HANSEN’S DISEASE
HISTORY
Definition
Leprosy is a chronic systemic disease caused by
Mycobacterium leprae manifesting as development of
specific granulomatous or neurotropic lesions in the skin,
mucous membrane, eyes, nerves, bones and viscera.
Oldest infection known to mankind.
Synonym’s : Kushtha Roga
TRANSMISSION OF
LEPROSY
Respiratory route : inhalation of bacilli-laden droplets
Cutaneous : skin to skin contact
GIT : Ingestion of contaminated food
not yet proven
Intradermal : Inoculation by tattoos
EPIDEMIOLOGICAL
FACTORS
Occurs at all age groups
Peak age of onset : 10-20 years
Males > females
Children most susceptible
Immune status (host resistance)
Over crowding
Low socioeconomic status
IMMUNITY AND LEPROSY
HOST RESISTANCE CLINICAL MANIFESTATION
EXCELLENT NO INFECTION
GOOD SUBCLINICAL INFECTION WITH
SPONTANEOUS REGRESSION
INDETERMINATE, PURE NEURITIC,
FAIR TUBERCULOID
MID-BORDERLINE, BORDERLINE
POOR LEPROMATOUS
LEPROMATOUS
VERY POOR
MYCOBACTERIUM
LEPRAE
Obligate, intracellular, acid fast bacillus
Affinity for skin, nerves and muscle tissue
Found in macrophages, histiocytes and
Schwann cells
Non cultivable
Grown in animal models
Closely resembles M.tuberculosis, but less acid
fast
Multiplies in 11-13 days
RIDLEY JOPLING
CLASSIFICATION
Indeterminate leprosy
Tuberculoid leprosy
Borderline : borderline tuberculoid, mid-borderline,
borderline lepromatous
Lepromatous
CLASSIFICATION (WHO)
Paucibacillary Leprosy (PB) :
Indeterminate Leprosy (I)
Tuberculoid Leprosy (TT)
Borderline Tuberculoid (BT)
Pure neuritic (PN)
Multibacillary Leprosy (MB) :
Midborderline Leprosy (BB)
Borderline Lepromatous (BL)
Lepromatous Leprosy (LL)
TUBERCULOID (TT)
Single or few, asymmetrical, well defined, erythematous or
copper colored patches.
Sensations – Absent.
Nerves – Thickened, presence of feeding nerves, abscesses.
Skin smears – negative.
Lepromin test – strongly positive.
Course – Relatively benign and stable, with good prognosis
TUBERCULOID LEPROSY
BORDERLINE LEPROSY
(BB)
Common type of leprosy.
Subdivided into – BT, BB & BL.
Course – Unstable with variable prognosis, may
progress to sub-polar LL leprosy.
Most prone to reactions.
Lepromin test – Negative , weakly positive in BT
BORDERLINE
TUBERCUOID (BT)
Few asymmetric, hypo pigmented or skin
colored macules, plaques with ill defined
margins.
Presence of satellite lesion near the advancing
margin of patch.
Sensory impairment – Marked.
Nerve involvement – Marked and asymmetrical.
MIDBORDERLINE (BB)
Unstable form.
Reactions frequent.
Annular lesions with characteristic punched out
appearance (inverted saucer shaped).
Sensory impairment – Moderate.
Nerve involvement – Marked and asymmetrical.
BORDERLINE
LEPROMATOUS (BL)
Multiple shiny macules, papules, nodules and plaques with
sloping edges.
Sensory impairment – Slight.
Nerve involvement – Widespread and less asymmetrical.
Glove and stocking hypoanesthesia
LEPROMATOUS LEPROSY
LEPROMATOUS LEPROSY
(LL)
Hypopigmented, erythematous or coppery, shiny macules,
papules, nodules.
Lesions symmetrically distributed, small, multiple, shiny
with normal or mild sensory loss.
Leonine facies – Infiltration of skin with nodules, loss of
eyebrows and eyelashes.
Nerve involvement – Symmetrical ; glove and stocking
anesthesia.
Lepromin test – Negative.
LEPROMATOUS LEPROSY
LEPROMATOUS
LEPROSY
LEPROMATOUS
LEPROSY
NERVE INVOLVEMENT IN LEPROSY
Sensory involvement - Anesthesia in hands and feet, glove
and stocking anesthesia.
Motor involvement - Wasting and paralysis of muscles.
Autonomic involvement - Icthyosis and loss of hair and
sweating.
OTHER FEATURES
Nasal stuffiness / crusting.
Epistaxis.
Hoarseness of voice.
Gynaecomastia.
Saddle nose.
Bone resorption.
Lymphadenopathy.
DIFFERENTIAL DIAGNOSIS
Vitiligo
Occupational leukoderma
Tinea versicolor
Pityriasis alba
Post kala azar dermal leishmaniasis (macular
lesions)
Naevus depigmentosus
scars
D / D – INFILTRATED
LESIONS
Lupus vulgaris
Lupus erythematosus
Granuloma annulare
Annular syphilides
Post kala azar dermal leishmaniasis
(infiltrated lesions)
Sarcoidosis
Psoriasis
D / D – NODULAR
LESIONS
Post kala azar dermal leishmaniasis (nodular
lesions)
Syphilis
Onchocerciasis
Sarcoidosis
Leukemia cutis
Mycosis Fungoides
Nodules of neurofibromatosis
DIAGNOSIS
CARDINAL SIGNS OF LEPROSY
Sensory impairment in affected areas.
Enlargement of peripheral nerves associated
with signs of peripheral nerve damage.
Finding acid-fast bacilli in the lesions.
CLINICAL EXAMINATION
Type and number of skin lesions
Sensory impairment
Motor examination
Nerve examination
Sweating
Loss of hair
CLINICAL EXAMINATION - SENSORY
TOUCH
Tested with a wisp of cotton, nylon thread or feather
TEMPERATURE
Tested with two test tubes – one containing hot water and
other cold
PAIN
Tested by pin prick
MOTOR – testing done clinically.
NERVES
Supra / infraorbital.
Great auricular.
Clavicular.
Radial.
Superficial radial cutaneous.
Ulnar.
Median.
Lateral popliteal.
Posterior tibial.
Anterior tibial.
Sural.
INVESTIGATIONS
BACTERIOLOGICAL EXAMINATION
SKIN SMEARS
Made by slit and scrape method from the most active looking
edge of skin lesion and stained with Zeil-Neelsen method.
READING OF SMEARS:
Bacteriological index – Indicates density of leprosy bacilli (live
& dead) in the smears and ranges from 0 to 6+
Morphological index – It is the percentage of presumably living
bacilli in relation to total number of bacilli in the smear.
Histopathological examination
Nerve biopsy
Sweat function test
Lepromin test
Animal models : Armadillo, Thymectomised and
irradiated nude mice, Korean chipmunk etc.,
ARMADILLO
MDT - WHO
Paucibacillary leprosy (6 months)
- Cap. Rifampicin (600mg) monthly supervised
- Tab. Dapsone (100mg) daily
Multibacillary leprosy (1 year)
- Cap. Rifampicin (600mg) monthly supervised
- Cap. Clofazimine (300mg) monthly supervised
- Tab. Dapsone (100mg) daily
- Cap. Clofazimine (50mg) daily
