Leprosy

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 Leprosy (Hansen’s Disease)
• A chronic infectious disease caused by the bacterium Mycobacterium
leprae
• It is mainly a Granulomatous disease affecting: peripheral nerves and
mucosa of the upper-respiratory tract
• Granulomatous - refers to granulomas which are lesions of epithelioid
macrophages

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 A Little History …
• Gerhard Henrik Armauer Hansen was
a physician which first identified
Mycobacterium leprae as the cause of
leprosy in 1873

FYI

7/29/1841-2/12/1912
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 A little taxonomy ….
Kingdom Bacteria

Phylum Actinobacteria

Order Actinomycetales

Suborder Corynebacterineae

Family Mycobacteriaceae

Genus Mycobacterium

Species M. leprae

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 Pathology
• Gram-positive
• Intracellular
• Aerobic rod-shaped bacillus
• With a waxy coating
• M. leprae is unable to grow in vitro
• This is thought to be due to the fact that it no longer has the genes
needed for independent growth
• Because of its inability to grow on agar, nude mice and nine-banded
armadillos are used as animal models

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 Clinical Features
• Skin lesions, typically anaesthetic at the tuberculoid end
of the spectrum
• Thickened peripheral nerves
• Acid-fast bacilli on skin smears or biopsy
• Acid-fast is a property of Mycobacteria in which they a
resistant to decolorization by acids during staining
• This is a helpful diagnostic tool for M. tuberculosis and M.
leprae

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 Symptoms
Tuberculoid Borderline Borderline Borderline Lepromatous
Tuberculoid Lepromatous

Skin

Infiltrated Defined plaques, Polymorphic, Papules, nodules, Diffuse Diffuse thickening

lesions irregular plaques, partially raised punched-out thickening
healing centers edges, satellites centers

Macular Single, small Several, any Multiple, all sizes, Innumerable, Innumerable,
lesions size bizarre small confluent

Peripheral Solitary, enlarged Irregular Many nerves Late neural Slow, symmetrical
Nerve nerves enlargement of involved thickening, ‘glove-and-
lesions several large symmetrical asymmetrical stocking’
nerves, patterns anaesthesia anaesthesia
asymmetrical and paresis
patterns

Note: Contrary to popular belief leprosy does not cause body parts to simply fall off

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Hypopigmented Macule in Tuberculoid
Leprosy
Borderline Tuberculoid Leprosy Skin Lesion
What determines the clinical picture of
leprosy?
 Immunology
• Tuberculoid leprosy
- Patient’s lymphocytes respond to M. leprae in vitro
- Skin tests with lepromin elicit a strong positive response
- They also have a Th1- type response producing interleukin-2 and interferons-γ
- These strong cell-mediated responses clear antigens, but cause local tissue
destruction
• Lepromatous leprosy
- Patients in this case do not mount a normal cell mediated response to
M. leprae, and in fact their lymphocytes do not respond to M. leprae in
vitro
- They are also unresponsive to lepromin
- They have specific T cell failure and macrophage dysfunction, and
problems producing interleukin-2 and interferons-γ
- But they do produce Th2-type cytokins

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 Social Aspect
• WHO reported that at the start of 2007 there were 224,717 reported
cases (from 109 countries and territories)
• In comparison with the number of new cases detected in 2006 which
was 259,017, the number of new cases fell by more than 40,019 cases
(a 13.4% decrease)
• In the last five years, the global number of new cases has dropped on
average by 20% per year.
• Also Leprosy has been around since about 300BC

FYI

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Geographic Rage For Leprosy

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 Transmission
• The transmission of leprosy is thought to occur through the
respiratory track
• Infected individuals discharge bacilli through their nose and a healthy
individual breaths them in
• But it is important to note that the extract mechanism is not known
• The main reservoir is humans
• Risk group: children, people living in endemic areas, in poor
conditions, with insufficient diet, or have a disease that compromises
their immunity (ie HIV)

“In the 19th century leprosy was believed to be a hereditary ailment” 14

 Types of Leprosy
1. Indeterminate Leprosy

2. Determined Leprosy

3. Lepromatous Leprosy

4. Tuberculoid Leprosy

5. Borderline leprosy
 Leprosy. Pathogenesis
• Bacilli enter respiratory via, disseminate hematogenous
way and grow particularly in dermal nerves.

• The consequences of the infection depend on the immune

status of the host.

•The bacillus itself is non-toxic (killed intracellular by

macrophages activated by specifically prime T cells).

•The lesions are produces by evoking a potentially

destructive granulomatous reaction or by interference with
the metabolism of cells.
Morphology. Tuberculoid leprosy
• Begin with localized skin lesions that are at first flat and
red but enlarge and develop irregular shapes with
indurated, elevated, hyperpigmented margins and
depressed pale centers.
• Neuronal involvement dominates tuberculoid leprosy.
• Nerves become enclosed within granulomatous
inflammatory reactions. Nerves degenaration causes
skin anesthesias and skin and muscle atrophy(skin
ulcer).
• On microscopic examination, all sites of involvement
disclose granulomatous lesions resembling those found
in tuberculosis, and bacilli are almost never found.
 Morphology. Lepromatous leprosy
• Involves the skin, peripheral nerves, anterior
chamber of the eye, upper airways, testes, hand, and
feet.
• Lepromatous lesions contain large aggregates of
lipid-laden macrophages (lepra cells), often with
masses of acid-fast bacilli.
• Failure to form granulomas (failure of Th1 response).
• Macular, papular, or nodular lesions form on the face,
ears, wrists, elbows, and knees with progression, the
nodular lesions coalesce to yield a distintive leonine
facies.
Lepromatous
Peripheral nerve. Note the inflammatory cell infiltrates
in the endoneural and epineural compartments
Lepromatous leprosy. Acid-fast bacilli ("red
snappers") within macrophages
 Diagnosis
• Is clinical, by finding signs of leprosy and supported with the use of
acid-fast bacilli smear or skin biopsy
• But this is contingent on experienced histopathologist
• What doctors typically look for include: anaesthesia of skin lesions,

 
and peripheral nerve thickening and tenderness
• There is no serological test

                             
Note: The genome has been sequenced

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