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

THANKYOU