Leprosy

Hansen’s Disease
Leprosy 1873
Granulomatous infection of the skin and nerves
Endemic in developing countries
Predominantly a young man’s disease
Transmission
Still unkown
Possibly:
Inhalation of respiratory secretions
Contact with infected soil
Insect vectors
Congenital transmission
Prolonged close contact required
Incubation period
2 to 40 years
Predisposing factors
Born or raised in an endemic area
Blood relative with the disease
Nine-banded armadillo exposure
Poverty or malnutrition?
High degree of suspicion
Firm diagnosis
Requires presence of consistent peripheral nerve abnormality
Demonstration of M. leprae in the tissues
Nerve Changes
Enlargement of the nerves close to the skin
Sensory loss in skin lesions
Nerve trunk palsies
Symmetrical acral anesthesia
Nerve Changes
Diagnostic aids
Culture
Skin biopsy
Slit skin smears
Diagnostic aids
Lepromin test
Diagnostic?
Classification?
Positive: mm induration in 21 days
Negative: <3mm induration in 21 days
Simple classification
Paucibacillary
No bacillary detectable

Multibacillary
Detectable in tissue sections/smears
From one to many
Ridley System
Representation of the host’s cell-mediated immunity response to the
pathogen

TT= Polar tuberculoid

BT= Borderline tuberculoid
BB= Borderline
BL= Borderline lepromatous
LLs= Subpolar lepromatous
LLp= Polar lepromatous
Tuberculoid type
Tuberculoid type
Borderline type
Borderline type
Lepromatous type
Lepromatous type
Immunlogic Responses
Lepra type I reactions
BT & BL pts develop inflammation w/in existing lesions
Assoc. w/ fever, neuritis, new satellite lesions

Downgrading reactions
Occurs before therapy

Reversal reactions
Occurs in response to therapy
Reversal reaction
Immunological responses
Lepra type 2 reactions
50% of LL

Erythema nodosum leprosum

Occurs after initiation of anti-lepromatous tx
Generally w/in 1st 2 years of tx
Massive inflammation
Erythema nodosum leprosum
Immunological responses
Lucio’s reaction
Those with diffuse LL
Hemorrhagic ulceration which heal poorly
Recurs frequently
Lucio reaction
Multi-drug treatment
WHO regimen
Dapsone + Rifampin
Clofazamine
6 mos. for paucibacillary
1-2 years for multibacillary
Prognosis
Non-contagious in 2 weeks of treatment
Completion of desired duration is necessary for full bacilli eradication
Confirmation? Repeat biopsy adjacent to previously used site

1/3 will have debilitating permanent neurological deficit

Due to irreversible nerve injury
Chronic disability of the hands and feet
Pregnancy and lactation
Anti-leprosy drugs are not proven sure to be safe
Untreated patients have viable bacilli in their breast milk
AIDS
• Does not behave as an opportunistic infection
• In contrast to tuberculosis
Causes of Urticaria and Angioedema
Medications
Aspirin, other salicylates, NSAIDs, Codeine, other narcotic agents, Antibiotics-
Penicillins and Sulfa drugs, ACE inhibitors
Ingestants/Contactants
Food-shellfish, nuts, strawberries, inhalants-pollen, spores, mites, volatile
chemicals, aerosols, cosmetics, animal and plant materials
Physical stimuli
Extremes of temperature, exercise, pressure, vibration
Infections
Viral, bacterial, parasitic
Psoriasis
A hyper proliferative disorder
Chronic, recurrent, non contagious with genetic predisposition
In children, mean age of onset is 8.1 years
Erythematous plaques with whitish silvery lamellated scales
Predilects scalp, elbows, knees
May have nail changes
Most common variant: Plaque type
Guttate type more common in children
Trigger factors: weather, trauma, infection, stress, drugs, alcohol
Treatment: NO cure
1st line= topical steroids
Contact dermatitis
An acute or chronic inflammatory reaction to substances that comes
in contact with skin

Two types:
Irritant contact dermatitis
Allergic contact dermatitis
Irritant contact dermatitis
Exposure to a chemical capable of irritating the skin
Reaction usually ensues with a single exposure
Reaction depends on concentration of offending agent and
penetrability/thickness of Stratum corneum
Hands are the most frequently affected areas
Allergic contact dermatitis
An eczematous pruritic dermatitis due to re-exposure to a substance
to which an individual has been previously sensitized
A classic delayed-type cell mediated hypersensitivity reaction
Exposure to a strong allergen may take a week or so
Exposure to a weak allergen may take years