Pathogen

• Mycobacterium leprae

Epidemiology & transmission

• Transmission by droplets from the nose and mouth during close and frequent contact with untreated cases who have live bacillus (bit like TB)

• Host immune response (more likely to develop disease with poor nutrition, environment etc)

Clinical

Disease of skin and nerves

• Skin manifestations: painless depigmentation?

• Peripheral neuropathy (sensory & motor) leading to disabilities and deformities: ulnar nerve, foot drop, ulcers, burns, lagobthalmous

Diagnosis

• Slit-skin smear (don’t confuse with skin snip for onchocerciasis). Taken from ear lobe - mycobacterium like cooler

Classification

• Ridley-Jopling: TT, BT, BB, BL, LL (difficult to implement in the field)

• WHO (field) classification: , MB (AFB detected) vs. PB

Tuberculose

• Paucibacillary, strong immunity, (like autoimmune disease), PB (less than 5 lesions)

Lepromatous

• Multibacillary, weak immunity, nodules (bacteria everywhere), (more than 5 lesions)

Management

3 drug regimen for both MB and PB:

• Dapsone (DDS)

• Rifampicin (RFP)

• Clofazimine (CLF)

Complications

• Reactions

• Type 1: reversal: immune system fighting back (inflammation of existing skin lesions or peripheral nerves)

• Type 2: lepra raction / erythema nodosum leprosum

• Lucio’s Phenomenon (NEJM)

Long-term management