All About Leprosy Prasad PVS
INDEX
Page numbers followed by f refer to figure, t refer to table and b refer to box
A
Acid-fast bacilli (AFB) 20, 29f
Acute neuritis
management in leprosy 357
Acute neuropathic disintegration of foot 311
Acute osteitis 195
Adenosine diphosphate (ADP) 26
Adenosine triphosphate (ATP) 26
Adrenals involvement
in leprosy 194
Adrenocorticotropic hormone (ACTH) 194
Alpha (α) dystroglycan 27
Amitriptyline
for neuropathic pain 183
Amyloidosis 56
Anemia
in leprosy 137
Anesthetic deformities
in leprosy 216
Animal experiments
in leprosy
animals used 237
armadillo 240, 244
chimpanzees 237
cold-blooded animals 238
guinea pigs 238
international experiments 240
monkeys 237
nude mice 240
rabbits 237
rats and mice 237
severe combined immunodeficient mice 244
slender loris 238
Syrian hamsters 237
white-handed gibbon 238
Indian experiments 239
infection induction 238, 242
Mycobacterium leprae viability 241
principles 236
Annular lesions 146
differential diagnosis 146b
Annular psoriasis 146
Antigen-based radioimmunoassay 54
Antigen-presenting cells (APC) 45, 48, 331
Antileprosy drug
in leprosy 224
in pregnancy 357
Antimicrobial chemotherapy 262
Antimonial 275
Apoptosis 65
Azathioprine 267
B
Bacille Calmette-Guérin (BCG) 19, 59, 283, 296
adverse effects 289
results 288
Bacterial index (BI) 29, 36
calculation 30b
concepts 30
Bacterial persisters 277
Bacteriological index (BI) 133
BCG + armadillo-derived killed Mycobacterium leprae 285
Bilateral gynecomastia 120
Bilateral pedal edema 120
Biopsy index 31, 39
Bisphosphonates 333
Boeck and Danielssen 24
Bombay leprosy project (BLP) 355
Bone change
in leprosy 194
acute osteitis 195
concentric absorption 196
cupping of the join 196
enlarged nutrient foramina 195
florid reactive periosteitis 196
honeycombing 194
osteomyelitis 195
osteoporosis 196
pseudocyst 195
secondary periosteitis 196
tuft erosion 196
Borderline borderline (BB) leprosy
diagnosis 340
Borderline lepromatous leprosy 124
features 136
Borderline tuberculoid leprosy 122
features 135
in children 226
Borrelia burgdorferi 144
Brand paul 5
C
Carbamazepine
for neuropathic pain 183
Cell mediated immunity 51
in borderline leprosy 51
in lepromatous leprosy 52
in tuberculoid leprosy 51
Chaulmoogra fruit 2
Chaulmoogra oil therapy 7
Chemoprophylaxis
in leprosy 295
limitations 295
principles 295
Chlamydia 253
Chloroquine
indications 275
mechanism of action 275
side effects 275
Chromosome 10p13 48, 330
Clarithromycin 265
drug resistance 333
Claw hand 306
surgery for 306, 313
active intrinsic replacement procedures 306
extensor indicis transfer 306
extensor to flexor four tailed graft 306
palmaris longus many tailed graft 306
sublimis transfer 306
Claw toe deformity 309
treatment 309
Clinical leprosy 134
Clofazimine-induced ichthyosis 175
Clofazimine 7, 225, 255, 263
drug resistance 332
GI side effects 273
ichthyosis 273
in pregnancy 233
indications 257b, 274
in type 2 reaction in leprosy 166
mechanism of action 255
monitoring guidelines 257
pharmacokinetic properties 262t
pharmacology 255, 270
side effects 256b, 273
therapeutic effects 256
Cluster of differentiation 44, 45t
CD4 44
CD8 45
Cochrane index 36
Cochrane's method 30, 31t, 39
Cochrane study 233
Cocked up toe 310
extensor tenotomy 310
Combination regimen
for leprosy 270, 293
ROM 293
Common peroneal nerve 119
Congenital sensory neuropathy
features 154
Connective tissue sheath 97
Control of disease 297
Corneal reflex 117
Crossed immune electrophoresis (CIE)
application 57
C-type lectin receptors 49
Cutaneous branch of radial 119
Cutaneous leishmaniasis 147
Cyclones 264
Cyclosporine 267
Cytokines 51
in leprosy 331
Cytotoxic cells 50
D
Dapsone 7, 6, 224, 247
adverse effects 250b
anemia 271
drug resistance 332
excretion 248
in pregnancy and lactation 251
indications 249, 271
induced FDE 271
metabolism 248
modes of action 248, 271
monotherapy 270
parenteral preparations 271
pharmacokinetic properties 262t
