Lepra Reaction And Erythma Nodosum Leprosum

 

Lepra Reaction And Erythma Nodosum Leprosum

Q. 1 Which of the following is not used in lepra reaction?
 A

Chloroquin

 B

Rifampicin

 C Clofazimine
 D Thalidomide
Q. 1 Which of the following is not used in lepra reaction?
 A

Chloroquin

 B

Rifampicin

 C Clofazimine
 D Thalidomide
Ans.B

Explanation:

Rifampicin

REF: Rook’s 7′ ed p. 29.1-29.14

Treatment of lepra reactions according to severity

Type 1

Type 2

Mild

NSAIDS

NSAIDS

Moderate

Nsaids , Corticosteroids

NSAIDS , Clofazimine, Thalidomide, Chloroquine

Severe

NSAIDS . Corticosteroids

Thalidomide , Corticosteroids , Parenteral antimony


Q. 2

Drug not used in Type 1 Lepra reac‑ tion is:

 A Antileprotics
 B Analgesics
 C Corticosteroids
 D Thalidomide

Q. 2

Drug not used in Type 1 Lepra reac‑ tion is:

 A Antileprotics
 B Analgesics
 C Corticosteroids
 D Thalidomide
Ans.D

Explanation:

Thalidomide


Q. 3

Type-II lepra reaction is found in:

 A BL
 B LL
 C BT
 D None of the above

Q. 3

Type-II lepra reaction is found in:

 A BL
 B LL
 C BT
 D None of the above
Ans.B

Explanation:

LL


Q. 4

Drugs used in lepra reaction is:

 A Thalidomide
 B Clofazimine
 C Chloroquine
 D All of the above

Q. 4

Drugs used in lepra reaction is:

 A Thalidomide
 B Clofazimine
 C Chloroquine
 D All of the above
Ans.D

Explanation:

All of the above


Q. 5

Drug of choice for type II Lepra Reaction is:

 A Thalidomide
 B Steroids
 C Clofazamine
 D Rifampicrn

Q. 5

Drug of choice for type II Lepra Reaction is:

 A Thalidomide
 B Steroids
 C Clofazamine
 D Rifampicrn
Ans.B

Explanation:

Corticosteroids are the drug of choice for type 2 lepra reaction or erythema nodosum leprosum. Thalidomide can be used if corticosteroids are ineffective.

Ref: Textbook of Dermatology, Venereology and Leprology By Devinder Mohan Thappa, 2nd Edition, Chapters 33 and 34, Pages 327-28, 332-33

Q. 6

Type 2 lepra reaction occurs in:

 A Pauci bacillary leprosy
 B Multi bacillary leprosy
 C Both of the above
 D None of the above

Q. 6

Type 2 lepra reaction occurs in:

 A Pauci bacillary leprosy
 B Multi bacillary leprosy
 C Both of the above
 D None of the above
Ans.B

Explanation:

There are two principal types of Lepra reactions. Type 1 and Type 2. 
  •  Type 1 Lepra Reaction also known as Reversal Reaction may occur both in Pauci Bacillary (PB) and Multi Bacillary (MB) leprosy. 
  •  Type 2 reaction is also known as Erythema Nodosum Leprosum (ENL) andoccurs only in MB leprosy.
Ref: http://nlep.nic.in/pdf/MO%20training%20Manual.pdf

Q. 7

Which of the following anti leprosy drugs is used in treatment of type 2 lepra reaction:

 A Clofazimine
 B Dapsone
 C Rifampicin
 D None of the above

Q. 7

Which of the following anti leprosy drugs is used in treatment of type 2 lepra reaction:

 A Clofazimine
 B Dapsone
 C Rifampicin
 D None of the above
Ans.A

Explanation:

Clofazimine is also effective for Type 2 reaction but is less potent than corticosteroids and often takes 4-6 weeks to develop its full effects, so it should never be started as the sole agent for the treatment of recurrent Type 2 reaction.
 
However, clofazimine may be extremely useful for reducing or withdrawing corticosteroids in patients who have become dependent on them. 
Ref: http://nlep.nic.in/pdf/MO%20training%20Manual.pdf

Q. 8

If a leprosy patient on multi drug therapy develops type II lepra reaction, what is the next course of action?

