Post on 14-Apr-2018
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LEPROSY
BY: KRISTETA G. ACEBEDO
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INTRODUCTION
Caused by Mycobacterium leprae
Clinical manifestations are largely confined to
the skin, PNS, upper respiratory tract, eyes,and testes.
Historically, society has developed a profound
social stigma on this disease
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ETIOLOGY obligate intracellular bacillus (0.31 m wide and
18 m long)
acid-fast, ideally detected in tissue sections by a
modified Fite stain.
M. leprae is well adapted to penetrate and residewithin macrophages, yet it may survive outsidethe body for months.
M. leprae grows best in cooler tissues
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EPIDEMIOLOGY
Leprosy is almost exclusively a disease of thedeveloping world, affecting areas of Asia, Africa,Latin America, and the Pacific
While Africa has the highest disease prevalence,Asia has the most cases.
Estimated range of affected individuals are 0.6 to
8 million individuals.
600,000 new cases annually, 60% of them inIndia.
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EPIDEMIOLOGY
Leprosy is associated with poverty and ruralresidence.
It appears not to be associated with AIDS,perhaps because of leprosys long incubationperiod.
The most severe lepromatous form of leprosy istwice as common among men as among womenand is rarely encountered in children.
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TRANSMISSION
The route of transmission of leprosy remainsuncertain, and transmission routes may in fact bemultiple.
prime candidates of transmission are nasaldroplet infection, contact with infected soil, andeven insect vectors.
Direct dermal inoculation may transmit M. leprae
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TRANSMISSION
M. leprae and that experimentally infected
mosquitoes can transmit infection to mice.
Skin-to-skin contact is generally not
considered an important route of
transmission.
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TUBERCULOID LEPROSY
Less severe kind of leprosy
These forms of leprosyresult in symptoms confined
to the skin and peripheralnerves.
The skin lesions of
tuberculoid leprosy consistof one or a fewhypopigmented macules orplaques
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TUBERCULOID LEPROSY
often have erythematous orraised borders, and are devoid ofthe normal skin organs thus aredry, scaly, and anhidrotic
Tuberculoid leprosy patients mayhave asymmetric enlargement ofone or a few peripheral nerves
Tuberculoid leprosy is the mostcommon form of the diseaseencountered in India and Africabut is virtually absent inSoutheast Asia
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LEPROMATOUS LEPROSY
Lepromatous leprosy patientspresent with symmetricallydistributed skin nodules
Late manifestations include loss
of eyebrows and eyelashes,pendulous earlobes, and dryscaling skin, particularly on thefeet
Bacilli are numerous in the skinwhere they are often found inlarge clumps
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LEPROMATOUS LEPROSY
Bacilli are plentiful in circulatingblood and in all organ systemsexcept the lungs and the centralnervous system
Macrophages of lepromatousleprosy patients appear to befunctionally intact
Circulating monocytes exhibitnormalmicrobicidal function
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COMPLICATIONS
THE EXTREMITIES
THE NOSE
THE EYE TESTES
AMYLOIDOSIS
NERVE ABSCESSES
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THE EXTREMITIES
Complications of the extremities in leprosypatients are primarily a consequence ofneuropathy leading to insensitivity and myopathy.
Insensitivity affects fine touch,pain, and heatreceptors
Spares position and vibration appreciation.
Most commonly affected nerve trunk is the ulnarnerve at the elbow
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THE EXTREMITIES
Plantar ulceration, particularly at the
metatarsal heads, is probably the most
frequent complication of leprous neuropathy.
The loss of distal digits in leprosy is a
consequence of insensitivity, trauma, and
secondary infection.
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THE NOSE
In lepromatous leprosy, bacillary invasion ofthe nasal mucosa can result in chronic nasal
congestion and epistaxis.
Saline nose drops may relieve thesesymptoms.
Long-untreated LL leprosy may further result
in destruction of the nasal cartilage Nasal reconstructive procedures can
ameliorate significant cosmetic defects.
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THE EYE
Owing to cranial nerve palsies, lagophthalmos
and corneal insensitivity may complicate
leprosy
Eyedrops during the day and ointments at
night provide some protection from such
consequences
Leprosy is a major cause of blindness in the
developing world
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THE TESTES
Males with lepromatous leprosy often
manifest mild to severe testicular dysfunction
Elevation of luteinizing and follicle stimulating
hormones
Decreased testosterone
Aspermia
Patients may become impotent and infertile
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AMYLOIDOSIS
A complication of LL leprosy
May result in abnormalities of hepatic andparticularly renal function.
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NERVE ABSCESSES
Patients with various forms of leprosy, but
particularly those with the BT form, may
develop abscesses of nerves
Affected nerve is swollen and exquisitely
tender.
Glucocorticoids may reduce signs of
inflammation
Rapid surgical decompression is necessary to
prevent irreversible sequelae
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DIAGNOSIS
Leprosy most commonly presents with bothcharacteristic skin lesions and skin
histopathology
Tuberculoid/ paucibacillary- skin should be
biopsied because normal-appearing skin does
not have pathologic features
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DIAGNOSIS
Hyperglobulinemia- A condition characterized
by abnormally large amounts of globulins in
the blood.
Thickened, enlarged peripheral nerves
Sensory loss
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MEDICAL MANAGEMENT:
ANTIMICROBIAL THERAPY
Established agents used to treat leprosyinclude :dapsone (50100 mg/d)
clofazimine (50100mg/d, 100 mg
three times weekly, or 300 mgmonthly)
rifampin (600mg daily or monthly)
Dapsone were the first antimicrobial agentsfound to be effective for the treatment ofleprosy and are still the mainstay of therapy
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MEDICAL MANAGEMENT:
ANTIMICROBIAL THERAPY
Dapsone- skin lesions are resolved and numbers
of viable bacilli in the skin are reduced.
Dapsone is generally safe and inexpensive
Individuals with glucose-6-phosphate
dehydrogenase deficiency who are treated with
dapsone may develop severe hemolysis
Clofazimine is often cosmetically unacceptabletolight-skinned leprosy patients because it causes
a red-black skin discoloration
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PREVENTION AND CONTROL
Vaccination
- Bacillus Calmette-Guerin (BCG) at birth
Chemoprophylaxis- Dapsone
campaign mobilized and energized
nongovernmental organizations and nationalhealth services to treat leprosy with multiple
drugs and to clean up outdated registries.
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OT MANAGEMENT
ACTIVITIES OF DAILY LIVING TRAINING
SPLINT DESIGN & FABRICATION
GROUP THERAPY