Leprosy - Dr. Julius King Kwedhi
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Transcript of Leprosy - Dr. Julius King Kwedhi
LEPROSYJulius King Kwedhi
ПМГУ им И.М. СЕЧЕНОВА
Background Hansen’s Disease (he discovered it in
1873) Can be grown in animals (armadillos,
mouse foot-pads)
Etiology A chronic infection caused by
Mycobacterium leprae Acid-fast, rod shaped Main route of infection:
nasal droplets, Eating armadillos (south america)
Not very contagious, but close relatives are at high risk of infection
Epidemiology In 2012 ~ 180,000 cases Most affected areas:
Tropics Subtropics Travelling increases spread of leprosy to other areas of
the world Affected countries:
India (more than half of infections) In 2015 there were 14 countries reporting more than
1,000 new cases of leprosy: Bangladesh, Brazil, DR Congo, Ethiopia, India, Indonesia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, the Philippines, Sri Lanka and Tanzania.
Leprosy In Namibia
Leprosy in Namibia Biggest community of lepers live in
Mashare, Kavango East Region (east of Rundu)
Mashare hospital used to be a leprosarium till early 1980s when it closed due to war Patients came from Namibia, Angola &
Botswana ~60 people with leprosy in Namibia
Last screening revealed 58 cases 26 lepers are being treated in Kavango, 16 of
those are in Rundu
The Last Leper Colony of Europe
Spinalonga video
spinalonga
Classification of Leprosy 2 Types of Leprosy Different in number of skin lesions
(poorly pigmented numb skin patches) presentPaucibacillary (tuberculoid) leprosy (<5
lesions)o (-)ve skin smear
Multibacillary (lepromatous) leprosy (>5 lesions)o (+)ve skin smear
Spectrum of leprosy: Tuberculoid to Lepromatous
Clinical Presentation Depends on immune response:
Paucibacillary tuberculoid type High resistance
Multibacillary repromatous type Low resistance
Initially infections without symptoms & typically remain this way for 5 to as long as 20 years.
Signs & Symptoms Flat or raised skin lesions or nodules, often less pigmented than the
surrounding skin, though they may appear reddish or copper colored Single or multiple skin lesions that are often found on cooler parts of
the body such as the face, buttocks, and extremities Thickening of the skin and peripheral nerves Ulcerations of the skin Peripheral nerve involvement leading to loss of pain sensation Peripheral nerve involvement leading to muscle weakness (for
example, clawed hand deformities, contractures, and foot drop) HoarsenessTesticular involvement leading to sexual dysfunction or
sterility Eye involvement including eye pain, eye redness, inability to close the
eyelids, corneal ulcers, and blindness Loss of eyebrows and eyelashes Destruction of the nasal cartilage Deformities & disability
Leprosy in Europe
Leprosy in Kenya
Tuberculoid vs Lepromatous Leprosy
Borderline Tuberculosis
Borderline Lepromatous
Differential Diagnosis Unlike tuberculous leprosy, there is no loss
of sensation in:Vitiligo – usually complete loss of pigmentPityriasis versicolor – mycelia and spores in
scrapings examinationPityriasis alba – common cause of scaly
hypopigmented areas on the cheeks of childrenPostinflammatory depigmentation of any cause;
and borderline leprosy consider sarcoidosis, granuloma annulare, necrobiosis lipiodica
Differential Diagnosis Lepromatous leprosy
Widespread leishmaniasis can closely simulate lepromatous leprosy. The nodules seen in neurofibromatosis and mycosis fungoides, and multiple sebaceous cysts, can lead to confusion,
Acral deformities seen in yaws (endemic treponema) and systemic sclerosis (multisystem autoimmune disorder) can lead to confusion also
Leprosy is a great imitator.
Diagnosis Biopsy of skin or sensory nerve. Lepromin test - no use in diagnosis of leprosy but helps to decide
which type of disease is present ((+)ve in tuberculoid type). DNA PCR Skin or nasal smears, stained with Acid-Fast Stains Ziehl–
Neelsen or Fité stains, will show up the large number of organisms seen in the lepromatous type Fité stain - combines peanut oil with the deparaffinizing solvent (xylene),
minimizing the exposure of the bacteria's cell wall to organic solvents, thus protecting the precarious acid-fastness of the organism.
Ziehl-Neelsen stain - Lipoid capsule of the acid-fast organism takes up carbol-fuchsin and resists decolorization with a dilute acid rinse. The lipoid capsule of the mycobacteria is of such high molecular weight that it is waxy at room temperature and successful penetration by the aqueous-based staining solutions (such as Gram's) is prevented.
Treatment Resistant strains of M. leprae, dapsone alone is
not enough Multi-drug therapy (MDT) approach Paucibacillary leprosy:
Dapsone and Rifampicin (bactericidal)6 months course
Multibacillary leprosyDapsone, rifampicin, & clofazimine1 year course
Examine all household contacts
Prevention BCG inoculation Hygiene Sanitation Public awareness and education
BCG Vaccination
DO YOU BELIEVE IN MIRACLES?
Reference: Signs and symptoms of leprosy, http://www.emedicinehealth.com/leprosy/page3_em.htm Leprosy, http://viralinfections.info/article/550223300/leprosy/ Leprosy, https://en.wikipedia.org/wiki/Leprosy#cite_note-WHO2014-1 PERCEIVED as a forgotten or biblical disease, leprosy cases continue to pop up in Namibia annually, http://
www.namibian.com.na/index.php?id=78076&page=archive-read, The Namibian Newspaper Which countries is leprosy found in the world today?, https://
www.leprosymission.org.uk/about-us-and-leprosy/faqs/which-countries-is-leprosy-found-in-the-world-toda/ http://emedicine.medscape.com/article/220455-followup#e5 http://www.leprosymission.org.au/TLM/Prevention https://www.youtube.com/watch?v=4WzIYEssTPQ https://www.google.ru/imgres?imgurl=http%3A%2F%2F1.bp.blogspot.com%2F-Va7qmy5M92s%2FUJJgM9D9HoI
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