MYCOBACTERIUM
LEPRAE
DR.M.AKHILA PG PART -1 GHMC,KADAPA
FACULTY - DR.R.MALLESH MD (HOM.) MEDICINE, NIH (KOLKATA)
ASSISTANT PROFESSOR, DEPT OF MEDICINE, GHMC KADAPA
INTRODUCTION
Leprosy caused by mycobacterium leprae, is a chronic bacterial
disease recognised since ancient times.
First identified by Hansen in 1873.
Leprosy is also called as Hansons disease.
MORPHOLOGY :
Straight or slightly curved rod, 1-8 x 0.2-0.5 µm in size.
Polar bodies and intracellular
Elements present.
Clubbed forms, lateral buds or
branching may be observed.
It is a Gram positive bacilli, and stains more readily than the tubercle
bacillus.
The bacilli are seen singly and in groups, bacilli being bound together by
a lipid like substance the glia.
These masses are known as GLOBI
The parallel rows of bacilli in the globi
present a CIGAR BUNDLE APPERANACE.
RESISTANCE
• Lepra bacilli have been found to remain viable in a warm humid
environment for 9-16 days.
• They survive exposure to direct sunlight for 2 hours and ultraviolet
light for 30 minutes.
LEPROSY
• Leprosy is a chronic granulomatous disease of humans primarily
involving the skin, peripheral nerves and nasal mucosa.
• But they are capable of effecting any tissue or organ.
The disease may be classified into 4 types :
1. Lepromatus
2. Tuberculoid
3. Dimorphous
4. Indeterminate
1. LEPROMATUS LEPROSY :
Its is seen where host resistance is low.
This is known as multibacillary disease.
SKIN LESIONS – Many, symmentrical , margin is irregular,
Multiple nodules [Lepromata]
Nodules ulcerate , become secondariliy infected and cause distortion.
Bacilli invade the mucosa of the nose, mouth and upper respiratory
tract and are shed in large numbers in nasal and oral secretions.
The reticuloendothelial system, eyes, testes. Kidneys and bones are
also involved.
The lepromatous is more infective than the other types.
Prognosis is very poor, Lepromin test is negative in lepromatous
leprosy.
2. TUBERCULOID LEPROSY :
It is seen in patients with high degree of resistance.
SKIN LESIONS – Few, asymmetrical,
Margin is sharp.
Lesions are hypopigmented , with elevated borders.
Neural involvement occurs early leading to deformities, Particularly in
hands and feet.
Infectivity is minimal, lepromin test is positive.
This is known as paucibacillary disease.
3. BORDERLINE :
The term borderline or dimorphous type refers to lesions possessing
charecteristics of both tuberculoid and lepromatous types.
May shift to lepromatous or tuberculoid part
of the spectrum depending on chemotherapy
or alterations in host resistance.
4. INDETERMINATE
Is the early unstable tissue reaction which is not characteristic of either
the lepromatous or tuberculoid type.
In many persons the indeterminate lesions undergo spontaneous
healing.
In others the lesions may progress to the tuberculoid or lepromatous
types.
PURE NEUROTIC TYPE –
Neural involvement without any skin lesion.
Bacteriologically negative.
CLASSIFICATION –
RIDELY AND JOPLING have introduced a scale for classifying the spectrum
of leprosy into 5 groups
tuberculoid (TT), borderline tuberculoid (BT), borderline (BB), borderline
lepromatous (BL) and lepromatous (LL).
EPIDEMIOLOGY :
SOURCE OF INFECTION : Patient
MODE OF TRANSMISSION : Aerosols containing M.LEPRAE
PORTAL OF ENTRY : Nose or skin
• Asymptomatic infection appears to be quite common in endemic areas
and these have an important role in transmission.
• INCUBATION PERIOD : 2-5 years.
IMMUNITY
A high degree of innate immunity against lepra bacilli seems to exist.
Infection with lepra bacilli induces both humoral and cellular immune
response.
LEPROMIN TEST
An sample of 0.1 ml of inactivated Hansens bacillus is intradermally
injected just under the skin, on the forearm.
The injection site is labelled and examined 3 days 28 days later to see the
reaction.
The introduction of lepromin gives 2 types of reaction :
1. Early reaction of Fernandez – Erythema develops in 24-48 hours
2. Late reaction of Mitsuda – Nodule appears after 1- 2 weeks
Lepromin test is used for –
To classify the lesions of leprosy patients.
To asses the prognosis and response to treatment.
To asses the resistance of individuals to leprosy.
LABORATORY DIAGNOSIS
1. Specimen collection :
Nasal smear
skin smear
Slit skin smear
Nerve biopsy
2. MICROSCOPY : Diagnosis consists of demonstration of acid fast bacilli in
the lesions. The smears are stained by the Ziehl-Neelsen technique
• Biopsy of the nodular lesions and thickened nerves, lymph node
puncture may be necessary.
• SEROLOGY – Detection of antibody
• ELISA Detecting IgM antibodies.
PROPHYLAXIS
• Case finding and adequate therapy
• BCG vaccine
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