Leprosy: Difference between revisions
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==Background== | ==Background== | ||
*Also known as Hansen's Disease | *Also known as Hansen's Disease<ref>White C, Franco-Paredes C. Leprosy in the 21st century. Clin Microbiol Rev. 2015;28(1):80-94. PMID 25567223</ref> | ||
*Infectious disease caused by Mycobacterium leprae | *Infectious disease caused by Mycobacterium leprae | ||
*Most new cases found in developing countries | *Most new cases found in developing countries | ||
Latest revision as of 10:16, 22 March 2026
Background
- Also known as Hansen's Disease[1]
- 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/
Antibiotic Dosing
Adult
- Rifampin Paucibacillary, single lesion; 600 mg PO x1 with ofloxacin and minocycline; Paucibacillary; 600 mg PO qmo x 6mo with dapsone; Multibacillary; 600 mg PO qmo x 12mo with dapsone and clofazimine
- Dapsone paucibacillary: 100mg PO QD x6mo; Use with rifampin; multibacillary: 100mg PO QD x12mo; Use with rifampin, clofazimine
Pediatric
- Rifampin Paucibacillary, 10-14 yo; 450mg PO qmo x6mo with dapsone; Paucibacillary, 15+ yo; 600 mg PO qmo x 6mo with dapsone; Multibacillary, 10-14 yo; 450mg PO qmo x 12mo with dapsone and clofazimine; Multibacillary, 15+ yo; 600 mg PO qmo x 12mo with dapsone and clofazimine
Disposition
Complications
- Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms
External Links
See Also
References
- ↑ White C, Franco-Paredes C. Leprosy in the 21st century. Clin Microbiol Rev. 2015;28(1):80-94. PMID 25567223