pharmacology 248
resistance 246
secondary 247
proof of 272
safety in pregnancy 232
side effects 249, 271
Dapsone syndrome 250f
symptoms 271
Dasypus novemcinctus 18
Decay-missing-filled teeth (DMFT) index 192
Deformity
Deformity
in leprosy 215
as per World Health Organization (WHO) 204
causes 217
classification 216
face deformities 205, 210
anesthetic 210
claw toes 210
foot drop 210
hand deformities 206
anesthetic 210
median claw hand 209
paralytic thumb 210
ulnar claw hand 208
wrist drop 210
nasal deformities 206
types 205
Dejerine-Sotta's syndrome 155
Delipidified Mycobacterium leprae components 286
Diabetes mellitus 151
Diabetic neuropathy
features 154
Diastematomyelia 151
Diffuse lepromatous leprosy (DLL) 126, 166
Disability
in leprosy 203
D-isomer of dihydroxyphenylalanine
(DOPA) 26, 36
DNA amplification technique 33
DOPA See D-isomer of dihydroxyphenylalanine
(DOPA)
E
Ear lesions
in leprosy 192
Early morphea 144
Ehrlich, Paul 246
Elephantiasis 2
Elephantiasis graecorum 6, 261
Elimination of disease 297
leprosy 297
Endocrine diseases 153
Enzyme-linked immunosorbent assay (ELISA) 21, 54
35 KD antigen-based 55
PGL-1-based 54
Epithelioid cell granulomas 102
ERBB2 receptor 27
Erythema multiforme 147
Erythema necroticans 56
Erythema nodosum leprosum (ENL) 77, 90, 163, 331
complications in 164
dermal 91
differentiation from type 3 reactions 345t
necrotizing 91
pathogenesis 90, 102
precipitating factors 174
pustular 102
types 91
types of reactions 174
Erythematous macules 143
Etanercept and infliximab 267
Ethidium bromide staining 34
Ethionamide
side effects 274
Experimental leprosy 237
External meatal stenosis 309
Extinction 297
Eye involvement
in leprosy 187
clinical manifestations 189
conjunctiva and episclera 189
cornea 189
iris and ciliary body 190
sclera 190
direct invasion of 189
mechanism of 188
secondary to cranial nerves 188
F
Facial
deformity 307
nerve paralysis 307
palsy 206
skin laxity 308
Father Damien 8
Fernandez reaction 32, 33t, 40
Fite-Faraco's stain
advantages 97
Fite-Faraco method 24
Fixed drug eruption 144, 144f
FLA-ABS test 36
application 59
importance 60
Fluorescein diacetate staining 34
Fluorescent leprosy antibody absorption test 34, 54
Fluoroquinolones 264, 293
mode of action 276f
Foot
structural deformities 311
Foot drop 309
early 309
established 309
treatment 313
Frozen hand 175, 217
G
Gabapentin
for neuropathic pain 183
Gandhi Memorial Leprosy Foundation (GMLF) 5
Gatifloxacin 264
Gonadotropic hormone (GTH) 194
Grading of movements 205t
Graft versus host reaction
importance 60
Granuloma annulare 145, 145f
Granuloma multiforme 146
Great auricular nerve 118
course 199
Grenz zone 7, 100
Gynecomastia 138, 309
causes 155
in leprosy 194
causes 138
mastectomy 309
Gynecothelia 138
H
Haemophilus influenzae 253
Hair follicles 220
Hand muscle 219
Hansen hypothesis 6
Hansen's disease 63, 76
borderline lepromatous 76
borderline tuberculoid 76, 83, 84f
etiopathogenesis 63
fine needle aspiration cytology 95
advantages 95
methodology 95
histoid 76, 86
indeterminate 76, 78f
lepromatous disease
borderline lepromatous 82
polar lepromatous 76, 86, 87f
polar tuberculoid 79f
tuberculoid spectrum of 76
Hematoxylin and eosin stain 73
Hepatitis B infections 28
Hereditary sensory and autonomic
neuropathy 150
Histamine test 40
Histoid 7
habitus 130
Hansen's 75, 89f
leprosy 100, 128, 341
differentiation from lepromatous
leprosy 130t
features 137
types 137
Histological index 101
Histone-like protein (HLP) 179
HIV-leprosy coinfection 229
clinical spectrum 229
reactions 229
treatment 229
Honeycombing 194
Hot foot syndrome 311
Human immunodeficiency virus 28
and leprosy 228
Human leukocyte antigen 330
Human toll-like receptors (TLRs) 48
Hypopigmented macules 140
Hypopigmented patch
in children 233
I
Ichthyosis of lepromatous leprosy 175
ICRC vaccine 285
IFN-α 163
IFN-γ 163
Immune cytochemical staining 35
Immune precipitation technique 35
Immune reconstitution inflammatory
