Leprosy: WHO Classification ,WHO Disability grading

Leprosy:WHO Classification ,WHO Disability grading

Q. 1

Skin biopsy in leprosy is characterizedby:

 A

Pariappendegial bacilli

 B

Pariappendegeal lymphocytosis

 C

Perivascular lymphocytosis

 D

All of above

Q. 1

Skin biopsy in leprosy is characterizedby:

 A

Pariappendegial bacilli

 B

Pariappendegeal lymphocytosis

 C

Perivascular lymphocytosis

 D

All of above

Ans. D

Explanation:

D i.e. All of above

Skin Biopsy of Leprosy

–           Lymphocytes, epitheloid cells, granuloma, Langhans type giant cell infiltration around blood vessels, appendages & nervesQ

–           Foam cells which consists of histiocytes loaded with lipid globules derived from the leprosy bacilli; (in LL)

–           Z – N stain show large no. of lepra bacilliQ in dermal infiltrate & foam cells. (in LL)

Lepromatous Leprosy (LL)

– Histology: Thinning of epidermis, and flattening of rate ridges above a clear (free) subepidermal grenz zoneQ. The papillary layer of dermis appears as clear band whilst deeper in dermis lies diffuse leproma consisting of dense, uniform, foamy macrophage infiltrate, with a addition of few pseudo follicular aggregates of lymphocytes, plasma cells and mast cells. The dermis contains enormous number of AFB, singly or in clumps (globi) Q. There is asymptomatic bacillation of schwann cells Vt foamy degenerationQ. Demyelinaton, damage and destruction of axis cylinder are prominent features lit Wallerian degeneration. Despite large numbers of bacilli in nerve there is only a small inflammatory responseQ; ultimately the nerve fibroses and hyalinized. In LLs there is an onion skin perineurial lamination but not infiltration. In LLp perineurium is undisturbed.

Diffuse erythema becoming worse on exposure to sun; Mucous membrane involvement & ulceration; Regurgitation due to perforation of palate.


Q. 2

In multibacillary leprosy the follow up examination after adequate treatment should’be done yearly for –

 A

3 years

 B

2 years

 C

5 years

 D

10 years

Q. 2

In multibacillary leprosy the follow up examination after adequate treatment should’be done yearly for –

 A

3 years

 B

2 years

 C

5 years

 D

10 years

Ans. C

Explanation:

Ans. is ‘c’ i.e., 5 years

Surveillance after treatment

o Clinical surveillance of cases after completion of treatment is an important part of the current recommendations for

multidrug therapy.

o It is essential for the assurance of long term success of treatment and for the early detection of any relapses.

o The recommendations are –

i)      Paucibacillary leprosy clinical examination at least once a year for a minimum period of 2 years after completion of treatment.

ii)     Multibacillary leprosy clinical examination at least once a year for a minimum period of 5 years after completion of treatment.


Q. 3

Multibacillary leprosy follow up for – 

 A

12-18 months 

 B

2 years

 C

5 years

 D

10 years

Q. 3

Multibacillary leprosy follow up for – 

 A

12-18 months 

 B

2 years

 C

5 years

 D

10 years

Ans. C

Explanation:

Ans. is ‘c’ i.e., 5 years 

o Follow-up in paucibacillary leprosy —> 2 years

o Follow-up in multibacillary leprosy —> 5 years


Q. 4

Which of the following is true for multibacillary leprosy:

September 2006

 A

More than 5 lesions on skin smears

 B

Clofazimine is an important drug to be given

 C

Treatment is to given for 12 months

 D

All of the above

Q. 4

Which of the following is true for multibacillary leprosy:

September 2006

 A

More than 5 lesions on skin smears

 B

Clofazimine is an important drug to be given

 C

Treatment is to given for 12 months

 D

All of the above

Ans. D

Explanation:

Ans. D: All of the above

In classification based on skin smears, patients with negative smears at all sites are grouped as having paucibacillary (PB) leprosy, whereas those showing positive smears at any site are grouped as having multibacillary (MB) leprosy. Persons with more than 5 patches and involvement of more than 1 nerve trunk are also considered to have MB leprosy.

The PB group includes TT and BT types, whereas the MB group includes BB, BL, and LL.

Paucibacillary leprosy should be treated for 6 months with dapsone 100 mg/day unsupervised plus rifampin 600 mg/month supervised.

Multibacillary leprosy should be treated for 12 months with dapsone 100 mg/day unsupervised, clofazimine 50 mg/day unsupervised, and rifampin 600 mg plus clofazimine 300 mg/month supervised.


