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INFECTIVE NEUROPATHIES LEPROSY - Coggle Diagram
INFECTIVE NEUROPATHIES
LEPROSY
TREATMENT :
Multidrug Therapy (MDT):
A combination of antibiotics: Rifampicin, Dapsone, and Clofazimine.
MDT is provided free of cost in many countries through WHO programs.
Treatment Duration :
*Paucibacillary (PB) leprosy: 6 months.
*Multibacillary (MB) leprosy: 12 months.
*Adherence is critical to ensure successful treatment.
Managing Complications :
Nerve damage: Early detection and steroid therapy, such as prednisolone, can prevent further damage.
Physical therapy: Prevents deformities and improves function.
Protective footwear: Reduces ulcers and injuries in patients with nerve impairment.
KEY FEATURES:
Cause
: Mycobacterium leprae or Mycobacterium lepromatosis.
Transmission
: Prolonged close contact with an untreated infected person, typically through respiratory droplets. It is not highly contagious.
Affected Areas
: Skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes.
PATHOPHYSIOLOGY:
Bacilli discharged from nose
Inhaled by susceptive person
Taken up by alveolar macrophages
Disseminated through blood
Spreads to nerve and skin
Bacilli proliferate especially in Schwann cells
MODE OF TRANSMISSION:
Prolonged close contact with an infected person
Respiratory droplets (coughing/sneezing) from untreated cases
Direct contact with infected skin or nasal secretions
Possible transmission through broken skin (rare)
Animal-to-human transmission (e.g., armadillos in some regions)
DEFINITION :
Leprosy, also known as
Hansen's disease
, is a chronic infectious disease caused by the bacterium
Mycobacterium leprae
or
Mycobacterium lepromatosis
.
It primarily affects the
skin, peripheral nerves, mucosal surfaces of the upper respiratory tract, and eyes.
Leprosy can lead to
skin lesions, nerve damage, muscle weakness, and disability
if left untreated.
RESERVOIR :
Humans are the only reservoir of proven significance
INCUBATION PERIOD :
9 months to 20 years (average 2-5 years for tuberculoid cases and 8-12 years for lepromatous cases)
TYPES OF LEPROSY :
Tuberculoid Leprosy (TT):
Immune Response:
Strong immune response to Mycobacterium leprae, limiting bacterial growth.
Symptoms:
Few, well-defined hypopigmented skin patches.
Loss of sensation in the affected areas due to nerve involvement.
Thickened peripheral nerves.
Bacterial Load:
Very low, often undetectable in skin smears.
Infectivity:
Low, as bacterial presence is minimal.
Lepromatous Leprosy (LL) :
Immune Response:
Weak immune response, allowing uncontrolled bacterial multiplication.
Symptoms:
Multiple, poorly defined skin lesions, including nodules and plaques.
Symmetrical involvement of skin, nerves, and other organs.
Loss of sensation and muscle weakness due to nerve damage.
Bacterial Load:
High, with abundant bacteria visible in skin smears.
Infectivity:
High, due to the large number of bacteria.
Other Features:
Can lead to deformities such as claw hand or foot drop if untreated.
Borderline Leprosy
a. Borderline Tuberculoid (BT) :
Features:
Closer to tuberculoid leprosy, with fewer, asymmetrical skin lesions and some nerve involvement.
Immune Response:
Moderately strong.
Bacterial Load:
Low.
b. Borderline Borderline (BB)
Features:
Intermediate state with both tuberculoid and lepromatous features.
Immune Response:
Unstable, fluctuating over time.
Bacterial Load:
Variable.
c. Borderline Lepromatous (BL) :
Features:
Closer to lepromatous leprosy, with numerous lesions and significant nerve damage.
Immune Response:
Weak.
Bacterial Load:
High.
Indeterminate Leprosy :
Immune Response:
Early form of the disease with uncertain immune response.
Symptoms:
Few hypopigmented macules, often without clear sensory loss or nerve involvement.
Bacterial Load:
Low, may not be detectable initially.
Progression:
Can resolve spontaneously or evolve into one of the other types.
Histoid Leprosy :
Special Variant:
Seen in patients with a history of lepromatous leprosy.
Symptoms:
Nodular lesions with a shiny surface, often resistant to standard therapy.
Bacterial Load:
Very high.
DIAGNOSIS :
Physical examination:
Inspecting Skin Lesions: Think: Are there any discolored patches? Test if these areas feel normal when touched or exposed to heat or pain.
Palpating Peripheral Nerves: Feel for: Are the nerves thicker than usual? Do they hurt when pressed?
Assessing Nerve Function: Check: Can the person feel light touches or temperature differences? Are certain muscles weaker than expected?
Observing Other Signs: Look for: Is the skin dry or cracked? Are there ulcers, or any deformities in hands or feet?
Lab test :
Skin Smear Test:
What it is: Sample taken from skin patches, stained, and checked under a microscope.
What it shows: If bacteria are present, it confirms leprosy.
Skin or Nerve Biopsy:
What it is: A small piece of skin or nerve is tested.
What it shows: Infected tissue may have bacteria or specific cells linked to leprosy.
PCR (Polymerase Chain Reaction):
What it is: A highly sensitive test that detects bacteria’s DNA.
What it shows: Confirms leprosy, even in early or difficult cases.
Serological Tests:
What it is: Blood test to find antibodies against leprosy bacteria.
What it shows: Indicates exposure but may not confirm active leprosy.
Lepromin Test:
What it is: Checks the body’s immune response to leprosy bacteria.
What it shows: Helps classify the type of leprosy but doesn’t diagnose it.
NCS:
Motor nerves: Slowed conduction velocity and prolonged latency.
Sensory nerves: Absent or reduced SNAPs.
Amplitude: Decreased CMAP and SNAP amplitudes.
Mixed neuropathy: Both motor and sensory involvement detected.
Subclinical detection: Identifies nerve damage before symptoms develop.