Leprosy: Difference between revisions

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*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
*Level 3 Countries with higher numbers of cases include: India, Brazil, Indonesia, Bangladesh, Nigeria  
**Level 3 Countries with higher numbers of cases include: India, Brazil, Indonesia, Bangladesh, Nigeria  
*Means of transmission not fully understood; likely respiratory.  
*Means of transmission not fully understood - likely respiratory.  
*Has variety of clinical and histopathologic manifestations due to broad range of cellular immune response
*Has variety of clinical and histopathologic manifestations due to broad range of cellular immune response


==classification==
===Classification===
*Disease spectrum ranges from strong immune reaction and few organisms (tuberculoid) to weak immune reaction and numerous organisms (lepromatous)
*Disease spectrum ranges from strong immune reaction and few organisms (tuberculoid) to weak immune reaction and numerous organisms (lepromatous)
*Categories  
*Categories  
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**Indeterminate (I)
**Indeterminate (I)


==Risk Factors==
===Risk Factors===
*Close contact
*Close contact with infected person
*Type of leprosy in the contact (lepromatous may be more contagious than tuberculoid)
**Type of leprosy in the contact (lepromatous may be more contagious than tuberculoid)
*Armadillo exposure
*Armadillo exposure
*Increased age
*Increased age
*Genetic influences
*Genetic influences


==Presentation==
==Clinical Features==
*Consider leprosy in patients who have skin lesions that do not respond to conventional treatments or when there are associated sensory disturbances
*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==
*Systemic lupus erythematosus
*[[SLE]]
*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
 
==Manifestations==
*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


==Work Up==
==Evaluation==
*Diagnosis made by skin biopsy
*Diagnosis made by skin biopsy


==Management==
==Management==
*The National Hansen's Disease Program recommends:
*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: National Hansen’s Disease Programs 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/
*Refer patient:
 
National Hansen’s Disease Programs
==Disposition==
1770 Physicians Park Drive
 
Baton Rouge, Louisiana 70816
1-800-642-2477
Http://www.hrsa.gov/hansensdisease/


==Complications==
==Complications==
*Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms
*Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms


==Sources==
==External Links==
*UpToDate
*[http://www.hrsa.gov/hansensdisease/ National Hansen's Disease Program]
*Diagnosaurus
 
*National Hansen's Disease Program Http://www.hrsa.gov/hansensdisease/
==See Also==
*Wright SW, Jack M. Chapter 21. Tropical Medicine. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. eds. The Atlas of Emergency Medicine, 3e. New York, NY: McGraw-Hill; 2010.
 
*http://www.ncbi.nlm.nih.gov/pubmed/10805626
 
==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

Evaluation

  • Diagnosis made by skin biopsy

Management

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