Paucibacillary Multibacillarey
-definition: leprosy also called Hansen's
disease , is a chronic infectious disease 1)Indeterminate leprosy(IL) 1)Borderlin borderline (BB)
-caused by bacterium mycobacterium 2)Tuberculoid leprosy(TL) 2)Border linelepromatous(BL)
leprae an acid fast bacilli . 3)Border linetuberculoid(BT) 3)Lepromatous leproy(LL)
-It is granulomatous disease
Indeterminate leprosy Tuberculoid leprosy(TT) Border line leprosy Lepromatous leprosy
primarily affects : Tuberculoid (TT) leprosy is the -Very numerous ill defined lesions.(
-Usually single may be multiplemacules or -Few or many asymmetrical patches.
the skin , peripheral nerves and mucosa of paucibacillaryform macules , papules , patches and nodules ).
patches. -Partially well defined.
upper respiratory tract, the eyes, liver, -Hypo pigmented or faintly erythematous.
defined clinically by:
-Sensory impairment range from
-Symmetrically distributed all over the
testes, muscles and bones. -Usually single but may few < 5 body.
-Sensation normal but sometimes impaired. slight to marked.
sharply definedred patches, -Loss of eyebrow and eyelashes.(Leonina
-The peripheral nerve normal , no palpable -Slit skin smear is usually positive.
asymmetrical with raised borders face).
peripheral nerve. -Peripheral nerves asymmetrically
-or a single larger -No sensory impairments in lesions.
-Slit skin smear negative enlarged.
hypopigmented patch lessthan 10 -Nerve involvement in lepromatous leprosy
-Leprosy is a curable disease if treated early cm in diameter
-Satellite lesions around the patches
is characteristically symmetrical and
inborderline tuberculoid.
-If it isn’t treated, it can cause severe -Loss of sweating with rough dry exhibits a stocking-glove distribution,
disfigurement and significant disability. hairless skin in the patches unrelated to the location of skin lesions. -
-Animals reservoir of leprosy are armadillo , -Loss of sensation in lesions Affected Peripheral nerve involvement may initially
nerves are thickened on palpation. be manifestedas loss of temperature
chimpanzee and mangabey monkey. -Slit skin smear negative.. sensation, followed by loss oflight touch,
pain, and deep pressure sense.
Skin biopsy: -Peripheral nerves symmetrically enlarged.
1.Clinical examination: -Granulomas formed by:
What are the cardinal sign of leprosy? 1)epithelioidcells Skin biopsy :
1)Hypopigmented or erythematous patch / 2)Langerhans giant cells -foamy histiocytes full of bacilli foamy cells
plaques. 3)lymphocytes. -Few lymphocytes and Grenz zone
2)Complete or partial loss sensation. -No lepra bacilli subepidermal.
3)Thickening of peripheral nerves. -Numerous lepra bacilli
2. Slit skin smear
-Confirm diagnosis of leprosy.
Leprosy diagnosis : -Classify the disease.
-Follow-up patients on treatment.
-Slit skin smear at 6 standard sites :ear lobes , Leprosy reaction
elbows , knees.
by fatema okoff
-stain with (Z-N) stain.
*It is acute inammatory response Risk factors Treatment
3. Skin biopsy : occurring in the course of the disease -pregnancy/ Postpartum -This is urgent,as irreversible eye, nerve
This is thought to be due to teration in period damage can occur
the immunological status of the patient -Alcohol intake. -anti leprosy therapy must he continued.
*lt is the major cause of nerve damage -Physical stress. *Type 2 lepra reaction(ENL) can be treated
Monthly dose:
and disability in leprosy -Intercurrent infection with :
1)Rifampicin 600mg
MDT for PB *It can occurat anytime before, during or -Surgical operation. -Prednisolone 1mg/kg tapering rapidly for 12
2)Dapsone 100mg
leprosy after treatment Occurs in 30-40% -Effective treatment weaks.
6 months ofleprosy cases -Sometimes spontaneously. 1)analgesics.
Daily dose:
The drugs that are commonlyused in leprosy: 2)Chloroquine
1)Dapsone 100mg
1. Dapson. 3)Clofezimine. Given in a dose 100mg bd for
2. Rifampicin. 12weaks then tapering.
treatment: monthly dose:
2. Clofazimine. 4)antpyretic.
* The combination of these drugs known as 1)Rifampicin 600 mg 5)Thalidamid
multidrug therapy (MDT) 2)Clofazimine 300mg * Type 1 lepra reaction can be treated with:
MDT for MB leprosy 3)dapsone 100 mg. -Prednisolone 40 mg - 60 mg for 3to 6 months.
24 months
Daily dose:
1)Dapsone 100 mg
2)clofazimine 50mg
complications of peripheral nerve: