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Morbus hansen tipe borderline lepromatous pada seorang anak dengan riwayat narakontak erat kusta tipe mulibasiler: laporan kasus

  • Ni Luh Putu Ratih Vibriyanti Karna ,
  • I Gusti Ngurah Ariwangsa Asbita ,
  • I Gusti Ayu Agung Dwi Karmila ,
  • Luh Made Mas Rusyati ,
  • Ni Putu Ayu Riska Yunita Sari ,


Abstract

Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae and Mycobaterium lepromatosis. Children are one of the populations at risk of M. leprae transmission. Prompt treatment is needed to avoid complications of disability in children with leprosy. Therefore, this study aims to describe a pediatric patient who had borderline lepromatous morbus hansen with a history of close contact multibacillary leprosy.

Case: A 16 years old girl, complained red spots on the right and left legs that are numb. Dermatological examination found multiple erythema macules-patches, firm boundaries, rounded to geographic shapes, discrete distribution on the face and right and left anterior and posterior extremities. Thickening of the right ulnar nerve, right and left common peronial nerve, decreased sensation of touch, pain and temperature were found. Histopathological examination found a non-caseating granulomata lesion, consistent with borderline tuberculoid leprosy type. Slit skin smear found acid fast bacilli (AFB) in the right earlobe 25-30 AFB/1 visual field (VF) (bacterial index (IB): +4)) fragmented, in the left earlobe>100 smear/1 VF (IB: +5) fragmented, and morphological index (IM): 0. The patient was diagnosed with borderline lepromatous (BL) leprosy and given multidrug therapy (MDT) for multibacillary (MB) leprosy. After 6th package of MDT, leprosy reactions or side effects of treatment were not found.

Conclusion: The highest risk of transmission of leprosy is close contact with leprosy patients, especially the multibacillary type of leprosy. In this case, a child with BL type leprosy was treated with an adult dose of MDT MB according to the patient's age and body weight.

 

Latar belakang: Morbus hansen (MH) merupakan penyakit granulomatosa kronis yang disebabkan oleh Mycobacterium leprae dan Mycobaterium lepromatosis. Anak-anak merupakan salah satu populasi berisiko terhadap transmisi M. leprae. Terapi lebih dini diperlukan untuk menghindari komplikasi kecacatan pada anak dengan morbus hansen. Untuk itu, tujuan dari studi ini adalah memaparkan seorang pasien anak anak yang mengalami morbus hansen tipe borderline lepromatous dengan riwayat narakontak erat kusta tipe multibasiler.

Kasus: Seorang anak perempuan, 16 tahun, dengan keluhan utama bercak kemerahan pada kaki kanan dan kiri yang mati rasa. Pemeriksaan status dermatologis ditemukan makula hingga patch eritema multipel, batas tegas, bentuk bulat hingga geografika, tersebar diskret di lokasi wajah dan ekstremitas anterior et superior dextra et sinistra serta penebalan nervus ulnaris dekstra dan nervus peronius komunis dekstra et sinistra dan penurunan sensasi raba, nyeri dan suhu. Pemeriksaan histopatologi ditemukan kesan non-caseating granulomata lesion. Pemeriksaan bakteriologis dengan pengecatan Ziehl-Neelsen ditemukan basil tahan asam (BTA) pada cuping telinga kanan 25-30 BTA/1 lapang pandang (LP) (indeks bakteri (IB): +4)) fragmented, pada cuping telinga kiri >100 BTA/1 LP (IB: +5) fragmented, dan indeks morfologi (IM): 0. Pasien didiagnosis dengan MH tipe borderline lepromatous (BL) dan diberikan multidrug theraphy (MDT) untuk MH tipe multibasiler (MB). Evaluasi pada konsumsi MDT paket ke-VI tidak menunjukkan adanya reaksi kusta ataupun efek samping pengobatan.

Simpulan: Risiko tertinggi penularan kusta adalah kontak erat dengan pasien kusta terutama kusta tipe multibasiler. Pada kasus ini didapatkan anak dengan kusta tipe BL dan diterapi dengan MDT MB dosis dewasa menyesuaikan usia dan berat badan pasien.

