Leprosy

Question 1

Leprosy - organism

Answer 1

1. Mycobacterium leprae, Mycobacterium lepromatosis
2. Intracellular organism (not possible to culture)

Question 2

Key signs of leprosy (5)

Answer 2

Loss of sensation in a typical skin lesion, numbness or loss of motor function in the hands or feet, ptosis, reaction presentation (fever, joint pains, inflamed skin) is possible

Question 3

Clinical examination findings in leprosy

Answer 3

1. Enlarged peripheral nerves (often coinciding with a patch)
2. Dryness in hands and feet
3. Peripheral neuropathy
4. Skin lesions (macules, nodules, papules)
5. Loss of eyebrows/eyelashes
6. Blindness from decreased corneal sensation leading to trauma or directly due to nerve damage
7. Nasal collapse

Question 4

Define leprosy (TT and BT) and treatment

Answer 4

1. At lower ends of bacterial load, there is more cell mediated immunity
2. A singular well defined lesion only (5 lesios or less)
3. 6 months of treatment with rifampicin + dapsone

Question 5

Side effects of dapsone

Answer 5

Life threatening hypersensitivity, anaemia

Question 6

Define leprosy more advanced (i.e. BL/LL) and treatment

Answer 6

Multiple (>6) symmetrical lesions over the body OR if they have a positive skin smear
12 months treatment with Rifampicin + dapsone + clofazimine

Question 7

Diagnosis of leprosy

Answer 7

1. No useful serological test
2. Slit skin smears (look for the rods - but does not culture)
3. Skin and nerve biopsy showing granulomas (rarely done)

Question 8

Second line treatment of leprosy

Answer 8

1. Minocycline 2. Perfloxacin 3. Clarithromycin

Question 9

Management of leprosy contacts

Answer 9

Chemoprophylaxis with a single dose of rifampicin

Question 10

Secondary impairments in leprosy

Answer 10

1. Ulcers and wounds due to Recurrent injuries from loss of sensation
2. Muscle atrophy and contactures due to long-term nerve damage
3. Blindness
4. Amputation
5. Psychological

Question 11

Leprosy reactions (3)

Answer 11

1. Type 1 - acute inflammation of the skin/nerves, treat with steroids
2. Erythema nodosum leprosum - systemic fever, malaise, painful nodules, arthritis, neuritis, orchitis, nephritis, treat with steroids
3. Lucio’s phenomenon - necrotising vasculitis leading to complications like sepsis in untreated or partially treated patients

Question 12

Side effects of clofazimine

Answer 12

Hyperpigmentation and ichtyosis