leprosy mailing list1 diagnosis of leprosy 1leprosy mailing list salvatore noto, pieter a m...

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leprosy mailing list 1 Diagnosis of leprosy 1 leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

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Page 1: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 1

Diagnosis of leprosy

1leprosy mailing list

Salvatore Noto, Pieter A M Schreuder

Leprosy mailing list, April 2010

Introduction

Page 2: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 2

Definition of leprosy

Leprosy is a chronic infectious disease

caused by M. leprae. It affects mainly

the skin and the peripheral nerves.

leprosy mailing list

Page 3: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 33

“Proteiform diseases”

Leprosy: the great imitator

Syphilis: “ “

SLE: “ “

leprosy mailing list

Page 4: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 44leprosy mailing list

Leprosy

Courtesy of S. Noto

Page 5: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 55Leprosy leprosy mailing list

Courtesy of S. Noto

Page 6: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 66leprosy

leprosy mailing list Courtesy of S. Noto

Page 7: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 77leprosy mailing listLeprosy Courtesy of S. Noto

Page 8: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 88

Leprosy

leprosy mailing list Courtesy of S. Noto

Page 9: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 9

Leprosy, BL reactive after pregnancy

Courtesy of B Naafs

Page 10: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 10

Leprosy, BL reactive after pregnancy

Courtesy of B Naafs

Page 11: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 11

Leprosy, BL

reactive after

pregnancy

Courtesy of B Naafs

Page 12: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 1212leprosy mailing listLeprosy Courtesy of S. Noto

Page 13: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 13

Leprosy

(in reversal reaction)

leprosy mailing list

Courtesy of S. Noto

Page 14: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 1414leprosy mailing listLeprosy Courtesy of S. Noto

Page 15: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 1515leprosy mailing list

LeprosyCourtesy of S. Noto

Page 16: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 1616leprosy mailing list

Leprosy

Courtesy of S. Noto

Page 17: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

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Leprosy

leprosy mailing list

Courtesy of S. Noto

Page 18: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 18

Slides 15,16 and 17

• These patients were all treated with multi-drug therapy. Sequelae in themselves are not an indication to start treatment.

• These kind of patients need urgently physical and social-economic rehabilitation.

Page 19: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 1919leprosy mailing list

Courtesy of J A da Costa Nery

Leprosy in families:

father and child

Page 20: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 2020

- The 3 cardinal signs of leprosy;

- Ridley and Jopling classification;

- Reactions and nerve damage.

How to put order in clinical leprosy

leprosy mailing list

Page 21: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

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The 3 cardinal signs of leprosy

1. Skin patch with loss of sensation;

2. enlarged peripheral nerve;

3. positive slit-skin smear.

21leprosy mailing list

Page 22: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

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The leprosy spectrumaccording to the Ridley and Jopling classification

  

tuberculoid leprosy borderline leprosy lepromatous leprosy TT BT BB BL LL BI - - - -, 2+, 3+ 3+, 4+ 5+, 6+

(1+,2+)

BT = borderline tuberculoid leprosyBB = mid borderline leprosyBL = borderrline lepromatous leprosyBI = bacteriological index

- - = negative+ = degree of positivity

leprosy mailing list

Page 23: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

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Nerve damage in leprosy

1. dermal nerves;

2. cutaneous nerves;

3. major nerve trunks.

Source: B Naafs (1994) in E Nunzi, D Leiker, “Manuale di leprologia”

leprosy mailing list

Page 24: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

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Nerve damage in leprosy

Most of the nerve damage in leprosy takes place

during acute exacerbations of the disease called

“Reactions”.

leprosy mailing list

Page 25: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 25

How to diagnosis leprosy

• history taking;

• physical assessment; and

• laboratory investigations.

leprosy mailing list 25

Page 26: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

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• Slides 27 and 28 show the importance of the source of light in clinical examination

Page 27: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 27

Skin lesions must be examined in a good light BUT NOT direct sunlight Indeterminate leprosy. Compare these photos, same patient, same day, same verandah!B. examined in bright sunlight. Note shadows and that lesion can hardly be identified.A. a well defined edge for part of the lesion, is apparent. It is slightly erythematous, whenseen in good light, but not in sun. Appearance of lesion varies with angle of the rays oflight. Tangential light is best, as on front of chin.

Courtesy of Grace Warren

Page 28: Leprosy mailing list1 Diagnosis of leprosy 1leprosy mailing list Salvatore Noto, Pieter A M Schreuder Leprosy mailing list, April 2010 Introduction

leprosy mailing list 2828Courtesy of S Noto

Direct sunlight passing trough the foliage of the tree creates false skin lesions!