M leprae Morphological index Bacteriological index CULTIVATION Hansens
M leprae • Morphological index • Bacteriological index
CULTIVATION
Hansen's disease, leprosy Chronic granulomatous communicable disease occurring in tropical and subtropical regions; characterized by inflamed nodules beneath the skin and wasting of body parts; caused by the Mycobacterium leprae. • Chronic disease, disfigurement, common in third world, millions of cases • Infects the skin –neural involvement, low temperature
Ridley Jopling Classification of Leprosy Basis - Immunological RR-Reversal reaction; ENL-Erythema nodosum leprosum; PB-Paucibacillary, MBMultibacillary
PATHOGENESIS Mycobacterium Leprae enters the body The Immune cells attempt to seal off the infection, which can destroy sweat glands and hair follicles and the skin’s sensitivity. On of these things can happen Immune cells unable to destroy M. Leprae and the bacteria multiplies freely in the skin.
Tuberculoid Leprosy
Lepromatous leprosy
CLINICAL PICTURE • • • Type 1/ Reversal reaction: Eryhtema, swelling Pain & tenderness Type 2/ENL: Tender, inflamed subcut nodules Fever, LNpathy, Arthralgia
Erythema Nodosum Leprosum (ENL) Cause – Type III hypersensitivity Immune complex Vasculitis.
Lepromin test 2 types of reaction: a. Early reaction (Fernandez reaction) > resembles tuberculin test > seen in 24 -48 hrs b. Late reaction (Mitsuda reaction) > indurated nodule develops after 3 -4 wks > corresponds to the formation of an immunologic granuloma
Laboratory Diagnosis • Demonstration of AFB – Nasal mucosa – Skin Lesion – Ear lobule • Skin clippings from 5 -6 areas – Buttocks – Forehead – Chin – Cheek – Ear
Laboratory Diagnosis Detection of antibody against M leprae phenolic glycolipid antigen
Treatment • DDS (4, 4’-diaminodiphenylsulfone) or dapsone • WHO recommended combined regimen: Dapsone, Rifampin & Clofazimine for all patients w/ LL & Dapsone & Rifampin for TT • Continue treatment until skin smears are free of bacilli
Prevention • Early detection & rigid isolation of all acute LL & indeterminate types of leprosy are important • Prophylactic chemotherapy for all persons in close contact w/ the patient • Develop anti leprosy vaccine • BCG vaccination, 3 trials were made in endemic areas= divergent results
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