P. 1
KULIAH MORBUS HANSEN

KULIAH MORBUS HANSEN

|Views: 31|Likes:
Published by Black Cookies

More info:

Published by: Black Cookies on Nov 14, 2011
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PPT, PDF, TXT or read online from Scribd
See more
See less

09/10/2013

pdf

text

original

LEPROSY ( MORBUS HANSEN

)
Dr AMBAR RIALITA SpKK

DEFINITION :

• Chronic infection disease • Mainly affects the skin, peripheral nerves, mucosa upper respiratory tract, reticulo endothelial system, eye, bone , testis, except central nervous system.

AETIOLOGY :
• • • • • • •

Mycobacterium leprae

Curved rod shaped Acid Fast Bacilli Gram positive 1 – 8 μ long, ø 0,2 – 0,5 μ Intracellular Prefer a growth temperature of less than 37° C • Can not be cultured

000 ----.000 .2000 : 1 / 10.World • All ages ranging : early infancy to very old age • 15 – 25 years old >> • Both sex : Males : Females = 2 : 1 • Very long period : 3 – 5 years • 1990 : 7 / 10.EPIDEMIOLOGY : • Africa / Central Asia ---.

TRANSMISSION : • Contact person .Skin  .Biological .Virulence .Physical .Immunity .Respiratory tract .Environment : .Social .

The Microbiology of Leprosy : • M. Prognosis . To get a cross spectrum 3. leprae  can not be cultured Bacteriological examination : 1. Evaluations 4. Diagnosis 2.

Material : • • • Skin lession Ear lobe Nasal secretions / Nose blows .

Hipopigmented or reddish skin lession with definite loss of sensation 2. as demonstrated by definite enlargement / thickening peripheral nerves with loss of sensation 3. Involvement of the peripheral nerves.DIAGNOSIS of LEPROSY : If shown one or more of the following cardinal signs : 1.Observation for 3 – 6 months . Skin smear positive for Acid Fast Bacilli Not Yet ----.

Diagnosis 2.Measurement of the Bacterial Index : 1. To get a cross the spectrum 3. Therapy evaluation .

Scoring the B I : Average Number of Acid Fast Bacilli 1000 / field 100 – 1000 / field 10 – 100 / field 1 – 10 / field 1 – 10 / 10 fields 1 – 10 / 100 fields 0 / 100 fields Bacterial Index (BI) 6+ 5+ 4+ 3+ 2+ 1+ 0 .

Regularly stained bacteria = Solidly bacteria .Irregularly stained bacteria = Fragmented + Granular bacteria .Morphological Index : • The proportion or percentage of regularly stained bacteria of the total scored • Ridley ( 1971 ) : .

M I will be a guide in determining : • 1.M I  quickly B I  slowly . Response to treatment • 2. Drug resistance • 3. Determining the infectiousness of a patient Treatment --.

If M I  and then  : possibility • Irregularly • Malabsorbtion • Drug resistance .

3.THE AIM OF CLASSIFICATION OF LEPROSY : 1. 2. 4. Infectious / Non infectious Possible – infectious Possible – Disability Duration of treatment .

Tuber.Border.Lepromatous minate culoid line WHO ( 1988 ) Paucy Bacillar Leprosy Multi Bacillar Leprosy .CLASSIFICATION SPECTRUM Ridley & Jopling TT BT BB BL LL MADRID Indeter.

CLINICAL LEPROSY Indeterminate Infectious (-) Children TT Infectious (-) 2–3 lesion BT Infectious (-) Satelit lesion Macules : hipopigmented / reddish BB Infectious BL Infectious LL Infectious Punch Out Dimorphous features and tend symmetry Symetrical Symetripapul. buttock . cal papul. mented back. nodules nodules HipopigMacules – mented / hipopigpink : Face.

6 Nerve (+) swollen (-) Lepromin (-) Acid Fast Bacilli (-) (+) 4 (-) (+) (+) (+) 3 (+) / (-) (+) 1 -2 (+) 3 .4 Nerve damaged (-) (+) 5 .CLINICAL LEPROSY Indeterminate Loss of sensation (-) TT (+) BT (+) BB (+) BL LL Sensory Stocking loss. and gloves decreases anesthesia sweating and hair growth Nerve damaged (-) (+) 3 .

To interrupt the transmission of the infection .Prevention & treatment of resistance .TREATMENT of LEPROSY : • Multi Drug Therapy : .As short a period of time for treatment .

W H O ( 1997 ) : • Paucibacillary Single Lesion Leprosy (one lesion) • Paucibacillary Leprosy (2-5 skin lesion) • Multibacillary Leprosy (More than 5 skin lesion) .

P B SINGLE LESION CHILD ADULT Rifampicin 300 mg Ofloxacin 200 mg Minocycline 50 mg Rifampicin 600 mg Ofloxacin 400 mg Minocycline 100 mg Dosage : Single Dose R O M .I.

P B 2 – 5 SKIN LESION CHILD Monthly Treatment : Day 1 : Rifampicin 450 mg Dapsone 50 mg ADULT Monthly Treatment : Day 1 : Rifampicin 600 mg Dapsone 100 mg Daily : Daily : Day 2 – 28 Day 2 – 28 Dapsone 50 mg/daily Dapsone 100 mg/daily Duration of treatment : 6 .II.9 Months .

M B : CHILD Monthly treatment Day 1 : Rifampicin 450 mg Clofazimine 150 mg Dapsone 50 mg Daily 2 – 28 : Clofazimine 50 mg / daily Dapsone 50 mg / daily ADULT Monthly treatment Day 1 : Rifampicin 600 mg Clofazimine 300 mg Dapsone 100 mg Daily 2 – 28 : Clofazimine 50 mg / daily Dapsone 100 mg / daily Duration of treatment : 12 – 18 months .III.

