leprosy [prof. bambang sp. kk]
TRANSCRIPT
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
1/23
LEPROSY
Bambang SuhariyantoLab/ SMF. I.K.Kulit & Kelamin
FK. UNEJ/ RSUD. Dr.SoebandiJember
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
2/23
G.N.A HANSEN (1873)
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
3/23
How to diagnose and treat
leprosy?
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
4/23
How to examine for leprosy?
Examine in a well-lit room
Examine the whole body
Ask since when the patch was noticed Ask what treatments have been tried
Test for sensation
Look for any visible deformities
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
5/23
How to diagnose leprosy
Examine skin
Check for patches
Test for sensation Count the number
of patches
Look for damage
to nerves
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
6/23
Signs of leprosy
Pale or slightly reddish patch
Definite loss of sensation in the patch
Signs of damage to nerves
definite loss of sensation in hands/feet
weakness of muscles of hands/feet/face
visible deformity of hands/feet/face
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
7/23
Leprosy patches...
. Can be pale, reddish orcopper coloured
. Lack sensation to pain,
touch and heat
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
8/23
Leprosy patches ...
can be flat or raised
do not itch
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
9/23
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
10/23
What is not leprosy
Skin patches which
have normal feeling
are present from birth
cause itching
are white, black, dark red or silver coloured
show scaling
appear and disappear periodically
spread quickly
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
11/23
Classification of leprosy
PB MBSkin Lesion 2 to 5 > 5
Nerve Trunk One 2 to 5
Skin Smear Negative Negative or positive
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
12/23
Treating a patient with WHO MDT
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
13/23
Classification for treatment
Leprosy is diagnosed on finding a
definite loss of sensation in one or more
patches
When you have examined the wholebody, count the number of patches
1-5 patches is
paucibacillary (PB)
leprosy
More than 5 patches is
multibacillary (MB)
leprosy
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
14/23
Steps to start MDT
Classify as PB or MB leprosy
Inform the patient about the disease
Explain the MDT blister pack - show drugs to be takenonce a month and every day
Explain possible side effects (e.g. Darkening of skin) andpossible complications and when they must return tothe health centre
Ask the patient when it is convenient for him/her to
come back to the health centre. Give enough MDTblister packs to last until the next visit.
Fill out the patient treatment card
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
15/23
Treatment regimens
PB Adult
(Treatment: 6 blister packs)
Rifampicin 600 mg once a
month
Dapsone 100 mg every
day
MB Adult
(Treatment: 12 blister packs)
Rifampicin 600 mg once amonth
Clofazimine 300 mg once
a month
Clofazimine 50 mg and
dapsone 100 mg every
day
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
16/23
MDT side-effects
Red coloured urine
Darkening of skin
Severe itching of skin
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
17/23
IDENTITAS PENDERITA
Nama : Ny. S
No RM : 138471
Jenis kelamin : Perempuan
Umur : 35 tahun
Status : Menikah
Pekerjaan : Ibu Rumah Tangga Alamat : Lumajang
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
18/23
RESUME
Px perempuan, 35 tahun dg keluhan sejak 1 th yll muncul bercakkemerahan di pipi kiri salep oleh mantri tidakberkurang/menghilang, hanya warnanya menjadi tdk begitumerah. Karena tdk ada keluhan lainnya, maka bercak tersebutdibiarkan saja. Beberapa bln kemudian, muncul bercak2 di
kaki dg ukuran yg lebih kecil dbd bercak di wajah, tidak gataldan tidak nyeri berobat ke Puskesmas dan dikatakanalergi.
5 bln kemudian muncul bercak lagi di tangan dan di dada, tidakgatal, tidak nyeri. 3 bln kemudian px merasa tangannyabengkak dan saat dicubit sering tdk terasa sakit. Namun halini dibiarkan saja. Px merasa badannya terus lemah dansering gringgingan terutama di kaki dan tangan.
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
19/23
Bbrp mgg yll px merasa alisnya lebih tipis dari biasanya, bentuk
hidungnya berubah berobat ke RS dr. Soebandi. Sebelumnya tdk
pernah menderita penyakit spt ini. Namun px mengatakan pernah
kontak dg px kusta (tetangga dekat), 10 th yll. Kontak selama > 5th.
Pmx fisik lesi: > 5, efluoresensi: macula hiperpigmentasi,
hipoanestesi, ukuran lentikuler-numuler, bulat - lonjong, batas
tegas, simetris bilateral, pinggir eritematous, terdistribusi scr
general di regio fasialis didapatkan pula nodul simetris pd regio
torakal dan ekstremitas superior dan inferior. Madarosis (+), saddle
nose (+) dan fascies leonina (+) serta infiltrasi di kedua lobulus
auricula. Pada pmx saraf: penebalan N. Auricularis Magnus D/S, g3
sensasi raba didalam dan luar lesi, g3 sensasi nyeri di dalam lesi.Kulit terlihat iktiosis dan oedema di keempat ekstremitas. Kekuatan
motoris sedang. Pemeriksaan lab: BI +3 dan MI 70%.
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
20/23
DIAGNOSIS BANDING
1. Drug Eruption
2. Dermatitis Alergica
DIAGNOSIS KERJA
Kusta Tipe Multi basiler (LL)
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
21/23
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
22/23
silahkan bertanya
-
7/27/2019 Leprosy [Prof. Bambang Sp. KK]
23/23