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7/25/2019 2. PIT IDI 2015
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KASUS KUSTA YANGMERAGUKAN :Bagaimana
menegakkandiagnosa ?
INDROPO AGUSNI
7/25/2019 2. PIT IDI 2015
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Leprosy :
- Chronic infection
- Cause : M.leprae
- Primarily attackperipheral nerve,
secondarily attack
other organs,
including nasalcavity
Mycobacterium leprae
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1. skin patch with loss of sensation
2. enlarged peripheral nerve
3. positive slit-skin smear
Physical examination will diagnose leprosy in most casesPhysical examination plus skin smear will diagnose
leprosy in the vast majority of cases
The cardinal signs of leprosy
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5
The 1st cardinal sign of leprosy
Skin patch with loss ofsensation• Hypopigmented
•
Erythematous
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Enlarged
greatauricularnerve
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The slit andscrapemethod
Incision, turnthe blade 90degrees
LOCATION :
EarlobeChinExtensor forearmDorsal fingersButtocksKnees
BACTERIOLOGIAL EXAMINATIONIN LEPROSY
Courtesy from
Dr. Colette van Hees
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Bacterial Index (BI) : total number of bacilli ( 1+ to 6+ )
Morphological Index (MI) : % of solid staining bacilli,
number of viable bacilli
SOLID
GRANULAR FRAGMENTED
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KUSTA ?
7/25/2019 2. PIT IDI 2015
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Penyakit sudah lama / kronis :sudah bbrp bulan / tahun
Tidak gatal, tidak nyeri Adanya sumber penularanPasien berasal dari daerah
endemik kustaSudah dicoba dengan berbagai
salep
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Light touchTemperature discrimination
Pain (pin prick)
Decreasedsweating
CLINICALEXAMINATION
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Palpation ulnar nerve
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BILA SEMUA HASILPEMERIKSAAN MERAGUKAN :
Alternatif :1. Dirujuk ke dokter yg lebih
ahli.2. Ditunggu sampai cardinal
sign muncul, baru diobati
3. Periksa laboratorik tambahan.
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MENUNGGU SAMPAIKAPAN ?
- Sebaiknya evaluasisetiap 3 bulan tanpa terapi
- Bila sampai 6 bulan tidak ada perubahan, namun
dokter tetap curiga M.H. :BOLEH diberi obat anti kusta
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TUBERCULOID BORDERLINE LEPROMATOUS
CELLULAIRIMMUNITY
HUMORALIMMUNITY
CLINICAL SPECTRUM OF LEPROSY
AFB
Number
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Ridley & Jopling (1964) :
TT BT BB BL LL
WHO ( 1980 )
KLASIFIKASI PENYAKIT KUSTA
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Pitiriasis Versicolor
Pityriasis alba
Birth MarkM TT
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DIAGNOSA BANDING M.H.
MH BT-
type
Pityriasis RoseaTinea Pedis
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Erythro-Papulo-Squamous lesions
MH-BB type
Psoriasis
Lues II
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Charcot Marie Tooth Disease :
( genetic peripheral nerve disorder)
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1. Bacteriological Examination 2. Histopathology ( skin biopsy) 2. Serological Examination 3. Molecular Biology tests :
- Polymerase Chain Reaction / PCR
- Reverse Transcriptase / RT-PCR- DNA Sequencing for Drug Resistance- Genomic Study of M. leprae
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Detection of Anti PGL-1antibodies
Cut off value : IgM = 605 u/ml IgG = 650 u.ml
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INDICATION OF SEROLOGICALTEST IN LEPROSY :
• Diagnosis support of LeprosyLeprosy Classification
• Detection of SubclinicalInfection of Leprosy
• Treatment Evaluation
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SEROLOGICAL EXAMINATION INLEPROSY
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FILTER PAPER METHOD
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FILTER PAPER METHOD
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POLYMERASE CHAIN REACTION( PCR ) IN LEPROSY
NON-TYPICAL LEPROSYSKIN LESION
INDICATION :Detection of M. Leprae DNA in the samples
- skin slit preparation- blood- nasal swab- biopsy tissues etc.
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spl1 spl2 spl 3 spl 4 spl 5 Marker Negatip Positip
(-) (-) (+) (+) (+) (ladder) kontrol kontrol
99bsp
PCR test for M.leprae : sensitivity up to 90%
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Thank You…