LEPROSY REACTIONS : • Type 1 reaction • Type 2 reaction : Reversal reaction : Erythema Nodosum Leprosum ( E N L reactions ) .

Same . Reversal reaction Mild Skin Nerve .< 6 weeks .Ulceration .Nerve damage.Manifestation of : • 1.Enlarge.Painful on peripheral nerves .< 6 weeks Severe . painfull (-) .Lesion become reddish Nerve . malaise .Lesion become reddish & swollen .> 6 weeks .> 6 weeks Skin & .Enlarge.Swollen on hand & foot . painfull (+) . loss sensation .Nerve enlarge -.Nerve damage (-) .Same & rarely new skin lesion .Fever.

Painful .Fever & malaise Enlarge Painful & swollen Nerve damage Painful Visual impairment Painful.Tender reddish . Enlarge .Ulceration .Same . E N L reaction MILD SEVERE Skin Skin nodules : .Ulceration Enlarge Painful (-) Nerve damage (-) Not involvement Swollen.Fever Nerve Eye Testis Skin. testis .Very painful . Same eye.2. Painful (-) Skin nodules >> . nerve.

Rest • SEVERE REACTION : Reffered to the nearest hospital .TREATMENT of REACTION : • Prednisone : 30 – 80 mg / daily and then tappering off • Continued M D T without interruption • MILD REACTION : .Immobilization .

MH tipe BB .

MH tipe BL .

MH tipe BT .

MH indeterminate .

MH tipe TT .

MH tipe LL .

MH tipe LL .

Eritema Nodusum Leprosum(ENL) .

.Lepromatous leprosy. Note the diffuse infiltration of the face with leonine facies and madarosis.

D.Sequele of leprosy. . Courtesy of Evangeline Handog. The patient has madurosis. M. a saddle nose and blindness in the left eye.

.

.

G 8023 G :363 .

65  99::.50 .93  ..3.  993./:69/. G .5 76::/3.51.

656.6:  #6::/3 :./3.' "&&'"!" #%"&  50. .  9..9.6:  #6::/3 50.6:!6550.45..

&&'"! &#'% %13  6735 '' '    % 51.9.

'/9.

6919.

0. 0361 35 "  #..033.6: 45.. 7964..033.9 796: .9 796: 3.

9.!#%"& 51.

. 45. 50.6: .

3195 '' 50.6: .

6: .6: 50.6: 50.   3:65 '    50.6: 50.

3. &.03: 767.. 3:65 .

1 911: #50". 45. 469.

90. 76: .9 &4..51.51 :44.3 &4.9.9: .

73  5613: 5613: 767. 7.37.73  0.

03: 767. .

0  45.602 .1 752. 45.1 /..02  /.

!#%"& 51.9.

. 6::6 :5:. 45..65 .

5. !9 1.:.:: .5:.6025 .5136: 36::  109. '' '    &5:69 &.51 ..4.1 .996. :.

.

4.1 .  !9 1.

.

 !9 :6335 .

79645 .

 . 01.:.033 .

 .

  .

.

  .

9'9.7 .'%' !'6#%"&  3.

9.69::.65 . #95.50 ..45..

79616..9. .45. ::69.469 ..

9.997. '65.65 ...5:4::656. 50.

033.033.9796: .0/.0/."    #.9&53:65796: 653:65  #.

5:25 3:65 ..033./.9796: 69.:253:65  3.

47054 "36.47054 "36.054 5600354 6:.  &536:%" .054 5600354 ' %. #&!&"!  %.

  .. .7:654 .7:654 ' 65.47054 .3 ..656.3'9.9.7:6541.47054 .45.3 9. # &!&"!  65.45.45.3 . .3 .7:6541.. %..  .3'9.. %.

: .  65.

3.9.    65. .3 9.47054 36. %.7:6541.3  36.45.7:6541.7:654 ..454 .656. 465.45.: .3  36..7:654 .3 . .9.4541..454 .47054 36.4541.3 ' 65.3 .45.9. %.3..

65  '79.39.4.65: .65 9.#%"&%'"!&  '79.0.0.65 %9:.0.0.!616:4 796:4 !9.

656   %9:....5:.0.39.65 31 &25 !9 .

:65/064911: :6335 .

9 7.533 . 53.

.

 . !91.4.

.

2: &9 .

&.4 9.935:253:65 .

9 4.: .3.

9 7. 53.533 .

. 36:::5:.65 . !91.4.

2: .

&.4 .

309.65 ..

&633565.51 66. .

!953.9 .

.

2: &25  .

:65/064911: !9 .

3 59: .53657979. #.

2: .

0.65  &25 &255613: . !9.

'519911: .

65 53.9 #..53 . 309.

4. !91. .

!6.56345.53 . &6335 #.

&% &255613: .

53 . #.

.65 . 309.

945.9 #.53 :6335 !91. #.53 53. 9 4.4.3. #.53 :.9 .: 53.347.

4 . &.

97.53 .

: &25 59  &.:. 9 !9  ':.4  .: .

77956  65.51.6.5.997..'%' !'6%'"!  #915:65  41.3.51 '.5 .65  %'"! .

. 446/3.65 .

9:.5.  &%%'"! %91.6:7.6. %:.3 ..

7 ..

.7 .

.7' .

. .51.945.

.7'' .

7 ..

.7 .

9.4.!61:4796:4 ! .

09 043301../.3/2.94341901.7488 .05742.94:805748 49090/11:803197.08..

82.3/ -3/308839001900 4:790841.$06:004105748 %05.3030..8.9039./:7488 .//03480.3/4   .

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->