Leprosy info.

Leprosy: (Hansen’s disease).

Leprosy is a chronic inflammatory disease caused by Mycobacterium leprae infecting macrophages and peripheral nerve Schwann cells.
It’s presentation and progress are determined by the patient’s cell mediated immune response to the mycobacterium. Most people (~95% develop an effective immune response to clear the M.leprae. The minority that cannot mount this immune response develop clinical leprosy.

Clinical Features of leprosy:
Classification Spectrum of Immune response Skin Lesion Nerve Involvement
Indeterminate Solitary hypo pigmented 2-5 cm lesion. Centre may show sensory loss. May become TT like. None clinically detectable.
Tuberculoid
(TT)
paucibacillary Strong but ineffective immune response to the bacteria which damages peripheral nerves and skin Lesions with well defined borders and sensory loss.
Patch is dry (loss of sweating) and hairless. May have one peripheral nerve affected. Occasionally presents as a mono-neuropathy.
Borderline Tuberculoid
(BT) Varying immunity and bacterial loads. Irregular plaques with raised edges and sensory loss.
Satellite lesions at the edges. Asymmetrical peripheral nerve involvement.
Borderline
(BB) Varying immunity and bacterial loads Many lesions with punched out edges. Satellites are common. Widespread nerve enlargement. Sensory and motor loss.
Borderline Lepromatous
(BL) Varying immunity and bacterial loads Many lesions with diffuse borders and variable anesthesia. Widespread nerve enlargement. Sensory and motor loss.
Lepromatous
(LL)
multibacillary Cellular anergy towards M.leprae with abundant bacillary multiplication. Numerous nodular skin lesions in a symmetrical distribution. Lesions are not dry or anesthetic. There are often thickened shiny earlobes, loss of eyebrows, and skin thickening. Widespread nerve enlargement. Sensory and motor loss.


Presentation:
1. Skin lesions
2. Nerve Damage: Weakness and Numbness occurs in the peripheral nerve trunks. Great auricular nerve, ulnar nerve (elbow), radial cutaneous nerve (wrist), median nerve (wrist), lateral popliteal nerve (neck of the fibula), and posterior tibial nerve (medial malleolus) lead to regional sensory and motor loss. Small dermal nerves are also involved producing patches of anesthesia in TT/BT lesions and glove and stocking sensory loss in LL patients.
3. A burn or ulcer in an anesthetic hand or foot
4. Borderline patients: nerve pain, sudden palsy, multiple new skin lesions, pain in the eye, or systemic febrile illness.
5. Ulceration and digit loss is due to secondary damage in neuropathic hands and feet.

Transmission:
Untreated patients discharge bacilli from he nose.
Infection- M.leprae invades via the nasal mucosa with hematogenous spread to skin and nerve. Leprosy bacilli can survive for several days in the environment.
People in contact with people have a greater but still small chance of becoming infected.
Incubation period is 2-5 yrs. For TT and 8-12 yrs for LL cases.


Diagnosis:
1. Macular hypo pigmented, hypo aesthetic lesion skin lesions.
2. Nerve enlargement
3. Positive skin smear for Acid Fast Bacilli
*Test Skin lesions for sensation.
*Palpate peripheral nerves to assess enlargement and tenderness.
*Assess nerve function b testing the small muscles’ power and sensation in hands and feet.
*Check eye function- Visual acuity, corneal sensation, and eyelid closure.
* Serology is not helpful.

Management:
1.Chemotherapy to treat the infection:
Leprosy Type Drug: Monthly Supervised Drug: Daily self administered Treatment Duration
Paucubacillary (2-5 skin lesions) Rifampicin 600mg Dapsone 100mg 6 months
Multibacillary (>5 lesions) Rifampicin 600mg Clofazimine 50 mg 12 months
Clofazimine 300mg Dapsone 100mg




2. Educate the patient: Patients are non-infectious within 72 hours and can lead a normal life. No limitations on touch. This is not a punishment from God. Deformities are not a result of the disease but due to the patients lack of sensation and harm without knowing it.
3.Prevent disability: Monitor sensation and muscle power in pts. Hand, feet, and yes as part of routine follow up so that new nerve damage is detected early. Treat any new damage with Prednisolone 40 mg daily, reducing by 5mg/day each month. Protect hands and feet!!
4. Support the patient socially and psychologically.

PICS

Hey Everyone!
I'm back safely and have uploaded pics
www.snapfish.com
email: sorensenk@uthscsa.edu
password: india
I hope you all enjoy!
My last week was a bit of a crazy "whirl wind" tour of India. New Delhi, Jaipur and Agra and I started last week on Inpatient with the Christian Family Practice Residency in Harlingen. (I get to work with Matt close by again which I really enjoy!) It was a hard transition back and I was very tired but it is such a blessing to be so welcomed by my friends here and to be encouraged again in my faith.
I will be posting an essay on leprosy soon for those of you who are interested. God bless! Thank you all again so much for your prayers! It's great to be back safe and sound.