syndrome 167
criteria for the diagnosis 169t
immunology 168
type 1 169
Immune reconstitution inflammatory
syndrome 230, 233
Immunity 43
acquired 43
cell-mediated 43, 49
humoral 43
innate 43
Immunological complications 55
amyloidosis 56
antigen-derived 55
erythema nodosum leprosum 55
Lucio phenomenon 56
reversal and downgrading reactions 56
Immunology 46
of leprosy 46
Immunoprophylaxis 288
Immunotherapy
in leprosy 287, 296
Impairment 216
primary 216
secondary 216
Indeterminate leprosy 46, 120
features of 136
Indian Association of Leprosy (IAL)
classification 108
Indian Lepers Act 7
Interferon 46
INF-beta 46
INF-gamma 46
INF-alpha 46
Interleukins 45
IL-1 45
IL-2 45, 296
Intrafascicular/Schwann cell 68
Iridocyclitis 199
J
Jaundice 271
Jergerson-Lewandos’ law 98
K
Kaposi's sarcoma 147
Killed
cross-reacting mycobacterium 285
ICRC bacillus 285
Mycobacterium welchii vaccine 285
M. leprae 296
Mycobacterium leprae 284
Mycobacterium leprae with live BCG 284
Koch's postulates 24
L
Lagophthalmos 189f, 198, 206
surgery 307
Larynx lesions
in leprosy 192
Lazarine leprosy 131, 137
Leonine facies 135, 153
Lepra bonita 131
Lepra bubalorum 132
Lepra cell 7
Lepra facies 134
Lepra Manchada 131
Lepra reaction 295
treatment 258, 258t, 274
Leprolin 34
Leprologists 3
Drognat Landré 4
Gerhard Henrik Armauer Hansen 3
San Lazaro Hospital 3
Lepromatous leprosy 126, 127
causes of death 134
clinical features of 135
diffuse 126
features 136
nodular 126
pedal edema causes 135
Lepromatous neuropathy 68
Lepromatous ulcer 310
treatment 310
Lepromin 39
Lepromin test 32, 32t, 40
Leprosin 34
Leprosy
acquired immune response 48
active cases 133
adrenal involvement 138, 194
age prevalence 19
and human immunodeficiency virus 228
and tuberculosis 231
anemia 137
animal experiments See also animal experiments, in leprosy
antigen 65
autoantibodies 56
biblical 2, 3f
bone involvement 194
borderline borderline (BB) 65
borderline lepromatous (BL) 65
borderline tuberculoid 65
Cairo classification 106
cardinal signs of 134
carrier state 21
census 5
cell-mediated immunity See also cell mediated immunity
diminished 61
cellular infiltrate 101
chemoprophylaxis
chemoprophylaxis 233, 267, 295
Chinese name 7
classification 104, 111
Cairo 111
Danielssen and Boeck 105
Darier 105
dharmendra 108
earlier classification 104
Hansen and Looft 105
Havana 106, 111
IAL 111
Indian 107
Jadassohn 105
Job and Chacko 112
Madrid 106, 111
Manila 111
Neisser 105
NLEP classification 109, 112
pan American 106, 111
pre-Manila 111
Ridley and Jopling 109, 112
Rogers and Muir 105
WHO 106
classification based upon diagnosis 120
clinical examination 116, 134
bilateral gynecomastia 120
bilateral pedal edema 120
cranial nerves examination 120
ear lobe infiltration 119
madarosis 119
muscles examination 120
sensory testing 116
trophic changes and ulcers 120
clinical examination 117b
completion of treatment 11
complication 174, 175
control in India 351, 356
control of deformities 319
current status of 14
diagnostic tests 38
diagnostic tool 326
drug resistance 294, 332
dry skin 312
ear, nose and throat manifestations 190
early lesions in 134
elimination in India 5
environmental sources of 18
epidemiological features 16
evolution 66
experimental model 242
eye involvement 198
eye manifestations 188
features of immunity 57
genes associated 61
genetic influences 47
global statistics 10, 16
gonads involvement 193
granuloma significance 98
gynecomastia 194
hereditary theory 24
histological features 66
history 1
humoral immunity 53
hypopigmentation causes 135
immune prophylaxis 59
immune therapy 60
in 12th to 15th century 2
in children 11, 225
chemoprophylaxis 228
chemotherapy 228t
diagnosis 227
differential diagnosis 227
epidemiology 225
multibacillary therapy 228
treatment 227
in pregnancy
consequences 232
inactive cases 133
incubation period 21
indeterminate 92, 120
innate resistance 47
international classification 105
investigation purpose 27
laboratory tests 58
lepromatous leprosy (LL) 65
lepromatous spectrum 64
lesions 68
early lesion 70
established lesion 70
evolving lesion 70
resolving lesion 70
local immunity 41
macules 121
modes of transmission 20
multidrug therapy (MDT) See also multidrug therapy (MDT), in leprosy
natural history 64
nerve biopsy 96
neuropathology 68
non-governmental organizations (NGOs) role 354
oral manifestations 192
pathology 46f
PCR usage in diagnosis 58
portals of entry and exit 20
postelimination era 347
reaction 86, 157
pathogenesis 179
rehabilitation services 317
rehabilitative care 317
basic rehabilitation measures 319
complications management 321
control of deformities 319
orthosis 319
paralysis 320
self-care procedures 320
splints 321
stigma reduction strategies 322
ulcer management 319
relapse 170, 332
Becx-Bleumink criteria 171
Beorrigter classification 171
clinical features 172
differentiation from erythema nodosum leprosum (ENL) 173
immunology 172
magnitude 171
microbiology 172
predisposing factors 172
treatment 173
renal complications 138
risk factors 19
sterility 138
stigma 322
systems involved 137
testicular dysfunction 138
treatment
as per WHO 269
of reactions 266
prevention of deformities 296
treatment outcome 350
tuberculoid spectrum 64
type 1 reaction 158
type 2 reaction 162
type 3 reaction 166
types in india 64
typical tuberculoid (TT) 65
vaccines used 59
VII nerve involvement 198
Leprosy Containing Policies in India 352
Leprosy-derived corynebacteria (LDC) 58
Leprosy elimination
history 5
milestones 13
Leprosy in children 233
Leprosy-like disease (LLD) 58, 238
Leprosy rehabilitation programs 316
community-based rehabilitation 316
Leprotic alopecia 128
Leprous neuritis 178
causes of nerve damage 180
feature of facial nerve involvement 185
features 184
investigations 182
mechanisms of nerve damage 182
pathogenesis 178
Leukocytes formation 44
Leukoderma colli 143
Leukotriene inhibitors 267
Levamisole 296
Leydig cells 193
Lipoarabinomannan 24
Lipoglycans 24
Lipomannan 24
Live Mycobacterium leprae 284
LLD See leprosy-like disease (LLD)
Local exacerbation reaction (LER) 102
Localized hypertrophic neuropathy 151
Lucio leprosy 131, 135
differentiation from erythema nodosum leprosum (ENL) 131t
Lucio phenomenon 56, 92, 345
Lupus vulgaris 146
Lyme disease 144
Lymphocyte stimulation test (LST) 46
Lymphocyte transformation test (LTT) 46
M
Macrolides 265, 293
Macrophage 53
Macrophages 50
Macular leprosy
differential diagnosis 141
Macules
in leprosy 121t
Madarosis 119, 151, 198, 205
causes 152b
treatment 198
Matrix metalloproteinase-1 (MMP-1) 25
Matrix metalloproteinase-2 (MMP-2) 25
Median claw hand 209
Median nerve 184
Median nerve paralysis 220
Median palsy 184
high 185
Median paralysis 220
Medina test 345
Memory T cells (TM) cells 45
Methenamine silver 35
Methotrexate 267
Methylene blue test 40
MI See morphological index (MI)
Mid-borderline leprosy (BB) 124
Minocycline
Minocycline 265, 293
drug resistance 333
dose 276
Mitsuda antigen 32
Mitsuda-H 32
Mitsuda reaction 33t, 40
Mitsuda type of lepromin test 39
M. lepromatosis 339
Modified Ziehl-Neelsen stain 74
Møller-Christensen 7
Monoclonal antibody competition assay 59
Morphological index (MI) 30, 36, 133
concepts 30
Morvan's syndrome 151
Mouse footpad (MFP) technique 246
Moving 2-point discrimination (M2PD) 116
limitation 116
Moxifloxacin 264
Multibacillary (MB)
multidrug therapy 270
recommendation NHDP 263t
WHO recommendation 263t
Multibacillary therapy
in children 228
Multidrug therapy (MDT)
in leprosy 247, 257
accompanied 294
adverse reaction 258
a-MDT 277
characteristics 247
for multibacillary disease 258t
for paucibacillary disease 257t
in pregnancy 277
pharmacological effects 257
quadruple regimen 294
single lesion paucibacillary disease 257t
U-MDT 277
uniform 294
Multidrug treatment
in leprosy uniform 350
Multiple nerve abscesses
treatment 343
Muscles
involved in leprosy 205t
Muscular paralysis 212
Mycetoma 147
Mycobacterium avium 25
Mycobacterium bovis 34, 54
Mycobacterium leprae 3, 6, 9, 18, 24, 46, 180,
194, 236, 241
advances in understanding 328
and skin 27
antigenic structure 53
antigens 57
biochemical properties 26
capsule 24, 37
cell membrane 25
cell wall 25
characteristics 37
characteristics 98
components 24
cytoplasm 25
demonstration 116
differentiation from M. tuberculosis 334
genetic influences 329
genome 25, 329
growth characteristics 26
growth of 329
host response 329
infection 114
cardinal signs 115
early symptoms 114
immune responses to 181
investigations 27
microbiological characteristics 24
mycobacterial features 37
non-mycobacterial features 37
period of viability 21
polymerase chain reaction 329
proteome 329, 335
structure 37
ultrastructure 24
Mycobacterium
lepraemurium 34
lepromatosis 36
nonchromogenicum 34, 54
scrofulaceum 35
tuberculosis 25
vaccae 34
welchii 296
welchii vaccine 285
Mycolic acids 36
Mycophenolate mofetil 267
Mycosis fungoides 148
Myelinated and unmyelinated fibers 68
Myxedema 135
N
Nasal deformity 308
reconstructive surgeries 308
nasal bridge support 308
replacement of nasal lining 308
Nasal lesion
in leprosy 190
in tuberculoid leprosy 191
Nasal mucosa 220
Nasal scrapings in leprosy 38
Nasal secretion 31
Nasal smear 31
National Cardiovascular Data Registry
(NCDR) 353
National Leprosy Control Program (NLCP) 7
National Leprosy Elimination Program of
India (NLEP) 107
National Leprosy Eradication Program
(NLEP) 7, 108
Natural killer (NK) cells 43, 331
Natural resistance-associated macrophage
protein 1 (NRAMP1) 47, 330, 335
Neisseria gonorrhoeae 253
Neisseria meningitidis 253
Nerve
assessment in leprosy 204
conduction study (NCS) in leprosy 342
damage in leprosy 296
function assessment 205
function impairment (NFI) 158
regeneration in leprosy 296
Nerves
enlarged scoring system 119
Neurilemmomas 149
Neuritis end stage 102
Neurofibroma 147, 150
Neuropathic pain 182
treatment for 183
Nevus anemicus 142
Nevus hypopigmentosus 142
Newer drugs
in leprosy 261
need 262, 292
NK cells 45, 50, 163
Nodular lepromatous leprosy 126
Nodular lesions 147
Nodular melanoma 148
Nortriptyline
for neuropathic pain 183
O
Ofloxacin 266
drug resistance 333
Oral cavity involvement
in leprosy 200
Oral lesions
in leprosy 192
Osteomyelitis 195
Osteoporosis 196
types 201
Ovary involvement
in leprosy 193
P
Papules and plaques 145
differential diagnosis 145b
Paralytic deformities
in leprosy 216
PARK2/PACRG 47, 57, 330, 334, 335
Paucibacillary leprosy
in children 228
multidrug therapy 270
NHDP recommendation 263t
WHO recommendation 263
PCR assay 33
PCR solid phase hybridization 34
PCR-direct DNA sequencing 34
PCR-single-strand conformation
polymorphism (PCR-SSCP) 34
Pentoxifylline 267, 295
Periodic acid-schiff (PAS) 35
Peripheral nerves enlargement 134
Peripheral neuritis 305
predisposing factors 305
surgery 305
indications 305
treatment 305
Peripheral neuropathy 149
causes 149
differential diagnosis 149
Persister bacilli 185, 247
Phenolic glycolipid-1 (PGL-1) 24
Pilocarpine test 40
Pin prick (PP) test 116
Pinta 142
Pituitary involvement
in leprosy 194t
Pityriasis alba 141
Pityriasis rosea 143
Pityriasis versicolor 140
Plantar ulcer 310
complications 311
treatment 310
Plastazote 313
Polymerase chain reaction (PCR) 33
clinical application 33
technique 33
Posterior tibial nerve 119
Postinflammatory lesions 141, 142b
Post-kala-azar dermal leishmaniasis 142
Pregnancy and leprosy 223
Pressure necrosis 211
Previtiligo 141
Primary amyloidosis
features 154
Primary systemic amyloidosis 150
Progressive macular hypomelanosis 142
Pseudocyst 195
Psoriasis 145
Phthiocerol dimycocerosate (PDIM) 24
Pure neuritic leprosy 128
R
Radial nerve 119
Rafael lucio 7
Reaction hand 175, 217
Reactions
in leprosy 157, 174
comparison of 168t
type 1 reaction 158
corticosteroids 161
epidemiology 158
immunology 160
precipitating factors 161
treatment 161
type 2 reaction 162