 A Stop multi drug therapy
 B Start steroids
 C Start steroids and clofazimine
 D None of the above

Q. 8

If a leprosy patient on multi drug therapy develops type II lepra reaction, what is the next course of action?

 A Stop multi drug therapy
 B Start steroids
 C Start steroids and clofazimine
 D None of the above
Ans.C

Explanation:

If a patient develops lepra reaction during treatment, multi drug therapy should not be stopped.

Type II lepra reaction is treated with steroids and clofazimine.

Ref: Park 21st edition, page 298.

Q. 9

Characteristic of type II lepra reaction ‑

 A Erythema & edema
 B ENL
 C Lymphadenopathy
 D All

Q. 9

Characteristic of type II lepra reaction ‑

 A Erythema & edema
 B ENL
 C Lymphadenopathy
 D All
Ans.D

Explanation:

. Ans. is ‘a’ i.e., Erythema & edema; ‘b’ i.e., ENL; ‘c’ i.e., Lymphadenopathy

1) Lepra 1 reaction

  • Type 1 lepra reaction is a type IV hypersensitivity.
  • There are classical signs of inflammation (Redness, pain & Tenderness) within previously involved macule,

papules or plaque.

  • Systemic features do not occur (in contrast to type 2 reaction).
  • Neuritis is common and ulnar nerve is involved most commonly.

2) Lepra 2 reaction (Erythema nodosum leproticum : ENL)

  • The presenting symptoms include 0 Crops of fresh painful erythematous papules or nodules are most common presenting feature.

ii) Systemic features :- Fever, malaise, arthritis, neuritis, dactylitis, orchitis, uveitis (iridocyclitis), lymphadenitis, glomerulonephritis, periostitis, hepatitis.


Q. 10

Reversal lepra reaction shown no response to :

 A Cloafazimine
 B Chloroquine
 C Glucocorticoids
 D Thalidomide

Q. 10

Reversal lepra reaction shown no response to :

 A Cloafazimine
 B Chloroquine
 C Glucocorticoids
 D Thalidomide
Ans.D

Explanation:

D. i.e. Thalidomide

Appearance of new skin lesions or signs of inflammation (e.g. redness and swelling etc.) in prevous lesions, neuritis (e.g. nerve pain) and low grade fever in borderline forms of leprosy suggest the diagnosis of Jopling’s type I (delayed type IV hype/sensitivity) reaction. If type I lepra reaction preceeds the initiation of appropiate antimicrobial therapy it is k/a down grading reaction & the case becomes histologically more lepromatous. When it occurs after initiation of therapy, it is termed as reversal reaction & the case becomes more tuberculoid.

– This is presentation of lepra reaction (type I – reversal) & in any case of lepra reaction antileprotic drug is not stopped.

Thalidomide is ineffective and has no role in type I lepra (downgrading and reversal) reactionsQ.


Q. 11

DOC in type I lepra reaction with severe neuritis

 A Thalidomide
 B Clafazamine
 C Dapsone
 D Systemic Corticosteroid

Q. 11

DOC in type I lepra reaction with severe neuritis

 A Thalidomide
 B Clafazamine
 C Dapsone
 D Systemic Corticosteroid
Ans.D

Explanation:

D i.e. Systemic corticosteroid


Q. 12

Antileprotic drug also used in lepra reaction is:

 A Rifampcin
 B Dapsone
 C Ciprofloxacin
 D Clofazimine

Q. 12

Antileprotic drug also used in lepra reaction is:

 A Rifampcin
 B Dapsone
 C Ciprofloxacin
 D Clofazimine
Ans.D

Explanation:

D i.e. Clofazamine


Q. 13

Which among the following is the main cytokine involved in the reaction marked by a red arrow in a leprosy patient? 

 A InterLeukin-2.
 B Interferon-gamma.
 C Tumor necrosis factor-alpha.

 
 D Macrophage colony stimulating factor.

