Leprosy physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
Leprosy may have different presentations, depending on the [[immune response]] of the | Leprosy may have different presentations, depending on the [[immune response]] of the host. The disease often affects the [[skin]], [[nerves]], and [[mucous membranes]] in different patterns and with different intensities. The possible physical findings of the disease include:<ref name="pmid16450473">{{cite journal| author=Elinav H, Palladas L, Applbaum YH, Gilead L, Moses AE, Cohen-Poradosu R| title=Plantar ulcers and eyebrow-hair paucity. | journal=Clin Infect Dis | year= 2006 | volume= 42 | issue= 5 | pages= 684-5, 722-4 | pmid=16450473 | doi=10.1086/502983 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16450473 }} </ref><ref name=CDC>{{cite web | title = Hansen's Disease (Leprosy) Signs and Symptoms | url = http://www.cdc.gov/leprosy/symptoms/index.html }}</ref><ref name="pmid16707521">{{cite journal| author=Daniel E, Ffytche TJ, Kempen JH, Rao PS, Diener-West M, Courtright P| title=Incidence of ocular complications in patients with multibacillary leprosy after completion of a 2 year course of multidrug therapy. | journal=Br J Ophthalmol | year= 2006 | volume= 90 | issue= 8 | pages= 949-54 | pmid=16707521 | doi=10.1136/bjo.2006.094870 | pmc=PMC1857220 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16707521 }} </ref><ref name="EichelmannGonzález González2013">{{cite journal|last1=Eichelmann|first1=K.|last2=González González|first2=S.E.|last3=Salas-Alanis|first3=J.C.|last4=Ocampo-Candiani|first4=J.|title=Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment|journal=Actas Dermo-Sifiliográficas (English Edition)|volume=104|issue=7|year=2013|pages=554–563|issn=15782190|doi=10.1016/j.adengl.2012.03.028}}</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
* [[Fatigue]] is often present | * [[Fatigue]] is often present | ||
* [[Weight loss]] is often present | * [[Weight loss]] is often present | ||
* [[Anhidrosis]] may be present | * [[Anhidrosis]] may be present | ||
===Vitals=== | ===Vitals=== | ||
* A [[fever]] may be present | * A [[fever]] may be present | ||
===Skin=== | ===Skin=== | ||
* Painless cuts, [[wounds]] and [[burns]] are often present, predominantly on the [[hands]], [[arm]]s, [[legs]] and [[feet]] | * Painless cuts, [[wounds]] and [[burns]] are often present, predominantly on the [[hands]], [[arm]]s, [[legs]] and [[feet]] | ||
* In ''tuberculoid leprosy'' (or ''paucibacillar'' in the [[WHO]] classification), larger [[Hypopigmentation|hypopigmented]] or [[erythematous]] [[macules]] are often present. | * In ''tuberculoid leprosy'' (or ''paucibacillar'' in the [[WHO]] classification), larger [[Hypopigmentation|hypopigmented]] or [[erythematous]] [[macules]] are often present. | ||
* In ''borderline tuberculoid leprosy'' (or ''paucibacillar'' in the [[WHO]] classification), macules are often sharply defined with a central clearing, more numerous than the in previous category and generally located on one side of the body | * In ''borderline tuberculoid leprosy'' (or ''paucibacillar'' in the [[WHO]] classification), macules are often sharply defined with a central clearing, more numerous than the in previous category and generally located on one side of the body | ||
* In ''mid-borderline'' and ''lepromatous leprosy'' (or ''multibacillar'' in the [[WHO]] classification) [[lesions]], central area is often [[anesthetic]] | * In ''mid-borderline'' and ''lepromatous leprosy'' (or ''multibacillar'' in the [[WHO]] classification) [[lesions]], central area is often [[anesthetic]] | ||
* In ''borderline lepromatous leprosy'', [[lesions]] are often [[erythematous]] [[macules]] and/or [[papules]], symmetrically distributed throughout the [[body]]. [[Nodular]] lesions are often present and there may be areas of normal [[skin]] between the [[lesions]], however, the margins of the [[lesions]] are often diffuse, instead of well-defined. Larger [[lesions]] often have an asymmetrical diffusion | * In ''borderline lepromatous leprosy'', [[lesions]] are often [[erythematous]] [[macules]] and/or [[papules]], symmetrically distributed throughout the [[body]]. [[Nodular]] lesions are often present and there may be areas of normal [[skin]] between the [[lesions]], however, the margins of the [[lesions]] are often diffuse, instead of well-defined. Larger [[lesions]] often have an asymmetrical diffusion | ||