Keywords: Kusta morbus hansen borderline lepromatous anak-anak M. leprae

References

  1. Salgado CG, Brito AC, Salgado UI SJ. Leprosy. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ OJ, editor. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw-Hill; 2019. p. 2892–924.
  2. Kumar B, Dogra S. Case Definition and Clinical Types of Leprosy. In: Kumar B, Kar H, editors. IAL Textbook of Leprosy 2nd ed. New Delhi: Jaypee Brothers Medical Publishers; 2017. p. 236–53.
  3. Bhandari J, Awais M, Robbins B, Gupta V. Leprosy. Treasure Island (FL): StatPearls Publishing; 2022. 1–110 p.
  4. Saraswati PA, Mas Rusyati LM, Karmila ID. Karakteristik Penderita Kusta Multi Basiller (MB) dengan Reaksi Erythema Nodosum Leprosum (ENL) di Poliklinik Kulit dan Kelamin RSUP Sanglah selama Tahun 2016-2018. Intisari Sains Medis. 2019;10(3):655–8.
  5. Rusyati LMM, Sasmita PA, Adiguna MS. Diagnostic test using monofilament compared to electroneuromyography (ENMG) for detection of peripheral neuropathy in leprosy at Sanglah General Hospital, Bali-Indonesia. Bali Med J. 2019;8(3):722–7.
  6. Raghavendra B, Aneesh S, Yarramachu S, Gopal D, Mohamed M. Clinical pattern of deformities and disabilities in leprosy patients in rural Bangalore-A two year study at tertiary level hospital. Indian J Clin Exp Dermatology. 2017;3(3):101–9.
  7. Ploemacher T, Faber WR, Menke H, Rutten V, Pieters T. Reservoirs and transmission routes of leprosy; A systematic review. PLoS Negl Trop Dis. 2020;14(4):1–27.
  8. Malaviya G. Deformity and Disability Prevention. In: Kumar B, Kar H, editors. IAL Textbook of Leprosy 2nd ed. New Delhi: Jaypee Brothers Medical Publishers; 2017. p. 541–61.
  9. World Health Organization (WHO). World Health Organization. Global leprosy (Hansen disease) update, 2019: time to step-up prevention initiatives. Wkly Epidemiol Rec. 2020;95(36):417–40.
  10. Direktorat Pencegaham dan Pengendalian Penyakit Menular Kementerian Kesehatan. Laporan Kinerja 2022. Jakarta; 2022:1-127.
  11. Prakoeswa CRS, Lubis RS, Anum Q, Argentina F, Menaldi SL, Gunawan H, et al. Epidemiology of Leprosy in Indonesia: a Retrospective Study. Berk Ilmu Kesehat Kulit dan Kelamin. 2022;34(1):29–35.
  12. Thorat D, Sharma P. Epidemiology. In: Kumar K, Kumar B, editors. IAL Textbook of Leprosy 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2010. p. 24–31.
  13. WHO. Global leprosy update, 2018: moving towards a leprosy- free world. Wkly Epidemiol Rec. 2019;94(35/36):389–412.
  14. Araújo FA, Abreu LC, Laporta GZ, Santos VS, Moreira JGV, Grumach AS. Hanseniasis in the municipality of Western Amazon (Acre, Brazil): are we far from the goal of the World Health Organization?: Hansen and Western Amazon. Brazilian J Infect Dis. 2021;25(1):1-7.
  15. Demet Akpolat N, Akkus A, Kaynak E. An Update on the Epidemiology, Diagnosis and Treatment of Leprosy. Hansen Dis - Forgot Neglected Dis. 2019;
  16. Kumar B, Narang T. Leprosy in children. Indian J Paediatr Dermatology. 2019;20:12–24.
  17. James DW, Elston DM, Treat JR, Rosenbach MH NI. Hansen Disease. In: Andrew’s Diseaseas of The Skin. 13th ed. Elsevier Inc.; 2020. p. 336–9.
  18. Barua JK, Khan S, Chandra A, Dhabal A, Halder S. Clinico-epidemiological profile of adult leprosy patients from a referral hospital in Eastern India: A retrospective study. J Pakistan Assoc Dermatologists. 2021;31(2):158–64.
