Test: Hansen’s Disease - 1 - NEET PG MCQ

CNS is typically seen as not playing a role in leprosy. Instances of involvement of the cerebral cortex are uncommon.

Neuritic leprosy affects the surface nerve trunks present in the skin. It is more easily differentiated from the indeterminate type since the neuritic form displays nerve involvement without the characteristic skin lesions. The SSS test includes both clinical and bacteriological assessments and can identify pure neuritic cases solely when the bacterial count exceeds 10,000. When comparing neuritic and indeterminate types, neuritic is the preferable choice due to its clinical skin involvement.

The image depicts an annular, punched-out lesion of BB Hansen, characterised by a raised edge and a clear central area.

• Observe the distinct features that are typical of BB Hansen.

The presence of granulomas beneath the skin is indicative of tuberculoid leprosy.

In queries of this nature, the initial step is to determine whether the patient leans more towards the lepromatous or tuberculoid spectrum. Signs such as:

• Multiple lesions
• Symmetrical nerve involvement

indicate borderline leprosy (BL). It cannot be lepromatous leprosy (LL) since LL does not present with hypoesthesia. Therefore, this would suggest a progression towards the lepromatous side, specifically BL.

In scenarios like these, the first step is to determine whether the patient leans towards the lepromatous or tuberculoid spectrum.

• Multiple lesions, hypoesthesia, segmented lesions, and a high number of acid-fast bacilli indicate borderline leprosy.
• It cannot be lepromatous leprosy (LL) as LL is characterised by the absence of hypoesthesia or hypopigmentation.
• It cannot be indeterminate leprosy, which also lacks hypoesthesia and does not present with numerous bacilli.
• It cannot be tuberculoid leprosy, which typically features a single lesion and is paucibacillary.

Therefore, the most accurate conclusion is that the patient has borderline leprosy.

Decreased proprioception is generally not observed in leprosy.

• Nerve involvement in leprosy leads to motor palsy, resulting in abnormal EMG readings.
• Voluntary muscle testing would reveal these motor alterations.
• Reduced sensations are typically noted.
• An increased tactile response suggests a type 1 lepra reaction, accompanied by hyperesthesia.

Proprioception and vibration sense remain intact in leprosy.

• Symmetrical nerve involvement leads to glove and stocking anaesthesia.
• It also results in mononeuritis multiplex in LL.

Observe the nearly symmetrical lesions associated with borderline leprosy (BL). Additionally, take note of the solitary annular, punched-out lesion located on the left side of the trunk. Such annular lesions may be present in both BB and BL.

• The extensive number of lesions suggests a preference for BL over BB.

While complete clinical nerve enlargement is not observed in every form of leprosy (for instance, indeterminate Hansen's displays normal nerve diameters), nerve involvement occurs subclinically in all individuals affected by leprosy.

Leprosy patients may exhibit a type 2 lepra reaction following treatment.

• Symptoms such as fever, painful papules or nodules, along with lymphadenopathy, all indicate the presence of erythema nodosum leprosum (ENL).

Multiple hypopigmented lesions are indicative of borderline lepromatous (BL) leprosy. Sensory testing reveals hypoesthesia. Slit-skin smear (SSS) tests positive. Biopsy shows sparse tuberculoid granulomas with abundant foam cells. The lepromin test is used for prognosis, not diagnosis.

In lepromatous leprosy (LL), nodules form, and saddle nose deformity often occurs due to nasal bridge collapse. Lagophthalmos results from facial nerve involvement, where the first ophthalmic division of the fifth cranial nerve causes corneal anesthesia, and the zygomatic branch of the seventh cranial nerve paralyzes the orbicularis oculi muscle, preventing proper eye closure. LL typically leads to ear lobe infiltration, resulting in large, pendulous "Buddha ears," not small lobes. Microstomia is unrelated to LL.

The Indian programme has discontinued single-dose ROM (rifampicin, ofloxacin, minocycline) therapy.

As per the WHO, there is no need for any follow-up after MDT at this time.