* In ''lepromatous leprosy'', lesions are often generalized throughout the [[body]] and be of [[macular]], [[papular]] or [[nodular]] origin. In this class of leprosy, there is often loss of [[body hair]], particularly of the [[eyebrows]] and [[eyelashes]] | * In ''lepromatous leprosy'', lesions are often generalized throughout the [[body]] and be of [[macular]], [[papular]] or [[nodular]] origin. In this class of leprosy, there is often loss of [[body hair]], particularly of the [[eyebrows]] and [[eyelashes]] | ||
* In ''indeterminate leprosy'', [[lesions]] are often [[Hypopigmentation|hypopigmented]] or [[erythematous]] [[macules]], with [[loss of sensation|diminished sensation]] | * In ''indeterminate leprosy'', [[lesions]] are often [[Hypopigmentation|hypopigmented]] or [[erythematous]] [[macules]], with [[loss of sensation|diminished sensation]] | ||
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===Head=== | ===Head=== | ||
* [[Facial paralysis]] may be present | * [[Facial paralysis]] may be present | ||
* Lack of [[eyebrows]] and [[eyelashes]] may be present | * Lack of [[eyebrows]] and [[eyelashes]] may be present | ||
* Lumps are often present, predominantly on the [[face]] | * Lumps are often present, predominantly on the [[face]] | ||
===Eyes=== | ===Eyes=== | ||
* [[Lagophthalmos]] is often present | * [[Lagophthalmos]] is often present | ||
* Dry [[cornea]]s are often present | * Dry [[cornea]]s are often present | ||
* [[Corneal abrasion]] is often present | * [[Corneal abrasion]] is often present | ||
* [[Corneal ulcer|Corneal ulceration]] is often present | * [[Corneal ulcer|Corneal ulceration]] is often present | ||
* [[Blindness]] may be present | * [[Blindness]] may be present | ||
===Ears=== | ===Ears=== | ||
* [[Nodular]] thickening of the [[earlobe]]s may be present | * [[Nodular]] thickening of the [[earlobe]]s may be present | ||
===Nose=== | ===Nose=== | ||
* Collapsed [[nose]] ([[saddle nose]]) may be present, particularly in ''lepromatous leprosy''. | * Collapsed [[nose]] ([[saddle nose]]) may be present, particularly in ''lepromatous leprosy''. | ||
* Perforated [[nasal septum]] may be present | * Perforated [[nasal septum]] may be present | ||
* Invasion of the nasal mucous may be present, particularly in ''lepromatous leprosy'', imitating [[Nasal congestion|nasal stuffiness]] | * Invasion of the nasal mucous may be present, particularly in ''lepromatous leprosy'', imitating [[Nasal congestion|nasal stuffiness]] | ||
* [[Epistaxis]] may be present | * [[Epistaxis]] may be present | ||
===Extremities=== | ===Extremities=== | ||
* [[Weakness]] of the [[hands]] and [[feet]] may be present | * [[Weakness]] of the [[hands]] and [[feet]] may be present | ||
* Claw [[fingers]] are often present | * Claw [[fingers]] are often present | ||
* [[Foot drop]] is often present | * [[Foot drop]] is often present | ||
* [[Edema]] of the [[hands]] and [[feet]] may be present | * [[Edema]] of the [[hands]] and [[feet]] may be present | ||
* [[Fractures]] may be present | * [[Fractures]] may be present | ||
===Neurologic=== | ===Neurologic=== | ||
* [[Sensory loss|Sensory]] and/or [[Motor neuron|motor]] loss are often present, predominantly on [[skin lesions]] and on the territories located after enlarged [[peripheral nerves]]: | * [[Sensory loss|Sensory]] and/or [[Motor neuron|motor]] loss are often present, predominantly on [[skin lesions]] and on the territories located after enlarged [[peripheral nerves]]: | ||
:* In ''tuberculoid leprosy'' this often occurs in the vicinity of the [[skin lesion]] | :* In ''tuberculoid leprosy'' this often occurs in the vicinity of the [[skin lesion]] | ||
:* In ''lepromatous leprosy'' this loss is often more generalized | :* In ''lepromatous leprosy'' this loss is often more generalized | ||
* [[Paresthesias]] are often present, predominantly in the [[hands]] and [[feet]] | * [[Paresthesias]] are often present, predominantly in the [[hands]] and [[feet]] | ||
* [[Tenderness|Tender]] and/or enlarged [[peripheral nerves]] are often present | * [[Tenderness|Tender]] and/or enlarged [[peripheral nerves]] are often present | ||
* Painful [[neuropathy]] may be present | * Painful [[neuropathy]] may be present | ||
==References== | ==References== | ||
Revision as of 18:37, 7 July 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Physical examination will depend on the class of leprosy in each patient and may include findings such as hypopigmented skin lesions, usually macular or papular, thickened dermis, loss of sensation or peripheral nerve thickening, with common evolvement of the nasal mucosa.
