Leprosy Leprosy

Dr. Ashok Jaisingani Dr. Ashok Jaisingani

Introduction Introduction

► Leprosy is also called as “Hansen's disease”Leprosy is also called as “Hansen's disease”► It is chronic curable infectious disease It is chronic curable infectious disease

caused by mycobacterium leprae. caused by mycobacterium leprae. ► It occurs mainly in tropical regions and It occurs mainly in tropical regions and

developing countries.developing countries.► The majority of the cases are located in The majority of the cases are located in

Indian subcontinents Indian subcontinents ► Patient suffer not only from the primary Patient suffer not only from the primary

affect of disease but also from the social affect of disease but also from the social discrimination, sadly compounded by discrimination, sadly compounded by inappropriate term ‘leper’ for one who inappropriate term ‘leper’ for one who afflicted with that disease. afflicted with that disease.

Pathology Pathology

► The transmission occurs through nasal The transmission occurs through nasal secretionsecretion

► It is attributed to poor hygiene and unsanitary It is attributed to poor hygiene and unsanitary conditions conditions

► The incubation period is several years The incubation period is several years ► The disease present with skin, upper The disease present with skin, upper

respiratory and neurological symptomsrespiratory and neurological symptoms► The infection occur in childhood or early The infection occur in childhood or early

adolescence adolescence ► The bacillus is acid fast but so weakly when The bacillus is acid fast but so weakly when

compared with mycobacterium tuberculosis. compared with mycobacterium tuberculosis.

Classification Of Disease Classification Of Disease

►The disease is broadly classified into The disease is broadly classified into two groups. two groups. 1- Lepromatous 1- Lepromatous 2- Tuberculoid 2- Tuberculoid

Lepromatous Leprosy Lepromatous Leprosy

► In lepromatous leprosy there is wide In lepromatous leprosy there is wide spread dissemination of abundant spread dissemination of abundant bacilli in the tissues with the bacilli in the tissues with the macrophages and a few lymphocytes. macrophages and a few lymphocytes.

►This denote a poor host immune This denote a poor host immune reaction.reaction.

Tuberculoid Leprosy Tuberculoid Leprosy

► In tuberculoid leprosy the pts show In tuberculoid leprosy the pts show strong immune response with scant strong immune response with scant bacilli in tissues, epithelioid bacilli in tissues, epithelioid granuloma, numerous lymphocytes granuloma, numerous lymphocytes and giant cells. and giant cells.

►Thus that condition occurs when host Thus that condition occurs when host resistance is stronger than virulence of resistance is stronger than virulence of organisms. organisms.

Clinical Features Clinical Features ► Disease is slowly progressive affecting skin, upper Disease is slowly progressive affecting skin, upper

respiratory tract and peripheral nerves. respiratory tract and peripheral nerves. ► Tuberculoid Leprosy:Tuberculoid Leprosy: There is damage to tissues There is damage to tissues

occurs early and is localized to one part of the body, occurs early and is localized to one part of the body, which limited deformity of that organ. which limited deformity of that organ.

► Neural involvement is characterized by thickening of Neural involvement is characterized by thickening of the nerves which are tenders.the nerves which are tenders.

► There may be asymmetrical well defined anesthetic There may be asymmetrical well defined anesthetic hypopigmented or erythamatous macules with hypopigmented or erythamatous macules with elevated edges and dry and rough surface lesion elevated edges and dry and rough surface lesion called “leprids”. called “leprids”.

► Lepromatous Leprosy:Lepromatous Leprosy: There is disease is There is disease is symmetrical and extensive. Cutanous involvement symmetrical and extensive. Cutanous involvement occurs in the form of the several pale macules that occurs in the form of the several pale macules that form plaques called ‘lepromas’. form plaques called ‘lepromas’.

Deformities Deformities

►The deformities produced by the The deformities produced by the disease which are divided into disease which are divided into

►Primary:Primary: These are caused by the These are caused by the leprosy or by its reactionsleprosy or by its reactions

►Secondary:Secondary: These resulting from These resulting from effects such as anesthesia of hands effects such as anesthesia of hands and feet. and feet.

