Leprosy

SPEAKER:

NUR HANISAH BINTI ZAINOREN

SERIAL NO. 55

MATRIC NO. 62

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.

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 moistclimate

• 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

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.

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 thenose and mouth, during close and frequent contacts with untreated cases.

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

However, the majority of leprosy cases have more variableimmune resistance and do not fall into either of the twopoles.

Ridley-Jopling Classification

• based on clinico-pathological spectrum

T.T. B.T. B.B. B.L. L.L.

POLAR GROUP POLAR GROUPBORDERLINE GROUP

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.

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)

Tuberculoid leprosy Lepromatous leprosy

Treatment

• Multiple drug therapy for 12 – months is key to treatment, this is carried out by WHO guideline using.1- Rifampicin2- Dapsone3- 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.

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

Thank You