Definition
Chronic granulomatous infection of skin & peripheral nerves by Mycobacterium Leprae
Epidemiology
Endemic in some tropical regions
Commonest cause of peripheral neuropathy worldwide
Microbiology
Acid-Fast bacilli
- Carbol Fuchsin stain
- unable to be grown on artificial media
Pathology
Virchow Cells
Vacuolated macrophages
Granuloma
Transmission
Definitive route of transmission has not been proven
- is likely to be respiratory similar to TB
- broken skin transmission reported
Clinical Findings
Insidious onset
Involves
- skin
- superficial nerves
- nose, pharynx & larynx
- eyes
- testicles
Skin lesions
- pale anaesthetic macule 1-10 cm
- diffuse erythematous nodules 1-5 cm
- diffuse skin infiltration
Neurological disturbances
- nerve infiltration & thickening
- anaesthesia & paresthesia
- trophic ulcers & bone absorption
- short digits
- leonine Facies
- charcot joints
Types
1. Lepromatous Type
Progressive malignant course
- characterised by severely impaired cell-mediated immunity
- late symmetrical polyneuropathy
2. Tuberculoid Type
Non Progressive benign course
- characterised by vigorous cell-mediated response
- anaesthetic skin patches
- thickened nerves
Diagnosis
Bacilli seen in scrapings from skin or nasal mucosa
Culture Negative
Management
Sulphone & Rifampicin for ~ 2yrs