1. Swasthya Kalyan Homoeopathic Medical
College & Research Center
Department of Community Medicine
SUBMITTED TO:-
Dr. ALKA JAIN
Dr. RAJKRITI DHAKAD
SUBMITTED BY:-
ANUSOOYA MUNDEL
HARSHITA JAIMAN
FINAL YEAR (2014-15)
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4. What is Leprosy ?
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In Greek “Leper” means ‘Scaly’.
Leprosy is a chronic, granulomatous, infectious disease.
Caused by “Mycobacterium leprae”.
Mainly involve skin and peripheral subcutaneous
nerves.
5. What causes it ..??
Mycobacterium Laprae bacilli.
It is:
An intracellular, pleomorphic, Gram +ve &
acid fast bacillius.
Having parallel sides and round ends.
Found in bundles and clumps.
Discovered by GH Armaer Hansen in 1873.
It was the first bacterium to be identified as
causing disease in humans.
5m. laprae
6. History…
One of the oldest and most dreaded disease known
to mankind.
In India it is described as Kushta roga in sushruta
Samhita.
In 1873, the pathogen M. Leprae was discovered by
GH HANSEN. So this is often called ‘Hansendisease’.
In 1916,Mitsuda , described ‘lepromin test’.which
helped in the classification and assessment of
prognosis of leprosy.
In 1943,Sulphones were introduced for treatment of
leprosy.
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GH Armaer Hansen
7. Contnd……
In 1955, Govt. of India launched National Leprosy Control
Programme (NLCP).
In 1960, Shepard discovered that M. Leprae could
multiyply to a limit extent (by injected into the foot pad of
mice).
In 1981, MultidrugTherapy (MDT) was introduced for
treatment.
In 1983, NLCP was redesigned as National Leprosy
Eradication Programme (NLEP).
In 1997. NLEP was appraised to National Leprosy
Elimination Campaign (NLEC). 7
8. Clinical Features:-
Hypopigmented patches.
With loss of sensation.
Thickening and enlargement of the nerves.
Demonstration of M. leprae from the cutaneous lesions.
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In the advanced stage-
Nodules over the face.
Claw hands, loss of fingers or toes, footdrop.
Trophic ulceration giving rise to ugly disfigurement with
deformities leading to permanent disability and handicap of the
individual if not treated in time.
10. World
As per WHO guideline, Leprosy is considered as a major public health problem in
those areas, where its prevalence rate is at least 1 per 1000 population.
During 1985 about 12 million cases of leprosy, out of 6 billion population of the
world, were existing. and more than 1 billion people were living in those areas,
where the prevalence of leprosy is more than 1 per thousand population.
South Asia and Africa are considered to represent the ancestral home of leprosy,
tracing back to 2500 years BC. 10
Epidemiology
World & India
11. Contd…
During 1966, globally the prevalence rate of leprosy was 8.4 cases per
10,000 population.
It was increased to 12 per 10,000 during 1985 due to increased detection.
Since there has been a steady decline, in a natural way, in the developed
countries due to improved socioeconomic conditions, improved nutritional
status, effective isolation of infectious cases and quality of life of the people.
Northern Europe was the first to experience the natural decline of leprosy
Since 1985, the total number of leprosy cases has dropped dramatically by
85 percent and by 67 percent since 1991.
During 1996, the global leprosy level was 1.8 million patients.
By 2002, the global prevalence rate of leprosy was below 1 per 10,000
population and total number was around 5,34,000 cases.
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12. India
During 1981, the prevalence rate was 57 per 10,000 population.
By 2004, it reduced dramatically to 2.3 per 10,000 population, due to the
change in the strategy of leprosy control from Monotherapy to multidrug
therapy.
The disease is said to be eliminated when the prevalence rate is reduced to less
than 1 per 10,000 population. Leprosy elimination has already been achieved in
16 states and 7 states are very near to this goal.
