Leprosy

DrHanisah'sNotes

1. Leprosy SPEAKER: NUR HANISAH BINTI ZAINOREN SERIAL NO. 55 MATRIC NO. 62

2. Leprosy Synonym: Hansen’s disease Is a chronic infectious disease that primarily affects the peripheral nerves , skin and mucous membrane . Caused by Mycobacterium leprae Slender rod-shaped bacilli Cannot be grown on artificial culture media/cell culture   *The ability for  Mycobacterium leprae  to survive and cause damage within humans is poorly understood.

3. History M. leprae , discovered by G.A. Hansen in Norway in 1873 One of the oldest known diseases It is attributed to poor hygiene and unsanitary conditions Leprosy is endemic in tropical countries with hot and moist climate Patient suffer not only from the primary affect of disease but also from the social discrimination , sadly compounded by inappropriate term ‘leper’ for one who afflicted with that disease

4. Symptoms Skin lesions that are lighter than normal skin color Lesions have decreased sensation to touch, heat, or pain Numbness   Sensory loss People with long-term leprosy may lose the use of their hands or feet due to repeated injury because they lack feeling in those areas. Amputation A patient with leprosy can lose the feeling in his hands suddenly during a lepra reaction, so that he complains of an immediate numbness, or so slowly that he hardly notices it. When this happens, neglected bruises, blisters, and cuts cause scars that progressively destroy the pulps of his fingers .

5. Mode of Transmission Air-borne transmission Through inhalation of the bacilli Direct contact with leprosy patient who shed numerous bacilli from damaged skin, nasal secretions, mucous membrane of mouth & hair follicles Materno-foetal transmission across the placenta Transmission from milk of leprosy patient to infant *Leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases.

6. Classification The disease has been first divided into two poles. They are: 1- Tuberculoid leprosy (T.T.) Has maximal capacity to mount an immunological response against M. leprae 2- Lepromatous leprosy (L.L.) Has least capacity to mount an immunological response against M. leprae H owever , the majority of leprosy cases have more variable immune resistance and do not fall into either of the two poles .

7. Ridley- Jopling Classification based on clinico -pathological spectrum T.T. B.T. B.B. B.L. L.L. POLAR GROUP POLAR GROUP BORDERLINE GROUP

8. Ctd . These are then classified into: 3- Borderline leprosy (B.L.) This exactly falls mid way between the two poles 4- Borderline Tuberculoid leprosy (B.T.) Tend to be more towards T.T. Immune status is between B.B. and T.T. 5- Borderline Lepromatous leprosy (B.L.) Tend to be more towards L.L. Immune status is between B.B. and L.L.

9. Differences Lepromatous Leprosy (LL) Disfigurement is there Leonine facies Claw-shaped hands Pendulous ear lobes Saddle nose Suppressed (low resistance) Tuberculoid Leprosy (TT) Well demarcated, dry patch Minimal disfigurement No leonine facies No claw-shaped hands No pendulous ear lobes Good immune response (high resistance)

10. Tuberculoid leprosy Lepromatous leprosy

11. Treatment Multiple drug therapy for 12 – months is key to treatment, this is carried out by WHO guideline using. 1- Rifampicin 2- Dapsone 3- Clofazimine During treatment, patient may develop acute manifestation, which controlled by steroids Surgical treatment is indicated in advance stage of disease for functional disability of limbs, cosmetic disfigurement of face and visual problems. Surgical reconstruction requires the expertise of hand surgeon, orthopedic surgeon and plastic surgeon .

12. References AK Mandal , Shramana Choudhury , Textbook of Pathology For MBBS, Volume I, Avichal Publishing Company, 2010. http://bacteria.emedtv.com/mycobacterium-leprae/mycobacterium-leprae.html http://www.cdc.gov/nczved/divisions/dfbmd/diseases/hansens_disease/technical.html/#transmission

13. Thank You