Upload
kciapm
View
55
Download
1
Tags:
Embed Size (px)
Citation preview
History:
* * 1870 - Hansen ( Norway) :
….. Transmissible agent,
…… 1873 - Isolated Organisms,
* In vitro culture - NOT POSSIBLE
* Animal models - footpads of mouse,
- 9-banded armadillos
- Monkeys & Chimpanzees.
** Chronic infection,
* Caused by Mycobacterium leprae,
** Affects cooler parts:
… Skin,
… Upper respiratory tract,
… Superficial nerves,
… Eye,
… Testes;
Introduction:
Uncertain ,
Nasorespiratory tract,
Skin to skin ( uncommon ),
Man to man,
5 to 25% of wild armadillos (Louisiana)
To man ( ? Zoonosis ).
WHO ---- 5.5 Million Patients in the world,
Mainly in-- India,
-- Tropical Africa,
-- South America,
-- Southeast Asia,
-- Philippines,
-- South Pacific Islands.
Incidence:
60.9% of global cases,
57 / 10,000 ----- 1981,
5 / 10,000 ----- 2000,
High Incidence:
Bihar, UP, MP, Orissa, WB = 62%.
Incidence in India:
1966 -- Ridley & Jopling:
Immunologic, Pathologic, Clinical features-
* TT -- Tuberculoid,
* BT -- Borderline-tuberculoid,
* BB – Mid-borderline,
* BL -- Borderline-lepromatous,
* LL -- Lepromatous,
Indeterminate,
Pure Neuritic,
Lucio leprosy,
Histoid leprosy,
• PAUCIBACILLARY …--- Skin smear -- Negative;
• MULTIBACILLARY …--- Skin smear -- Positive;
Clinical Features:
Hypoesthetic skin lesions,
-- Nearly all have peripheral neuropathy,
Thickened Superficial Nerves,
-- 1 in 4 shows deformity,
A F B In Skin Smears;
Skin patches which
have normal feeling
are present from birth
cause itching
are silvery white, black, dark red coloured
show scaling
appear and disappear periodically
spread quickly
Pale white or slightly reddish patch
DEFINITE LOSS OF SENSATION IN THE PATCH
Signs of damage to nerves
definite loss of sensation in hands/feet
weakness of muscles of hands/feet/face
visible deformity of hands/feet/face
Defective Cell-Mediated Immunity:
Antigen-recognition by Helper T-cells
Interleukin --2
Interferon gamma -->Activation of macrophages.
Pathogenesis:
Examine skin
Check for patches
Test for sensation
Count the number of patches
Look for damage to nerves
How to diagnose leprosy
Tuberculoidleprosy:
- No free zone,
- Well formed epitheloid cell granulomas +
- AFBs: + or -
Lepromatous leprosy:
-Grenz (free) zone +
-No epitheloid cell granulomas,
-Foamy macrophages,
- Numerous AFBs- (globi, cigar bundle)
----Lepra cells/ Virchow cells.
Cutaneous Pathology:
Grenz Zone
Virchow Cells with Globi
Leprous orchitis:
--Sterility & Impotence
Osteitis & Periosteitis:
--Skeletal deformities (collapsed nose),
Nasal mucosa: Macrophage infiltration,
Eye: Lagophthalmos, Exposure keratopathy,
Trophic Ulcers.
Other organs affected:
Clinical Examination,
Split Skin Smear,
Histopathological Examination,
( Fites-Ferraco stain for AFB )
Diagnosis: .. To be done with Utmost caution,
.. And Confidentiality.
( Social stigma )
Multi-Drug Therapy,
Dapsone
Rifampin
Clofazimine
Chemoprophylactic drugs to contacts
Can be CURED COMPLETELY
Leprosy: Treatment
22