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OS 212 DERMATOLOGY > Leprosy > Flashcards

Flashcards in Leprosy Deck (39):
1

Chronic infection of nerves with skin manifestation

Leprosy

also known as Hansen's disease

2

According to WHO, the following groups are considered to have cases of leprosy

Persons having one or more of the following:

Hypopigmented or reddish skin lesions with loss of sensation

Involvement of peripheral nerves

Skin smear positive for acid fast bacilli

3

Incubation Period of hansen's disease

5 years (6 months to 20 years)

has a subclinical stage where immunity must weaken before any lesion

4

Mode of transmission for Leprosy:

Droplet transmission

5

Susceptibility in Leprosy

Most people are actually only mildly susceptible

Factors:
Genetic
Repeated exposure

6

Etiology of Hansen's disease

Mycobacterium leprae

7

Mycobacterium leprae

slow-growing
Doubling time of 2 weeks
Does not grow in culture media
Prefers cooler temp (27-35)

8

The clinical immunologic Spectrum Leprosy

Cell mediated Immunity
Antibody response

9

Cell Mediated Immunity

In the first phase; T cells and macrophages are the ones that respond to the bacteria

The T cells and macrophages are what we need to kill and contain bacteria

The T cells and a granulomatous reaction in the body if the cell-mediated immunity isn;t enough

10

Antibody Response

T cell response weakens and becomes an antibody-dominant response

strong AB response but useless

These AB cannot kill the bacteria therefore, this phase leads to more extreme cases of leprosy

11

Indeterminate Leprosy

some cases may resolve, while some may progress to full term

Patches may have loss sensation and when biopsied may have granulomatous infiltrates

Ill defined patch

12

Single or few, assymetrical, well defined hyppigmented, erythematous or copper colored patches with raised borders

no satellite lesion

Tuberculoid leprosy

13

Few, asymetrical, well demarcated, dry plaques. May be annular with clearly defined outer borders. Surface may be scaly

Bordeline TL

14

More numerous lesions than TL (>3 and <10 lesions)

Asymmetrical, less well demarcated, shiny plaques, often annular with sharply-marginated inner and outer borders

Mid borderline Leprosy

15

Numerous (>5) smaller,, rougly symmetrical, shiny, macules, papules, nodules, and plaques with sloping edges

Annular punched out lesions

Bordeline Lepromatous Leprosy

16

Very numerous, symmetrically distributed, erythematous or sopper colored, shiny macules

Presents with a lot of infiltration on the skin

LL

17

Classifies cases of leprosy bases on clinical features

Ridley Jopling classification

18

WHO classification of leprosy

Multibacillary
Paucibacillary

19

Multibacillary Leprosy

>5 skin lesions
+ AFB
>1 nerve trunk involves

20

Paucibacillary Leprosy

<5 skin lesions
NO AFB in skin smears
0-1 Nerve trunks involved

21

MB - Ripley-jolling

Lepromatous
BL
BT

22

PB- Ripley jopling

BT
T
Indertimate

23

"Leprary reactions"

Cured persons with late reactions

Cured persons with residual disabilities

24

2 nervess usually examined in Leprosy

Ulnar and common peroneal

25

Diagnostic test of leprosy

Slit skin smear
Skin biopsy

26

MDT of Lprosy

Rifampicin
Clofazimine
Dapsone

27

A leprosy patient becomes non-infectious after taking MDT for _______ month

1 month

28

Treatment for PB leprosy (Indeterminate, TT, BT)

Rifampicin 600mg once a month for 6 months

+

Dapsone 100 mg daily for 6 months

29

Treatment for MB Leprosy( BT, BB, BL, LL)

Rifampicin 600 mg and Clofazimin 300 mg once a month

+

Dapsone 100mg and clofazimine 50 mg for 12 months or until skin smears show no more solid staining Bacilli

30

Side effects for treatment of Leprosy

Rifampicin: Reddish urine

Clofazimine: Dark brown skin discoloration

Dapsone: Hemolytic anemia

31

Medical Management of lepra Reactions

High Risk: MB + nerve impairment

Clinical indications

Nerve pain
Loss of sensation
Loss of function

32

management of Mild Lepra reactions (Type 1 and 2)

Features: Mildly swollen skin lesion, Mild fever

Mild analgesics
Continue MDT
Do nerve function assessment every 2 weeks
Advise Bed rest

33

Management of Severe Lepra reactions

Prednisolone x 12 weeks
and.or clofazzimine x 3months + continue MDT

Nerve Fx assessment every 2 weeks

Alagesics
Refer persistent, non responding reactions

34

Severity grading for Lepra reaction

Mild - only the skin

Severe - skin, nerve and systemic

35

Characteristics of Lepra reactions

Type I - reversal reaction

Type II -erythema nodosum leprosum

36

Type 1 (Reversal Reaction)

Mostly borderline

Associated wih alteration in CMI due to sudden increase inCMI

37

Type 2 (ENL)

Mostly lepromatous

Immune-complex syndrome due to precipitation of antigen and antibody complexes in tissues spaces, blood, lymphatics

38

Peripheral nerve inflammation manifests into 2 ways in Leprosy

1. Enlarged and/or very painful

2. Silent neuritis

39

Impairment, disability and deformity

Claw hand

Foot ulcer - posterior tibial nerve

Foot drop - Peroneal nerve damage

Ocular complications - Facial or trigeminal nerve damage