These 7 states are Goa, Gujarat, Madhya Pradesh, Karnataka,
TamilNadu,Lakshadeep andAndaman and Nicobar islands where the
prevalence rate is between 1 and 2 per 10,000 population.
During 2005, the prevalence rate was 1.3/10,000 population, 0.84/10,000
population during 2006 and during 2011 it was reduced to 0.69/10,000
population.
So leprosy is now said to be eliminated. 12
14. Reservoir of Infection
Main Reservoir: Human being.
Animal Reservoir: 9-Banded Armadillos.(Best)
Mangby monkeys.
Rhesus monkeys.
African green monkeys.
Chimpanzees.
9-Banded Armadillos.
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15. Age Incidence:
• All the age groups, but maximum between 20 and 30 years of age.
• In endemic areas, the infection is acquired during childhood.
• In non endemic areas, the disease appears at a still later age.
Sex Incidence:
• Leprosy is twice as common among males than among females
(in the ratio of 2:1).
Malnutrition:
• Malnutrition lowers the cell mediated immunity and
thereby increases the susceptibility for the disease.
Environmental Factors:
• High humidity, overcrowding and poorly ventilated living
conditions favor the transmission of leprosy.
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16. Social Factors:
Poverty, illiteracy, ignorance, over-crowding, poorstandard of living
conditions, lack of knowledge, etc.
Some myths and misbeliefs, right from the ancient times giving rise to pointing the lepers as
‘social stigma’ resulting in untouchability and ‘away from lepers’.
The lepers consider the disease as incurable and is a punishment by God.
The deformities and disfigurement caused in neglected cases has reinforced this concept
(myth) and inspired an aura of dread or horror among the patients resulting in alienation
from their societies.
This has contributed to frustration and misery of patients and condemned them to
destitution, squalor and beggary (poverty). So the patients try to conceal the disease due to
social ostracization and stigma attached to the disease. Thus, the stigma of leprosy is worse
than the disease itself. The stigma attached to the disease is so great that even the medical
profession takes an unsympathetic and unscientific view of leprosy. Thus the social factors,
the prejudice, the apathetic and indifferent attitude towards the patients, the social stigma
are all the legends, which have hampered the control of leprosy in the country. Unless this
negative attitude towards leprosy changes, it is not possible to eradicate this disease.
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17. Facts….
Not all the cases of leprosy are infectious.
Those cases,who are shedding bacilli either from the nose
and throat or from the ulcerative, cutaneous lesions are
infectious to others.
Generally 95 to 97 percent of human beings are not
susceptible to leprosy. Only 3 to 5 percent are susceptible to
leprosy.
Among the susceptibles 80 to 85 percent patients get self-
healing.Only remaining 15 to 20 percent develop the disease.
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18. Modes ofTransmission:-
Direct modes:
By droplet mode(Major route): Major route of transmission.
By direct skin-to skin contact: with the ulcerative lesions of
leprosy patients.
Indirect modes:
Through fomites are based upon the fact that the organisms
are capable of surviving outside the body for about 8 to 10
days.
The other hypothetical modes of transmission are vector
borne, breast-milk borne, soil borne and transplacental.
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Incubation Period:
- It is very long and variable.
- Average it is about 5 to 7 years.
- Minimum side it is 2 to 3 years and the maximum side it is 40 years or
even more.
Classification of Leprosy:-
Two types of classification:
1. WHO Classification / Skin smear result classification
2. Clinical classification / Field Worker’s Classification /
Ridley Jopling
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1. WHO Classification:
This is based on number of skin lesions and bacteriological status.
a. Single skin lesion, paucibacillary leprosy
• Single skin lesion
• No nerve involvement
• Skin smear for AFB negative
b. Paucibacillary leprosy (PBL)
• 2–5 lesions (skin and nerves)
• Only one nerve trunk
• Skin smear for AFB negative
c. Multibacillary leprosy (MBL)
• More than 5 lesions (i.e. 6 and above)
• More than one nerve trunk involvement
• Skin smear positive..
