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 | *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 | ||
== | ==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 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== | ||
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*Neuropathy of other etiology | *Neuropathy of other etiology | ||
== | ==Diagnostic Evaluation== | ||
*Diagnosis made by skin biopsy | *Diagnosis made by skin biopsy | ||
==Management== | ==Management== | ||
*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: | *Refer patient: | ||
National Hansen’s Disease Programs | National Hansen’s Disease Programs | ||
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1-800-642-2477 | 1-800-642-2477 | ||
Http://www.hrsa.gov/hansensdisease/ | Http://www.hrsa.gov/hansensdisease/ | ||
==Disposition== | |||
* | |||
==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 | ||
== | ==External Links== | ||
* | *[http://www.hrsa.gov/hansensdisease/ National Hansen's Disease Program] | ||
==See Also== | |||
==References== | |||
<References/> | |||
[[Category:TropMed]] | [[Category:TropMed]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 08:49, 6 September 2015
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
- SLE
- Sarcoidosis
- Syphilis
- Erythema nodosum
- Erythema multiforme
- Cutaneous tuberculosis
- Vitiligo
- Scleroderma
- Tinea versicolor
- Mycosis fungoides
- Diffuse cutaneous leishmaniasis
- Neuropathy of other etiology
Diagnostic Evaluation
- Diagnosis made by skin biopsy
Management
- 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:
- Refer patient:
National Hansen’s Disease Programs 1770 Physicians Park Drive Baton Rouge, Louisiana 70816 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/
Disposition
Complications
- Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms