03 Leprosy and Brucillosis

LEPROSY ‫الجذام‬
By DR. Maeen Gamal AL-Hadhrami

❖ definition: is a chronic, progressive bacterial
infection caused by the slow-growing
bacterium Mycobacterium leprae.
➢ It primarily affects the nerves of the
extremities, the skin, the lining of the nose,
and the upper respiratory tract.
➢ Leprosy is also known as Hansen’s disease.
➢ Leprosy is one of the oldest diseases in
recorded history. The first known written reference to leprosy is from
around 600 B.C.
❖ Etiology:
• Caused by the slow-growing
bacterium Mycobacterium
leprae.
• It is an acid-fast rod-shaped
bacillus
• divide once every 13 days
❖ Spread:
• direct by: droplet infection
sneezing and coughing.
• close, repeated contact with an untreated person for a longer period of time
can lead to contracting leprosy.
❖ Incubation period:
• 5 years.
❖ Pathology:
• Affect peripheral nerves, skin and mucosa of upper respiratory tract.
• There are two systems for classifying leprosy:
1
1- Tuberculoid leprosy vs. lepromatous leprosy vs. borderline leprosy:
A person’s immune response to the disease determines which of these
types of leprosy they have:
a. In tuberculoid leprosy, the immune response is good.
b. In lepromatous leprosy, the immune response is poor.
c. In borderline leprosy, there are clinical features of both
tuberculoid and lepromatous leprosy. This type is considered to be
between the other two types.
2- World Health Organization (WHO) classification: based on the type
and number of affected skin areas:
a. Paucibacillary: There are five or fewer lesions and no bacterium
detected in the skin samples.
b. Multibacillary: There are more than five lesions, the bacterium is
detected in the skin smear, or both.
❖ Clinical picture:
1- Paucibacillary (PB), or tuberculoid
leprosy:
a. one or a few hypopigmented or
hyperpigmented skin macules in
the lateral aspect of the arms,
shoulders, buttock and legs that
exhibit loss of sensation, dryness
and scaling.
b. swelling of the peripheral nerves
2- Multibacillary (MB), or lepromatous leprosy:
a. generalized or diffuse involvement
of the skin
b. thickening of the peripheral nerves
under microscopic examination
c. involve other organs, the eyes,
nose, testes, and bone.
d. The nodular form of this condition
is the most advanced form of the
disease
2
3- Borderline leprosy:
a. the most common form.
b. It is a mixture of tuberculoid and
lepromatous leprosy
❖ Complications:
Delayed diagnosis and treatment can lead to serious
complications. These can include:
1- Disfigurement.
2- hair loss, particularly on
the eyebrows and eyelashes.
3- muscle weakness.
4- permanent nerve damage in the arms and legs.
5- iritis, which is an inflammation of the iris of the eye.
6- glaucoma, an eye disease that causes damage to the optic nerve.
7- blindness.
8- erectile dysfunction (ED) and infertility
9- kidney failure.
❖ Diagnosis:
1- CBC
2- Skin smear and culture
3- Skin biopsy
4- Nerve biopsy
5- Acid fast bacilli
❖ Treatment:
• Is treated with multidrug therapy (MDT) using a combination of antibiotics
depending on the form of the disease:
➢ Paucibacillary form – 2 antibiotics are used at the same time, daily dapsone
and rifampicin once per month
➢ Multibacillary form – daily clofazimine is added to rifampicin and dapsone.
• Treatment usually lasts between one to two years. The illness can be cured if
treatment is completed as prescribed.
3
BRUCILLOSIS
❖ Is also called undulant fever ‫ الحمى المتموجة‬or Malta fever ‫ الحمى المالطية‬or
Mediterranean fever ‫حمى البحر األبيض المتوسط‬.
❖ definition: it is a zoonotic disease caused by various brucella species.
❖ Etiology:
• it is caused by brucella species a gram-negative
coccobacillus
• multiple species: B. abortus, B. melitensis, B.
canis
• mainly infect cattle, swine, goats, sheep and
dogs.
❖ Transmission:
• Infection is most likely caused by
ingesting unpasteurized milk, raw
meat or cheese from infected goats or
sheep.
• Direct contact with an infected animal
or its bodily discharge
• inhaling airborne agents in barns,
stables, and sometimes laboratory
❖ incubation period:
• 5 days to 3 months.
❖ Clinical picture:
• Fever:
o Acute: high continuous fever.
o Insidious: intermittent/irregular (undulating) over 7-10 days.
• Sweating at night and Chills
• Splenomegaly and hepatomegaly
4
• Headache and Loss of
appetite
• Muscle, joint, and back
pain and Fatigue and
lethargy
❖ Complications:
1- Endocarditis (an infection of
the endocardium, which is
the inner lining of the heart
or valves)
2- Arthritis
3- Orchitis (inflammation of the
testicles)
4- Spleen or liver inflammation
5- Central nervous system
inflammation.
❖ Investigations:
1- CBC, ESR / CRP.
2- Blood and bone marrow culture
3- Serological test, ELISA and PCR
❖ Treatment:
• General measures: Paracetamol and I.V fluids.
• Anti-biotics: Doxycycline 200 mg daily + Rifampicin 600-900 mg daily For 6
months.
❖ Prevention:
• There is no vaccine that can prevent Malta fever, so it is important to take
precautions to prevent it with the following steps:
✓ Make sure to cook meat well at a temperature of 63-74°C.
✓ Do not drink or eat unpasteurized dairy products, including milk and
cheese.
✓ Take safety precautions at workplaces (e.g. during handling samples in
laboratories).
✓ Wash your hands before and after handling animals.
✓ Wear rubber gloves and protective clothing and glasses if you work in a
field where you come in contact with animals.
✓ Ensure that wounds are covered with a bandage.

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LEPROSY ‫الجذام‬

By DR. Maeen Gamal AL-Hadhrami

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