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    KUsta PDF

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    TokekKompie
    This document discusses diagnosing uncertain cases of leprosy. It emphasizes the importance of physical examination and tests like slit skin smears to diagnose most cases. When results are unclear, alternatives include referral to a specialist, repeated examinations over time, or additional laboratory tests like bacteriological, serological, or molecular exams. Diagnostic uncertainty should not delay treatment for more than 6 months if the doctor still suspects leprosy. A variety of differential diagnoses are also presented to aid in distinguishing leprosy from other conditions.

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    KUsta PDF

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    162 views29 pages
    This document discusses diagnosing uncertain cases of leprosy. It emphasizes the importance of physical examination and tests like slit skin smears to diagnose most cases. When results are unclear, alternatives include referral to a specialist, repeated examinations over time, or additional laboratory tests like bacteriological, serological, or molecular exams. Diagnostic uncertainty should not delay treatment for more than 6 months if the doctor still suspects leprosy. A variety of differential diagnoses are also presented to aid in distinguishing leprosy from other conditions.

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    This document discusses diagnosing uncertain cases of leprosy. It emphasizes the importance of physical examination and tests like slit skin smears to diagnose most cases. When results are unclear, alternatives include referral to a specialist, repeated examinations over time, or additional laboratory tests like bacteriological, serological, or molecular exams. Diagnostic uncertainty should not delay treatment for more than 6 months if the doctor still suspects leprosy. A variety of differential diagnoses are also presented to aid in distinguishing leprosy from other conditions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    162 views29 pages

    KUsta PDF

    Uploaded by

    TokekKompie
    This document discusses diagnosing uncertain cases of leprosy. It emphasizes the importance of physical examination and tests like slit skin smears to diagnose most cases. When results are unclear, alternatives include referral to a specialist, repeated examinations over time, or additional laboratory tests like bacteriological, serological, or molecular exams. Diagnostic uncertainty should not delay treatment for more than 6 months if the doctor still suspects leprosy. A variety of differential diagnoses are also presented to aid in distinguishing leprosy from other conditions.

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    of 29

    KASUS KUSTA

    YANG
    MERAGUKAN :
    Bagaimana
    menegakkan
    diagnosa ?

    INDROPO AGUSNI

    Leprosy :
    - Chronic infection

    - Cause : M.leprae
    - Primarily attack

    peripheral nerve,
    secondarily attack

    other organs,
    including nasal

    cavity

    Mycobacterium leprae

    The cardinal signs of leprosy

    1. skin patch with loss of sensation

    2. enlarged peripheral nerve

    3. positive slit-skin smear

    Physical examination will diagnose leprosy in most cases


    Physical examination plus skin smear will diagnose
    leprosy in the vast majority of cases

    The 1st cardinal sign of leprosy


    Skin patch with loss of
    sensation

    Hypopigmented
    Erythematous

    Enlarged
    great
    auricular
    nerve

    BACTERIOLOGIAL EXAMINATION
    IN LEPROSY
    The slit and
    scrape
    method
    Incision, turn
    the blade 90
    degrees

    LOCATION :

    Courtesy from
    Dr. Colette van Hees

    Earlobe
    Chin
    Extensor forearm
    Dorsal fingers
    Buttocks
    Knees

    FRAGMENTED

    GRANULAR

    SOLID

    Bacterial Index (BI) : total number of bacilli ( 1+ to 6+ )


    Morphological Index (MI) : % of solid staining bacilli,
    number of viable bacilli

    KUSTA ?

    Penyakit

    sudah lama / kronis :


    sudah bbrp bulan / tahun
    Tidak gatal, tidak nyeri
    Adanya sumber penularan
    Pasien berasal dari daerah
    endemik kusta
    Sudah dicoba dengan berbagai
    salep

    CLINICAL
    EXAMINATION

    Decreased
    sweating

    Light touch
    Temperature discrimination
    Pain (pin prick)

    Palpation ulnar nerve

    BILA SEMUA HASIL


    PEMERIKSAAN MERAGUKAN :
    Alternatif :
    1. Dirujuk ke dokter yg lebih
    ahli.
    2. Ditunggu sampai cardinal
    sign muncul, baru diobati
    3. Periksa laboratorik
    tambahan.

    MENUNGGU SAMPAI
    KAPAN ?
    - Sebaiknya evaluasi
    setiap 3 bulan tanpa terapi
    - Bila sampai 6 bulan tidak
    ada perubahan, namun
    dokter tetap curiga M.H. :
    BOLEH diberi obat anti kusta

    CLINICAL SPECTRUM OF LEPROSY

    TUBERCULOID

    CELLULAIR
    IMMUNITY

    BORDERLINE

    LEPROMATOUS

    HUMORAL
    IMMUNITY

    AFB
    Number

    KLASIFIKASI PENYAKIT KUSTA

    Ridley & Jopling (1964) :

    TT

    BT

    BB

    WHO ( 1980 )

    BL

    LL

    MH- TT
    Birth Mark
    Pityriasis alba

    Pitiriasis Versicolor

    DIAGNOSA BANDING M.H.

    MH BTtype

    Pityriasis Rosea

    Tinea Pedis

    MH-BB type

    Psoriasis

    Lues II

    Erythro-Papulo-Squamous lesions

    Charcot Marie Tooth Disease :


    ( genetic peripheral nerve disorder)

    1.
    2.
    2.
    3.

    Bacteriological Examination
    Histopathology ( skin biopsy)
    Serological Examination
    Molecular Biology tests :
    Polymerase Chain Reaction / PCR
    Reverse Transcriptase / RT-PCR
    DNA Sequencing for Drug Resistance
    Genomic Study of M. leprae

    Detection of
    Anti PGL-1
    antibodies

    Cut off value :

    IgM = 605 u/ml

    IgG = 650 u.ml

    INDICATION OF SEROLOGICAL
    TEST IN LEPROSY :

    Diagnosis support of Leprosy


    Leprosy Classification

    Detection of Subclinical
    Infection of Leprosy

    Treatment Evaluation

    SEROLOGICAL EXAMINATION IN
    LEPROSY

    FILTER PAPER METHOD

    POLYMERASE CHAIN REACTION


    ( PCR ) IN LEPROSY
    INDICATION :
    Detection of M. Leprae
    DNA in the samples
    - skin slit preparation
    - blood
    - nasal swab
    - biopsy tissues etc.
    NON-TYPICAL LEPROSY
    SKIN LESION

    PCR test for M.leprae : sensitivity up to 90%

    99bsp
    spl1

    spl2

    spl 3

    spl 4

    spl 5

    Marker Negatip Positip

    (-)

    (-)

    (+)

    (+)

    (+)

    (ladder) kontrol kontrol

    Thank You

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