Health Significance Of The Different Clinical Presentations Of Leprosy

Funom MakamaStarred Page By Funom Makama, 20th Mar 2014 | Follow this author | RSS Feed
Posted in Wikinut>Health>General Health>Diseases & Infections

Leprosy, clinically and physically presents itself in various forms. At an early stage, it presents as indeterminate leprosy, but as the disease advances, it presents as Tuberculoid and Lepromatous Leprosy. A special type know as Lucio Leprosy could also manifest.

The early stage (Indeterminate Leprosy)

The disease starts with a single lesion or a few multiple lesions which appear as small hypo-pigmented or erythematous macules. Careful testing may reveal hyperaesthesia, paraesthesia, hypoesthesia or hypoalgesia. At this state, nerve trunks are not thickened. Slit skin smears are usually negative for acid-fast bacilli. Lepromin reaction may be negative or doubtfully positive. Evolution into the polar forms takes a long time after infection. In the early stage, which is known as indeterminate leprosy, the distinctive features are absent. Though, diagnosis is possible, it is difficult to predict the clinical outcome and the type.

Tuberculoid leprosy (TL)

In this form the skin lesions are only a few (3 or less) and they vary in size. They are hypopigmented or erythematous and the margins are well defined. The lesions may be flat or raised. Either the entire lesion or only the margins may be elevated. The surface is dry, rough and anhidrotic. BY this time, the touch and pain sensations are impaired. Never trunks, especially in the vicinity of the raised lesions are palpably thickened. Supraorbital and great auricular nerves in the head and neck. Ulnar, cutaneous branch of radial, the main radial and median nerve in the upper limn and lateral popliteal (common peroneal), posterior tibial, musculocutaneous and sural nerve in the lower limbs are the common nerves palpated. Slit skin smear does not show acid-fast bacilli and lepromin test is positive (1+ to 3+). Early lesions may heal spontaneously without complications. More advanced lesions also heal ultimately, but residual damage to nerves may occur due to reactions, which complicate the illness.

Lepromatous Leprosy (LL)

In this form, the bacilli spread rapidly from the skin, both by local extension and through the blood stream, to other parts of the body. Extensive involvement of nerves, mucosa of the upper respiratory tract and the internal organs is seen. Eyes, testes, lymph nodes, marrow of the phalanges, superficially placed muscles, liver, spleen and kidney may all be involved to varying degrees.

The morphology of the skin lesions depends upon the stage of the disease. Early lesions are flat, smooth, shiny, hypopigmented or coppery red, with ill defined margins. Numerous small lesions are distributed symmetrically. The entire body surface may be involved except certain areas like the axilla, groin and the flexor aspects of the limbs. In dark subjects they may be inconspicuous and can be made out only by careful search. Early lesions do not show sensory loss. As the disease progresses, papules and nodules appear especially on the ears and face. The eyebrows are lost. The facies is described as leonine and this is caused by infiltration and thickening of skin of the face. The mucosal lesion leads to ulceration of the nose, mouth, trachea and larynx. Nasal discharge teems with the bacilli. Nasal bones may be destroyed resulting in deformity of the nose. Involvement of the pre-maxilla leads to loss of the upper incisors.

Clinical evidence of nerve damage occurs late in lepromatous leprosy. The nerve trunks are symmetrically enlarged and soft to feel. Dorsal aspects of the fore-arms and legs show anesthesia spreads over the whole body except the palms, soles, axillae and groins. Motor weakness follows further nerve damage. Tendon reflexes are preserved till the late stages. Paradoxically, the wasted muscles may be hyper-reflexic. In addition to neural damage, muscular dysfunction may result from direct invasion of the muscles by the bacilli. Affection of the tests gives rise to impotence and enlargement of the breasts.

Occular involvement may result from extension from the skin or by hematogenous spread. Common lesions include military lepromata on the iris and superficial punctuate keratitis. All parts of the eye except the retina may be affected.

Lepromatous leprosy progresses relentlessly if left untreated, crippling the victim further. Progression of the disease can be arrested, with treatment though complete clearance of bacilli is difficult to achieve.

Lucio Leprosy

This is a special type of diffuse lepromatous leprosy originally described from Mexico, but it is also seen in other areas. The whole skin becomes smooth and stiff with loss of body hair, especially on the eyebrows. Slit skin smears are always positive for the organisms.

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author avatar Funom Makama
22nd Mar 2014 (#)

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