NExt microbiology: tuberculoid vs lepromatous infection
Tuberculoid leprosy and lepromatous leprosy are two distinct forms of leprosy, also known as Hansen's disease, caused by the bacterium Mycobacterium leprae. These forms of leprosy represent opposite ends of the clinical spectrum and are characterized by differences in immune response, clinical presentation, and bacterial load. Here's a comparison between tuberculoid leprosy and lepromatous leprosy:
**Tuberculoid Leprosy:**
1. **Immune Response:**
- Tuberculoid leprosy is characterized by a strong cell-mediated immune response. T cells play a key role in controlling the infection, leading to limited bacterial growth.
2. **Clinical Presentation:**
- Skin lesions in tuberculoid leprosy are usually well-defined, hypopigmented or reddish, and show loss of sensation. Nerves can be affected, leading to nerve damage and sensory loss.
- There may be a few, asymmetric, and well-demarcated skin lesions.
- Nerve involvement can cause sensory loss and muscle weakness in the affected areas.
3. **Bacterial Load:**
- The bacterial load in tuberculoid leprosy is relatively low, as the immune response is effective in containing the infection.
4. **Histopathology:**
- Granulomas are present in the affected tissues, indicating a strong immune response. These granulomas are composed of immune cells, mainly T cells.
5. **Transmission Risk:**
- Individuals with tuberculoid leprosy are less contagious and have a lower risk of transmitting the disease.
**Lepromatous Leprosy:**
1. **Immune Response:**
- Lepromatous leprosy is characterized by a weak cell-mediated immune response. The immune system is less effective in controlling bacterial growth.
2. **Clinical Presentation:**
- Lepromatous leprosy is characterized by numerous skin lesions that are symmetrically distributed. The lesions are usually nodular, erythematous, and infiltrative.
- Extensive skin involvement is common, and mucous membranes may be affected, leading to facial disfigurement.
- Nerve involvement can cause sensory loss and muscle weakness, similar to tuberculoid leprosy, but more severe.
3. **Bacterial Load:**
- The bacterial load in lepromatous leprosy is high, as the immune response is unable to contain the infection effectively.
4. **Histopathology:**
- Lepromatous leprosy is characterized by the presence of large numbers of M. leprae bacteria within macrophages and foamy cells, forming diffuse infiltrates in the skin and affected tissues.
5. **Transmission Risk:**
- Individuals with lepromatous leprosy are more contagious and have a higher risk of transmitting the disease.
**Treatment:**
Both forms of leprosy are treated with multi-drug therapy (MDT), a combination of antibiotics that effectively target M. leprae and lead to the cure of the disease. The treatment regimen and duration may vary based on the severity and type of leprosy.
It's important to note that leprosy exists on a spectrum, and there are intermediate forms that share features of both tuberculoid and lepromatous leprosy. The classification of leprosy is essential for determining the appropriate treatment and managing the disease's clinical manifestations.
Of course, here are 10 multiple-choice questions (MCQs) related to tuberculoid and lepromatous leprosy, along with their answers:
1. **Q: Tuberculoid leprosy is characterized by:**
- A) Strong cell-mediated immune response
- B) Weak humoral immune response
- C) Hyperpigmented skin lesions
- D) Involvement of mucous membranes
- **Answer: A) Strong cell-mediated immune response**
2. **Q: Lepromatous leprosy is associated with:**
- A) Strong cell-mediated immune response
- B) Weak humoral immune response
- C) Hypopigmented skin lesions
- D) Limited skin involvement
- **Answer: B) Weak humoral immune response**
3. **Q: Which type of leprosy is characterized by well-defined, hypopigmented or reddish skin lesions with nerve involvement?**
- A) Tuberculoid leprosy
- B) Lepromatous leprosy
- C) Intermediate leprosy
- D) Indeterminate leprosy
- **Answer: A) Tuberculoid leprosy**
4. **Q: What type of immune cells are mainly involved in controlling the infection in tuberculoid leprosy?**
- A) B cells
- B) Macrophages
- C) T cells
- D) Neutrophils
- **Answer: C) T cells**
5. **Q: Which of the following accurately describes the clinical presentation of lepromatous leprosy?**
- A) Well-defined skin lesions
- B) Loss of sensation in affected areas
- C) Erythematous and infiltrative nodules
- D) Asymmetric distribution of lesions
- **Answer: C) Erythematous and infiltrative nodules**
6. **Q: In which type of leprosy is nerve involvement more severe, leading to facial disfigurement and muscle weakness?**
- A) Tuberculoid leprosy
- B) Lepromatous leprosy
- C) Intermediate leprosy
- D) Borderline leprosy
- **Answer: B) Lepromatous leprosy**
7. **Q: Which form of leprosy has a higher bacterial load due to the immune response's inability to control the infection?**
- A) Tuberculoid leprosy
- B) Lepromatous leprosy
- C) Intermediate leprosy
- D) Borderline leprosy
- **Answer: B) Lepromatous leprosy**
8. **Q: What type of hemolysis is typically seen in the skin lesions of lepromatous leprosy on blood agar plates?**
- A) Alpha-hemolysis
- B) Beta-hemolysis
- C) Gamma-hemolysis
- D) No hemolysis
- **Answer: D) No hemolysis**
9. **Q: Which type of leprosy is characterized by the presence of large numbers of M. leprae bacteria within macrophages and foamy cells?**
- A) Tuberculoid leprosy
- B) Lepromatous leprosy
- C) Intermediate leprosy
- D) Borderline leprosy
- **Answer: B) Lepromatous leprosy**
10. **Q: Multi-drug therapy (MDT) is used to treat both forms of leprosy. What is the primary goal of MDT?**
- A) Eradicate the bacterial infection
- B) Enhance the humoral immune response
- C) Promote nerve regeneration
- D) Reduce inflammation
- **Answer: A) Eradicate the bacterial infection**
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