The Different Clinical Manifestations And Reactions In Leprosy (Lepra Reaction)

Funom MakamaStarred Page By Funom Makama, 21st Mar 2014 | Follow this author | RSS Feed | Short URL
Posted in Wikinut>Health>General Health>Diseases & Infections

In this form, the clinical picture truly reflects the absence of localization seen in histology. Skin lesions are numerous, which are asymmetrical, varying in size and shape. The flat lesions are not so well defined as in tuberculoid leprosy.

Borderline Leprosy

The margins may be entire or deficient in places and they slope outwards to the periphery. Satellite lesions may be present. Papules and nodules form only rarely, and would show central dimpling when they occur. The involvement of nerve is more widespread than in tuberculoid disease. Nerve damage is earlier in onset than in lepromatous disease. Bacillary count and the lepromin test are variable. Spontaneous healing is uncommon except in the very early stages. Improvement in the immune status converts the disease into the tuberculoid form with tendency to heal. Loss of immunity downgrades the lesion to the lepromatous type with its characteristic features, but nerve damage is seen in addition. Borderline leprosy can be further subclassified into borderline tuberculoid (BT), midspectrum borderline (BB) and borderline lepromatous (BL) based on the bacterial index and lepromin test.

Pure Neuritic Leprosy

Though in all forms of leprosy, the nerves are the first targets of attach, sooner or later, the lesion extends into the skin. In some patients, only nerve involvement is seen without any perceptible skin lesions. This form is called pure neuritic leprosy. Clinically, the presentation is with the affection of single or multiple large nerve trunks. The nerves are enlarged, firm and tender. Both sensory and motor disturbances are evident. Skin smears are negative for bacilli. Lepromin test is generally positive but it may be doubtful or negative in some. Definite diagnosis of this stage can be made only by nerve biopsy.

Reactions In Leprosy (Lepra Reaction)

Episodes of acute inflammation (called reactions) occur during the course of leprosy. In some patients occurrence of a reaction may be the precipitating event to seek medical help. The reactions are of two different types of hypersensitivity mechanisms. An improvement in immune status with shift towards the tuberculoid pole is called upgrading reaction and a loss of immunity with shift towards the lepromatous pole is called a downgrading reaction. These reactions are clinically indistinguishable.

Type I reactions: Occur near the tuberculoid pole in borderline leprosy cases. There is a sudden change in cellular hypersensitivity. These reactions may be spontaneous or precipitated by therapy.

Existing lesions increase in size and seveirt and may become erythematous, edematous and tender. New lesions may develop. The nerve become, swollen, painful and tender, and nerve abscesses may form. The neurological deficit may increase. Edema of feet, hands and face may occur. Constitutional symptoms like fever are rare.

Type II reaction: It is caused by vasculitis resulting from the deposition of immune complexes, without a shift along the immunological spectrum. This type of reaction is seen in about one half of the patients with lepromatous leprosy and one-fourth with borderline leprosy. Commonly, this reaction occurs during the second year of treatment. These reactions may be associated with the appearance of tender erythematous nodules, which are called erythema nodosum leprosum (ENL). Type II reactions are characterized by general inflammatory phenomena such as fever, rigor, pain and tenderness in the skin and nerves, arthritis, lymphadenopathy, iritis and keratitis. Further damage to nerves and eyes may develop and repeated reactions aggravate the disability.

Lucio Phenomenon

This is a severe form of type 2 reaction occurring in lucio leprosy. It is characterized by the formation of erythematous macules which become purpuric or ulcerated. Later, they heal with atrophic scarring.

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author avatar Funom Makama
22nd Mar 2014 (#)

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