2. mycobacterial infection leprosy- dr. sinhasan, mdzah
TRANSCRIPT
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History:
* * 1870 - Hansen ( Norway) :
….. Transmissible agent,
…… 1873 - Isolated Organisms,
* In vitro culture - NOT POSSIBLE
* Animal models - footpads of mouse,
- 9-banded armadillos
- Monkeys & Chimpanzees.
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** Chronic infection,
* Caused by Mycobacterium leprae,
** Affects cooler parts:
… Skin,
… Upper respiratory tract,
… Superficial nerves,
… Eye,
… Testes;
Introduction:
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Uncertain ,
Nasorespiratory tract,
Skin to skin ( uncommon ),
Man to man,
5 to 25% of wild armadillos (Louisiana)
To man ( ? Zoonosis ).
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WHO ---- 5.5 Million Patients in the world,
Mainly in-- India,
-- Tropical Africa,
-- South America,
-- Southeast Asia,
-- Philippines,
-- South Pacific Islands.
Incidence:
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60.9% of global cases,
57 / 10,000 ----- 1981,
5 / 10,000 ----- 2000,
High Incidence:
Bihar, UP, MP, Orissa, WB = 62%.
Incidence in India:
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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,
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• PAUCIBACILLARY …--- Skin smear -- Negative;
• MULTIBACILLARY …--- Skin smear -- Positive;
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Clinical Features:
Hypoesthetic skin lesions,
-- Nearly all have peripheral neuropathy,
Thickened Superficial Nerves,
-- 1 in 4 shows deformity,
A F B In Skin Smears;
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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
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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
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Defective Cell-Mediated Immunity:
Antigen-recognition by Helper T-cells
Interleukin --2
Interferon gamma -->Activation of macrophages.
Pathogenesis:
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Examine skin
Check for patches
Test for sensation
Count the number of patches
Look for damage to nerves
How to diagnose leprosy
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Tuberculoidleprosy:
- No free zone,
- Well formed epitheloid cell granulomas +
- AFBs: + or -
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Lepromatous leprosy:
-Grenz (free) zone +
-No epitheloid cell granulomas,
-Foamy macrophages,
- Numerous AFBs- (globi, cigar bundle)
----Lepra cells/ Virchow cells.
Cutaneous Pathology:
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Grenz Zone
Virchow Cells with Globi
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Leprous orchitis:
--Sterility & Impotence
Osteitis & Periosteitis:
--Skeletal deformities (collapsed nose),
Nasal mucosa: Macrophage infiltration,
Eye: Lagophthalmos, Exposure keratopathy,
Trophic Ulcers.
Other organs affected:
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Clinical Examination,
Split Skin Smear,
Histopathological Examination,
( Fites-Ferraco stain for AFB )
Diagnosis: .. To be done with Utmost caution,
.. And Confidentiality.
( Social stigma )
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Multi-Drug Therapy,
Dapsone
Rifampin
Clofazimine
Chemoprophylactic drugs to contacts
Can be CURED COMPLETELY
Leprosy: Treatment
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