Lesion involving Face Lesion involving Face

► In the acute phase of lepromatous variety the In the acute phase of lepromatous variety the nodular lesion on the face are known as “Leonine nodular lesion on the face are known as “Leonine facies” (looking like lion) facies” (looking like lion)

► Later there is wrinkling of skin and aged appearance Later there is wrinkling of skin and aged appearance to young individuals. to young individuals.

► There is loss of eyebrows There is loss of eyebrows ► Destruction of lateral cartilage and septum of nose Destruction of lateral cartilage and septum of nose

with collapse of nasal bridge and lifting of tip of nose. with collapse of nasal bridge and lifting of tip of nose. ► There may be paralysis of branches of facial nerves There may be paralysis of branches of facial nerves

in bony canal or of zygomatous branches. in bony canal or of zygomatous branches. ► Paralysis of orbicularis occuli cause incomplete Paralysis of orbicularis occuli cause incomplete

closure of eyes, epiphoras and conjunctivae. closure of eyes, epiphoras and conjunctivae.

Lesion Involve Hands & FeetLesion Involve Hands & Feet

► Lesions Involving Hands:Lesions Involving Hands: The hands are The hands are typically clawed because of involvement of ulner typically clawed because of involvement of ulner nerve at elbow and median nerve at wrist. nerve at elbow and median nerve at wrist.

► Anesthesia of hands makes these pts susceptible Anesthesia of hands makes these pts susceptible to frequent burns and injuries. to frequent burns and injuries.

► Lesion Involving Feet:Lesion Involving Feet: There is clawing of toes There is clawing of toes occurring as result of involvement of posterior occurring as result of involvement of posterior tibial nerve. When lateral popliteal nerve is tibial nerve. When lateral popliteal nerve is affected it leads to foot drop and nerve can be affected it leads to foot drop and nerve can be felt to be thickened behind the upper end of felt to be thickened behind the upper end of fibulae fibulae

► Anesthesia of feet predispose to trophic Anesthesia of feet predispose to trophic ulceration, chronic infection, contraction and ulceration, chronic infection, contraction and autoimputation. autoimputation.

Leprosy Diagnosis Leprosy Diagnosis

►Typical clinical features and awareness of the Typical clinical features and awareness of the disease should help to make a diagnosisdisease should help to make a diagnosis

►The face has an aged look about it with The face has an aged look about it with collapse of nasal bridge and eyes changes. collapse of nasal bridge and eyes changes.

►Thickened peripheral nerves, patches of Thickened peripheral nerves, patches of anesthetic skin, claws hands, foot drop and anesthetic skin, claws hands, foot drop and trophic ulcer are characteristic. trophic ulcer are characteristic.

►Microbiological examination of acid – fast Microbiological examination of acid – fast bacillus and typical history on skin biopsy. bacillus and typical history on skin biopsy.

Treatment Treatment ► Multiple drug therapy for 12 – months is key to Multiple drug therapy for 12 – months is key to

treatment, this is carried out by WHO guideline using.treatment, this is carried out by WHO guideline using.1- Rifampicin 1- Rifampicin 2- Dapsone 2- Dapsone 3- Clofazimine 3- Clofazimine

► During treatment, pts may develop acute During treatment, pts may develop acute manifestation, which controlled by steroidsmanifestation, which controlled by steroids

► Surgical treatment is indicated in advance stage of Surgical treatment is indicated in advance stage of disease for functional disability of limbs, cosmetic disease for functional disability of limbs, cosmetic disfigurement of face and visual problems. disfigurement of face and visual problems.

► Surgical reconstruction requires the expertise of hand Surgical reconstruction requires the expertise of hand surgeon, orthopedic surgeon and plastic surgeon.surgeon, orthopedic surgeon and plastic surgeon.

► General surgeon may be called upon, when it require General surgeon may be called upon, when it require amputation or in emergency situation abscess amputation or in emergency situation abscess drainage. drainage.

Prevention Of Disease Prevention Of Disease

►Educating the patient about the Educating the patient about the dreadful sequelae of the disease so dreadful sequelae of the disease so that they seek medical help early as that they seek medical help early as important. important.

►Education of general public should be Education of general public should be the keystone in prevention. the keystone in prevention.