MTE DV: 9. KUSTA (dr Subagio, SpKK)

Summary

The video discusses a variety of medical topics, primarily focusing on leprosy (kusta) and its diagnosis and treatment. It covers clinical examinations, including sensory and motor testing, as well as the importance of early detection and prevention of disability. The video also delves into different testing methods, such as microbiological and serological examinations, and the use of multi-drug therapy (MDT) in managing leprosy. Additionally, it explains the immunological reactions of leprosy, including the acute reactions and their impact on the patient’s condition. Overall, the video serves as a comprehensive guide to understanding leprosy diagnosis and treatment.

Takeaways

• 😀 The diagnosis of leprosy involves multiple clinical and laboratory techniques, including sensory and motor tests, microbiological examination (BTA), and serology (PGL).
• 😀 Sensory testing in leprosy includes assessing pain, temperature, and pressure perception using cotton, needles, and temperature stimuli.
• 😀 Motor testing evaluates muscle strength and function, including facial muscles and extremities, to detect abnormalities or paralysis.
• 😀 The presence of nerve thickening, such as in the sternocleidomastoid or epicondylus, is a clinical indicator of leprosy-related neuropathy.
• 😀 The laboratory test BTA (bacillus acid-fast) is used for detecting Mycobacterium leprae in tissue samples, and it helps classify the disease.
• 😀 Serological tests measure antibodies like PGL-1 (phenolic glycolipid-1), which are elevated in individuals with leprosy, aiding in diagnosis.
• 😀 Pathology assessments, such as histopathological examinations, help differentiate between different leprosy types, like tuberculoid and lepromatous.
• 😀 Leprosy reactions, particularly erythema nodosum leprosum (ENL), are acute inflammatory episodes that can cause further nerve damage and disability.
• 😀 Treatment of leprosy involves multi-drug therapy (MDT), including rifampicin, ofloxacin, minocycline, and dapsone, tailored to the patient's clinical presentation.
• 😀 Reactions to treatment may cause fluctuations in the disease's severity, with ‘upgrading’ (improvement) and ‘downgrading’ (worsening) of symptoms based on immune response.
• 😀 Multi-drug therapy for leprosy should be continued according to the prescribed regimen to prevent resistance and ensure effectiveness, typically over a six-month period for paucibacillary cases.

Q & A

What is leprosy, and how does it affect the body?

Leprosy, or *Mycobacterium leprae* infection, is a chronic disease that primarily affects the skin, nerves, and mucous membranes. It can lead to sensory and motor nerve damage, causing skin lesions, numbness, and, if untreated, deformities or disabilities.

How can sensory deficits be tested in a patient with suspected leprosy?

Sensory testing in leprosy involves checking the ability to perceive stimuli like temperature (hot/cold), pain (using a needle or cotton), and touch (using a cotton swab). If the patient is unable to differentiate these stimuli after multiple attempts, it indicates potential nerve damage.

What are the motor tests used to assess leprosy patients?

Motor tests involve checking muscle strength, such as the ability to close the eyelids or make hand and foot movements. Weakness or inability to perform these actions could indicate nerve impairment, often associated with leprosy.

What is the purpose of microbiological testing (BTA) in diagnosing leprosy?

BTA (Bacillus Acid Fast Test) is used to detect *Mycobacterium leprae* in skin biopsies or other samples. The presence of acid-fast bacilli confirms the diagnosis of leprosy.

What is the significance of serological testing in leprosy diagnosis?

Serological testing detects antibodies like PGL1, which are specific to *Mycobacterium leprae*. A positive result helps confirm leprosy, particularly in cases where clinical signs are unclear.

How are leprosy reactions classified, and what are their implications?

Leprosy reactions are classified into two types: Type 1 (Reversal Reactions) and Type 2 (Erythema Nodosum Leprosum). Type 1 involves changes in the immune response, which can either improve (upgrading) or worsen (downgrading) the condition. Type 2 causes painful nodules on the skin and is associated with the multibacillary form of leprosy.

What is the role of multidrug therapy (MDT) in leprosy treatment?

MDT is the standard treatment for leprosy and involves a combination of drugs. For paucibacillary leprosy, it includes rifampicin, ofloxacin, and minocycline. For multibacillary leprosy, rifampicin, dapsone, and clofazimine are used. MDT helps to kill the bacteria and prevent resistance.

What is the difference between paucibacillary and multibacillary leprosy?

Paucibacillary leprosy is characterized by 1-5 skin lesions and a negative or low bacterial load. Multibacillary leprosy involves more than 5 lesions and a higher bacterial load, requiring a more intensive treatment regimen.

What is the treatment regimen for paucibacillary leprosy?

For paucibacillary leprosy, the treatment consists of a single dose of rifampicin (600 mg), ofloxacin (400 mg), and minocycline (100 mg). This combination is taken once and is effective for most patients with few lesions.

What should be done if a leprosy patient experiences a reaction during treatment?

If a reaction occurs during treatment, such as erythema nodosum leprosum or reversal reactions, corticosteroids like prednisolone are used to manage inflammation. The dosage is adjusted based on the severity of the reaction and the patient's response.