Mycobacterium leprae

Which single clinical feature best distinguishes tuberculoid leprosy from lepromatous leprosy?

A 38-year-old man from rural Maharashtra presents with a 2-year history of progressive numbness in his feet and hands. On examination, he has well-demarcated hypopigmented macules over his trunk and extensor surfaces with loss of sensation in these lesions. His ulnar and posterior tibial nerves are thickened and tender. Slit-skin smear from the lesion shows acid-fast bacilli. Which of the following best describes the classification of his leprosy based on clinical and bacteriological findings?

Which of the following is the primary reason Mycobacterium leprae cannot be cultured on standard laboratory media?

Which of the following is the characteristic temperature preference of Mycobacterium leprae that explains its predilection for cooler body sites?

A 42-year-old woman with lepromatous leprosy (LL) on MDT for 4 months (rifampicin, dapsone, clofazimine) presents with sudden onset of painful nodules, fever, and worsening of existing skin lesions. Slit-skin smear AFB count has not decreased significantly. What is the most appropriate next step in management?