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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