Leprosy Classification-Madrid and Ridley and Jopling Classification

Leprosy Classification-Madrid and Ridley and Jopling Classification


CLASSIFICATION OF LEPROSY

Madrid classification

  1. Lepromatous(extreme form)
  2. Tuberculiod(extreme form)
  3. Dimorphous
  4. Interminate
  5. Pure neuritic(additional type in Indian classification

Ridley and Jopling Classification(Clinical, bacteriological, immunological, histological classification)

  1. Tuberculiod
  2. Boderline Tuberculiod
  3. Boderline borderline
  4. Boderline Lepromatous
  5.  Lepromatous

SYMPTOMS

HISTOLOGICAL  FEATURES

TUBERCULIOD

  • Can be either one large red patch with well-defined raised borders or a large hypopigmented asymmetrical spot
  • Non caseating granuloma in nerve
  • Lesions become dry and hairless
  • Loss of sensation may occur at site of some lesions
  • Tender, thickened nerves with subsequent loss of function are common
  • Spontaneous resolution may occur in a few years or it may progress to borderline or rarely
  • neural involvement occurs early and may be pronounced

 

  • Epithelioid cells
  • lymphocytes
  • giant cells form noncaseating granulomas.
  • Dermal nerves are destroyed. Normal skin organs (e.g., sweat glands, hair follicles) are lost. 
  • ENL reaction seen
  • Bacilli are frequently absent
  • Max. no. of CD4 – T cells (TH -1)
 

Boderline Tuberculiod

  • Similar to tuberculoid type except that lesions are smaller and more numerous
  • Normoesthetic and symmetrical lesions
  • Disease may stay in this stage or convert back to tuberculoid form, or progress

 

  • BT leprosy, granulomas are epithelioid, with a preponderance of lymphocytes. Dermal nerves are mostly destroyed. Bacilli may be scanty or absent.

 

Boderline Boderline

  • Numerous, red, irregularly shaped plaques
  • Sensory loss is moderate
  • Disease may stay in this stage, improve or worsen
  • Asymmetrical thickening of
  • several nerves.
  • Several hypoesthetic macules on skin
  • Lesions looking like inverted saucers are common

 

  • granulomas are epithelioid
  • dermal nerves may be visible
  • bacilli are seen more often than in BT leprosy

Boderline Lepromatous

  • Numerous lesions of all kinds, plaques, macules, papules and nodules.
  • Hypoesthetic
  • Symmetrical nerve thickening; glove and stocking anesthesia

 

  • histiocytes form granulomas
  • dermal nerves are visible, 
  • bacilli are seen in greater number.

Lepromatous

  • Early nerve involvement may go unnoticed
  • Normoesthetic, small, symmetrical and numerous lesions of all kinds, plaques, macules, papules and nodules
  • Early symptoms include nasal stuffiness, discharge and bleeding, and swelling of the legs and ankles

 

  • epidermis is normal 
  • rete flattened. 
  • clear space separates the epidermis from diffuse granulomatous reaction with macrophage
  • large, foamy histiocytes (Virchow or lepra cells); and many intracellular AFB, which are frequently found in globi
  • Epithelioid cells and giant cells are not found.
  • Granulomas are most numerous around blood vessels, nerves, and skin appendages.
  • Plasma cells are found
  • Dermal nerves are easily visible.
  • Max. no. of CD8 – T cells

If LL Left untreated, the following problems may occur:

  • Leonine facies 
  • Ear lobes thicken, upper incisor teeth fall out
  • Photophobia (light sensitivity), glaucoma and blindness
  • Ucers
  • Gynaecomastia:Testicles shrivel causing sterility and enlarged breasts (males)
  • Internal organ infection causing enlarged liver and lymph nodes
  • Saddle nose
  • Voice becomes hoarse
  • Slow scarring of peripheral nerves resulting in nerve thickening and sensory loss.
  • Fingers and toes become deformed due to painless repeated trauma.

