KULIAH MORBUS HANSEN

8/3/2019 KULIAH MORBUS HANSEN

1/37

LEPROSY( MORBUS HANSEN )

Dr AMBAR RIALITA SpKK


2/37

DEFINITION :

Chronic infection disease

Mainly affects the skin,

peripheral nerves, mucosaupper respiratory tract, reticuloendothelial system, eye, bone ,

testis, except central nervoussystem.


3/37

AETIOLOGY :

Mycobacterium leprae Curved rod shaped

Acid Fast Bacilli

Gram positive 1 8 long, 0,2 0,5

Intracellular

Prefer a growth temperature of less than37 C

Can not be cultured


4/37

EPIDEMIOLOGY :

Africa / Central Asia ---- World

All ages ranging : early infancy to very

old age 15 25 years old >>

Both sex : Males : Females = 2 : 1

Very long period : 3 5 years 1990 : 7 / 10,000 ----- 2000 : 1 / 10,000


5/37

TRANSMISSION:

Contact person

- Respiratory tract

- Skin

- Immunity

- Virulence

- Physical

- Environment : - Biological

- Social


6/37

The Microbiology of Leprosy :

M. leprae can not be cultured

Bacteriological examination :1. Diagnosis

2. To get a cross spectrum

3. Evaluations4. Prognosis


7/37

Material :

Skin lession Ear lobe

Nasal secretions / Nose blows


8/37

DIAGNOSIS of LEPROSY :

If shown one or more of the following cardinal

signs :

1. Hipopigmented or reddish skin lession with

definite loss of sensation2. Involvement of the peripheral nerves, as

demonstrated by definite enlargement /thickening peripheral nerves with loss of

sensation3. Skin smear positive for Acid Fast Bacilli

Not Yet ----- Observation for 3 6 months


9/37

Measurement of the Bacterial Index :1. Diagnosis

2. To get a cross the spectrum3. Therapy evaluation


10/37

Scoring the B I :

Average Number ofAcid Fast Bacilli Bacterial Index( B I )

1000 / field 6 +

100 1000 / field 5 +

10 100 / field 4 +

1 10 / field 3 +

1 10 / 10 fields 2 +

1 10 / 100 fields 1 +

0 / 100 fields 0


11/37

Morphological Index :

The proportion or percentage ofregularly stained bacteria of the totalscored

Ridley ( 1971 ) :

- Regularly stained bacteria = Solidlybacteria

- Irregularly stained bacteria =Fragmented + Granular bacteria


12/37

M I will be a guide in determining :

1. Response to treatment

2. Drug resistance

3. Determining the infectiousness of apatient

Treatment --- M I quickly

B I slowly


13/37

If M I and then : possibility

Irregularly

Malabsorbtion

Drug resistance


14/37

THE AIM OF CLASSIFICATION OFLEPROSY :

1. Infectious / Non infectious

2. Possible infectious3. Possible Disability

4. Duration of treatment


15/37

CLASSIFICATION

SPECTRUM

Ridley &Jopling

T T B T B B B L L L

MADRID Indeter-minate

Tuber-

culoid

Border-

line

Lepromatous

WHO

( 1988 )

Paucy Bacillar

Leprosy

Multi Bacillar

Leprosy


16/37

CLINICAL LEPROSY

Indeter-minate

T T B T B B B L L L

Infectious

(-)

Infectious

(-)

Infectious

(-)

Infectious Infectious Infectious

Children 2 3lesion

Satelit

lesion

Punch Out

Hipopig-mented /

pink : Face,back,buttock

Macules hipopig-

mented

Macules :hipopig-

mented /reddish

Dimor-phous

featuresand tendsymmetry

Symetricalpapul,

nodules

Symetri-cal papul,

nodules


17/37

CLINICAL LEPROSY

Indeter-minate

T T B T B B B L L L

Loss ofsensation(-)

(+) (+) (+) Sensoryloss,decreases

sweating andhair growth

Stockingand glovesanesthesia

Nerveswollen (-)

