LEPROSY LEPROSY

LEPROSYLEPROSY(Hansen’s disease, Hanseniasis)(Hansen’s disease, Hanseniasis)

Def:Def: is a chronic disease caused by is a chronic disease caused by Mycobacterium leprae.Mycobacterium leprae.

Infectious in some cases and affecting the Infectious in some cases and affecting the peripheral nervous system, the skin and peripheral nervous system, the skin and

certain other tissues.certain other tissues.* The bacilli do not cross the placenta* The bacilli do not cross the placenta Mode of transmission : is not yet known Mode of transmission : is not yet known

certaincertain(3 possible route : via the skin, GIT, Resp Tract )(3 possible route : via the skin, GIT, Resp Tract )

LEPROSYLEPROSY• Bacterial :Bacterial :

- Incubation periode : 2-7 years - Incubation periode : 2-7 years (ussually (ussually 3-5 years)3-5 years)- is an acid fast, an obligate intracellular- is an acid fast, an obligate intracellular- Ziehl-Neelsen of staining M Leprae in - Ziehl-Neelsen of staining M Leprae in smear.smear.- can be taken from skin lesion, nose - can be taken from skin lesion, nose mucous and earlobemucous and earlobe

LEPROSYLEPROSY• Bacterial Index :Bacterial Index :

is the density of bacterial in smears (living is the density of bacterial in smears (living and and dead bacillidead bacilli

6+ Many clumps of bacilli in average field (over 6+ Many clumps of bacilli in average field (over 1000)1000)

5+ 100-1000 bacilli in an average field5+ 100-1000 bacilli in an average field4+ 10-100 bacilli in an average field4+ 10-100 bacilli in an average field3+ 1-10 bacilli in an average field3+ 1-10 bacilli in an average field2+ 1-10 bacilli in 10 field2+ 1-10 bacilli in 10 field1+ 1-10 bacilli in 100 field1+ 1-10 bacilli in 100 field

LEPROSYLEPROSY• Morfological IndexMorfological Index : is the percentage : is the percentage

of solid stain bacilli of solid stain bacilli Solid stain bacilli Solid stain bacilli x 100%

Living and dead bacilliLiving and dead bacilli

- tell if the px’s leprosy tell if the px’s leprosy activeactive or or notnot- give valuable information as to response to txgive valuable information as to response to tx- give early intimation of bacterial resistance give early intimation of bacterial resistance

to chemotheraphy or of defaulting to txto chemotheraphy or of defaulting to tx

LEPROSYLEPROSY

General discription :General discription :(According to the Ridley-Jopling classification)(According to the Ridley-Jopling classification) Indeterminate leprosyIndeterminate leprosy

- Skin lesions : single flat macule, slightly hipopigmented - Skin lesions : single flat macule, slightly hipopigmented or slightly erythematous, roughly oval or rounded in or slightly erythematous, roughly oval or rounded in shape. Surface is smooth and margins may be definite, shape. Surface is smooth and margins may be definite, ussually rather vague. Lesions are frequently noted on ussually rather vague. Lesions are frequently noted on exposed suface. Sensor/loss over the macules is exposed suface. Sensor/loss over the macules is generally minimal.generally minimal.

- Bacteriologic smear : negativeBacteriologic smear : negative- Mitsuda reaction : positive, in some cases negativeMitsuda reaction : positive, in some cases negative

LEPROSYLEPROSYRedley-Jopling clasificationRedley-Jopling clasification

Observation Observation or testor test

TTTT BTBT BBBB BLBL LLLL

No of lesionsNo of lesions Single Single (usually)(usually)

Single or fewSingle or few severalseveral manymany Very manyVery many

Size of Size of lesionslesions

variablevariable variablevariable variablevariable variablevariable smallsmall

Surface of Surface of lesionslesions

Very dryVery dry drydry Slightly shinySlightly shiny shinyshiny shinyshiny

sensationsensation absentabsent Moderately-Moderately-markedly markedly diminisheddiminished

Slightly-Slightly-moderately moderately diminisheddiminished

Slightly Slightly diminisheddiminished

Not affectedNot affected

Hair growth Hair growth in lesionsin lesions

absentabsent markedly markedly diminisheddiminished

moderately moderately diminisheddiminished

Slightly Slightly diminisheddiminished

Not affectedNot affected

AFB in AFB in lesionslesions AFB in nasal AFB in nasal scrapscrap

NilNil

nilnil

Nil or scantyNil or scanty

nilnil

Moderate Moderate numbersnumbersnilnil

ManyMany

Usually nilUsually nil

Very many Very many (plus globi)(plus globi)Very many Very many (plus globi)(plus globi)

Lepromin Lepromin testtest

++++++ +/+++/++ negativenegative negativenegative negativenegative

LEPROSYLEPROSY

WHO clasification :WHO clasification :1. PB1. PB2. MB2. MB

ObservationObservation PBPB(paucibacillary)(paucibacillary)

MBMB(multibacillary)(multibacillary)

No of lesionsNo of lesions 1-5 lesions1-5 lesions >5 lesion>5 lesion

Enlargement of Enlargement of nervesnerves

1 nerve1 nerve > nerves> nerves

AFB in lesions and AFB in lesions and nasal scrapnasal scrap

negativenegative positivepositive

LEPROSYLEPROSY

• Type of reaction :Type of reaction :• Type 1 reaction (reversal):Type 1 reaction (reversal):

- change of some or all skin lesions appearance- change of some or all skin lesions appearance- peripheral nerves swelling and pain in - peripheral nerves swelling and pain in palpationpalpation- lack of peripheral nerves function- lack of peripheral nerves function

• Type 2 reaction (ENL) :Type 2 reaction (ENL) :- pain nodules, brighly red, variable in size, tend - pain nodules, brighly red, variable in size, tend to be distributed bilaterally and symetrcallyto be distributed bilaterally and symetrcally- peripheral nerves pain in palpation- peripheral nerves pain in palpation

LEPROSYLEPROSY

ChemotherapyChemotherapy- Dapsone- Dapsone- Clofazimin- Clofazimin- Rifampicin- Rifampicin- Ethionamide/protionamide- Ethionamide/protionamide

LEPROSYLEPROSY

MULTIDRUG THERAPY (MDT WHO program)MULTIDRUG THERAPY (MDT WHO program)MDT for MB :MDT for MB :- Rifampicin 600mg/month- Rifampicin 600mg/month- dapsone 100mg/day 1 year- dapsone 100mg/day 1 year- clofazimin 50mg/day- clofazimin 50mg/day- clofazimin 300mg/month- clofazimin 300mg/month

MDT for PB MDT for PB - Rifampicin 600mg/month- Rifampicin 600mg/month- dapsone 100mg/day- dapsone 100mg/day 6 months6 months