Transcript CLASSIFICATION - thegreentraveler.net

Module 1:
LEPROSY: The Disease
WHAT IS LEPROSY?
Leprosy is a chronic infectious disease
caused by Mycobacterium leprae,
an acid-fast,
rod-shaped bacillus
that mainly affects
the skin, peripheral nerves,
mucosa of the
upper respiratory tract
and eyes.
It has a very long incubation period or
latency which ranges from 3 to 15 years.
• Leprosy is an infectious disease directly
transmitted from man to man.
• It is acquired through prolonged
repeated exposure & chromo 6
• It is transmitted
from one
untreated person
to another via the
respiratory tract.
• Only a small proportion of the population
is affected (5%);(95%) develop immunity.
DIAGNOSIS OF LEPROSY:
Diagnosis of leprosy is mainly based
on clinical signs and symptoms.
Only in rare instances is there a need
to use laboratory and other investigations
to confirm a diagnosis of leprosy.
An individual should be regarded as
having leprosy if he exhibits the following
cardinal signs:
 Hypo-pigmented or reddish skin
lesion(s) with definite sensory loss;
 Peripheral nerve damage, as
demonstrated by loss of sensation and
muscle weakness in the hands, feet and/
or face;
 Positive skin smear.
Other signs of leprosy are:
 Skin lesion(s) with a decrease or loss of
sweating and/or hair growth;
Other signs of leprosy are:
 Skin lesion(s) with a decrease or loss of
sweating and/or hair growth;
 Constant redness in the eyes from
irritation and dryness;
Other signs of leprosy are:
 Skin lesion(s) with a decrease or loss of
sweating and/or hair growth;
 Constant redness in the eyes from
irritation and dryness;
 Loss of eyebrows and
eyelashes (madarosis);
Other signs of leprosy are:
 Skin lesion(s) with a decrease or loss of
sweating and/or hair growth;
 Constant redness in the eyes from
irritation and dryness;
 Loss of eyebrows and
eyelashes (madarosis);
Other signs of leprosy are:
 Nasal congestion /
obstruction and
frequent nosebleed
 Collapse of nose
bridge;
Other signs of leprosy are:
 Enlargement of the breast in males
(gynecomastia);
Other signs of leprosy are:
 Mobile or stiff
clawing of
fingers and
toes
Other signs of leprosy are:
 Chronic ulcers,
usually in the
sole of the foot,
palm of the
hands and
fingers.
Diagnosis of leprosy
is mainly based on
clinical signs and symptoms.
i
The development of
complications can be
effectively prevented
through early detection, correct
diagnosis and effective treatment.
i
PATIENT’S HISTORY:
The leprosy case history should have the
following information:
1. The nature of the first lesion or symptom
and its progress.
This is because the skin lesion usually
develops slowly over several months and
is not troublesome.
Ask:
• When did the patient
first notice the lesion?
• What was its appearance?
• How did it feel? Was it painful?
Itchy?
?
PATIENT’S HISTORY:
2. Past Treatment.
Ask:
• What did the patient do
when he first noticed the lesion?
• Did he apply any drug(s)?
• What was the effect of this/these
drug(s)?
?
PATIENT’S HISTORY:
3. Other Illnesses.
Pay attention to contra-indications to
MDT drugs; or any other illness requiring
special attention and/or referral.
Ask:
• Does the patient have a
history of liver disease?
• Allergy to drugs?
• If yes, what drugs?
?
PATIENT’S HISTORY:
4. Contact with Persons With Leprosy
(PWLs)
This information will help determine
the patient’s susceptibility to the disease.
Ask:
• Does/did anyone in the
family have leprosy?
• Does he have a friend or
acquaintance who has/had
leprosy?
?
CLASSIFICATION:
Leprosy can be classified on the basis of
clinical manifestations and skin smear results.
The Ridley-Jopling classification has
seven (7) types of leprosy:
CLASSIFICATION: (Ridley-Jopling)
1. Indeterminate (I).
Solitary, ill-defined,
faintly hypopigmented
macule, with partial loss
of sensation.
