LEPROSY

(MORBUS HANSEN)
Def : chronic infection disease, first afinity on
perifery nerve and can be affacted all organ
Etiol : mycrobacterium leprae → obligate
intracelular
Epidemiol :
- mode of inf ??? →long & continue
direct contact.
- incubation ??? → 40 d – 40 y
- bactery can be found : skin, hair follicel,
sweat gland, breast milk, nouse mucous

Sign & symptom :
- Dx : - clinical (most important)
- bacterioscopic
- histopatologic
Clinical symp :

Clification Zone of leprosy spectrum
Ridley & Jopling
TT BT BB BL LL
Madrid
Tuberculoid Borderline Lepromatose
WHO Pausibaciler (PB) Multibaciler (MB)
TT BT BB BL LL
Lesion

Hypopigm
ent
macule,
sharp
border,1
or >,
asym,dry
surf,anaes
th (+)
Hypopigm
ent/erim
macule,sh
arp
border,>1,
asym,dry
surf,anaes
th (+)
Plack,pun
ched-
out,infiltra
t,macule
sharp
border,ma
ny,tend to
sym,dry,ro
ugh &
glossy
surf,anaes
th (+/-)

Infiltrat,pa
pule,>BB,s
ym,smoot
h & glossy
surf,anaes
th (+/-)
Infiltrat,pa
pule,nodul
e,minimal
healthy
skin,sym
Bact _ _ +/- +2 or > +4 or >
Nerve
enlarg
+ asym +,>1
asym
Tend to
sym
sym sym
LABORATORY
- Location : nose
ear-lobe
skin lesion
- Bacterial Index (BI):
1+ : 1-10 bac 100 v f
2+ : 1-10 bac 10 v f
3+ : 1-10 bac 1 v f
4+ : 11-100 bac 1 v f
5+ : 101-1000 bac 1 v f
6+ : > 1000 bac 1 v f
- Morfology Index (MI):

solid bac 100%
solid + non solid bac
- 100 bac in 1 lesion
- BI 1+ → IM (-)

Teraphy
MDT MB :
- Rifampicin 600mg / M
- DDS 100mg / d
- Lampren 300mg / M, 50mg / d
→ 1 year treatment, lab evaluated every 3 M

RFT
↓ 5 Y,6M evaluate
RFC
MDT PB :
- Rifapicin 600mg / M
- DDS 100mg / d
- Lampren 300mg / M
→ 6 months treatment, 3 m lab ev

RFT
↓2 y, 6 M ev
RFC
TUBERCULOSIS
OF THE SKIN

Def : chronic infection disease of Mycobacterium
tuberculous extra pulmonary → skin
Clasification :
- Primary : TB Chanre
Miliary TB
- Secondary : Schrofuloderma
Warty TB
Lupus Vulgaris
Orificial TB

TB Chanre
- Def : inoculation M TB without natural or
artificially acqired immunity to this
organism
- Clinical feature :
- brownish papule/ragged ulcer
undermined edge, haemoragic base

apple-jelly + silvery scale
Miliary TB
Def : lesion that appear cause of the
spreading of body focus. Reaction of
tuberculin test is negative
Clinical features :
profuse crop of bluish papules,
vesicles, pustules or haemoragic lesins

small ulcers
Schrofuloderma
- Def : results from the involvement and
breakdown of the skin overlying a TB fokus,
ussually a lymph glands (cervical, axilla,
inguinal, retroauricular)
- Clinical feature :
bluish-red nodule overlying the infected
gland

undermined ulcers
↓ fistula
intercommunicate beneath rigdes

scar
Warty TB
- Def : indolent, warty, plaque like form →
inoculation M TB into the skin of a previously
infected patient who usually has a moderate
or high degree of immunity
- Clinical features :
- hands, knees, ankle, buttocks
- indurated warty papule, slight areola →
verucous plaque, purpelish, red or brown
colour
- DD : wart (subungual/digital), tertiary syphilis
Lupus Vulgaris
- Def : a progressive form of cutanedus TB
occuring in a person with a moderat or high
degree of immunity
- Clinical feature :
*generaly confluence nodules erytem
becomes yellowish and look like apple-jelly
with diascopy
- plaque form: plaque eritem with scale like
psoriasis appearance, edge becomes
thickened and hyperkeratotic


Teraphy :
- Isobiazid 300mg/d → 6 m
- Rifampicin 450mg/d ≤ 50kg BW,
600mg/d > 50kg BW
- Pyrazinamide 1,5 gr/d 50-74 kg BW, 2,5
gr/d >75 kg BW → 2 m (I)
- Ethambutol 15mg/kg BW/d → 2 m (I)