1. Professor Shagufta Hussain
MYCOBACTERIUM LEPRAE
Professor Shagufta Hussain

2. SPECIES OF MYCOBACTERIUM
Mycobacterium leprae leprosy.
Mycobacterium tuberculosis --tuberculosis
Mycobacterium bovis tuberculosis
Mycobacterium africanum----- tuberculosis
TB complex
Atypical mycobacteria(MOTT) (opportunistic)
more than 50 Mycobacterium species, including many that are saprophytes

3. LEPROSY Chronic Infectious Disease affecting Skin Peripheral nerves
Mucosa of upper respiratory tract
Eyes mucosa

4. Global Leprosy Situation 1998

5. MORE INTERESTING FACTS:
In the 1940’s having leprosy was considered a criminal offense
People with leprosy could be hunted down and shipped off to remote islands where they could spend the rest of their lives in solitude
At one point, Patients in Kalawao,Hawaii who were about to be shipped off could request a re-diagnosis
It turned out that ten out of eleven people who requested a re-diagnosis did not have leprosy after all

6. Ziehl-Neelsen stain - II
Less acid-fast than TB
5% sulphuric acid fast not to 25%

7. Mycobacterium leprae leprosy
Described by Hansen in 1873
9 years before Koch's discovery of the tubercle bacillus
more than 10 million cases of leprosy, mainly in Asia.
Not cultivated on nonliving bacteriologic media.
Typical acid-fast bacilli—singly, in parallel bundles, or in globular masses

8. Mycobacterium leprae leprosy
Slow growing 14 days
Armadillos reservoirs in USA only
Intracellular multiplication in skin histiocytes ,endothelial cells & schawann cells

9. Two major types Lepromatous Tuberculoid
With several intermediate stages.

12. TUBERCULOID TYPE LEPROMATOUS TYPE Course benign non progressive
macular skin lesions
severe asymmetric sudden onset nerve involvement
Few bacilli present in lesions
Anemia,lymphadenopathy
Eye involved & Amyloidosis.
Cell-mediated immunity intact and skin infiltrated with helper T cells.
Positive lepromin skin test.
Course malign progressive
nodular skin lesions
slow symmetric nerve involvement
Abundant t bacilli in lesions
Continuous bacteremia
Cell-mediated immunity is markedly deficient and skin infiltrated with suppressor T cells
Negative lepromin skin test

13. EPIDEMIOLOGY
Transmission occur when small children are exposed for prolonged periods to heavy shedders of bacilli.
Nasal secretions likely infectious material for family contacts.
incubation period 2–10 years.
Without prophylaxis 10% of exposed children may acquire the disease.
Treatment reduces and abolish infectivity of patients
Naturally infected armadillos in Texas and Mexico play no role in transmission to humans.

14. Clinical Findings Insidious.
lesions in cooler tissue of the body: skin, superficial nerves, nose, pharynx, larynx, eyes, and testicles
macular skin lesions pale, anesthetic 1–10 cm in diameter;
nodules diffuse or discrete erythematous, infiltrated 1–5 cm in diameter;
diffuse skin infiltration leonine facies.

15. NEUROLOGIC DISTURBANCES
Nerve infiltration and thickening, causes anesthesia, neuritis, paresthesia, trophic ulcers, bone resorption and shortening of digits.
Never damage due to direct inflitration and CMI
Disfigurement due to skin infiltration and nerve involvement in untreated cases may be extreme.

16. FLOW CHART FOR DIAGNOSIS AND CLASSIFICATION

17. DIAGNOSIS Scrapings from skin or nasal mucosa
Biopsy of earlobe skin smeared on slide.
Stained by the Ziehl-Neelsen 11
Biopsy of skin or of a thickened nerve gives a typical histologic picture.
No serologic tests are of value.
Non treponemal serologic tests for syphilis frequently yield false-positive results in leprosy.

18. Diagnosis
bacilli within the endothelial cells of blood vessels or mononuclear cells
When bacilli inoculated into footpads of mice, local granulomatous lesions develop with limited multiplication of bacilli.
Inoculated armadillos develop extensive lepromatous leprosy, and armadillos naturally infected with leprosy have been found in Texas and Mexico.
contains a unique o-diphenoloxidase, enzyme

19. ARMEDILLO

20. TREATMENT
Sulfones e.g Dapsones are first-line therapy for both tuberculoid and lepromatous leprosy.
Rifampin or clofazimine generally included in initial regimens due to resistance
Other drugs minocycline, clarithromycin, and some fluoroquinolones
2 years of therapy or till lesions free of organism

21. Multi Drug Therapy

22. TREATMENT In LL treatment causes ERYTHEMA NODOSUM LEPROSUM
Sign of CMI RESTORATION

23. PREVENTION Isolation of Lepromatous cases
Chemoprophylaxis of exposed children with Dapsone
No vaccine

24. MORE FACTS ABOUT LEPROSY
Four leprosy vaccines currently in trail
1)BCG –34.1% PROTECTION
2)BCG+KILLED M.LEPRAE – 64.0%
3)M.W – 25.7%
4)ICRC – 65.5%
7 controlled trails and 9 case –control studies evaluating BCG in prevention of leprosy carried out in world

25. Thank you for your patience