8/17/2019 PIT IDI KUSTA.pdf

1/29

8/17/2019 PIT IDI KUSTA.pdf

2/29

Leprosy :

- Chronic infection

- Cause : M.leprae

- Primarily attackperipheral nerve,

secondarily attack

other organs,

including nasalcavity

Mycobacterium leprae

8/17/2019 PIT IDI KUSTA.pdf

3/29

8/17/2019 PIT IDI KUSTA.pdf

4/29

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

8/17/2019 PIT IDI KUSTA.pdf

5/29

5

The 1st cardinal sign of leprosy

Skin patch with loss ofsensation• Hypopigmented

•

Erythematous

8/17/2019 PIT IDI KUSTA.pdf

6/29

Enlarged

greatauricularnerve

8/17/2019 PIT IDI KUSTA.pdf

7/29

8/17/2019 PIT IDI KUSTA.pdf

8/29

Bacterial Index (BI) : total number of bacilli ( 1+ to 6+ )Morphological Index (MI) : % of solid staining bacilli,number of viable bacilli

SOLID

GRANULAR FRAGMENTED

8/17/2019 PIT IDI KUSTA.pdf

9/29

8/17/2019 PIT IDI KUSTA.pdf

10/29

Penyakit sudah lama / kronis :sudah bbrp bulan / tahun

Tidak gatal, tidak nyeri Adanya sumber penularanPasien berasal dari daerah

endemik kustaSudah dicoba dengan berbagai

salep

8/17/2019 PIT IDI KUSTA.pdf

11/29

Light touchTemperature discrimination

Pain (pin prick)

Decreasedsweating

CLINICALEXAMINATION

8/17/2019 PIT IDI KUSTA.pdf

12/29

Palpation ulnar nerve

8/17/2019 PIT IDI KUSTA.pdf

13/29

BILA SEMUA HASILPEMERIKSAAN MERAGUKAN :

 Alternatif :1. Dirujuk ke dokter yg lebih

ahli.2. Ditunggu sampai cardinal

sign muncul, baru diobati

3. Periksa laboratorik tambahan.

8/17/2019 PIT IDI KUSTA.pdf

14/29

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

8/17/2019 PIT IDI KUSTA.pdf

15/29

TUBERCULOID BORDERLINE LEPROMATOUS

CELLULAIRIMMUNITY 

HUMORALIMMUNITY 

CLINICAL SPECTRUM OF LEPROSY

 AFB

Number

8/17/2019 PIT IDI KUSTA.pdf

16/29

Ridley & Jopling (1964) :

TT BT BB BL LL

WHO ( 1980 )

KLASIFIKASI PENYAKIT KUSTA

8/17/2019 PIT IDI KUSTA.pdf

17/29

Pitiriasis Versicolor

Pityriasis alba

Birth MarkM TT

8/17/2019 PIT IDI KUSTA.pdf

18/29

DIAGNOSA BANDING M.H.

MH BT-

type

Pityriasis RoseaTinea Pedis

8/17/2019 PIT IDI KUSTA.pdf

19/29

Erythro-Papulo-Squamous lesions

MH-BB type

Psoriasis

Lues II

8/17/2019 PIT IDI KUSTA.pdf

20/29

Charcot Marie Tooth Disease :

( genetic peripheral nerve disorder)

8/17/2019 PIT IDI KUSTA.pdf

21/29

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 

8/17/2019 PIT IDI KUSTA.pdf

22/29

Detection of Anti PGL-1antibodies

Cut off value : IgM = 605 u/ml IgG = 650 u.ml

8/17/2019 PIT IDI KUSTA.pdf

23/29

INDICATION OF SEROLOGICALTEST IN LEPROSY :

• Diagnosis support of LeprosyLeprosy Classification

• Detection of SubclinicalInfection of Leprosy

• Treatment Evaluation

8/17/2019 PIT IDI KUSTA.pdf

24/29

SEROLOGICAL EXAMINATION INLEPROSY 

8/17/2019 PIT IDI KUSTA.pdf

25/29

FILTER PAPER METHOD

8/17/2019 PIT IDI KUSTA.pdf

26/29

FILTER PAPER METHOD

8/17/2019 PIT IDI KUSTA.pdf

27/29

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.

8/17/2019 PIT IDI KUSTA.pdf

28/29

spl1 spl2 spl 3 spl 4 spl 5 Marker Negatip Positip

(-) (-) (+) (+) (+) (ladder) kontrol kontrol

99bsp

PCR test for M.leprae : sensitivity up to 90%

8/17/2019 PIT IDI KUSTA.pdf

29/29

Thank You…