Q. 13

Which among the following is the main cytokine involved in the reaction marked by a red arrow in a leprosy patient? 

 A InterLeukin-2.
 B Interferon-gamma.
 C Tumor necrosis factor-alpha.

 
 D Macrophage colony stimulating factor.
Ans.C

Explanation:

Ans:C.)Tumor necrosis factor-alpha.

The reaction marked by a red arrow in the leprosy patient above represent erythema nodosum leprosum (ENL) reaction.


Q. 14

The lepra reaction as shown in a 38 year old female patient as represented in the picture below are features of which of the following types of leprosy? 

 A Lepromatous.
 B Borderline.
 C Tuberculoid.
 D Borderline tuberculoids.

 

Q. 14

The lepra reaction as shown in a 38 year old female patient as represented in the picture below are features of which of the following types of leprosy? 

 A Lepromatous.
 B Borderline.
 C Tuberculoid.
 D Borderline tuberculoids.

 
Ans.A

Explanation:

Ans:A.)Lepromatous

The patient is suffering from Type II Lepra reaction(Erythema Nodosum)

Type II lepra reactions (ENL) is seen in Lepromatous Leprosy. Erythema nodosum leprosum is a type III hypersensitivity.

Signs

Type I

 

Type II

Type of reaction 

Delayed Hypersensitivity,associated with an increase in cell-mediated immunity.

It is a type IV delayed hypersensitivity.

Antigen antibody reaction due to the deposition of extravascular immune complexes,type III hypersensitivity

Inflammation of  the skin

Skin lesions suddenly becomes reddish, swollen, warm, painful,

tender but the rest of  the skin is normal

Red, painful, tender, cutaneous nodules (deep) appear that are not associated with leprosy patches. ENL may appear commonly on face, arms, legs.

Cytokines involved

Increased activity of T helper (Th)-1 lymphocytes expressing IL-2 and IFN-γ.IL-12 is consistently expressed and IL-4 is absent. The IFN-γ and TNF-α producing CD4 cells and T cytotoxic cells are selectively increased .

.

Tumor necrosis factor-alpha play a central role in the pathobiology of type II lepra reaction/ ENL.

 A predominant Th2 cytokine profile has been observed  with increased expression of IL-6, IL-8, and IL-10 as well as sustained production of Th2 cytokines, IL-4, and IL-5.

Nerve involvement 

Nerves close to skin may be enlarged, tender and painful (neuritis) with loss of nerve function (loss of sensation and muscle weakness) and may appear

suddenly or rapidly

Nerves may be affected but not as common or severe/acute as in Type I

General condition

of the patient

 

Good, with little or no fever

Poor, with fever and general malaise

Timing of presentation and type of patient

Usually early on in the course of

MDT; occurs in people with both

PB and MB,more common in patients between the two poles of the leprosy spectrum with immunologically unstable borderline forms,with a significantly higher incidence in BB and BL patients as compared with BT patients.

Usually later in the treatment; occurs in people with MB leprosy,seen in  borderline lepromatous (BL) and lepromatous leprosy (LL)

Eye involvement

Weakness of eyelid closure may occur (nerve involved)

Internal eye disease (iritis) occurs

Other Organs 

Not affected

May be affected like periosteal pain (especially tibiae), muscle pain (myositis), pain and swelling of the tendons and joints, rhinitis, epistaxis, painful dactylitis, swollen tender lymph nodes especially femoral, acute epididymo-orchitis, hepato-splenomegaly with hepatitis and endocarditis with/without arhythmia,Glomerulonephritis.

Treatment

If the Type 1 reaction is mild and there is no evidence of neuritis (pain, loss of sensation or function), the reaction should be treated with analgesics, such as acetylsalicylic acid or paracetamol. However, if there is nerve involvement, treat type 1 reactions with analgesics and corticosteroids, such as oral prednisolone.

Therapy for type 2 reactions may include analgesics, such as acetylsalicylic acid or paracetamol, and corticosteroids, such as oral prednisolone.

In patients with severe type 2 reactions, who do not respond to corticosteroids or in whom corticosteroids are contraindicated, clofazimine at high doses or thalidomide may be used

 



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