Leprosy: Difference between revisions
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==Background== | ==Background== | ||
*Also known as Hansen's Disease | |||
*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 | ||
| Line 6: | Line 7: | ||
*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== | ||
*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 | |||
*Type of leprosy in the contact (lepromatous may be more contagious than tuberculoid) | |||
*Armadillo exposure | |||
*Increased age | |||
*Genetic influences | |||
==Presentation== | |||
*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 | |||
*Sarcoidosis | |||
*Syphilis | |||
*Erythema nodosum | |||
*Erythema multiforme | |||
*Cutaneous tuberculosis | |||
*Vitiligo | |||
*Scleroderma | |||
*Tinea versicolor | |||
*Mycosis fungoides | |||
*Diffuse cutaneous leishmaniasis | |||
*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== | |||
*Diagnosis made by skin biopsy | |||
==Management== | ==Management== | ||
*The National Hansen's Disease Program recommends: | |||
**Tuberculoid: TT and BT | |||
***Treat for twelve months with both: | |||
****Dapsone 100mg daily + Rifampin 600mg daily | |||
**Lepromatous: LL, BL, BB | |||
***Treat for twenty-four months with all three: | |||
****Dapsone 100mg daily + Rifampin 600mg daily + Clofazimine 50mg daily | |||
*Refer patient: | |||
National Hansen’s Disease Programs | |||
1770 Physicians Park Drive | |||
Baton Rouge, Louisiana 70816 | |||
1-800-642-2477 | |||
Http://www.hrsa.gov/hansensdisease/ | |||
== | ==Complications== | ||
*Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms | |||
==Sources== | ==Sources== | ||
*UpToDate | |||
*Diagnosaurus | |||
*National Hansen's Disease Program Http://www.hrsa.gov/hansensdisease/ | |||
*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 | |||
Revision as of 15:46, 21 December 2014
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
- Type of leprosy in the contact (lepromatous may be more contagious than tuberculoid)
- Armadillo exposure
- Increased age
- Genetic influences
Presentation
- Consider leprosy in patients who have skin lesions that do not respond to conventional treatments or when there are associated sensory disturbances
Differential Diagnosis
- Systemic lupus erythematosus
- Sarcoidosis
- Syphilis
- Erythema nodosum
- Erythema multiforme
- Cutaneous tuberculosis
- Vitiligo
- Scleroderma
- Tinea versicolor
- Mycosis fungoides
- Diffuse cutaneous leishmaniasis
- 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
- Diagnosis made by skin biopsy
Management
- The National Hansen's Disease Program recommends:
- Tuberculoid: TT and BT
- Treat for twelve months with both:
- Dapsone 100mg daily + Rifampin 600mg daily
- Treat for twelve months with both:
- 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:
- Tuberculoid: TT and BT
- Refer patient:
National Hansen’s Disease Programs 1770 Physicians Park Drive Baton Rouge, Louisiana 70816 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/
Complications
- Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms
Sources
- UpToDate
- Diagnosaurus
- National Hansen's Disease Program Http://www.hrsa.gov/hansensdisease/
- 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