Physical Examination
Leprosy may have different presentations, depending on the immune response of the host. The disease often affects the skin, nerves, and mucous membranes in different patterns and with different intensities. The possible physical findings of the disease include:[1][2][3][4]
Appearance of the Patient
- Fatigue is often present
- Weight loss is often present
- Anhidrosis may be present
Vitals
- A fever may be present
Skin
- Painless cuts, wounds and burns are often present, predominantly on the hands, arms, legs and feet
- In tuberculoid leprosy (or paucibacillar in the WHO classification), larger hypopigmented or erythematous macules are often present.
- In borderline tuberculoid leprosy (or paucibacillar in the WHO classification), macules are often sharply defined with a central clearing, more numerous than the in previous category and generally located on one side of the body
- In mid-borderline and lepromatous leprosy (or multibacillar in the WHO classification) lesions, central area is often anesthetic
- In borderline lepromatous leprosy, lesions are often erythematous macules and/or papules, symmetrically distributed throughout the body. Nodular lesions are often present and there may be areas of normal skin between the lesions, however, the margins of the lesions are often diffuse, instead of well-defined. Larger lesions often have an asymmetrical diffusion
- In lepromatous leprosy, lesions are often generalized throughout the body and be of macular, papular or nodular origin. In this class of leprosy, there is often loss of body hair, particularly of the eyebrows and eyelashes
- In indeterminate leprosy, lesions are often hypopigmented or erythematous macules, with diminished sensation
 |
Head
- Facial paralysis may be present
- Lack of eyebrows and eyelashes may be present
- Lumps are often present, predominantly on the face
Eyes
- Lagophthalmos is often present
- Dry corneas are often present
- Corneal abrasion is often present
- Corneal ulceration is often present
- Blindness may be present
Ears
Nose
- Collapsed nose (saddle nose) may be present, particularly in lepromatous leprosy.
- Perforated nasal septum may be present
- Invasion of the nasal mucous may be present, particularly in lepromatous leprosy, imitating nasal stuffiness
- Epistaxis may be present
Extremities
- Weakness of the hands and feet may be present
- Claw fingers are often present
- Foot drop is often present
- Edema of the hands and feet may be present
- Fractures may be present
Neurologic
- Sensory and/or motor loss are often present, predominantly on skin lesions and on the territories located after enlarged peripheral nerves:
- In tuberculoid leprosy this often occurs in the vicinity of the skin lesion
- In lepromatous leprosy this loss is often more generalized
- Paresthesias are often present, predominantly in the hands and feet
- Tender and/or enlarged peripheral nerves are often present
- Painful neuropathy may be present
References
- ↑ Elinav H, Palladas L, Applbaum YH, Gilead L, Moses AE, Cohen-Poradosu R (2006). "Plantar ulcers and eyebrow-hair paucity". Clin Infect Dis. 42 (5): 684–5, 722–4. doi:10.1086/502983. PMID 16450473.
- ↑ "Hansen's Disease (Leprosy) Signs and Symptoms".
- ↑ Daniel E, Ffytche TJ, Kempen JH, Rao PS, Diener-West M, Courtright P (2006). "Incidence of ocular complications in patients with multibacillary leprosy after completion of a 2 year course of multidrug therapy". Br J Ophthalmol. 90 (8): 949–54. doi:10.1136/bjo.2006.094870. PMC 1857220. PMID 16707521.
- ↑ Eichelmann, K.; González González, S.E.; Salas-Alanis, J.C.; Ocampo-Candiani, J. (2013). "Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment". Actas Dermo-Sifiliográficas (English Edition). 104 (7): 554–563. doi:10.1016/j.adengl.2012.03.028. ISSN 1578-2190.