2. pit idi 2015

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KASUS KUSTA YANGMERAGUKAN :Bagaimana

menegakkandiagnosa ?

INDROPO AGUSNI

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Leprosy :

- Chronic infection

- Cause : M.leprae

- Primarily attackperipheral nerve,

secondarily attack

other organs,

including nasalcavity

Mycobacterium leprae

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1. skin patch with loss of sensation

2. enlarged peripheral nerve

3. positive slit-skin smear

Physical examination will diagnose leprosy in most casesPhysical examination plus skin smear will diagnose

leprosy in the vast majority of cases

The cardinal signs of leprosy

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5

The 1st cardinal sign of leprosy

Skin patch with loss ofsensation• Hypopigmented

•

Erythematous

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Enlarged

greatauricularnerve

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The slit andscrapemethod

Incision, turnthe blade 90degrees

LOCATION :

EarlobeChinExtensor forearmDorsal fingersButtocksKnees

BACTERIOLOGIAL EXAMINATIONIN LEPROSY 

Courtesy from

Dr. Colette van Hees

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Bacterial Index (BI) : total number of bacilli ( 1+ to 6+ )

Morphological Index (MI) : % of solid staining bacilli,

number of viable bacilli

SOLID

GRANULAR FRAGMENTED

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KUSTA ?

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Penyakit sudah lama / kronis :sudah bbrp bulan / tahun

Tidak gatal, tidak nyeri Adanya sumber penularanPasien berasal dari daerah

endemik kustaSudah dicoba dengan berbagai

salep

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Light touchTemperature discrimination

Pain (pin prick)

Decreasedsweating

CLINICALEXAMINATION

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Palpation ulnar nerve

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BILA SEMUA HASILPEMERIKSAAN MERAGUKAN :

 Alternatif :1. Dirujuk ke dokter yg lebih

ahli.2. Ditunggu sampai cardinal

sign muncul, baru diobati

3. Periksa laboratorik tambahan.

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MENUNGGU SAMPAIKAPAN ?

- Sebaiknya evaluasisetiap 3 bulan tanpa terapi

- Bila sampai 6 bulan tidak ada perubahan, namun

dokter tetap curiga M.H. :BOLEH diberi obat anti kusta

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TUBERCULOID BORDERLINE LEPROMATOUS

CELLULAIRIMMUNITY 

HUMORALIMMUNITY 

CLINICAL SPECTRUM OF LEPROSY

 AFB

Number

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Ridley & Jopling (1964) :

TT BT BB BL LL

WHO ( 1980 )

KLASIFIKASI PENYAKIT KUSTA

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Pitiriasis Versicolor

Pityriasis alba

Birth MarkM TT

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DIAGNOSA BANDING M.H.

MH BT-

type

Pityriasis RoseaTinea Pedis

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Erythro-Papulo-Squamous lesions

MH-BB type

Psoriasis

Lues II

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Charcot Marie Tooth Disease :

( genetic peripheral nerve disorder)

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1. Bacteriological Examination 2. Histopathology ( skin biopsy) 2. Serological Examination 3. Molecular Biology tests :

- Polymerase Chain Reaction / PCR

- Reverse Transcriptase / RT-PCR- DNA Sequencing for Drug Resistance- Genomic Study of M. leprae 

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Detection of Anti PGL-1antibodies

Cut off value : IgM = 605 u/ml IgG = 650 u.ml

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INDICATION OF SEROLOGICALTEST IN LEPROSY :

• Diagnosis support of LeprosyLeprosy Classification

• Detection of SubclinicalInfection of Leprosy

• Treatment Evaluation

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SEROLOGICAL EXAMINATION INLEPROSY 

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FILTER PAPER METHOD

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FILTER PAPER METHOD

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POLYMERASE CHAIN REACTION( PCR ) IN LEPROSY 

NON-TYPICAL LEPROSYSKIN LESION

INDICATION :Detection of M. Leprae DNA in the samples

- skin slit preparation- blood- nasal swab- biopsy tissues etc.

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spl1 spl2 spl 3 spl 4 spl 5 Marker Negatip Positip

(-) (-) (+) (+) (+) (ladder) kontrol kontrol

99bsp

PCR test for M.leprae : sensitivity up to 90%

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Thank You…