Leprosy: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Hypopigmented or red patches of skin | *Hypopigmented or red [[rash|patches]] of skin | ||
**Diminished sensation or lost sensation within patches | **Diminished sensation or lost sensation within patches | ||
*Paresthesias | *[[Paresthesias]] | ||
*Painless wounds on hands or feet | *Painless wounds on hands or feet | ||
*Lumps on earlobes or face | *Lumps on earlobes or face | ||
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*[[Sarcoidosis]] | *[[Sarcoidosis]] | ||
*[[Syphilis]] | *[[Syphilis]] | ||
*Erythema nodosum | *[[Erythema nodosum]] | ||
*[[Erythema multiforme]] | *[[Erythema multiforme]] | ||
*Cutaneous tuberculosis | *Cutaneous [[tuberculosis]] | ||
*[[Vitiligo]] | *[[Vitiligo]] | ||
*[[Scleroderma]] | *[[Scleroderma]] | ||
*[[Tinea versicolor]] | *[[Tinea versicolor]] | ||
*Mycosis fungoides | *Mycosis fungoides | ||
*Diffuse cutaneous leishmaniasis | *Diffuse cutaneous [[leishmaniasis]] | ||
*Neuropathy of other etiology | *[[Neuropathy]] of other etiology | ||
== | ==Evaluation== | ||
*Diagnosis made by skin biopsy | *Diagnosis made by skin biopsy | ||
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*Tuberculoid: TT and BT | *Tuberculoid: TT and BT | ||
**Treat for twelve months with both: | **Treat for twelve months with both: | ||
***Dapsone 100mg daily + Rifampin 600mg daily | ***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily | ||
*Lepromatous: LL, BL, BB | *Lepromatous: LL, BL, BB | ||
**Treat for twenty-four months with all three: | **Treat for twenty-four months with all three: | ||
***Dapsone 100mg daily + Rifampin 600mg daily + Clofazimine 50mg daily | ***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily + [[Clofazimine]] 50mg daily | ||
*Refer patient: | *Refer patient: National Hansen’s Disease Programs 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/ | ||
National Hansen’s Disease Programs | |||
1-800-642-2477 | |||
Http://www.hrsa.gov/hansensdisease/ | |||
==Disposition== | ==Disposition== | ||
==Complications== | ==Complications== | ||
Latest revision as of 17:43, 20 September 2019
Background
- Also known as Hansen's Disease
- Infectious disease caused by Mycobacterium leprae
- Most new cases found in developing countries
- Level 3 Countries with higher numbers of cases include: India, Brazil, Indonesia, Bangladesh, Nigeria
- Means of transmission not fully understood - likely respiratory.
- Has variety of clinical and histopathologic manifestations due to broad range of cellular immune response
Classification
- Disease spectrum ranges from strong immune reaction and few organisms (tuberculoid) to weak immune reaction and numerous organisms (lepromatous)
- Categories
- Tuberculoid (TT)
- Borderline tuberculoid (BT)
- Mid-borderline (BB)
- Borderline lepromatous (BL)
- Lepromatous (LL)
- Indeterminate (I)
Risk Factors
- Close contact with infected person
- Type of leprosy in the contact (lepromatous may be more contagious than tuberculoid)
- Armadillo exposure
- Increased age
- Genetic influences
Clinical Features
- Hypopigmented or red patches of skin
- Diminished sensation or lost sensation within patches
- Paresthesias
- Painless wounds on hands or feet
- Lumps on earlobes or face
- Tender, enlarged peripheral nerves
Consider leprosy in patients who have skin lesions that do not respond to conventional treatments or when there are associated sensory disturbances
Differential Diagnosis
- SLE
- Sarcoidosis
- Syphilis
- Erythema nodosum
- Erythema multiforme
- Cutaneous tuberculosis
- Vitiligo
- Scleroderma
- Tinea versicolor
- Mycosis fungoides
- Diffuse cutaneous leishmaniasis
- Neuropathy of other etiology
Evaluation
- Diagnosis made by skin biopsy
Management
- Tuberculoid: TT and BT
- Lepromatous: LL, BL, BB
- Treat for twenty-four months with all three:
- Dapsone 100mg daily + Rifampin 600mg daily + Clofazimine 50mg daily
- Treat for twenty-four months with all three:
- Refer patient: National Hansen’s Disease Programs 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/
Disposition
Complications
- Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms