Upload
tokekkompie
View
226
Download
0
Embed Size (px)
Citation preview
8/17/2019 PIT IDI KUSTA.pdf
1/29
8/17/2019 PIT IDI KUSTA.pdf
2/29
Leprosy :
- Chronic infection
- Cause : M.leprae
- Primarily attackperipheral nerve,
secondarily attack
other organs,
including nasalcavity
Mycobacterium leprae
8/17/2019 PIT IDI KUSTA.pdf
3/29
8/17/2019 PIT IDI KUSTA.pdf
4/29
1. skin patch with loss of sensation
2. enlarged peripheral nerve
3. positive slit-skin smear
Physical examination will diagnose leprosy in most casesPhysical examination plus skin smear will diagnose
leprosy in the vast majority of cases
The cardinal signs of leprosy
8/17/2019 PIT IDI KUSTA.pdf
5/29
5
The 1st cardinal sign of leprosy
Skin patch with loss ofsensation• Hypopigmented
•
Erythematous
8/17/2019 PIT IDI KUSTA.pdf
6/29
Enlarged
greatauricularnerve
8/17/2019 PIT IDI KUSTA.pdf
7/29
8/17/2019 PIT IDI KUSTA.pdf
8/29
Bacterial Index (BI) : total number of bacilli ( 1+ to 6+ )Morphological Index (MI) : % of solid staining bacilli,number of viable bacilli
SOLID
GRANULAR FRAGMENTED
8/17/2019 PIT IDI KUSTA.pdf
9/29
8/17/2019 PIT IDI KUSTA.pdf
10/29
Penyakit sudah lama / kronis :sudah bbrp bulan / tahun
Tidak gatal, tidak nyeri Adanya sumber penularanPasien berasal dari daerah
endemik kustaSudah dicoba dengan berbagai
salep
8/17/2019 PIT IDI KUSTA.pdf
11/29
Light touchTemperature discrimination
Pain (pin prick)
Decreasedsweating
CLINICALEXAMINATION
8/17/2019 PIT IDI KUSTA.pdf
12/29
Palpation ulnar nerve
8/17/2019 PIT IDI KUSTA.pdf
13/29
BILA SEMUA HASILPEMERIKSAAN MERAGUKAN :
Alternatif :1. Dirujuk ke dokter yg lebih
ahli.2. Ditunggu sampai cardinal
sign muncul, baru diobati
3. Periksa laboratorik tambahan.
8/17/2019 PIT IDI KUSTA.pdf
14/29
MENUNGGU SAMPAIKAPAN ?
- Sebaiknya evaluasisetiap 3 bulan tanpa terapi
- Bila sampai 6 bulan tidak ada perubahan, namun
dokter tetap curiga M.H. :BOLEH diberi obat anti kusta
8/17/2019 PIT IDI KUSTA.pdf
15/29
TUBERCULOID BORDERLINE LEPROMATOUS
CELLULAIRIMMUNITY
HUMORALIMMUNITY
CLINICAL SPECTRUM OF LEPROSY
AFB
Number
8/17/2019 PIT IDI KUSTA.pdf
16/29
Ridley & Jopling (1964) :
TT BT BB BL LL
WHO ( 1980 )
KLASIFIKASI PENYAKIT KUSTA
8/17/2019 PIT IDI KUSTA.pdf
17/29
Pitiriasis Versicolor
Pityriasis alba
Birth MarkM TT
8/17/2019 PIT IDI KUSTA.pdf
18/29
DIAGNOSA BANDING M.H.
MH BT-
type
Pityriasis RoseaTinea Pedis
8/17/2019 PIT IDI KUSTA.pdf
19/29
Erythro-Papulo-Squamous lesions
MH-BB type
Psoriasis
Lues II
8/17/2019 PIT IDI KUSTA.pdf
20/29
Charcot Marie Tooth Disease :
( genetic peripheral nerve disorder)
8/17/2019 PIT IDI KUSTA.pdf
21/29
1. Bacteriological Examination 2. Histopathology ( skin biopsy) 2. Serological Examination 3. Molecular Biology tests :
- Polymerase Chain Reaction / PCR
- Reverse Transcriptase / RT-PCR- DNA Sequencing for Drug Resistance- Genomic Study of M. leprae
8/17/2019 PIT IDI KUSTA.pdf
22/29
Detection of Anti PGL-1antibodies
Cut off value : IgM = 605 u/ml IgG = 650 u.ml
8/17/2019 PIT IDI KUSTA.pdf
23/29
INDICATION OF SEROLOGICALTEST IN LEPROSY :
• Diagnosis support of LeprosyLeprosy Classification
• Detection of SubclinicalInfection of Leprosy
• Treatment Evaluation
8/17/2019 PIT IDI KUSTA.pdf
24/29
SEROLOGICAL EXAMINATION INLEPROSY
8/17/2019 PIT IDI KUSTA.pdf
25/29
FILTER PAPER METHOD
8/17/2019 PIT IDI KUSTA.pdf
26/29
FILTER PAPER METHOD
8/17/2019 PIT IDI KUSTA.pdf
27/29
POLYMERASE CHAIN REACTION( PCR ) IN LEPROSY
NON-TYPICAL LEPROSYSKIN LESION
INDICATION :Detection of M. Leprae DNA in the samples
- skin slit preparation- blood- nasal swab- biopsy tissues etc.
8/17/2019 PIT IDI KUSTA.pdf
28/29
spl1 spl2 spl 3 spl 4 spl 5 Marker Negatip Positip
(-) (-) (+) (+) (+) (ladder) kontrol kontrol
99bsp
PCR test for M.leprae : sensitivity up to 90%
8/17/2019 PIT IDI KUSTA.pdf
29/29
Thank You…