Leprosy: Difference between revisions
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==Background== | ==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== | ==Clinical Features== | ||
*Hypopigmented or red [[rash|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== | ==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== | ==Management== | ||
*Tuberculoid: TT and BT | |||
**Treat for twelve months with both: | |||
***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily | |||
*Lepromatous: LL, BL, BB | |||
**Treat for twenty-four months with all three: | |||
***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily + [[Clofazimine]] 50mg daily | |||
*Refer patient: National Hansen’s Disease Programs 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/ | |||
==Disposition== | ==Disposition== | ||
==Complications== | |||
*Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms | |||
==External Links== | |||
*[http://www.hrsa.gov/hansensdisease/ National Hansen's Disease Program] | |||
==See Also== | ==See Also== | ||
== | ==References== | ||
< | <References/> | ||
[[Category:Tropical Medicine]] | |||
[[Category:ID]] | |||
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