clinical features 164
clofazimine 166
complications in 164
epidemiology 163
pathogenesis 163
thalidomide 165
treatment 165
type 3 reaction 166
clinical features 167
epidemiology 166
pathogenesis 167
Recombinant interferon-γ (IFN-γ) 296
Red man syndrome 273
Refsum disease 150
Regression
signs 101
Ridley and Jopling 29
Ridley-Jopling classification 111
Ridley's scale 39
Rifampicin 7, 224, 251, 263, 293
advantages 254
adverse effects 253
dosage 254
drug interactions 252b, 254
drug resistance 332
effects on pregnancy 233
indications 254
mechanism of resistance 272
mode of action of 252, 272
monitoring 252b
pharmacokinetic properties 262t
pharmacology 252
side effects 253b, 272
Rifapentine 293
Roseolar leprosy 163, 174
Roseolar syphilide 143
Rosette toes 310
S
Saidapet study 134
Sarcoidosis 145, 147
Schwann cell 97, 178
studies 181
Schwann cell injury 296, 342
Schwann cells 27, 179
myelinated 179
non-myelinated 179
Scleritis
features 199
Seborrheic dermatitis 143, 144f
Seborrheic psoriasis 145f
Secondary syphilis 145
Semmes-Weinstein monofilament 133
Semmes-Weinstein monofilament
testing (SWMT) 116
Sensory nerve action potential (SNAP) 260
Sensory testing
in leprosy 116
corneal reflex 117
nerves 118
pain sensation 116
thermal sensation 117
Serological tests
disadvantages 59
Serum antibody competition test (SACT) 35
SFG index 36, 39 See solid, fragmented, granular index
Shepard's experiments 239
Silent neuropathy
pathogenesis 185
Single-lesion paucibacillary (PB)
NHDP 263t
WHO recommendation 263t
Single lesion paucibacillary (SLPB) regimens 228
Skin biopsy 69, 340
adnexal elements 72
bacterial load 72
cell types 72
epidermis 72
histological features 74
in borderline lepromatous leprosy 75
in borderline tuberculoid leprosy 74
in lepromatous leprosy 75
in lepromatous leprosy polar type 75
interpretation 76
in tuberculoid leprosy 74
necrosis 72
nerves 72
staining procedures of 73
tuberculoid spectrum 72
Skin test antigens 286
Slender loris 238
Slit-skin smear (SSS) 27, 340
cold method 29
equipment required 28t
hot method 29
Sodium dodecyl sulfite (SDS) 35
Solid, fragmented, granular index 31
Stasis ulcer
treatment 310
Sterility
in leprosy 138t
Steroid-induced hypomelanosis 143
Sulfone monotherapy 246
Sulfones 270
poisoning
symptoms 271
Supraorbital and supratrochlear nerves 118
Swiss cheese’ appearance 340
Syringomyelia 151
Systemic lupus erythematosus (SLE) 56
T
T8 suppressor cells 52
TAP2 gene 57
T-cell
CD1-restricted 49
cytokines 51
cytotoxic cells 50
macrophages 50
T-cell subtypes 45
T cytotoxic (TC) cells 45
Temporalis transfer 308
Testicular dysfunction
in leprosy 138
Testis involvement
in leprosy 193
Thalidomide 258
absorption 258
drug interactions 260b
hypnosedative effects 259
immunomodulatory and anti-inflammatory effects 259
indications 259b
in type 2 reaction in leprosy 165
mechanism of action 259
monitoring 261b
neural and vascular tissue effects 259
side effects 260, 275
T helper (TH) cells 44, 45
Thevanard's syndrome 151, 155
Thick nerve 341
Thumb deformities 307
surgery 307
Thymectomized mice 240
Thyroid involvement
in leprosy 194
T inducer (TI) cells 45
Tinea circinata 146
Tinea incognito 143, 144f
Tinea versicolor 141f
T lymphocytes 44
TNFα 48
Toll-like receptor-2 (TLR-2) 49, 179, 330
Tooth-Charcot-Hoffmann syndrome 155
Transporter associated with antigen processing
genes 48, 330
Trigeminal trophic syndrome 153
Triple nerve lesion 307
Trophic ulcer 151, 210, 220
differential diagnosis 151, 213
management 344
mechanisms 221
pathogenesis 211
sites of ulcerations 213
treatment 213
True tuberculoid leprosy 122
features 135
T suppressor (TS) cells 45
Tuberculoid contamination 130
Tuberculoid disease 80
borderline 80
polar 80
Tuberous sclerosis complex 148
Tumor necrosis factor alpha (TNFα) 330
Twisted finger deformity 218
Type 1 lepra reaction 157
Type 2 lepra reaction 157
U
Ulnar nerve 119
Ulnar claw hand 208, 220
clinical examination 209
clinical features 208
