kuliah morbus hansen
TRANSCRIPT
-
8/3/2019 KULIAH MORBUS HANSEN
1/37
LEPROSY( MORBUS HANSEN )
Dr AMBAR RIALITA SpKK
-
8/3/2019 KULIAH MORBUS HANSEN
2/37
DEFINITION :
Chronic infection disease
Mainly affects the skin,
peripheral nerves, mucosaupper respiratory tract, reticuloendothelial system, eye, bone ,
testis, except central nervoussystem.
-
8/3/2019 KULIAH MORBUS HANSEN
3/37
AETIOLOGY :
Mycobacterium leprae Curved rod shaped
Acid Fast Bacilli
Gram positive 1 8 long, 0,2 0,5
Intracellular
Prefer a growth temperature of less than37 C
Can not be cultured
-
8/3/2019 KULIAH MORBUS HANSEN
4/37
EPIDEMIOLOGY :
Africa / Central Asia ---- World
All ages ranging : early infancy to very
old age 15 25 years old >>
Both sex : Males : Females = 2 : 1
Very long period : 3 5 years 1990 : 7 / 10,000 ----- 2000 : 1 / 10,000
-
8/3/2019 KULIAH MORBUS HANSEN
5/37
TRANSMISSION:
Contact person
- Respiratory tract
- Skin
- Immunity
- Virulence
- Physical
- Environment : - Biological
- Social
-
8/3/2019 KULIAH MORBUS HANSEN
6/37
The Microbiology of Leprosy :
M. leprae can not be cultured
Bacteriological examination :1. Diagnosis
2. To get a cross spectrum
3. Evaluations4. Prognosis
-
8/3/2019 KULIAH MORBUS HANSEN
7/37
Material :
Skin lession Ear lobe
Nasal secretions / Nose blows
-
8/3/2019 KULIAH MORBUS HANSEN
8/37
DIAGNOSIS of LEPROSY :
If shown one or more of the following cardinal
signs :
1. Hipopigmented or reddish skin lession with
definite loss of sensation2. Involvement of the peripheral nerves, as
demonstrated by definite enlargement /thickening peripheral nerves with loss of
sensation3. Skin smear positive for Acid Fast Bacilli
Not Yet ----- Observation for 3 6 months
-
8/3/2019 KULIAH MORBUS HANSEN
9/37
Measurement of the Bacterial Index :1. Diagnosis
2. To get a cross the spectrum3. Therapy evaluation
-
8/3/2019 KULIAH MORBUS HANSEN
10/37
Scoring the B I :
Average Number ofAcid Fast Bacilli Bacterial Index( B I )
1000 / field 6 +
100 1000 / field 5 +
10 100 / field 4 +
1 10 / field 3 +
1 10 / 10 fields 2 +
1 10 / 100 fields 1 +
0 / 100 fields 0
-
8/3/2019 KULIAH MORBUS HANSEN
11/37
Morphological Index :
The proportion or percentage ofregularly stained bacteria of the totalscored
Ridley ( 1971 ) :
- Regularly stained bacteria = Solidlybacteria
- Irregularly stained bacteria =Fragmented + Granular bacteria
-
8/3/2019 KULIAH MORBUS HANSEN
12/37
M I will be a guide in determining :
1. Response to treatment
2. Drug resistance
3. Determining the infectiousness of apatient
Treatment --- M I quickly
B I slowly
-
8/3/2019 KULIAH MORBUS HANSEN
13/37
If M I and then : possibility
Irregularly
Malabsorbtion
Drug resistance
-
8/3/2019 KULIAH MORBUS HANSEN
14/37
THE AIM OF CLASSIFICATION OFLEPROSY :
1. Infectious / Non infectious
2. Possible infectious3. Possible Disability
4. Duration of treatment
-
8/3/2019 KULIAH MORBUS HANSEN
15/37
CLASSIFICATION
SPECTRUM
Ridley &Jopling
T T B T B B B L L L
MADRID Indeter-minate
Tuber-
culoid
Border-
line
Lepromatous
WHO
( 1988 )
Paucy Bacillar
Leprosy
Multi Bacillar
Leprosy
-
8/3/2019 KULIAH MORBUS HANSEN
16/37
CLINICAL LEPROSY
Indeter-minate
T T B T B B B L L L
Infectious
(-)
Infectious
(-)
Infectious
(-)
Infectious Infectious Infectious
Children 2 3lesion
Satelit
lesion
Punch Out
Hipopig-mented /
pink : Face,back,buttock
Macules hipopig-
mented
Macules :hipopig-
mented /reddish
Dimor-phous
featuresand tendsymmetry
Symetricalpapul,
nodules
Symetri-cal papul,
nodules
-
8/3/2019 KULIAH MORBUS HANSEN
17/37
CLINICAL LEPROSY
Indeter-minate
T T B T B B B L L L
Loss ofsensation(-)
