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leprosy

leprosy. definition ： A chronic infectious disease caused by mycobacterium leprae, With neurologic and cutaneous lesions. leprosy. leprosy. the infectious agent ： mycobacterium leprae stained red with acid-fast stain ， contains o-diphenoloxidase

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leprosy

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  1. leprosy

  2. definition： A chronic infectious disease caused by mycobacterium leprae, With neurologic and cutaneous lesions.

  3. leprosy

  4. leprosy

  5. the infectious agent： mycobacterium leprae stained red with acid-fast stain， contains o-diphenoloxidase breed one generation a 13-14days

  6. M. leprae

  7. M.lepraein nasal secretion of patients， after drying ex vivo→still alive for 2-9 days, Keep alive 3-4 weeks 0℃,inactivation after boiled 8'， lose productivity after deposed to sunlight for 2-3h。

  8. epidemiology： （1）infectious agent：leper（lepromatous type） （2）route of transmission：damaged skin、mucosa，direct contact，droplet spread. （3）herd suseptibility：natural acquired immunity. （4）epidemic condition：clustering distrubition，endemic

  9. pathogenesis： Toxicity of M.leprae high:no invasion/autotherapy Organism resistance medium ：TT low：Borderline none：LL(infectious) Cytoimmunity hypofunction

  10. pathology： The pathological changes mainly occur in dermis and peripheral nerve. Tuberculoid type： tuberculoid type structure.hair follicle、coil gland、 sebaceous gland、blood vessel and nerve damaged. LL： focus of infection contains lepra cell(foam cell) histiocytic infiltrate around vessels.

  11. M.leprae

  12. Clinical features： Incubation:2-5years（3moths-10years） 1、 skin lesions： 2、 peripheral nerve syptoms

  13. 1、 skin lesions： 1.diversification of lesions 2.appendages of the skin involvement:pelage、sweat glands、sebaceous follicle 3.skin nerve terminal→superficial sensation dysesthesia 4.found M.leprae（especially LL、borderline type）

  14. 2、peripheral nerves symptoms： Pure neural leprosy spindle-shaped swelling 、nodules or uniformly enlargement can be found,often felt painful or tenderness. 1． anesthesia： 2． dyscinesia，muscular atrophy，palsy ulnar N→little finger and fourth finger contractures，hypothenar…claw hand median N→thenar eminence…ape hand radial N→wrist drop/mallet finger common peroneal N→foot drop facial N→facial paralysis 3. disturbance of trophicity 4. dyshemia

  15. little finger and fourth finger contractures，hypothnar…claw hand

  16. radial N→wrist drop/mallet finger

  17. median N→thenar eminence…ape hand

  18. Facial paralysis

  19. Spectrum classification: 1. Tuberculoid (TT) 2. Borderline tuberculoid (BT) 3. Borderline (BB) 4. Borderline lepromatous（BL） 5．Lepromatous(LL) 6．Early and indeterminate leprosy

  20. 1. tuberculoid(TT): High resistance, the evolution is slow, Without internal organs involvement, lesions are limited。 bacilli(-),lepromin test(+), Test for cellular immunity shows normal. Typical lesions，superficial sensation disturbance， Nerve trunk is enlarged and stiff。

  21. Tuberculoid

  22. tuberculoid

  23. tuberculoid

  24. tuberculoid

  25. tuberculoid

  26. Tuberculoid

  27. tuberculoid

  28. 2. Borderline tuberculoid(BT): Numerous lesions, dissymmetric,the edges of lesions are well defined borderline， Peripheral nerve involvement more than TT, fewer internal organs involvement, Bacilli + - ++，lepromin test weakly（+）-（-）in advanced stage, comparatively low cytoimmunity.

  29. BT

  30. BT

  31. BT

  32. 3. Borderline(BB): Lesions polymorphism、multi-color、macule like infiltration and nodules. Lesions are generalized and asymmetrical,internal organs involvement. Bacilli +++→++++，lepromin test（-）. Cytoimmunity between TT and BT

  33. BB

  34. 4. Borderline lepromatous（BL）： Diffuse infiltration、macula、plaque/nodule Peripheral nerve trunk involvement ，asymmetrical： Nerve enlarged、tender，madarosis bacilli++++ - +++++，lepromin test（-）in advanced stage，cytoimmunity test（-）.

  35. BL

  36. BL

  37. 5．Lepromatous(LL)： very low resistance, developing fast, lesions are numerous,symmetrical. bacilli（+）.

  38. LL

  39. LL

  40. LL

  41. 6．Indeterminate leprosy： nonage，hypopigmented macule，superficial sensory disturbance，slight peripheral involvement. Usually bacilli（－）or only a few（＋） Leromin test most（＋）in advanced stage

  42. Reactional leprosy： acute or subacute symptoms abrupt onset in the course of disease，it is an allergic phenomenon.

  43. Lepromin test： lepromin 0.1ML 48h（nonage〕3W（advanced stage）pratical value in late phase response： 1 (+)means high resistance 2 Useful to classify a given case

  44. diagnosis and differential diagnosis 1 lesions with superficial sensory disturbance or only anhidrosis， or only an anesthsia area. 2 peripheral nerve trunk or cutaneous nerve enlargement； 3 lesions or histology section found M.leprae； 4 Specific changes in histopathology if there are 2 or over 2 items accord with above 4 items, the leprosy can be diagnosed.

  45. treatment： 1 sulfone： dapsone(DDS) acedapsone (DADDS) 2 rifampicin 3 clofazimine 4 protionamide ethinamide drugs above should be used in trigeminy treatment

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