NERVES INVOLVED

  • Propioception is carried by Goll & Burdech tract (posterior column)
  • Which is not involved in leprosy
  • Temperature & pain lost earlier than touch & pressure. 
  • Leprosy mainly affects peripheral nerves, eventually lit muscle wasting.
  • Myopathy, muscle wasting may Vt abnormal EMGQ.
  • Commanly involved nerves are:
  1. Posterior tibial (most common)
  2. Ulnar (2″ most common, most commonly Vt abscess)
  3. Peroneal/lateral popliteal
  4. Median & Facial
  5. Posterior auricular
  6. Supra orbital, supraclavicular, 
Exam Question
 

Ridley and Jopling Classification(Clinical, bacteriological, immunological, histological classification

SYMPTOMS

HISTOLOGICAL  FEATURES

TUBERCULIOD

  • Can be either one large red patch with well-defined raised borders or a large hypopigmented asymmetrical spot
  • Non caseating granuloma in nerve
  • Lesions become dry and hairless
  • Loss of sensation may occur at site of some lesions
  • Tender, thickened nerves with subsequent loss of function are common
  • Spontaneous resolution may occur in a few years or it may progress to borderline or rarely
  • neural involvement occurs early

 

  • Epithelioid cells
  • lymphocytes
  • giant cells form noncaseating granulomas.
  • Dermal nerves are destroyed. Normal skin organs (e.g., sweat glands, hair follicles) are lost. 
  • ENL reaction seen
  • Bacilli are frequently absent
  • Max. no. of CD4 – T cells (TH -1)
 

Boderline Tuberculiod

  • Similar to tuberculoid type except that lesions are smaller and more numerous
  • -Normoesthetic and symmetrical lesions
  • -Disease may stay in this stage or convert back to tuberculoid form, or progress

 

  • BT leprosy, granulomas are epithelioid, with a preponderance of lymphocytes. Dermal nerves are mostly destroyed. Bacilli may be scanty or absent.

 

Boderline Boderline

  • Numerous, red, irregularly shaped plaques
  • Sensory loss is moderate
  • Disease may stay in this stage, improve or worsen
  • Asymmetrical thickening of
  • several nerves.
  • Several hypoesthetic macules on skin
  • Lesions looking like inverted saucers are common

 

  • granulomas are epithelioid
  • dermal nerves may be visible
  • bacilli are seen more often than in BT leprosy

Boderline Lepromatous

  • Numerous lesions of all kinds, plaques, macules, papules and nodules.
  • Hypoesthetic
  • Symmetrical nerve thickening; glove and stocking anesthesia

 

  • histiocytes form granulomas
  • dermal nerves are visible, 
  • bacilli are seen in greater number.

Lepromatous

  • Early nerve involvement may go unnoticed
  • Normoesthetic, small, symmetrical and numerous lesions of all kinds, plaques, macules, papules and nodules
  • Early symptoms include nasal stuffiness, discharge and bleeding, and swelling of the legs and ankles

 

  • epidermis is normal 
  • rete flattened. 
  • clear space separates the epidermis from diffuse granulomatous reaction with macrophage
  • large, foamy histiocytes (Virchow or lepra cells); and many intracellular AFB, which are frequently found in globi
  • Epithelioid cells and giant cells are not found.
  • Granulomas are most numerous around blood vessels, nerves, and skin appendages.
  • Plasma cells are found
  • Dermal nerves are easily visible.
  • Max. no. of CD8 – T cells

 If LL Left untreated, the following problems may occur:

  • Leonine facies, Saddle nose
  • Ear lobes thicken, upper incisor teeth fall out
  • Photophobia (light sensitivity), glaucoma and blindness
  • Testicles shrivel causing sterility and enlarged breasts (males)
  • Internal organ infection causing enlarged liver and lymph nodes
  • Renal lesion occurs,membranous glomerlonephritis .
  • Voice becomes hoarse
  • Slow scarring of peripheral nerves resulting in nerve thickening and sensory loss.
  • Fingers and toes become deformed due to painless repeated trauma.

NERVES INVOLVED

  • Propioception is carried by Goll & Burdech tract (posterior column)
  • Which is not involved in leprosy
  • Temperature & pain lost earlier than touch & pressure.
  • Commanly involved nerves are:
  1. Posterior tibial (most common)
  2. Ulnar (2″ most common, most commonly Vt abscess)
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