leprosy caused by Mycobacterium leprae bact

Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae

1. 1
M lepraeM leprae

3. Antigenic structure
•Cytoplasmic
•Cell wall associated
3

4. PATHOGENESIS
Mycobacterium
Leprae enters
the body
On of these
things can
happen
Immune cells unable to
destroy M. Leprae and
the bacteria multiplies
freely in the skin.
The Immune cells
attempt to seal off the
infection, which can
destroy sweat glands
and hair follicles and
the skin’s sensitivity.

5. 5
•A chronic infectious disease caused by the bacterium Mycobacterium
leprae
•It is mainly a Granulomatous disease affecting: peripheral nerves and
mucosa of the upper-respiratory tract
•Granulomatous - refers to granulomas which are lesions of epithelioid
macrophages
Leprosy (Hansen’s Disease)

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Transmission
•extract mechanism is not known
•The main reservoir is humans
•The transmission of leprosy is thought to occur through the respiratory
track
•Risk group: children, people living in endemic areas, in poor
conditions, with insufficient diet, or have a disease that compromises
their immunity (ie HIV)

7. Ridley Jopling Classification of Leprosy Ridley Jopling Classification of Leprosy
Basis - ImmunologicalBasis - Immunological
RR-Reversal reaction; ENL-Erythema nodosum leprosum; PB-Paucibacillary, MB-Multibacillary

8. Tuberculoid Leprosy

9. Lepromatous leprosy

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Symptoms
TuberculoidBorderline
Tuberculoid
Borderline
Lepromatous
BorderlineLepromatous
Skin
Infiltrated
lesions
Defined plaques,
irregular plaques,
healing centers
Polymorphic,
partially raised
edges, satellites
Papules, nodules,
punched-out
centers
Diffuse
thickening
Diffuse thickening
Macular
lesions
Single, smallSeveral, any
size
Multiple, all sizes,
bizarre
Innumerable,
small
Innumerable,
confluent
Peripheral
Nerve
lesions
Solitary,
enlarged nerves
Irregular
enlargement of
several large
nerves,
asymmetrical
patterns
Many nerves
involved
symmetrical
patterns
Late neural
thickening,
asymmetrical
anaesthesia
and paresis
Slow, symmetrical
‘glove-and-
stocking’
anaesthesia
Note: Contrary to popular belief leprosy does not cause body parts to simply fall off

11. Lepromatous vs. Tuberculoid Leprosy

12. TUBERCULOID LEPROSY
•Single or few Lesions
•Erythematous plaques
•Hypopigmanted
•Hypoasthatic
•Macular lesions
•Cutaneous nerve
•thickened

13. Lepromatous Leprosy (Early/Late Stages)

14. International Federation of Anti-Leprosy Associations (ILEP)
http://www.ilep.org.uk/en/
Sensory Loss Can Lead to Secondary
Infections and Severe Deformities

15. Tuberculoid vs. Lepromatous Leprosy
Clinical Manifestations and Immunogenicity

16. FLOW CHART FOR DIAGNOSIS
AND CLASSIFICATION
O NE SKIN LESIO N
SLPB leprosy
2-5 SKIN LESIO N
PB LEPRO SY
More than 5 lesions
MB LEPRO SY
SKIN LESIO N A ND
SENSO RY LO SS - LEPRO SY

17. Laboratory Diagnosis
•Demonstration of AFB
–Nasal mucosa
–Skin Lesion
–Ear lobule
•Skin clippings from 5-6 areas
–Buttocks
–Forehead
–Chin
–Cheek
–Ear

18. •Two indices which depend on observation
of M. leprae in smears are useful in
assessing the progress of the patient under
treatment.
the morphological index (MI)
the bacteriological index (BI).

19. CULTIVATION

20. 2 types of reaction:
a. Early reaction (Fernandez reaction)
> resembles tuberculin test
> seen in 24-48 hrs
b. Late reaction (Mitsuda reaction)
> indurated nodule develops after 3-4 wks
> corresponds to the formation of an
immunologic granuloma
Lepromin test

21. –Detection of antibodies to phenolic glycolipid-1 (PGL-1)
–PCR and recombinant DNA technology

–Lymphocyte migration inhibition test (LMIT):

22. TYPE -1 REACTION
OCCURS IN BORDERLINE CASES NOT
IN POLAR LEPROSY
•ACTIVATION OF PREVIOUSLY
INVOLVED SKIN LESIONS
•PANFUL & TENDER NERVES
•DOWNGREADING REACTION - WHEN
OCCURS BEFORE INITIATON OF
CHEMOTHERAPY
•REVERSAL REACTION AFTER
INITIATION OF CHEMOTHERAPY-
•CORTICOSTEROID TREATMENT OF
CHOICE

23. TYPE -2 REACTION
•OCCURS IN BL/LL FORM OF
LEPROSY
•ENL- ERYTHEMA NODOSUM
LEPROSUM
•FEVER
•ARTHRITIS
•UVEITIS
•ORCHITIS
•GLOMERULONEPHRITIS
•IMMUNE COMPLEX DEPOSITION
•THALIDOMIDE IS CHOICE OF TRT

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Treatment & Management
•Chemotherapy
-Second line drugs are ofloxacin and minocycline
-Triple –drug combinations have been used in cases where a patient has
only a single lesion
-Leprosy is combated with multidrug therapy to reduce the chance of
developing resistance

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Multibacillary (MB or lepromatous) is a 24-month treatment of rifampicin, clofazimine, and dapsone.
Paucibacillary (PB or tuberculoid) is a six-month treatment of rifampicin and dapsone.

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Treatment & Management
•New Nerve Damage
-Patients with motor or sensory loss of 6 moths or less should receive a 6 month
treatment of corticosteroids (a treatment for type 1 reactions)
•Patient Education
•Preventing Disability
-Nerve, leading to deformity
-Dryness can lead to skin cracking and ultimately infection
-Treatment involves soaking and applying oil- based creams to affected areas, also
physiotherapy can help prevent contractures, muscle atrophy and over stretching of
muscles
•Physiotherapy
•Reconstructive surgeries
•Rehabilitation programes
•Health education

27. Prevention
•Early detection & rigid isolation of all acute
LL & indeterminate types of leprosy are
important
•Prophylactic chemotherapy for all persons
in close contact w/ the patient
•Develop anti leprosy vaccine
•BCG vaccination, 3 trials were made in
endemic areas= divergent results