Ulnar nerve 184
Ulnar palsy 184
high 184
low 184
Ulnar paralysis 218
examination 218
Ultrasonography (USG) significance
in leprosy 342
V
Vaccine
in leprosy 283
candidate vaccines 285, 289
combination vaccines 286
first generation 284
pitfalls 286
second generation 289
second generation vaccines 286
testing 282
Virchow's cells 97
Vitamin D receptor (VDR) 48, 330
Vitiligo 141f
Voluntary muscle testing (VMT)
in leprosy 205
W
Webster's technique 309
Western immune blotting 35
Wrist drop 210
Y
Yaws 142
Z
Zinc 296
ZN staining 30
technique 38
×
Chapter Notes

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All About LEPROSY
All About LEPROSY
Second Edition
Prasad PVS MD DD DV FIAD FIMSA Professor Department of Dermatology, Venereology and Leprosy Former Dean Rajah Muthiah Medical College and Hospital Annamalai University Tamil Nadu, India E-mail: prasaderm@hotmail.com Forewords Patrick Yesudian
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All About Leprosy
First Edition: 2005
Second Edition: 2016
9789385891960
Printed at
My teacher, Professor, Rachel Mathai
My wife, Mrs Chellam
My postgraduate students
and
All my leprosy patients
Contributors
Foreword
It has been a while since a major textbook on leprosy has been published. ‘All About Leprosy’ is an appropriate title for the book since it comprehensively covers all aspects of this ancient disease—from history to the latest therapeutic approach—including surgical aspects and the future scenario.
There is at present, a tendency on the part of government and non-government organizations dealing with leprosy control to become complaisant saying that the disease has been eradicated from our country. This is far from true as can be seen by the statistics given in this book and also in my consulting chamber I still see from time to time florid cases of lepromatous leprosy who must be spewing the bacilli around. So this book is a wake-up call to those dealing with the disease never to let leprosy sink below the diagnostic horizon. Early diagnosis is a must in containment of the disease.
This book is invaluable to postgraduate students in dermatology because it is presented with key points in each chapter and also the viva voce questions and answers, which the students can easily memorize at the time of their final examination.
This book should be a definite addition to all libraries, particularly dermatological libraries and I recommend all PG students to own their personal copies.
Patrick Yesudian FRCP FAMS
Patron and Chief Consultant
Chennai Skin Foundation and
Yesudian Research Institute
Chennai, Tamil Nadu, India
Preface to Second Edition
I deem it a great honor that I am able to complete the task of writing a second edition of my book in a short span of time. I hesitated for a long time due to my other commitments, but when I got the feedback from many postgraduate students about the usefulness of first edition, I wanted to contribute to the readers what they deserve. This edition is completely changed when compared to previous edition. The vast knowledge since the last edition is incorporated to a large extent. Many new chapters are included in this edition such as Global Scenario, new concepts in Immunology, Leprosy in Special Scenario, Vaccines in Leprosy and Rehabilitation. The chapter ‘What's New in Leprosy?’ should be helpful to answer questions in the postgraduate examinations and also tried to retain questions at the end of chapters to a possible extend. Finally, a chapter on panel discussion has been added incorporating various questions and answers discussed in various forums during the last several years. I am sure that this will be thought-provoking segment to the young generation. Questions from various universities also have been updated in Appendices. This book will be interesting and useful for various kinds of readers such as undergraduate to postgraduate students and consultants.