  19. Cambri G, Mira M. Genetic Susceptibility to Leprosy — From Classic immune-Related Candidate Genes to Hypothesis- Free , whole Genome Approaches. Front Immunol. 2018;9(1674):1–10.
  20. Mi Z, Liu H, Zhang F. Advances in the Immunology and Genetics of Leprosy. Front Immunol. 2020;11(567):1–15.
  21. Paz J, Silvestre M, Moura LS, Furlaneto IP, Rodrigues YC, Lima KVB, et al. Association of the polymorphism of the vitamin D receptor gene (VDR) with the risk of leprosy in the Brazilian Amazon. Biosci Rep. 2021;41(7):1–9.
  22. Fischer M. Leprosy – an overview of clinical features, diagnosis, and treatment. JDDG - J Ger Soc Dermatology. 2017;15(8):801–27.
  23. Frota CC, Freitas MVC, Foss NT, Lima LNC, Rodrigues LC, Barreto ML, et al. Seropositivity to anti-phenolic glycolipid-I in leprosy cases, contacts and no known contacts of leprosy in an endemic and a non-endemic area in northeast Brazil. Trans R Soc Trop Med Hyg. 2010;104(7):490–5.
  24. Prakoeswa AC, Rumondor BB, Trianita MN, Iswahyudi, Rosida F, Astari L, et al. The correlation of Ig M Anti PGL-1 antibody between blood veins and dryed capillary blood on filter papers in household contact of leprosy patient. Dermatology Reports. 2019;11(S1):106–8.
  25. Pinho J, Rivas P, Mendes M. Presence of Mycobacterium leprae DNA and PGL-1 antigen in household contacts of leprosy patients from a hyperendemic area in Brazil. Genet Mol Res. 2015;14(4):1479–87.
  26. Nasution K, Nadeak K, Lubis S. Igm anti pgl-1 antibody level in patients with leprosy: A comparative study between ear lobes capillary and median cubital vein blood samples. Open Access Maced J Med Sci. 2018;6(8):1346–1348.
  27. Jin S, Ahn KJ, An S. Importance of the immune response to Mycobacterium leprae in the skin. Biomed Dermatology. 2018;2(1):1–6.
  28. Wewengkang K, Palandeng HMF, Rombot D V. Pencegahan Kecacatan Akibat Kusta di Kota Manado. J Kedokt Komunitas Dan Trop. 2016;4(2):87–92.
  29. Alinda MD, Geani S, Agusni RI, Kusumaputra BH, Reza NR, Prakoeswa CRS, et al. Diagnosis and Management of Leprosy. Berk Ilmu Kesehat Kulit dan Kelamin. 2020;32(2):149–57.
  30. De Paula HL, De Souza CDF, Silva SR, Martins-Filho PRS, Barreto JG, Gurgel RQ, et al. Risk Factors for Physical Disability in Patients with Leprosy: A Systematic Review and Meta-analysis. JAMA Dermatology. 2019;155(10):1120–8.
  31. Riyaz N, Sehgal VN. Leprosy: Trophic skin ulcers. Skinmed. 2017;15(1):45–51.
  32. WHO. Towards zero leprosy Global Leprosy (Hansen’s disease) Strategy 2021-2030. Cooreman E, editor. World Health Organization. India; 2021. 1–30 p.

How to Cite

Karna, N. L. P. R. V., Asbita, I. G. N. A., Karmila, I. G. A. A. D., Rusyati, L. M. M., & Ni Putu Ayu Riska Yunita Sari. (2023). Morbus hansen tipe borderline lepromatous pada seorang anak dengan riwayat narakontak erat kusta tipe mulibasiler: laporan kasus. Intisari Sains Medis, 14(2), 806–810. https://doi.org/10.15562/ism.v14i2.1591
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Ni Luh Putu Ratih Vibriyanti Karna
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I Gusti Ngurah Ariwangsa Asbita
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I Gusti Ayu Agung Dwi Karmila
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Luh Made Mas Rusyati
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Ni Putu Ayu Riska Yunita Sari
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