KULIAH

REGULER 2017
 LEPROSY
( MORBUS HANSEN )
DEFINITION :
• Chronic infection disease
• Mainly affects the skin,
peripheral nerves, mucosa
upper respiratory tract, reticulo
endothelial system, eye, bone ,
testis, except central nervous
system.
AETIOLOGY :
• Mycobacterium leprae
• Curved rod shaped
• Acid Fast Bacilli
• Gram positive
• 1 – 8 μ long, ø 0,2 – 0,5 μ
• Intracellular
• Prefer a growth temperature of less than
37° C
• Can not be cultured
EPIDEMIOLOGY :
• Africa / Central Asia ---- World
• All ages ranging : early infancy to very
old age
• 15 – 25 years old >>
• Both sex : Males : Females = 2 : 1
• Very long period : 3 – 5 years
• 1990 : 7 / 10,000 ----- 2000 : 1 / 10,000
TRANSMISSION :
• Contact person
- Respiratory tract
- Skin

- Immunity
- Virulence
- Physical
- Environment : - Biological
- Social
The Microbiology of Leprosy :
• M. leprae  can not be cultured

Bacteriological examination :
1. Diagnosis
2. To get a cross spectrum
3. Evaluations
4. Prognosis
Material :

• Skin lession
• Ear lobe
• Nasal secretions / Nose blows
DIAGNOSIS of LEPROSY :
If shown one or more of the following cardinal
signs :
1. Hipopigmented or reddish skin lession with
definite loss of sensation
2. Involvement of the peripheral nerves, as
demonstrated by definite enlargement /
thickening peripheral nerves with loss of
sensation
3. Skin smear positive for Acid Fast Bacilli

Not Yet ----- Observation for 3 – 6 months

Measurement of the Bacterial Index :
1. Diagnosis
2. To get a cross the spectrum
3. Therapy evaluation
 Scoring the B I :
Average Number of Bacterial Index
Acid Fast Bacilli (BI)
1000 / field 6+
100 – 1000 / field 5+
10 – 100 / field 4+
1 – 10 / field 3+
1 – 10 / 10 fields 2+
1 – 10 / 100 fields 1+
0 / 100 fields 0
Morphological Index :
• The proportion or percentage of
regularly stained bacteria of the total
scored
• Ridley ( 1971 ) :
- Regularly stained bacteria = Solidly
bacteria
- Irregularly stained bacteria =
Fragmented + Granular bacteria
M I will be a guide in determining :
• 1. Response to treatment
• 2. Drug resistance
• 3. Determining the infectiousness of a
patient

Treatment --- M I  quickly

B I  slowly
If M I  and then  : possibility
• Irregularly
• Malabsorbtion
• Drug resistance
THE AIM OF CLASSIFICATION OF
LEPROSY :

1. Infectious / Non infectious

2. Possible – infectious
3. Possible – Disability
4. Duration of treatment
 CLASSIFICATION
SPECTRUM

Ridley & TT BT BB BL LL
Jopling

MADRID Indeter- Tuber- Border- Lepromatous

minate culoid line

WHO Paucy Bacillar Multi Bacillar

( 1988 ) Leprosy Leprosy
 CLINICAL LEPROSY
Indeter- TT BT BB BL LL
minate
Infectious Infectious Infectious Infectious Infectious Infectious
(-) (-) (-)

Children 2–3 Satelit Punch Out

lesion lesion
Hipopig- Macules – Macules : Dimor- Symetrical Symetri-
mented / hipopig- hipopig- phous papul, cal papul,
pink : Face, mented mented / features nodules nodules
back, reddish and tend
buttock symmetry
 CLINICAL LEPROSY
Indeter- TT BT BB BL LL
minate
Loss of (+) (+) (+) Sensory Stocking
sensation loss, and gloves
(-) decreases anesthesia
sweating and
hair growth
Nerve (+) (+) (+) Nerve Nerve
swollen (-) damaged damaged

Lepromin (+) 4 (+) 3 (+) 1 -2 (-) (-)

(-)
Acid Fast (-) (+) / (+) 3 (+) 3 - 4 (+) 5 - 6
Bacilli (-) (-)
TREATMENT of LEPROSY :
• Multi Drug Therapy :
- Prevention & treatment of resistance
- As short a period of time for
treatment
- To interrupt the transmission of the
infection
W H O ( 1997 ) :

• Paucibacillary Single Lesion Leprosy

(one lesion)
• Paucibacillary Leprosy (2-5 skin lesion)
• Multibacillary Leprosy (More than 5 skin
lesion)
 I. P B SINGLE LESION

CHILD ADULT

Rifampicin 300 mg Rifampicin 600 mg

Ofloxacin 200 mg Ofloxacin 400 mg

Minocycline 50 mg Minocycline 100 mg

Dosage : Single Dose R O M

 II. P B 2 – 5 SKIN LESION
CHILD ADULT
Monthly Treatment : Monthly Treatment :
Day 1 : Day 1 :
Rifampicin 450 mg Rifampicin 600 mg
Dapsone 50 mg Dapsone 100 mg

Daily : Daily :
Day 2 – 28 Day 2 – 28
Dapsone 50 mg/daily Dapsone 100 mg/daily
Duration of treatment : 6 - 9 Months
 III. M B :
CHILD ADULT
Monthly treatment Monthly treatment
Day 1 : Day 1 :
Rifampicin 450 mg Rifampicin 600 mg
Clofazimine 150 mg Clofazimine 300 mg
Dapsone 50 mg Dapsone 100 mg

Daily 2 – 28 : Daily 2 – 28 :
Clofazimine 50 mg / daily Clofazimine 50 mg / daily
Dapsone 50 mg / daily Dapsone 100 mg / daily
Duration of treatment : 12 – 18 months
LEPROSY REACTIONS :
• Type 1 reaction : Reversal reaction
• Type 2 reaction : Erythema Nodosum
Leprosum
( E N L reactions )
 Manifestation of :
• 1. Reversal reaction
Mild Severe
Skin - Lesion become reddish - Same & rarely new skin lesion
& swollen - Fever, malaise
Nerve - Enlarge, painfull (-) - Enlarge, painfull (+)
- Nerve damage (-) - Nerve damage, loss sensation
- < 6 weeks - > 6 weeks
Skin & - Lesion become reddish - Same
Nerve - Painful on peripheral - Ulceration
nerves - Swollen on hand & foot
- < 6 weeks - Nerve enlarge
-- > 6 weeks
 2. E N L reaction
MILD SEVERE
Skin Skin nodules : Skin nodules >>
- Tender reddish - Painful
- Ulceration - Ulceration
- Fever & malaise
Nerve Enlarge Enlarge
Painful (-) Painful & swollen
Nerve damage (-) Nerve damage
Eye Not involvement Painful
Visual impairment
Testis Swollen, Painful (-) Painful, Enlarge
Skin, nerve, Same - Same
eye, testis - Very painful
- Fever
TREATMENT of REACTION :
• Prednisone : 30 – 80 mg / daily and then
tappering off
• Continued M D T without interruption
• MILD REACTION :
- Immobilization
- Rest
• SEVERE REACTION :
Reffered to the nearest hospital
MH tipe BB
MH tipe BL
MH tipe BT
MH indeterminate
MH tipe TT
MH tipe LL
MH tipe LL
Eritema Nodusum Leprosum(ENL)
Lepromatous leprosy. Note the diffuse infiltration of the face with
leonine facies and madarosis.
 Sequele of leprosy. The patient has madurosis, a saddle nose and
blindness in the left eye. Courtesy of Evangeline Handog, M.D.