LEPROSY

DR Dr Hannah Kiati T M Damar, Sp KK FINSDV FAADV

Fakultas Kedokteran Universitas Pelita Harapan
 Laboratory examination
Armauer Hansen  Mycobacterium leprae
Skin slit smear :
Nasal smear & scraping
Positive skin smears (In a small proportion of cases):
 Acid fast bacteria, Gram positif
 rod-shaped, red-stained leprosy bacilli’
 1-7 x 0,3 – 0,5 mikron
PCR ( polymerase chain reaction)
Slit skin smears

A smear was made on a clean glass slide, stained

with Ziehl neelsen stain and examined under the oil-
immersion objective of the microscope
Ziehl Neelson staining for Mycobacterium leprae
Leprae Reaction

Complications that occur in 20-50% of patients after the

start of therapy 
• Type I Reaction :

Reversal Reaction
• Type II Reaction :
Erythema nodosum
leprosum
Differential Diagnose

Granuloma Annulare

Leishmaniasis

Neurofibromatosis

Psoriasis, Plaque

Sarcoidosis

Syphilis

Tinea Versicolor

Vitiligo

Xanthomas
Differential diagnosis :

Dermatophytosis Neurofibromatosis
Tinea versicolor Granuloma annulare
Pityriasis rosea Xanthomatosis
Pityriasis alba Scleroderma
Dermatitis seborrhoic Leukemia cutis
Psoriasis Tuberculosis cutis veruccous
Birth mark
Examination for numbness
Examination for numbness

Pressing with a blunt pencil

or pen until a slight
indentation occurs
Examination for Nerve Enlargement
Examination for Nerve Enlargement

• N. Tibialis Posterior
Nerve enlargement
Examination for nerve enlargement
Treatment and medication

Early diagnosis and treatment

with multidrug therapy (MDT)

remain key in eliminating the disease as a

public health concern
Treatment
Treatment PB and MB leprosy for adult
Each blister contain treatment for 4 weeks
M B Treatment over 15 years of age
• .
Treatment PB leprosy in children
Complication of Leprosy
Morphological index : Procetage solid rod bacteria
Solid bacteria
------------------------------- X 100 % = .. %
solid + non solid
Lepra reaction

• The type 1 lepra reaction / lepra 1 reaction

• A delayed type of hypersensitivity to M. leprae antigens
• Most often occurs after treatment for leprosy has been started,
but it may also occur before treatment and after the end of the
treatment
• It reflects a strengthening of specific cellular immunity against M.
leprae towards the tuberculoid type
Type 1 lepra reaction

Skin signs of type 1 lepra reaction

• Erythema and induration of existing lesions
• Ulceration during very intense reactions

•Nerve involvement in type 1 lepra reaction

•Mainly affects the cubital, sciatic, external popliteal, facial, and cervical nerves
•Often results in pain or tenderness
•Loss of function for more than a few days
• Muscle weakness
• Loss of sensation
• Paralysis
• Deformity
The natural course of an untreated type 1 lepra reaction is for it to persist for several months
Type 2 lepra reaction

Type 2 lepra reaction or lepra 2 reaction or Erythema nodosum leprosum.

• An acute immune complex vasculitis affecting the skin and other organs

The type 2 lepra reaction occurs in

• Lepromatous leprosy
• Borderline l­epromatous leprosy

Commonly associated with:

• Puberty
• Pregnancy
• Lactation
Type 2 lepra reaction

The clinical features of lepra 2 reactions depend on its severity and which
organs are affected.
• Fatigue

Without treatment, type 2 lepra reactions continue for about 2 weeks then
settle down. Recurrences are frequent
Untreated type 2 lepra reactions can result :
• Renal failure requiring dialysis
• Liver failure requiring transplantation
• Blindness
• and/or long-term Inflammation of the testicles
Type 2 lepra reaction

Constitutional symptoms : Fever, Fatigue, Enlarged lymph nodes, Swollen painful red joints.

Skin lesions scattered on any part of the body (the extensor aspect of the limbs and on the face)
• Multiple small red painful nodules
• Sterile pustules and ulcers
• Lesions may be superficial or deep in the dermis

Other clinical features of type 2 lepra reaction may include:

• Iridocyclitis (inflammation of the eye)
• Orchitis (inflammation of a testis)
• Renal impairment or renal failure
• Proteinuria (excess protein in the urine)
• Cytolytic cholestasis (inability to produce bile)
• Swollen painful red joints
Type 2 lepra reaction

• Blood tests show high inflammatory markers:

• A high white cell count
• A high protein C level
• Renal and liver impairment (occasionally)

• Pathology is essential to confirm type 2 lepra reaction. A biopsy of a

new red nodule less than 24 hours old shows:
• An infiltrate of polymorphs superimposed on chronic inflammation
• A heavy bacterial load of M. leprae (special stains may be necessary)
Treatment for a type 2 lepra reaction
Treatment depends on the severity of the type 2 lepra reaction
• A mild cutaneous reaction without other organ impairment can be managed by
supportive care:
• Painkillers
• Control of fever
• Regular monitoring.
Treatment for severe type 2 lepra reactions :
• Prednison at a dose of about 1 mg/kg/day, quickly tapered
• Clofazimine (note that the MB regimen with clofazimine prevents type 2 lepra reactions)
• Thalidomide 400 mg/day for 5–10 days, tapered over 1–2 months.
• Ciclosporin, Azathioprine Methotrexate Mycophenolate mofetil and pentoxifylline have
been used successfully in small trials