques called the several pale macules that form plaques called
‘lepromas’. ‘lepromas’.

8. Deformities Deformities
►The deformities produced by the disease The deformities produced by the disease
which are divided into which are divided into
►Primary:Primary: These are caused by the leprosy These are caused by the leprosy
or by its reactionsor by its reactions
►Secondary:Secondary: These resulting from effects These resulting from effects
such as anesthesia of hands and feet. such as anesthesia of hands and feet.

9. Lesion involving Face Lesion involving Face
►In the acute phase of lepromatous variety the nodular In the acute phase of lepromatous variety the nodular
lesion on the face are known as “Leonine facies” (looking lesion on the face are known as “Leonine facies” (looking
like lion) like lion)
►Later there is wrinkling of skin and aged appearance to Later there is wrinkling of skin and aged appearance to
young individuals. young individuals.
►There is loss of eyebrows There is loss of eyebrows
►Destruction of lateral cartilage and septum of nose with Destruction of lateral cartilage and septum of nose with
collapse of nasal bridge and lifting of tip of nose. collapse of nasal bridge and lifting of tip of nose.
►There may be paralysis of branches of facial nerves in There may be paralysis of branches of facial nerves in
bony canal or of zygomatous branches. bony canal or of zygomatous branches.
►Paralysis of orbicularis occuli cause incomplete closure of Paralysis of orbicularis occuli cause incomplete closure of
eyes, epiphoras and conjunctivae. eyes, epiphoras and conjunctivae.

10. Lesion Involve Hands & FeetLesion Involve Hands & Feet
►Lesions Involving Hands:Lesions Involving Hands: The hands are The hands are
typically clawed because of involvement of ulner typically clawed because of involvement of ulner
nerve at elbow and median nerve at wrist. nerve at elbow and median nerve at wrist.
►Anesthesia of hands makes these pts susceptible Anesthesia of hands makes these pts susceptible
to frequent burns and injuries. to frequent burns and injuries.
►Lesion Involving Feet:Lesion Involving Feet: There is clawing of toes There is clawing of toes
occurring as result of involvement of posterior occurring as result of involvement of posterior
tibial nerve. When lateral popliteal nerve is tibial nerve. When lateral popliteal nerve is
affected it leads to foot drop and nerve can be felt affected it leads to foot drop and nerve can be felt
to be thickened behind the upper end of fibulae to be thickened behind the upper end of fibulae
►Anesthesia of feet predispose to trophic ulceration, Anesthesia of feet predispose to trophic ulceration,
chronic infection, contraction and autoimputation. chronic infection, contraction and autoimputation.

11. Leprosy Diagnosis Leprosy Diagnosis
►Typical clinical features and awareness of Typical clinical features and awareness of
the disease should help to make a diagnosisthe disease should help to make a diagnosis
►The face has an aged look about it with The face has an aged look about it with
collapse of nasal bridge and eyes changes. collapse of nasal bridge and eyes changes.
►Thickened peripheral nerves, patches of Thickened peripheral nerves, patches of
anesthetic skin, claws hands, foot drop and anesthetic skin, claws hands, foot drop and
trophic ulcer are characteristic. trophic ulcer are characteristic.
►Microbiological examination of acid – fast Microbiological examination of acid – fast
bacillus and typical history on skin biopsy. bacillus and typical history on skin biopsy.

12. Treatment Treatment
►Multiple drug therapy for 12 – months is key to treatment, Multiple drug therapy for 12 – months is key to treatment,
this is carried out by WHO guideline using.this is carried out by WHO guideline using.
1- Rifampicin 1- Rifampicin
2- Dapsone 2- Dapsone
3- Clofazimine 3- Clofazimine
►During treatment, pts may develop acute manifestation, During treatment, pts may develop acute manifestation,
which controlled by steroidswhich controlled by steroids
►Surgical treatment is indicated in advance stage of disease Surgical treatment is indicated in advance stage of disease
for functional disability of limbs, cosmetic disfigurement of for functional disability of limbs, cosmetic disfigurement of
face and visual problems. face and visual problems.
►Surgical reconstruction requires the expertise of hand Surgical reconstruction requires the expertise of hand
surgeon, orthopedic surgeon and plastic surgeon.surgeon, orthopedic surgeon and plastic surgeon.
►General surgeon may be called upon, when it require General surgeon may be called upon, when it require
amputation or in emergency situation abscess drainage. amputation or in emergency situation abscess drainage.

13. Prevention Of Disease Prevention Of Disease
►Educating the patient about the dreadful Educating the patient about the dreadful
sequelae of the disease so that they seek sequelae of the disease so that they seek
medical help early as important. medical help early as important.
►Education of general public should be the Education of general public should be the
keystone in prevention. keystone in prevention.