Tuberculoid Leprosy

One description of a clinical picture that results from tuberculoid leprosy is characterized by intact cell-mediated immunity, a positive lepromin skin reaction, granuloma formation, and a relative paucity of bacilli. At the other extreme, lepromatous leprosy is characterized by depressed cell-mediated immunity, numerous bacilli within the tissues, no granulomas, and a negative skin test for lepromin. Within these two extremes are the patients with an intermediate or borderline form of leprosy who show a variable lepromin reaction and few bacilli they may progress to either tuberculoid or lepromatous leprosy. 

Five forms of leprosy ate recognized, and a person may progress from one form to another. The least setioirs form is tubercrrloid leprosy. In this form, the skin lesions and nerve dam e ate minor. Tubercrrloid leprosy is evidence that the body s cellular immune response—the part of the immune system that seeks out and destroys infected cells—is working at a high level of efficiency. Tuberculoid leprosy is easily cured with antibiotics. 

Lepromatous leprosy occurs in people who exhibit an efficient antibody response to M. leprae but an inefficient cellular immune response. The antibody arm of the immune system is not useful in neutralizing intracellular pathogens such as M. leprae therefore, people who initially react to invasion by M. leprae by making antibodies may be at risk for developing more severe forms of leprosy. Researchers are not sure what determines whether a person will react with a cellular response or an antibody response current evidence suggests that the cellular immune response may be controlled by a special gene. If a person has this gene, he or she will probably develop the less severe tuberculoid leprosy if exposed to M. leprae. 

Tuberculoid leprosy—The least severe from of leprosy, characterized by a few skin lesions and little nerve damage. 

A man developed several erythematous plaques on his face due to borderline tuberculoid leprosy with a reversal reaction (31). He had severe CD4 T cell... 

Lawn SD, Wood C, Lockwood DN. Borderline tuberculoid leprosy an immune reconstitution phenomenon in a human immunodeficiency virus-infected person. Clin Infect Dis 2003 36(l) e5-6. 

Leprosy is a continuum between two extremes. At one end of the spectrum is tuberculoid leprosy, characterized by skin macules with clear centers and well-defined margins. M. leprae is rarely found in smears made from quiescent lesions but may appear during activity. Noncaseating foci are present. The patient s cell-mediated immunity is normal, and a skin test for infection by leprosy is invariably positive. The disease is characterized by prolonged remissions with periodic reactivation. 

Twelve patients with quiescent tuberculoid leprosy were given dapsone 300 mg with probenecid 500 mg, and 5 hours later another 300-mg dose of dapsone. At 4 hours, the dapsone serum levels were raised about 50%. The urinary excretion of dapsone and its metabolites were reduced. ... 

Hemolytic anemia, rash, and liver damage may occur even with normal doses. In cases of overdosage, headache, vomiting, insomnia, and tachycardia are possible. Reactions may occur in leprosy with or without therapy. In lepromatous leprosy there is erythema nodosum, fever, and in some cases severe malaise. In tuberculoid leprosy the pain increases. About 50% of the treated patients with lepromatous leprosy show erythema nodosum within the 1st year, lasting for 2 weeks. As a rule, therapy with sulfones in combination with clofazimine may be continued in spite of the erythema nodosum. Analgetics, corticosteroids, and thalidomide are suitable for the treatment of leprosy reactions (Rea and Levan 1975). 

Patients with tuberculoid leprosy have localised lesions with scanty organisms and a strong delayed type hypersensitivity against M. leprae which leads to granuloma formation. 

A 37-year-old woman with RA receiving an anti-TNF agent developed a rash on her back and both legs that was finally diagnosed as tuberculoid leprosy [25 ]. This was the first case report of leprosy due to anti-TNF therapy... 

Leprosy (Hansen s disease) is a chronic granulomatous disease that attacks superficial tissues such as the skin, nasal mucosa, and peripheral nerves. There are two types of leprosy, lepromatous and tuberculoid. The sulfones, which are derivatives of 4,4 -diaminodiphenylsulfone, are bacteriostatic. 

Dapsone is u.sed in the treatment of both lepromatous and tuberculoid types of lcpro.sy. Dapsone is used widely for all forms of leprosy, often in combination with clofazimine and rifampin. Initial treatment often includes rifampin with dap-.sone. followed by dapsone alone. It is also u.s to prevent the occurrence of multibacillary lcpro.sy when given prophy-lactically. 

Isoniazid is ineffective in the treatment of leprosy or M. avium complex infection. Lepromatous (multibacillary) leprosy is treated with dapsone, clofazimine, and rifampin for a minimum of 2 years, whereas tuberculoid (pauciba-cillary) leprosy is treated with dapsone and rifampin for 6 months. 

Its mechanism of action is very much similar to that of sulphanilamide. It is employed profusely in the treatment of both lepromatous and tuberculoid types of leprosy. However, in combination with rifampin, it is regarded as the drug of choice in the chemotherapy of leprosy. Besides, the combination with clofazimine affords a similar therapeutic effect. The drug is the most preferred sulfone because of the two cardinal facts, such as (a) cost-effective and b) equally efficacious to other sulfones. 

Hansen s disease The preferred name for leprosy, caused by Mycobacterium leprae, it exhibits various clinical forms ranging from tuberculoid to lepromatous. 

Tuberculoid Referring to the anesthetic form of Hansen s disease leprosy in which areas of skin lose pigment and sensation. 

Leprosy is probably the best example of a disease that has a spectrum ranging from the anergic to the hypersensitive forms. In tuberculoid form the organised epithelioid cell granulomas are due mainly to the specific cell-mediated immunity. 

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