CLASSIFICATION: (Ridley-Jopling)
1. Indeterminate (I)
Solitary, ill-defined
hypopigmented macule
on left cheek; only
partially anesthetic.
CLASSIFICATION: (Ridley-Jopling)
1. Indeterminate (I)
Solitary, ill-defined,
faintly hypopigmented
macule on the dorsum
of the wrist; minimal
surface changes;
partially insensitive.
CLASSIFICATION: (Ridley-Jopling)
1. Indeterminate (I)
Single, slightly
hypochromic macule
with ill-define borders on
the dorsum of the lower
right forearm; minimal
surface changes;
partially anesthetic.
CLASSIFICATION: (Ridley-Jopling)
2. Tuberculoid (TT)
Small, solitary
marginally
hypopigmented oval
lesion, with papulated
well-defined margins
with flat, slightly atrophic
central area insensitive
to pain.
CLASSIFICATION: (Ridley-Jopling)
2. Tuberculoid (TT)
Faintly hypochromic,
rounded macule with
discontinuously papulate
borders, fairly defined,
anesthetic, above
smallpox vaccination
scar on the left arm.
CLASSIFICATION: (Ridley-Jopling)
2. Tuberculoid (TT)
Solitary, well-defined
early tuberculoid lesion
with slightly papulate
borders; completely
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
2. Tuberculoid (TT)
Sharp-edged,
hypopigmented,
ringworm-like lesion with
finely papulate borders;
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
2. Tuberculoid (TT)
Superficial, circinate
lesion with pinkish,
elevated, finely granular
margins; center is
insensitive to touch and
pain.
CLASSIFICATION: (Ridley-Jopling)
2. Tuberculoid (TT)
Well-defined,
hypopigmented lesion
with dry surface and
moderately raised
granular margins;
completely anesthetic.
CLASSIFICATION: (Ridley-Jopling)
3. Borderline
Tuberculoid (BT)
Rounded lesion with
wide, slightly brownish
and scaly elevated
margins fairly welldefined, center flat, with
noticeable hair loss; at
posterior aspect of the
leg; anesthetic.
CLASSIFICATION: (Ridley-Jopling)
3. Borderline
Tuberculoid (BT)
One of several sharpedged, erythematous
patches on the patient,
with fairly thick granular
margins and small
satellite lesions;
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
3. Borderline
Tuberculoid (BT)
Well-defined, dry and
rough surfaced plaque
on cheek, insensitive to
touch and pain; note
papulo-nodular lesions
near eye and upper lip
CLASSIFICATION: (Ridley-Jopling)
3. Borderline
Tuberculoid (BT)
Distinct, erythematohypochromic patch with
a dry surface and
raised, well defined
margins showing
satellite lesions;
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
3. Borderline
Tuberculoid
(BT)
Large patch with wide,
raised erythematous
well-defined margins
sloping toward center of
lesion; central portion is
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
3. Borderline
Tuberculoid (BT)
Multiple, sharplydemarcated, scaly
reddish-brown plaques;
these subsiding lesions
are only partially
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
3. Borderline
Tuberculoid (BT)
Large, thickly infiltrated,
sharp-edged plaque with
slightly scaling surface;
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
3. Borderline
Tuberculoid (BT)
Extensive, subsiding
lesions showing large,
clear center areas
surrounded by welldefined, slightly raised,
inner and outer margins;
centers are anesthetic.
CLASSIFICATION: (Ridley-Jopling)
4. Borderline (BB)
Fairly extensive
succulent plaque with
sharply demarcated
clear central area;
peripheral edges sloping
into surrounding normal
skin; central uninvolved
area anesthetic.
CLASSIFICATION: (Ridley-Jopling)
4. Borderline (BB)
Several “punched-out”
lesions very
characteristic of
borderline leprosy;
central areas are
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
4. Borderline (BB)
Irregular, erythematous,
infiltrated bands around
a large, anesthetic
central “immune” area;
inner margins of lesion
tend to be better defined
than the outer margins.
