KASUS KUSTA

YANG
MERAGUKAN :
Bagaimana
menegakkan
diagnosa ?

INDROPO AGUSNI

Leprosy :
- Chronic infection

- Cause : M.leprae
- Primarily attack

peripheral nerve,
secondarily attack

other organs,
including nasal

cavity

Mycobacterium leprae

The cardinal signs of leprosy

1. skin patch with loss of sensation

2. enlarged peripheral nerve

3. positive slit-skin smear

Physical examination will diagnose leprosy in most cases

Physical examination plus skin smear will diagnose
leprosy in the vast majority of cases

The 1st cardinal sign of leprosy

Skin patch with loss of
sensation

Hypopigmented
Erythematous

Enlarged
great
auricular
nerve

BACTERIOLOGIAL EXAMINATION
IN LEPROSY
The slit and
scrape
method
Incision, turn
the blade 90
degrees

LOCATION :

Courtesy from
Dr. Colette van Hees

Earlobe
Chin
Extensor forearm
Dorsal fingers
Buttocks
Knees

FRAGMENTED

GRANULAR

SOLID

Bacterial Index (BI) : total number of bacilli ( 1+ to 6+ )

Morphological Index (MI) : % of solid staining bacilli,
number of viable bacilli

KUSTA ?

 Penyakit

sudah lama / kronis :

sudah bbrp bulan / tahun
Tidak gatal, tidak nyeri
Adanya sumber penularan
Pasien berasal dari daerah
endemik kusta
Sudah dicoba dengan berbagai
salep

CLINICAL
EXAMINATION

Decreased
sweating

Light touch
Temperature discrimination
Pain (pin prick)

Palpation ulnar nerve

BILA SEMUA HASIL

PEMERIKSAAN MERAGUKAN :
Alternatif :
1. Dirujuk ke dokter yg lebih
ahli.
2. Ditunggu sampai cardinal
sign muncul, baru diobati
3. Periksa laboratorik
tambahan.

MENUNGGU SAMPAI
KAPAN ?
- Sebaiknya evaluasi
setiap 3 bulan tanpa terapi
- Bila sampai 6 bulan tidak
ada perubahan, namun
dokter tetap curiga M.H. :
BOLEH diberi obat anti kusta

CLINICAL SPECTRUM OF LEPROSY

TUBERCULOID

CELLULAIR
IMMUNITY

BORDERLINE

LEPROMATOUS

HUMORAL
IMMUNITY

AFB
Number

KLASIFIKASI PENYAKIT KUSTA

Ridley & Jopling (1964) :

TT

BT

BB

WHO ( 1980 )

BL

LL

MH- TT
Birth Mark
Pityriasis alba

Pitiriasis Versicolor

DIAGNOSA BANDING M.H.

MH BTtype

Pityriasis Rosea

Tinea Pedis

MH-BB type

Psoriasis

Lues II

Erythro-Papulo-Squamous lesions

Charcot Marie Tooth Disease :

( genetic peripheral nerve disorder)

1.
2.
2.
3.

Bacteriological Examination
Histopathology ( skin biopsy)
Serological Examination
Molecular Biology tests :
Polymerase Chain Reaction / PCR
Reverse Transcriptase / RT-PCR
DNA Sequencing for Drug Resistance
Genomic Study of M. leprae

Detection of
Anti PGL-1
antibodies

Cut off value :

IgM = 605 u/ml

IgG = 650 u.ml

INDICATION OF SEROLOGICAL
TEST IN LEPROSY :

Diagnosis support of Leprosy

Leprosy Classification

Detection of Subclinical
Infection of Leprosy

Treatment Evaluation

SEROLOGICAL EXAMINATION IN
LEPROSY

FILTER PAPER METHOD

POLYMERASE CHAIN REACTION

( PCR ) IN LEPROSY
INDICATION :
Detection of M. Leprae
DNA in the samples
- skin slit preparation
- blood
- nasal swab
- biopsy tissues etc.
NON-TYPICAL LEPROSY
SKIN LESION

PCR test for M.leprae : sensitivity up to 90%

99bsp
spl1

spl2

spl 3

spl 4

spl 5

Marker Negatip Positip

(-)

(-)

(+)

(+)

(+)

(ladder) kontrol kontrol

Thank You