Q. 5

As per WHO recommendation, duration of treatment of multibacillary leprosy is: 

September 2009

 A

3 months

 B

6 months

 C

9 months

 D

12 months

Q. 5

As per WHO recommendation, duration of treatment of multibacillary leprosy is: 

September 2009

 A

3 months

 B

6 months

 C

9 months

 D

12 months

Ans. D

Explanation:

Ans. D: 12 months

Paucibacillary leprosy should be treated for 6 months with dapsone 100 mg/day unsupervised plus rifampin 600 mg/ month supervised.

Multibacillary leprosy should be treated for 12 months with dapsone 100 mg/day unsupervised, clofazimine 50 mg/day unsupervised, and rifampin 600 mg plus clofazimine 300 mg/month supervised.


Q. 6

A patient with leprosy had slightly erythematous, anesthetic plaques on the trunk and upper limbs. He was treated with paucibacillary multidrug therapy (PB-MDT) for 6 months. At the end of 6 months, he had persistent erythema and induration in the plaque. The next step of action recommended by the World Health Organization (WHO) in such a patient is?

 A

Stop antileprosy treatment

 B

Continue PB-MDT till erythema subsides


 C

Biopsy the lesion to document acitivity 

 D

Continue dapsoen alone for another 6 months

Q. 6

A patient with leprosy had slightly erythematous, anesthetic plaques on the trunk and upper limbs. He was treated with paucibacillary multidrug therapy (PB-MDT) for 6 months. At the end of 6 months, he had persistent erythema and induration in the plaque. The next step of action recommended by the World Health Organization (WHO) in such a patient is?

 A

Stop antileprosy treatment

 B

Continue PB-MDT till erythema subsides


 C

Biopsy the lesion to document acitivity 

 D

Continue dapsoen alone for another 6 months

Ans. A

Explanation:

Stop antileprosy treatment .

WHO recommends that

“In paucibacillary leprosy, the multidrug therapy is stopped after months of treatment regardless of the presence of clinically active disease”.

o According to Indian leprologists

“The t/t with both Rifampicin and dapsone must be continued till all signs of activity have been subsided”.

It is believed that these patients are virtually always cleared of viable bacteria in 6 months with the WHO-MDT regime.

o Therefore the attainment of clinical inactivity should not be the condition guiding the continuation of multidrug therapy in paucibacillary leprosy.

o The lesions may be present but they will be cleared of all the organisms.

The clinical activity dos not correlate with bacterial multiplication.

o Incidence of relapse in paucibacillary patients is very low and follow up studies in paucibacillary patients demonstrates that complete clearing of lesions takes 1-2 years after t/t discontinuation.



Q. 7

A patient presented with Skin lesions as shown in the image(around four) over the body.All are the clinical features of a patient suffering from the type of leprosy shown in the image except:

 A

Good prospects for recovery

 B

Able to mount cell mediated immunity reaction

 C

Severity is mild

 D

The person is infectious

Q. 7

A patient presented with Skin lesions as shown in the image(around four) over the body.All are the clinical features of a patient suffering from the type of leprosy shown in the image except:

 A

Good prospects for recovery

 B

Able to mount cell mediated immunity reaction

 C

Severity is mild

 D

The person is infectious

Ans. D

Explanation:

Ans:D.)The person is infectious.

The image is of a patient suffering from Tuberculoid Leprosy.

 

 

 

Paucibacillary (PB) 

 Multibacillary (MB)

Previously called

Tuberculoid Leprosy

Lepromatous Leprosy

Severity

Mild

Can be extreme

(Without treatment, the patient will die)

Unique Signs and Symptoms

Few erythematous or hypopigmented plaques with flat centres and raised,demarcated borders;peripheral nerve damage with complete sensory loss;visible enlargement of nerves.

Many erythematous macules,papules or nodules;extensive tissue destruction(e.g:nasal cartilage,bones,ears);diffuse nerve involvement with patchy sensory loss,lack of nerve enlargement.

Distribution of lesions

Asymmetrical

Symmetrical

 

Occurs When

Infected person is able to mount a robust, cell-mediated immune response to the bacterium

Infected person unable to mount a cell-mediated immune response to the bacterium

Defined by World Health Organization as

1-5 patches associated with leprosy

(Paucibacillary)

>5 patches associated with leprosy.

(Multibacillary)

Is the person Infectious?

No

Possibly; bacterium is found in high concentrations in respiratory secretions and organs

Prospects for Recovery

Good

Cure from disease possible, however, underlying disease complications (such as limb damage due to infection) may not be reversible or require reconstructive surgery

Lepromin test

Positive

Negative

Erythema Nodosum Leprosum Absent Usually present

Q. 8

If a claw hand develops in a patient with Leprosy, th deformity is ‑

 A

Grade 0

 B

Grade I

 C

Grade II

 D

Grade III

Q. 8

If a claw hand develops in a patient with Leprosy, th deformity is ‑

 A

Grade 0

 B

Grade I

 C

Grade II

 D

Grade III

Ans. C

Explanation:

Ans. is `c’ i.e., Grade II 



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