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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