194.4 📌 章末速蚘

  • Leprosy = M. leprae (+ M. lepromatosis Mexico/Caribbean)
  • Cannot culture in vitro; armadillo / mouse footpad only
  • Spectrum: TT (strong CMI, few lesions) ↔ LL (weak CMI, many lesions, leonine facies, saddle nose, madarosis)
  • Triad: hypopigmented anesthetic skin lesion + peripheral nerve thickening + AFB+
  • Treatment WHO MDT:
    • PB (TT/BT): Rifampin monthly + Dapsone daily × 6 mo
    • MB (BB/BL/LL): + Clofazimine monthly+daily × 12 mo
  • Reactions:
    • Type 1 (Reversal): steroid
    • Type 2 (ENL): prednisolone + thalidomide
  • PEP: single rifampin 600 mg for household contacts (2018 WHO, reduces 50%)
  • G6PD screen before dapsone (hemolysis)
  • BCG some efficacy
  • Disability prevention: foot care, glasses, surgery
  • Stigma + psychosocial support critical