Leprosy Ms
Leprosy Ms
Leprosy Ms
Submitted by:-
Amit Kochhar
B.O.T. 2nd year
Pt. D.D.U. I.P.H.
Introduction
• Leprosy is a chronic bacterial infection with
Mycobacterium leprae.
• It primarily affects the skin, mucous membranes
(e.g. nose), peripheral nervous system (nerve
function), eyes and testes.
• The form the disease takes depends on the
person's immune response to the infection.
• Leprosy is also known as Hansen disease and is
one of the oldest known diseases of mankind.
• It is curable but if untreated can lead to severe
deformities.
Mycobacterium
leprae
History
• Leprosy has tormented humans
throughout recorded history.
• The earliest possible account of a disease
that many scholars believe is leprosy
appears in an Egyptian Papyrus document
written around 1550 B.C.
• Around 600 B.C.
• Indian writings describe a disease that
resembles leprosy.
• In Europe, leprosy first appeared in the records of
ancient Greece after the army of Alexander the
Great came back from India and then in Rome in
62 B.C. coinciding with the return of Pompeii's
troops from Asia Minor.
• Throughout its history, leprosy has been feared
and misunderstood.
• For a long time leprosy was thought to be a
hereditary disease, a curse, or a punishment from
God.
• Before and even after the discovery of its
biological cause, leprosy patients were
stigmatized and shunned.
• For example, in Europe during the Middle Ages,
leprosy sufferers had to wear special clothing,
ring bells to warn others that they were close,
and even walk on a particular side of the road,
depending on the direction of the wind.
• Even in modern times, leprosy treatment has
often occurred in separate hospitals and live-in
colonies called leprosarium because of the
stigma of the disease.
• Leprosy has been so prevalent in various areas
as certain times throughout history that is has
inspired art work and influenced other cultural
practices
Nigerian Mask: A representation of leprosy
disfigurement
• In 1873:
Dr. Gerhard Henrik Armauer Hansen of
Norway was the first person to identify the
germ that causes leprosy under a
microscope.
Hansen's discovery of Mycobacterium leprae
proved that leprosy was caused by a germ,
and was thus not hereditary, from a curse, or
from a sin.
classification
• Depending on clinical features, leprosy is
classified as:
Indeterminate leprosy (IL)
Tuberculoid leprosy (TT)
Borderline tuberculoid leprosy (BT)
Borderline borderline leprosy (BB)
Borderline lepromatous leprosy (BL)
Lepromatous leprosy (LL)
Intermediate Leprosy (IL)
• This is the earliest and mildest form of the
disease.
• Few numbers of hypopigmented macules
(cutaneous lesions) may occur.
• Loss of sensation is rare.
• Most cases progress into a later form, although
patients with strong immunity may either clear
the infection on their own or persist in this form
without progressing.
Intermediate leprosy :
hypoaesthesia and
hyposudation investigations
must be systematic in endemic
area.
• Patients with indeterminate leprosy, a very
early form of leprosy, may either be cured
or progress to one of the other forms of
leprosy depending on their immune status.
Tuberculoid leprosy (TT)
• Tuberculoid (TT) leprosy appears on the
extreme left of the Immunological Spectrum as
that form of the disease which is most resistant.
• Those who have this form have a good Cell-
Mediated Immunity (CMI).
• The key word in relation to this disease in
making a diagnosis is “LOCALISED”. Because
of the body’s strong CMI defenses, the disease
is being contained or localized either to a skin
patch - generally ONE patch in the early stages,
or to a nerve trunk.
• When the affected tissue of a Tuberculoid
patient is examined pathologically, such a
skin biopsy shows collections of these
epithelioid cells surrounded by many
groups of lymphocytes and, occasionally
“Giant Cells” can be seen in such a
grouping.
• Nerves in TT leprosy lesions can be
seriously affected and even destroyed if
the disease is not treated
• CLINICAL FEATURES IN TUBERCULOID
LEPROSY :-
(1) Lesions generally are on the face,
lateral aspect of extremities and the
buttocks
(2) Skin lesions may be single of few
(3) Lesions are asymmetrical
• DESCRIPTION OF SKIN LESIONS:-
Mycobacterium Leprae
enters the body
On of these things
can happen
Reversal reaction:
Peak time: during the first 2 month of therapy, even up 12
months, and after (MDT) is completed.
Corticosteroids 40-60mg daily, taper 5 mg every 2-4
weeks, duration of therapy 3-4 months.
Recovery rate for nerve function 60-70%, less with pre-
existing nerve damage or recurrent reaction.
MDT
Treatment
Type 2 reaction (ENL):