Clinical Cases in Leprosy

Preface
Acknowledgements
Contents
Contributors
Part I: Basics
	Chapter 1: Clinical Classification of Leprosy
		Introduction
		Classification of Leprosy
			Criteria Deciding Classifications
		Types
			Ridley-Jopling Classification [1, 2]
			Indian Classification [4]
			New IAL Classification [5]
			WHO Classification (1988)
			WHO Classification (1998) [6]
			Current WHO Classification
			Classification Under NLEP, India (2009) [8]
		Conclusion
		References
	Chapter 2: Clinical Examination
		Introduction
		Clinical Examination
			General Examination
			Cutaneous Examination
				Number of Skin Lesions
				The Distribution of Skin Lesions
				Examination of Individual Skin Lesion
					Morphology
					Size
					Shape
					Margin/Edge of Skin Lesions
					Satellite Lesions
					Color of Lesion
					Surface
					Tenderness
					Anesthesia
			Examination of Peripheral Nerves
			Examination of Musculoskeletal System
			Motor Examination
				Muscle Strength Grading in Peripheral Centers
			Mucosal Examination
				Nasal Mucosa Examination
				Oral Mucosa Examination
				Ocular Examination
				Test for Lagophthalmos
			External Genital Examination
			Other Systemic Examination
		Conclusion
		References
	Chapter 3: Microbiological Investigations and Histopathology
		Introduction
			Slit Skin Smear (SSS) [1, 2]
		Histopathology
			Tuberculoid Leprosy (TT)
			Borderline Tuberculoid Leprosy
			Borderline Leprosy
			Borderline Lepromatous Leprosy
			Lepromatous Leprosy
			Indeterminate Leprosy
			Histoid Leprosy
			Pure Neural Leprosy
			Type 1 Reaction
				Upgrading Reaction
				Downgrading Reaction
			Type 2 Reaction (Erythema Nodosum Leprosum)
		Resolution [8]
		References
	Chapter 4: Electrophysiological and Radiological Investigations
		Introduction
		Electrophysiological Studies
		Nerve Conduction Study (NCS)
			Principles
			Interpretation
			NCS and Leprosy
		Electromyography (EMG)
			Principles
			Interpretation
			EMG and Leprosy
			Radiologic Examination
		Radiography of the Hands, Feet, and Face
			Hands and Feet
			Face
		High-Resolution Ultrasonography (HRUS)
			Principles
			Parameters Assessed
			Interpretation
		Magnetic Resonance Imaging
			Principles
			Interpretation
		Conclusion
		References
	Chapter 5: Serological and Molecular Investigations in Leprosy
		Introduction
			Overview
		Diagnosis of Leprosy
			Serological Investigations
			Phenolic Glycolipid-1 (PGL-1)
			35kD Protein
			M. Leprae Recombinant Proteins and Development of LID-1 and NDO-LID Rapid Test
			IgA Antibody-Based Test
			Cytokines/Chemokines as Biomarker in Leprosy
		Gene-Based Assays
			M. Leprae-Specific PCR
			Multiplex PCR (M-PCR)
			In Silico Molecular Techniques
			Loop-Mediated Isothermal Amplification (LAMP) Assay
		Conclusion
		References
	Chapter 6: Treatment of Leprosy and Lepra Reactions
		Introduction
		Historical Regimes
			Dapsone Monotherapy
			Rifampicin Monotherapy
			WHO MDT (WHO Multidrug Therapy)
			The WHO FD-MDT Regimen [14]
				Alternate Regimens (Non-WHO MDT)
			Newer MDT Regimens
				MB Cases
				PB Cases
			Accompanied MDT [20]
			Uniform MDT [21]
			Resistance to MDT
			Defaulter
			Relapse
		Treatment of Lepra Reaction
			Childhood Leprosy
			Leprosy and Pregnancy
			Leprosy and Tuberculosis
			Leprosy and Human Immunodeficiency Virus (HIV)
			Non-acceptance to Clofazimine
			Dapsone Toxicity
			Hepatosafe Regimen
		References
	Chapter 7: Counselling in Leprosy
		Introduction
		The Burden of Stigma and Mental Illness in Leprosy Affected
		What Does Counselling Mean
		Objectives of Counselling
			Counselling in Leprosy
			Interventions in Counselling
		References
	Chapter 8: Physical Rehabilitation in Leprosy
		Introduction
		Components of Physical Rehabilitation
		Assessment of Nerve Damage
		Primary and Secondary Impairments in Leprosy Due to Nerve Damage
			Eye-Hand-Feet (EHF) Scoring
			Occupational Therapy
		Prevention of the Progression of Impairment
			Exercises
			Splints
			Self-Care of Anesthetic Parts
				Ulcer Management
			Surgical Rehabilitation
				Nerve Surgery
				Reconstructive Surgery
		References
	Chapter 9: Community Rehabilitation in Leprosy
		Introduction
		The Holistic Rehabilitation
			Case Study from India
		Social Support from Self-Help Groups and in the Form of Microcredits
			Case Study from India
			Case Study from Odisha
			Way Forward
		References
Part II: Case Studies
	Chapter 10: Annular Erythematous Plaque on the Face in a Lady
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 11: 27-Year-Old Male with Hypopigmented Patch on the Left Thigh
		Clinical Presentation
		What Is the Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 12: Erythematous Plaque on the Lower Face
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 13: Annular Erythematous Plaque on the Right Hand
		Clinical Presentation
		What Is Your Diagnosis?
		Investigation
		Final Diagnosis
		Discussion
		Conclusion
		References
	Chapter 14: A 50-Year-Old Male with Multiple Hypopigmented Macules and Patches
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 15: Multiple Asymptomatic Nodules on the Body
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis: Lepromatous Leprosy
		Discussion
		References
	Chapter 16: Skin-Coloured Nodules and Atrophic Scars
		Clinical Presentation
		What Is Your Diagnosis?
		Investigation
		Final Diagnosis
		Discussion
		References
	Chapter 17: 70-Year-Old Male with Nodules over Frictional Areas
		Clinical Presentation
		What Is Your Diagnosis?
		Investigation
		Final Diagnosis
		Discussion
		References
	Chapter 18: A-30-Year-Old Male with Left Foot Drop
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 19: Asymptomatic Papules and Nodules Over the Body
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 20: An Asymptomatic Swelling on the Right Arm
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 21: A Female with Erythematous Plaques Over the Face and Trunk
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 22: Erythematous Plaques over Photo Exposed Areas
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 23: Painful Nodules and Cribriform Scars on the Body
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 24: Generalized Painful Erythematous Nodules
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 25: Sudden Onset Painful Ulcers in an Adult Female
		Clinical Presentation
		What Is Your Diagnosis?
		Investigation
		Final Diagnosis
		Discussion
		References
	Chapter 26: Multiple Annular Plaques
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 27: Non-healing Ulcer on the Sole
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 28: 40-Year-Old Male with Claw Hand
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 29: A 55-Year-Old Male with Foot Drop and Claw Toes
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 30: A 60-Year-Old Female with Corneal Opacity
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 31: Reticulate Purpura and Painful Ulcers
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 32: Asymptomatic Finger Swelling
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 33: Generalized Erythematous Edematous Plaques and Nodules
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 34: Generalized Pustulo-Ulcerative Lesions
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
	Chapter 35: Acral Nodules in an Elderly Male
		Clinical Presentation
		What Is Your Diagnosis?
		Investigations
		Final Diagnosis
		Discussion
		References
Index