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Borderline (BB)—classical
‘punched-out’ lesions of
borderline leprosy; central
‘immune’ areas are anesthetic
Borderline tuberculoid (BT)—
multiple, sharply-demarcated,
scaly reddish-brown plaques;
these subsiding lesions are only
partially anesthetic
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Borderline lepromatous (BL)—numerous and
widespread borderline type plaques, annular
lesions, papules and macules; center of
large lesions show some loss of sensation.
31. Skin:
• Macules - hypopigmented lesions
• Papules - infiltrated, may be erythematous lesions.
• Nodules - in advanced leprosy, mostly on the face, nose and
ears caused by deepening of furrows and wrinkles.
• Ulcers. Nodules may undergo superficial necrosis producing
ulcers, which serve as portals of exit for leprosy bacilli.
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Clinical Presentation:
-The changes are seen in the skin, mucous membrane,
nerves and bones.
32. Mucous membranes:
Nodules may appear on the mucous membrane of nose, lips,
tongue, palate and larynx followed by ulceration.The
ulceration of nasal septum may advance to perforation and
destruction of the septal cartilage eventually leading to
saddle-nose deformity. Involvement of the larynx may result
in hoarse cough, husky voice and stridor.
Nerves:
loss of sensory, motor and autonomic .Sensations of light
touch and temperature first disappear followed by loss of
pain and pressure sense. later ending in paralysis and
atrophy. Paralysis of the muscles of hands and feet leads to
deformities.
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Bones:
• Bone changes due to deposition of bacilli in the
medullary cavities and periosteum.
• Necrosis of bones and the appearance of cysts.
• Involvement of periosteum results in leprous periostitis.
• Neurotrophic atrophy and resorption of bone tissue is
seen in the phalanges of hands and feet as well as in
metatarsals.
• The disappearance of affected bones results in
shortening of fingers and toes.
• Osteoporosis and ankylosis.
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-
1) Bacteriological examination.
2) Lepromin test.
1. Bacteriological examination:-
Smears is done by ‘slit and scrape’ method.
Take 7 smears:
4 from skin lesions,
2 from the ears (one each from right and left ear) and
1 from nose (nasal smear),
Smear uniformly spread on a clean glass slide, dried over flame and
stained with Ziehl-Neelson method and
at least 100 fields are examined under the microscope before
recording a negative result.
37. Diagnosis:-
Diagnosis of leprosy is most commonly based on the
clinical sign and symptoms.
A clinical diagnosis of leprosy is made by looking
for the cardinal signs:
• Skin lesions with partial or total loss of sensation,
• Thickened nerves with or without tenderness and
• Demonstration of lepra bacilli (AFB) in the smear
of cutaneous lesions.
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Investigations:
1. Bacteriological examinations
2. Lepromin test
3. Histamine test: 0.1 mL of 1/1000 solution of histamine acid
phosphate is injected intradermally in the hypopigmented
patch/anesthetic patch. In case of leprosy, because of the
involvement of nerves, the erythematous flare response is lost
(Normally in healthy persons, there will be positive flare
response). So negative test favors the diagnosis.
4. Histological examination (Biopsy of skin): This is not
recommended as a routine. It may be useful in some doubtful
cases.
5. Foot-pad culture: Inoculation of the test material into the foot-
pad of mice and the demonstration of lepra bacilli is a
confirmatory test. But not done as a routine.
41. 1. Medical measures:-
General measures:- By doing surveys.
Information about prevalence.
2. Early case detection.
3. Chemotherapy:-
MONOTHERAPY -Dapsone
MULTIDRUGTHERAPY(MDT)- Dapson.
Rifampicin.
Clofazimine.
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CONTROL OF LEPROSY
This can be discussed under the following headlines:
• Medical measures
• Social measures
• Managerial aspects
• Evaluation.
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Social Measures
Social assistance should be promoted through voluntary agencies and
department of social welfare. Thus social measures consist of social
rehabilitation and health education of the public. Social support consists of
mainly acceptance of the patient by the family members, job placement and
abolishing the social evil of beggary.
