Mycobacterium leprae

dr. Delima Fajar Liana, Sp.MK

Polita Aisyiyah 6 September 2021

Mycobacterium leprae
• nonmotile,
• non–spore-forming,
• aerobic gram-positive
• stain : acid-fast (i.e., resist decolorization with weak to strong acid solutions) due
to the presence of medium to long chains of mycolic acids in their cell wall.

Physiology and Structure of Mycobacteria

• Bacteria are classified in the genus Mycobacterium on the basis of :
• (1) their acid-fastness,
• (2) the presence of cell wall mycolic acids containing 70 to 90 carbons,
• (3) a high (61% to 71% mol) guanine plus cytosine (G+C) content in their deoxyribonucleic
acid (DNA).
• M. leprae cannot grow in cell-free cultures.
 M. Leprae
• Organisme ini tidak pernah berhasil ditumbuhkan pada media kultur sel
buatan.
• Bisa ditumbuhkan di telapak kaki tikus dan armadillo.
• Kesulitan dalam mengkultur organisme ini karena merupakan parasit
intra-seluler obligat yang tidak memiliki banyak gen yang diperlukan untuk
bisa hidup mandiri.

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Epidemiology
• Leprosy (also called Hansen disease) is caused by Mycobacterium leprae.
• Leprosy was first described in 600 bc and was recognized in the ancient
civilizations of China, Egypt, and India.
• Epidemiology :
• The global prevalence of leprosy has fallen dramatically with widespread use of
effective therapy.
• More than 5 million cases were documented in 1985 and fewer than 300,000 cases
20 years later.
• Currently, 90% of the cases are in Brazil, Madagascar, Mozambique, Tanzania, and
Nepal.
• In the United States, leprosy is uncommon, with only 64 cases reported in 2013.
Most cases occur in California and Hawaii and primarily in immigrants from Mexico,
Asia, Africa, and the Pacific Islands.
Transmission
• Leprosy is spread by person-to-person contact.
• the most important route of infection is unknown
• M. leprae is spread :
• through the inhalation of infectious aerosols
OR
• through skin contact with respiratory secretions and wound exudates.
Lepra atau Penyakit Hansen
• Lepra (Kusta): penyakit granulomatosa primer yang
terjadi pada saraf tepi, mukosa saluran pernapasan
atas, dan lesi kulit.
• Jika tidak diobati, bisa ada kerusakan progresif dan
permanen pada kulit, saraf, kaki dan mata.

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 Masa Inkubasi
• Masa Inkubasi dan waktu infeksi serta onset penyakit, sulit untuk ditentukan
• Masa inkubasi minimum 🡪 paling pendek beberapa minggu (lepra pada
anak-anak)
• Masa inkubasi maksimum🡪 paling lama 30 tahun, atau lebih
• Secara umum disepakati bahwa rata-rata masa inkubasi antara 3 sampai
dengan 5 tahun.

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Clinical Presentation
• the bacteria multiply very slowly 🡪 the incubation period is
prolonged, with symptoms developing as long as 20 years after
infection.
• The clinical presentation of leprosy ranges from the tuberculoid
form to the lepromatous form
 Tuberculoid leprosy
• also called paucibacillary Hansen
disease)
• have a strong cellular immune
reaction to the bacteria, with the
induction of cytokine production
that mediates macrophage
activation, phagocytosis, and
bacillary clearance.
• The tuberculoid form is
characterized by hypopigmented
skin macules
• Diagnosed by :
• reactive in skins tests to
mycobacterial antigen
(lepromin);
• acid-fast stains are generally
negative
lepromatous leprosy
• multibacillary Hansen disease
• have a strong antibody response
but a specific defect in the cellular
response to M. leprae antigens
• an abundance of bacteria are
typically observed in dermal
macrophages and the Schwann
cells of the peripheral nerves.
• This is the most infectious form of
leprosy.
• The lepromatous form is
associated with disfiguring skin
lesions, nodules, plaques,
thickened dermis, and involvement
of the nasal mucosa.
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 Gambaran
Klinik Lepra
(Kusta)

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 ●Ulkus, resorpsi tulang yang memburuk akibat dari penggunaan tangan
9/6/2021 yang ceroboh (kerusakan saraf) 15
 Diagnosis
• Tes Lepromin
• Tes Kulit
• Lepromin 🡪 suspensi M.leprae dari nodul lepromatosa, yang dibunuh dengan
pemanasan
• Jika diiinjeksi intrakutan 🡪
• Reaksi awal terlihat pada waktu 24 – 48 jam
• Reaksi lambat terlihat setelah 3 – 4 minggu

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 Diagnosis
• Reaksi awal : indikasi dari hipersensitivitas lambat dari
antigen M.leprae yang terlarut
• Reaksi lambat : kemampuan individual, tersensitisasi atau
tidak tersensitisasi untuk menghasilkan granuloma
imunologik
• Tuberculoid : memberikan reaksi awal dan lambat
• Lepromatous : tidak pernah memberikan reaksi
• Lepromin mempunyai spesifisitas yang kurang. uji lepromin
positif dapat terjadi pada keadaan normal, anak sehat yang
divaksinasi BCG

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DIAGNOSIS Aim : to estimate the bacillary load.
Important in the diagnosis and in the classification of disease
Clinical examination
Procedure :
1. Make a small incision through the epidermis
2. Scraping the dermal surface of the skin (includingThe
edge of the lesion)
skin slit smears 3. Smearing the scrapings on a glass slide 🡪 heat fixation
and Ziehl-Neelsen staining (or Fite staining, If available)
to detect the organism

Sampling site
The bacillary index is based on a logrithmic scale per
Ideally, at least six sites should
high-powered field (HPF), with a range from 1+ to 6+
be sampled, including :
1. The skin lesions
2. the earlobes, skin slit smears are poorly sensitive (especially for
3. eyebrows, individuals with paucibacillary disease)
4. elbow,
5. Knees
6. nasal mucosa.
Pemeriksaan Mikroskopik

• Bacteriological Index : the number of

organism present per oil immersion field
(x1000) – live and dead bacteria
• Morphological Index : the number of solid
staining cell per 100 total bacilli examined –
presumably living

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(Mandell, Douglass, and Bennett’s)
Treatment
• The treatment regimens advanced by the WHO have distinguished
between patients with the tuberculoid (paucibacillary) form and the
lepromatous (multibacillary) form.
• The paucibacillary form should be treated with rifampicin and
dapsone for a minimum of 6 months
• The multibacillary form should have clofazimine added to the
regimen, and treatment should be extended to 12 months.