CLASSIFICATION: (Ridley-Jopling)
4. Borderline (BB)
Classical “punched-out”
lesions of borderline
leprosy; central
“immune” areas are
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
5. Borderline
Lepromatous (BL)
Numerous and
widespread borderlinetype plaques, annular
lesions, papules and
macules; center of large
lesions show some loss
of sensation.
CLASSIFICATION: (Ridley-Jopling)
5. Borderline
Lepromatous (BL)
Thick, erythematous
plaques on face and
ears. Lesions are not
sharply defined and
show no sensory
impairment.
CLASSIFICATION: (Ridley-Jopling)
5. Borderline
Lepromatous
(BL)
Bilaterally distributed,
irregularly shaped,
erythematous, infiltrated
patches; these are not
anesthetic.
CLASSIFICATION: (Ridley-Jopling)
5. Borderline
Lepromatous
(BL)
Fairly uniform
symmetrically
distributed, infiltrated,
maculo-papular lesions,
none of which show
sensory impairment.
CLASSIFICATION: (Ridley-Jopling)
6. Sub-polar
Lepromatous (LLs)
Symmetrically
distributed infiltration
with prominent macular
lesions. Note
borderline-type,
punched-out patches on
the wrist.
CLASSIFICATION: (Ridley-Jopling)
6. Sub-polar
Lepromatous (LLs)
Symmetrical infiltration
and erythematous
macules, with an
unusual borderline-type
plaque on the left
buttock.
CLASSIFICATION: (Ridley-Jopling)
6. Sub-polar
Lepromatous
(LLs)
Extensive, symmetrically
distributed infiltration with
almost coalescent macules
and plaques. These lesions
are not anesthetic. Note small
rounded borderline-type
plaque on the left lumbar area.
CLASSIFICATION: (Ridley-Jopling)
7. Polar Lepromatous
(LLp)
Early lepromatous
leprosy with
recognizable diffuse
infiltration all over face
and ears.
CLASSIFICATION: (Ridley-Jopling)
7. Polar Lepromatous
(LLp)
Fairly advanced
lepromatous leprosy,
with symmetrically
distributed diffuse
infiltration, nodules on
face and ears, and
madarosis.
CLASSIFICATION: (Ridley-Jopling)
7. Polar Lepromatous
(LLp)
Advanced lepromatous
leprosy, with marked
diffuse infiltration,
madarosis and loss of
eyelashes.
CLASSIFICATION: (Ridley-Jopling)
7. Polar Lepromatous
(LLp)
Advanced lepromatous
leprosy with diffuse
infiltration coupled with
nodules over eyebrows,
cheeks, ala nasae and
chin, as well as
earlobes.
CLASSIFICATION: (Ridley-Jopling)
7. Polar Lepromatous
(LLp)
Advanced lepromatous
leprosy with diffuse
infiltration and nodular
lesions.
The World Health Organization (WHO)
classifies leprosy into only three (3) types:
• Single Lesion Paucibacillary (SLPB)
• Paucibacillary (PB)
• Multibacillary (MB)
CLASSIFICATION:
Characteristic
SLPB
PB
MB
Lesions:
• Type
Macule
Infiltrated
patches
Macules,
plaques,
papules &
infiltration
CLASSIFICATION:
Characteristic
SLPB
PB
MB
Lesions:
• Number
One (1)
Two (2) to
five (5)
More than
five (>5)
CLASSIFICATION:
Characteristic
SLPB
PB
MB
Lesions:
• Surface
Normal, dry
or scaly
Normal, dry
or scaly,
absence of
hair growth
Smooth &
shiny, some
lesions may
be dry
CLASSIFICATION:
Characteristic
SLPB
PB
MB
Lesions:
• Border
ill-defined to Well-defined, Vague,
well-defined clear-cut
sloping
margins
outwards,
merges
imperceptibly
with
surrounding
skin
CLASSIFICATION:
Characteristic
SLPB
None
Nerve
Involvement:
PB
Zero (0) to
one (1)
MB
More than
one (1)
CLASSIFICATION:
Characteristic
Slit Skin
Smear:
SLPB
Negative
PB
Negative
MB
Positive
NOTE: Positive skin smear = Multibacillary (MB) regimen.