(+) (+) (+) Sensoryloss,decreases
sweating andhair growth
Stockingand glovesanesthesia
Nerveswollen (-)
(+) (+) (+) Nervedamaged
Nervedamaged
Lepromin(-)
(+) 4 (+) 3 (+) 1 -2 (-) (-)
Acid FastBacilli (-)
(-) (+) /
(-)
(+) 3 (+) 3 - 4 (+) 5 - 6
-
8/3/2019 KULIAH MORBUS HANSEN
18/37
TREATMENT of LEPROSY :
Multi Drug Therapy :
- Prevention & treatment of resistance
- As short a period of time fortreatment
- To interrupt the transmission of the
infection
-
8/3/2019 KULIAH MORBUS HANSEN
19/37
W H O ( 1997 ) :
Paucibacillary Single Lesion Leprosy
(one lesion) Paucibacillary Leprosy (2-5 skin lesion)
Multibacillary Leprosy (More than 5 skin
lesion)
-
8/3/2019 KULIAH MORBUS HANSEN
20/37
I. P B SINGLE LESION
CHILD ADULT
Rifampicin 300 mg Rifampicin 600 mg
Ofloxacin 200 mg Ofloxacin 400 mg
Minocycline 50 mg Minocycline 100 mg
Dosage: Single Dose R O M
-
8/3/2019 KULIAH MORBUS HANSEN
21/37
II. P B 2 5 SKIN LESION
CHILD ADULT
Monthly Treatment :
Day 1 :
Rifampicin 450 mg
Dapsone 50 mg
Daily :
Day 2 28
Dapsone 50 mg/daily
Monthly Treatment :
Day 1 :
Rifampicin 600 mg
Dapsone 100 mg
Daily :
Day 2 28
Dapsone 100 mg/daily
Duration of treatment : 6 - 9 Months
-
8/3/2019 KULIAH MORBUS HANSEN
22/37
III. M B :
CHILD ADULTMonthly treatment
Day 1 :
Rifampicin 450 mg
Clofazimine 150 mg
Dapsone 50 mg
Daily 2 28 :Clofazimine 50 mg / daily
Dapsone 50 mg / daily
Monthly treatment
Day 1 :
Rifampicin 600 mg
Clofazimine 300 mg
Dapsone 100 mg
Daily 2 28 :Clofazimine 50 mg / daily
Dapsone 100 mg / daily
Duration of treatment : 12 18 months
-
8/3/2019 KULIAH MORBUS HANSEN
23/37
LEPROSY REACTIONS :
Type 1 reaction : Reversal reaction
Type 2 reaction : Erythema Nodosum
Leprosum
( E N L reactions )
-
8/3/2019 KULIAH MORBUS HANSEN
24/37
Manifestation of : 1. Reversal reaction
Mild Severe
Skin - Lesion become reddish& swollen
- Same & rarely new skin lesion
- Fever, malaise
Nerve - Enlarge, painfull (-)- Nerve damage (-)
- < 6 weeks
- Enlarge, painfull (+)- Nerve damage, loss sensation
- > 6 weeks
Skin &
Nerve
- Lesion become reddish
- Painful on peripheralnerves
- < 6 weeks
- Same
- Ulceration- Swollen on hand & foot
- Nerve enlarge
-- > 6 weeks
-
8/3/2019 KULIAH MORBUS HANSEN
25/37
2. E N L reaction
MILD SEVERE
Skin Skin nodules :- Tender reddish
- Ulceration
Skin nodules >>- Painful
- Ulceration
- Fever & malaise
Nerve EnlargePainful (-)
Nerve damage (-)
EnlargePainful & swollen
Nerve damage
Eye Not involvement Painful
Visual impairment
Testis Swollen, Painful (-) Painful, Enlarge
Skin, nerve,eye, testis
Same - Same
- Very painful
- Fever
-
8/3/2019 KULIAH MORBUS HANSEN
26/37
TREATMENT of REACTION :
Prednisone : 30 80 mg / daily and thentappering off
Continued M D T without interruption
MILD REACTION :
- Immobilization
- Rest
SEVERE REACTION :
Reffered to the nearest hospital
-
8/3/2019 KULIAH MORBUS HANSEN
27/37
MH tipe BB
-
8/3/2019 KULIAH MORBUS HANSEN
28/37
MH tipe BL
-
8/3/2019 KULIAH MORBUS HANSEN
29/37
MH tipe BT
-
8/3/2019 KULIAH MORBUS HANSEN
30/37
MH indeterminate
-
8/3/2019 KULIAH MORBUS HANSEN
31/37
MH tipe TT
-
8/3/2019 KULIAH MORBUS HANSEN
32/37
MH tipe LL
-
8/3/2019 KULIAH MORBUS HANSEN
33/37
MH tipe LL
-
8/3/2019 KULIAH MORBUS HANSEN
34/37
Eritema Nodusum Leprosum(ENL)
-
8/3/2019 KULIAH MORBUS HANSEN
35/37
Lepromatous leprosy. Note the diffuse infiltration of the face withleonine facies and madarosis.
-
8/3/2019 KULIAH MORBUS HANSEN
36/37
Sequele of leprosy. The patient has madurosis, a saddle nose andblindness in the left eye. Courtesy of Evangeline Handog, M.D.
-
8/3/2019 KULIAH MORBUS HANSEN
37/37