Leprosy

Benita Arini Kurniadi

406162073
Dibimbing oleh : dr. Eko Krisnarto, Sp. KK
 DEFINITION

 Based on WHO, chronic progressive granulomic

infectious disease caused by Mycobacterium leprae,
that affects the skin, mucous and peripheral nerves.
 Hansen’s disease
 “Lepra” means Scaly
EPIDEMIOLOGY
ETIOLOGY
• Gram (+), acid fast bacillus, intracellular
obligate
• Cell wall acts as immunogenic proteins for
human innate immunity
• Transmission : airborne, prolonged contact
• Best grow at cooler tissue areas
• Attack nerves by binding on basal lamina of
Schwann cells
• Incubation average : 3-5 years
NERVES INVOLVEMENT

Nerves Nerve enlargement (coolest

lesion temperature, body edge)
Sensory impairment near lesion

Nerve trunk palsies

SGP-SI (stocking glove pattern)

Symphatetic nerve involvement

 PHYSICAL EXAMINATION

 A thorough inspection of body surface (skin)  alopecia?

Apigmentation?
 Palpation of commonly involved superficial nerves :
1. Ulnar n. (near medial epycondyle)
2. Greater auricular n. (turns over SCM m.)
3. Lateral popliteal n.
4. Posterior tibial n.
 Testing for :
1. Loss of sensation : heat/cold, pain, touch
2. Paresis/paralysis
3. Anhydration
Nerve involved Impacts
Facial nerve Lagophtalmos, facial drop
Trigeminal nerve Corneal anesthesia
Ulnar nerve S : Anesthesia medial 1/3 palm
M : Claw 4&5th fingers
A : Dryness medial 1/3 palm
Median nerve S : Anesthesia lateral 2/3 palm
M : Claw 2nd&3rd fingers
A : Dryness lateral 2/3 palm
Radial nerve S : Anesthesia dorsum hand
M : Wrist drop
Common popliteal nerve S : Anesthesia lateral leg-dorsum
foot
M : Foot drop
Posterior tibial nerve S : Sole anesthesia
M : Claw foot
A : Dryness in sole
BACTERIOLOGICAL EXAMINATION

 Skin smears (4-6 locations)  2 at earlobes, 2/4 at

most infiltrative lesions
 Nasal blows

Bacterial Index (BI)  BI 0-6+

Morphologic Index (MI)
HISTOPATHOLOGY
TREATMENT
 LEPROSY REACTION

Acute episode of chronic leprosy disease

1. Reversal/Upgrading reaction
Sudden increase of CMI response (delayed type
hypersensitivity)
Neuritic pain
2. Erythema Nodusum Leprosum
Humoral immune response (Immune complex)
Affect Multi-organs
TREATMENT
 LEPROSY COMPLICATION

 Mutilation
 Deformity
 MODS
 Paralysis
 PROGNOSIS

 Ad vitam : dubia ad bonam

 Ad fungtionam : dubia ad malam
 Ad sanationam : dubia ad malam
 KESIMPULAN

Kusta/lepra/MH adalah suatu penyakit infeksi kronik progresif

disebabkan oleg bakteri M.leprae yang ditandai dengan kelainan kulit
dan gangguan saraf tepi. Reaksi kusta adalah episode akut pada
perjalanan kronis penyakit kusta, salah satu bentuk reaksi kusta adalah
reaksi kusta tipe reversal. Minimnya pengetahuan dan tingginya stigma
negatif masyarakat terhadap kusta membuat masyarakat enggan
untuk berobat, sehingga menyebabkan transmisi infeksi terus terjadi
dan angka kecacatan semakin tinggi. Padahal tujuan utama
pengobatan kusta adalah memutuskan mata rantai penularan untuk
menurunkan insiden penyakit, mengobati dan menyembuhkan
penderita, serta mencegah timbulnya komplikasi. Komplikasi berupa
kecacatan akan terus meningkat prevalensinya apabila penyakit kusta
tidak ditangani secara cepat dan tepat.