LEPROSY (MORBUS HANSEN)

LEPROSY (MORBUS HANSEN)

LEPRO-PHOBIA IN THE COMMUNITY

• 1) Wrong interpretations:

The book of the New Testament (Greece):

Leveticus verses 12 & 13:

.... Is a disease of LEPROSY and the curse of God, dst

Book of the Old Testament (bhs Hebrew):

-paragraph 13: 12 Levetikus &

…ZARATH is odious and to

the curse of God, etc. .... ...

• 2) wrong: Glance

Leprosy is a disease of the derivative

LEPROSY TRANSMISSION:

•  Prolonged contact
• Intimate
• Continuously

LEPROSY (LEPROSY, MORBUS HANSEN)

THE DEFINITION OF

• Chronic infectious diseases

• Due to Mycobacterium leprae

• Primary attack the peripheral nervous

• Secondary attack the skin and other organs

• Can cause disability

• Psycho-social cause problems

THE CONCEPT OF INFECTIOUS DISEASES

BASIL LEPROSY: Mycobacterium leprae

TRANSMISSION OF LEPROSY BACILLI

1. infection in droplets

2. Inoculation via injury on the skin

----------------------------------------

-Transplasental (?)

-Insect bite (?)

IMUNO-PATHOGENESIS

M. leprae from outside the body Defense System → natural body (Natural Immunity) → the body's Defense Systems acquired (Acquired Immunity) → leper

• Low socio-economic condition and poverty

• Bad environment

• Low education/ignorancy

POPULATION DENSITY

THE DIAGNOSIS OF LEPROSY

The 1st cardinal signs of leprosy:

Skin patches with loss of sensation

• Hypopigmented

• Erythematous

Highly sensitive in PB (90%)

Poorly sensitive in MB (50%)

Very specific

Light touch

Temperature any discrimination

Pine (pin prick)

Textur rough and dry for loss of sweating of the smooth and shiny

Less sweating on exercise

Histamine response decreased

There may be loss of hair growth

LEPROSY-SPECIFIC PATCHES

Has the properties 4-A:
• Anaesthesi
• Anhydrosis
• Achromia
• Atrophy

The 2st cardinal sign of leprosy :

Enlarged peripheral nerve

DD primary amyloidosis, some hereditaru neuropathies

The 3rd cardinal sign of leprosy :

Positive slit-skin smear

The slit and scrape method

Incision, turn the blade 90 degrees

Active edge of lesion

LL: sites with high probability of demonstrating AFB’s

Earlobe

Chin

Extensor forearm

Dorsal fingers

Buttocks

Knees

TYPE POLAR TUBERCULOID (TT)

BORDERLINE TUBERCULOID (BT)

TYPE BORDERLINE LEPROMATOUS (BL)

TYPE POLAR LEPROMATOUS (LL)

MANAGEMENT
1. CAUSAL TREATMENT : MDT-WHO

Drug	PB (6 months)	MB (12 months)
Rifampicin	600 mg / month, * supervised	600mg / month *supervised
DDS	100mg /day	100mg/ day
Lamprene	-	300mg/ month *   + 50mg/ day

 

ALTERNATIVE :

When one drug MDT cannot be given

- Ofloxacine 400 mg / day
- Minocycline 100 mg / day
- Clarithromycine 250 mg / day

NOTE :

Long administration of drugs varies, the longer the better

2. TREATMENT of SIMTOMATIS :

    • ulcer treatment

    • treatment reaction

3. IMPROVEMENT of NUTRITION/K.U.

4. MEDICAL REHABILITATION

5. EDUCATION :

    • the regularity of medical treatment

    • Prevention of disability

LEPROSY REACTIONS

	TYPE 1 (REVERSAL REACTION)	TYPE  2 ( E . N . L )
ONSET	Early therapy (1-3 months)	Mid/Late (> 6 month / RFT)
TYPE M.H.	PB/MB	MB
CLINICAL	Old lesions become inactive, to thicken	Inflamed nodule arising new
SYSTEMIC	Rarely, febris lightweight, oedem	Often, febris, artralgi, sefalgi etc.

TREATMENT FOR LEPROSY REACTIONS

• Principle: anti leprosy/MDT should be forwarded

Tx type 1 Reaction:

-Lightweight: simtomatis

-weight with neuritis: anti-inflammatory

Tx Reaction type 2:

-Systemic Steroids