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leprosy

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definition A chronic infectious disease caused by mycobacterium leprae, With neurologic and cutaneous lesions.

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leprosy

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the infectious agent mycobacterium leprae stained red with acid-fast stain contains o-diphenoloxidase breed one generation a 13-14days

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M. leprae

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M.leprae in nasal secretion of patients after drying ex vivostill alive for 2-9 days, Keep alive 3-4 weeks 0 ,inactivation after boiled 8' lose productivity after deposed to sunlight for 2-3h

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epidemiology 1 infectious agent leper lepromatous type 2 route of transmission damaged skin mucosa direct contact droplet spread. 3 herd suseptibility natural acquired immunity. 4 epidemic condition clustering distrubition endemic

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pathogenesis Toxicity of M.leprae high:no invasion/autotherapy Organism resistance medium TT low Borderline none LL(infectious) Cytoimmunity hypofunction

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pathology The pathological changes mainly occur in dermis and peripheral nerve. Tuberculoid type tuberculoid type structure.hair follicle coil gland sebaceous gland blood vessel and nerve damaged. LL focus of infection contains lepra cell(foam cell) histiocytic infiltrate around vessels.

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M.leprae

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Clinical features Incubation:2-5years 3moths- 10years 1 skin lesions 2 peripheral nerve syptoms

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1 skin lesions 1.diversification of lesions 2.appendages of the skin involvement:pelage sweat glands sebaceous follicle 3.skin nerve terminalsuperficial sensation dysesthesia 4.found M.leprae especially LL borderline type

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2 peripheral nerves symptoms Pure neural leprosy spindle-shaped swelling nodules or uniformly enlargement can be found,often felt painful or tenderness. 1 anesthesia 2 dyscinesia muscular atrophy palsy ulnar Nlittle finger and fourth finger contractures hypothenar claw hand median Nthenar eminence ape hand radial Nwrist drop/mallet finger common peroneal Nfoot drop facial Nfacial paralysis 3. disturbance of trophicity 4. dyshemia

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little finger and fourth finger contractures hypothnar claw hand

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radial Nwrist drop/mallet finger

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median Nthenar eminence ape hand

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Facial paralysis

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Spectrum classification: 1. Tuberculoid (TT) 2. Borderline tuberculoid (BT) 3. Borderline (BB) 4. Borderline lepromatous BL 5 Lepromatous(LL) 6 Early and indeterminate leprosy

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1. tuberculoid(TT): High resistance, the evolution is slow, Without internal organs involvement, lesions are limited bacilli(-),lepromin test(+), Test for cellular immunity shows normal. Typical lesions superficial sensation disturbance Nerve trunk is enlarged and stiff

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Tuberculoid

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tuberculoid

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tuberculoidtuberculoid

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Tuberculoid

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tuberculoid

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2. Borderline tuberculoid(BT): Numerous lesions, dissymmetric,the edges of lesions are well defined borderline Peripheral nerve involvement more than TT, fewer internal organs involvement, Bacilli + - ++ lepromin test weakly + - - in advanced stage, comparatively low cytoimmunity.

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BT

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3. Borderline(BB): Lesions polymorphism multi- color macule like infiltration and nodules. Lesions are generalized and asymmetrical,internal organs involvement. Bacilli +++++++ lepromin test - . Cytoimmunity between TT and BT

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B

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4. Borderline lepromatous BL Diffuse infiltration macula plaque/nodule Peripheral nerve trunk involvement asymmetrical Nerve enlarged tender madarosis bacilli++++ - +++++ lepromin test - in advanced stage cytoimmunity test - .

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BLBL

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BL

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5 Lepromatous(LL) very low resistance, developing fast, lesions are numerous,symmetrical. bacilli + .

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LL

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6 Indeterminate leprosy nonage hypopigmented macule superficial sensory disturbance slight peripheral involvement. Usually bacilli or only a few Leromin test most in advanced stage

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Reactional leprosy acute or subacute symptoms abrupt onset in the course of disease it is an allergic phenomenon.

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Lepromin test lepromin 0.1ML 48h nonage 3W advanced stage pratical value in late phase response 1 (+)means high resistance 2 Useful to classify a given case

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diagnosis and differential diagnosis 1 lesions with superficial sensory disturbance or only anhidrosis or only an anesthsia area. 2 peripheral nerve trunk or cutaneous nerve enlargement 3 lesions or histology section found M.leprae 4 Specific changes in histopathology if there are 2 or over 2 items accord with above 4 items, the leprosy can be diagnosed.

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treatment 1 sulfone dapsone(DDS) acedapsone (DADDS) 2 rifampicin 3 clofazimine 4 protionamide ethinamide drugs above should be used in trigeminy treatment