Managerial Aspects
Managerial and administrative support are essential ingredients for
effective implementation of any health program and leprosy control is no
exception. Availability of adequate infrastructure, trained personnel,
medicines, equipment, transportand finances must be ensured.
Evaluation
Proper evaluation of any health program is necessary to check whether the
desired results are achieved or not and if not, what modifications are needed.
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• Leprosy mission: This was the first organization for leprosy
work founded by Baily in 1874, in Chamba, Himachal Pradesh.
Presently its headquarter is in Purulia, WestBengal.
• Hind Kusth Nivaran Sangh: This was established in Delhi,
about 100 year later, i.e. during 1974, as a branch of the
Association in London.
• Gandhi Memorial Leprosy Foundation, Sevagram, Wardha.
• Belgium Leprosy Centre (Polambakkam, Chennai).
• Danish Save the Children Fund.
“Leprosy Organizations in India”
44. Cont…
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Bharath Sewashram Sangh
(Jamshedpur,Jharkhand).
Kashi Kusth Seva Sangh (Varanasi, UP)
Japovan (Amarvathi, Maharashtra).
German Leprosy Relief Association.
Damien Foundation.
Two other important organizations active in the field
of leprosy are JALMA Central Institute of Leprosy,
Agra, which is taken over by ICMR in 1975 and
Central Leprosy Teaching and Research Institute,
Chingleput.
45. Released inApril 2016.
Based on the principle of initiating action,ensuring accountability and promoting inclusion.
It is built around 3 pillars:
-To strengthen govt. ownership, coordination and partnership;
-To stop leprosy and its complications ;
- And to stop discrimination and promote inclusion.
3 key targets have been agreed by all national programmes:
1. Zero grade 2 deformity (G2D) among children diagnosed with leprosy.
2.The reduction of new cases(<1 case/million population).
3.And early detection and complete treatment with MDT.
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“Acceleratingtowardsa leprosy-freeworld”
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“National Leprosy Eradication Program”
The National Leprosy Control Programme (NLCP) has been in operation since 1955.
In 1983 the control programme was redesignated National Leprosy "Eradication"
Programme with the goal of eradicating the disease by the turn of the century.
The aim was to reduce case load to 1 or less than 1 per 10,000 population.
The components of the programme are as follows :
(1) Decentralized integrated leprosy services through general health care system;
(2) Capacity building of all general health services functionaries;
(3) Intensified information, education and communication;
(4) Prevention of disability and medical rehabilitation; and
(5) Intensified monitoring and supervision.
After introduction of MDT, the recorded case load of leprosy came down from 57.6
cases per 10,000 population in 1981 to less than one at the national level in
December 2005.
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At national level as set by the National Health Policy (2002). 33
states/UTs achieved the status of leprosy elimination. Only 2 States/UTs
viz. Chattisgarh and Dadra & Nagar Haveli are yet to achieve
elimination.
Major initiatives taken are as follows :
(1) More focus has now been given to new case detection than prevalence.
(2) More emphasis is being given on providing disability prevention and
medical rehabilitation (DPMR) services to leprosy affected persons.
(a) Dressing materials,supportive medicine.
(b) Micro-cellular rubber footwear.
(c) An amount of Rs. 5000/- is provided as incentive to each leprosy
affected person from BPL family.
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(4) Intensive IEC campaign with a theme
"Towards Leprosy Free India" has been carried out
towards further reduction of leprosy burden in the
community,
(3) ASHAs have been involved in bringing out suspected
leprosy cases from their villages for diagnosis and
treatment at PHC and follow-up of confirmed cases for
their treatment completion.
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Celebrated as ‘World Leprosy Day’, since 1954
World Leprosy Day is observed internationally every year
on the last Sunday of January to increase the public
awareness of the Leprosy or Hansen's Disease.
This day was chosen in commemoration of the death of
Gandhi, the leader of India who understood the importance
of leprosy.
“WORLD LEPROSY DAY”