Prasad PVS
Preface to First Edition
This book is designed to help the undergraduate, postgraduate medical students, medical practitioners and healthcare providers in leprosy. I have covered all the aspects on leprosy from its historical days to the latest research. Though India is one of the few countries with high prevalence of leprosy there is paucity of books on leprosy by Indian authors and hence this attempt. This book aims to be a user-friendly guide to the postgraduate students as it incorporates many viva questions. I welcome suggestions and criticisms from the readers, which may help to improve the further editions. I wish to thank M/s Jaypee Brothers Medical Publishers (P) Ltd, for their constant efforts throughout the production of this book.
Prasad PVS
Acknowledgments
I would like to thank Professor Dr Patrick Yesudian for his foreword. I wish to acknowledge my teachers, Professor Mrs Rachel Mathai and Professor Mrs Mary Jacob for teaching me the basic skills in leprosy. I also acknowledge my parents, wife and children for their constant and untiring support in my profession.
My thanks are due to contributors for incorporating new developments in their chapters. I wish to acknowledge all my postgraduate students over the last 17 years for showing keen interest in learning leprosy and its associated problems. I am grateful to all my colleagues in the department, including Mr S Muthukumaran for their constant support.
My sincere thanks to all my patients not only for providing clinical material but also for permitting us to take photographs and for providing the learning material.
I am sure the readers will appreciate the vast changes made in this edition when compared to the previous edition of this book and will benefit from this second edition.
My special thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing) and Mr Jayanandan (Senior Commissioning Editor, Chennai Branch) and staffs of Bengaluru Production Unit/Bengaluru Branch of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India.
Abbreviations ADP
Adenosine diphosphate
AFB
Acid-fast bacilli
AFO
Ankle-foot orthosis
ANA
Antinuclear antibody
ATP
Adenosine triphosphate
BB
Borderline leprosy
BCG
Bacille Calmetti-Guérin
BI
Bacteriological index
CBR
Community-based rehabilitation
CD
Cluster of differentiation
CDR
Case detection rate
CMI
Cell-mediated immunity
CPN
Common peroneal nerve
DMFT
Decayed missing filled teeth
DOPA
Dihydroxyphenylalanine
DTH
Delayed-type hypersensitivity
ELISA
Enzyme-linked immunosorbent assay
ENL
Erythema nodosum leprosum
FCU
Flexor carpi ulnaris
FDT
Fixed duration therapy
FLA-ABS
Fluorescent leprosy antibody absorption
GI
Gastrointestinal
GM-CSF
Granulocyte Microphage colony stimulating factor
GMLF
Gandhi Memorial Leprosy Foundation
H&E
Hematoxylin and eosin
HPE
Histopathological examination
HRUS
High-resolution ultrasound
ICRC
Indian Cancer Research Center
IL
Interleukins
IRIS
Immune reconstitution inflammatory syndrome
LAMMS
Laser microprobe mass spectrometry
LC
Langerhans’ cell
LDC
Leprosy-derived corynebacteria
LL
Lepromatous leprosy
LLp
Polar lepromatous
M2PD
Moving 2-point discrimination
Mab
Monoclonal antibody
MAF
Macrophage-activating factor
MC
Molluscum contagiosum
MDT
Multidrug therapy
MFP
Mouse foot pad
MHC
Major histocompatibility complex
MIF
Migration inhibitory factor
MI
Morphological index
MP
Metacarpophalangeal
MRI
Magnetic resonance imaging
NCDR
New case detection rate
NCS
Nerve conduction study
NCV
Nerve conduction velocity
NGOs
Non-governmental organizations
NLEP
National Leprosy Eradication Program
NSAIDs
Non-steroidal anti-inflammatory drugs
PABA
Para-aminobenzoic acid
PAS
Periodic acid-Schiff
PCR
Polymerase chain reaction
PDIM
Phthiocerol dimycocerosate
PGL-1
Phenolic glycolipid-1
PMH
Progressive macular hypomelanosis
PMNL
Polymorphonuclear leukocyte
PPD
Purified protein derivative
RF
Rheumatoid factor
RFT
Release from treatment
RT-PCR
Reverse transcription polymerase chain reaction
SACT
Serum antibody competition test
SET
Survey education and treatment
SLE
Systemic lupus erythematosus
SLPB
Single lesion paucibacillary
SSS
Slit-skin smear
SWMT
Semmes-Weinstein monofilament testing
TAP
Transporter associated with antigen processing
TB
Tuberculosis
TLR
Toll-like receptor
TNF
Tumor necrosis factor
TTp
Polar tuberculoid
VNTR
Variable number tandem repeat
WHA
World Health Assembly
WHO
World Health Organization
ZN
Ziehl-Neelsen