Medical Microbiology

270 4 BacteriaasHumanPathogens

whichnoleprosyinfectionispresent).Theclinicallydifferentiatedinfection

courseformsobservedareprobablyduetoindividualimmuneresponsevariants.

Clinicalpicture.Leprosyismanifestedmainlyontheskin,mucosa,andpe-

ripheralnerves.

Aclinical differentiationis madebetween tuberculoidleprosy (TL,

Fig.4. 14 )andlepromatousleprosy(LL,Fig.4. 15 ).Therearemanyintermediate

forms.TListhebenign,nonprogressiveformcharacterizedbyspottydermal

lesions.TheLLform,ontheotherhand,ischaracterizedbyamalignant,pro-

gressivecoursewithnodularskinlesionsandcordlikenervethickeningsthat

finallyleadtoneuroparalysis.Theinflammatoryfocicontainlargenumbersof

leprosybacteria.

Diagnosis.Detectionofthepathogensinskinornasalmucosascrapingsun-

derthemicroscopeusingZiehl-Neelsenstaining(p. 21 2).Molecularconfir-

mationofDNAsequencesspecifictoleprosybacteriainapolymerasechain

reactionispossible.

Therapy.Paucibacillaryformsaretreatedwithdapsonplusrifampicinforsix

months.Multibacillaryformsrequiretreatmentwithdapson,rifampicin,and

clofazimineoveraperiodofatleasttwoyears.

LepromatousLeprosy

Fig.4. 15 Inlepromatousleprosy,nod-

ulardermalandmucosallesionsdevel-

op.Nerveinflammationandneuropara-

lysisfollow,eventuallyresultinginmuti-

lations.

4

Kayser, Medical Microbiology © 2005 Thieme