(+) (+) (+) Nervedamaged

Nervedamaged

Lepromin(-)

(+) 4 (+) 3 (+) 1 -2 (-) (-)

Acid FastBacilli (-)

(-) (+) /

(-)

(+) 3 (+) 3 - 4 (+) 5 - 6


18/37

TREATMENT of LEPROSY :

Multi Drug Therapy :

- Prevention & treatment of resistance

- As short a period of time fortreatment

- To interrupt the transmission of the

infection


19/37

W H O ( 1997 ) :

Paucibacillary Single Lesion Leprosy

(one lesion) Paucibacillary Leprosy (2-5 skin lesion)

Multibacillary Leprosy (More than 5 skin

lesion)


20/37

I. P B SINGLE LESION

CHILD ADULT

Rifampicin 300 mg Rifampicin 600 mg

Ofloxacin 200 mg Ofloxacin 400 mg

Minocycline 50 mg Minocycline 100 mg

Dosage: Single Dose R O M


21/37

II. P B 2 5 SKIN LESION

CHILD ADULT

Monthly Treatment :

Day 1 :

Rifampicin 450 mg

Dapsone 50 mg

Daily :

Day 2 28

Dapsone 50 mg/daily

Monthly Treatment :

Day 1 :

Rifampicin 600 mg

Dapsone 100 mg

Daily :

Day 2 28

Dapsone 100 mg/daily

Duration of treatment : 6 - 9 Months


22/37

III. M B :

CHILD ADULTMonthly treatment

Day 1 :

Rifampicin 450 mg

Clofazimine 150 mg

Dapsone 50 mg

Daily 2 28 :Clofazimine 50 mg / daily

Dapsone 50 mg / daily

Monthly treatment

Day 1 :

Rifampicin 600 mg

Clofazimine 300 mg

Dapsone 100 mg

Daily 2 28 :Clofazimine 50 mg / daily

Dapsone 100 mg / daily

Duration of treatment : 12 18 months


23/37

LEPROSY REACTIONS :

Type 1 reaction : Reversal reaction

Type 2 reaction : Erythema Nodosum

Leprosum

( E N L reactions )


24/37

Manifestation of : 1. Reversal reaction

Mild Severe

Skin - Lesion become reddish& swollen

- Same & rarely new skin lesion

- Fever, malaise

Nerve - Enlarge, painfull (-)- Nerve damage (-)

- < 6 weeks

- Enlarge, painfull (+)- Nerve damage, loss sensation

- > 6 weeks

Skin &

Nerve

- Lesion become reddish

- Painful on peripheralnerves

- < 6 weeks

- Same

- Ulceration- Swollen on hand & foot

- Nerve enlarge

-- > 6 weeks


25/37

2. E N L reaction

MILD SEVERE

Skin Skin nodules :- Tender reddish

- Ulceration

Skin nodules >>- Painful

- Ulceration

- Fever & malaise

Nerve EnlargePainful (-)

Nerve damage (-)

EnlargePainful & swollen

Nerve damage

Eye Not involvement Painful

Visual impairment

Testis Swollen, Painful (-) Painful, Enlarge

Skin, nerve,eye, testis

Same - Same

- Very painful

- Fever


26/37

TREATMENT of REACTION :

Prednisone : 30 80 mg / daily and thentappering off

Continued M D T without interruption

MILD REACTION :

- Immobilization

- Rest

SEVERE REACTION :

Reffered to the nearest hospital


27/37

MH tipe BB


28/37

MH tipe BL


29/37

MH tipe BT


30/37

MH indeterminate


31/37

MH tipe TT


32/37

MH tipe LL


33/37

MH tipe LL


34/37

Eritema Nodusum Leprosum(ENL)


35/37

Lepromatous leprosy. Note the diffuse infiltration of the face withleonine facies and madarosis.


36/37

Sequele of leprosy. The patient has madurosis, a saddle nose andblindness in the left eye. Courtesy of Evangeline Handog, M.D.


37/37

Documents

KULIAH MORBUS HANSEN