Aljohin
Mjek. Psikiater.
Regjistruar: 07/07/2003
Vendbanimi: Padova
Mesazhe: 576
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patients had not reported a previous diagnosis of
leprosy. Twenty-one of 28 patients seen by a dermatologist
were promptly given the diagnosis. Similarly,
Nations et al.
pointed out that physicians in
the United States may lack familiarity with the disease,
with resulting delays in diagnosis.
Dr. Nesli Basgoz
(Infectious Disease): This patient
was referred to the infectious-disease clinic. On examination,
she was found to have a large hypopigmented
area with heaped-up borders on her back
and a similar, smaller lesion on her left arm (Fig. 4).
Both were anesthetic. She recalled having been told
15 years ago that she had a small hypopigmented
area on her back. This protracted time course illustrates
the fact that the cutaneous and nerve-related
manifestations of leprosy can progress very slowly,
because of the slow growth of the organism.
Most patients with leprosy have borderline leprosy.
Our patient had some features of tuberculoid
leprosy, including a small number of skin lesions
with elevated edges and some evidence of granuloma
formation on biopsy. However, she also had a
polyneuropathy and shiny skin, which are consistent
with some dermal infiltration, and there were
many acid-fast bacilli in the nerve-biopsy specimen
features more suggestive of the lepromatous
form of the disease. Therefore, she most likely had
borderline leprosy.
As was the case with this patient, most cases of
leprosy are not diagnosed by infectious-disease specialists
but, rather, by internists, neurologists, and
dermatologists. If any physician sees a patient from
an area where this infection is endemic (Asia, Africa,
the Pacific Islands, or South America) who has unexplained
skin lesions, particularly if they are anesthetic
or if there are accompanying neuropathies, it
is important to consider leprosy. Early diagnosis and
treatment can help prevent the neuropathic and other
complications of untreated leprosy.
Although leprosy is a much-feared disease, it is
not particularly infectious. The organisms are present
in the skin at the level of the dermis, so touching
the surface of the skin is without risk. The most
likely mode of transmission is respiratory, through
contact with nasal secretions. In areas where the
infection is endemic, clinical disease will develop
in only about 1 in 350 people who are infected with
M. leprae
. Once treatment is initiated, there is a rapid
disappearance of organisms from the nose, so
there is no indication for isolation.
In the current case, we treated the patient with
dapsone and rifampin. After nine months of treatment,
she continues to have slow improvement in
the pain and numbness in her hands and feet, as
well as improvements in motor strength. The skin
lesions have become less distinct. Treatment will
continue for several years.
anatomical diagnosis
Borderline leprosy.
addendum
At follow-up 14 months after the initiation of treatment,
the patients skin lesions had almost completely
resolved. The anesthetic areas on the dorsum
of the hands and feet had become sensitive to touch.
Her motor strength was normal.
__________________
"I believe there are more instances of the abridgement of the freedom of the people by gradual and silent encroachments of those in power than by violent and sudden usurpations." James Madison
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02 Shkurt 2006 17:13
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Forumi Horizont > Shkenca > Mjekėsia > Diagnoze
