(1) Leprosy is a chronic infectious disease caused by Mycobacterium leprae that mainly affects the skin, nerves, and respiratory tract. It can cause disfigurement and exclusion from society. (2) It is diagnosed by examining the skin for pale or reddish patches with loss of sensation. (3) Leprosy is treated and cured with multidrug therapy (MDT) involving rifampicin, dapsone, and clofazimine taken over 6-12 months depending on classification. Proper treatment can prevent disability.

1. LEPROSY AND YELLOW
FEVER
-Br.Rahul Doke

2. LEPROSY
It is a chronic infectious disease caused by
M.leprae, an acid fast, rod shaped bacillus. It
mainly affects the skin, peripheral nerves,
and mucosa of the respiratory tract etc., It
has left behind a terrifying image in history
and human memory of mutilation, rejection
and exclusion from society.

3. Discovered by Gerhard Armauer
Hansen in 1873

4. Leprosy is caused by
Mycobacterium leprae

5. Bacteria Resides in
Cooler Parts of the Body

6. Symptoms & Diagnosis:
(1) Skin Lesions

7. TRANSMISSION
Nasal/oral Droplets
Dermal Inoculations

8. Diagnosing a case of
leprosy

9. How to diagnose leprosy
 Examine skin
 Check for patches
 Test for sensation
 Count the number of patches
 Look for damage to nerves

10. Signs of leprosy
 Pale or slightly reddish patch
 Definite loss of sensation in the patch
 Signs of damage to nerves
 definite loss of sensation in hands/feet
 weakness of muscles of hands/feet/face
 visible deformity of hands/feet/face

11. What is not leprosy
 Skin patches which
 have normal feeling
 are present from birth
 cause itching
 are white, black, dark red or silver coloured
 show scaling
 appear and disappear periodically
 spread quickly

12. What is not leprosy (cont.)
 Signs of damage to hands/feet/face
without loss of sensation
 due to other reasons like injury, accidents,
burns, birth defects
 due to other diseases like arthritis
 due to other conditions causing paralysis

13. How to examine for leprosy?
 Examine in a well-lit room
 Examine the whole body
 Ask since when the patch was noticed
 Ask what treatments have been tried
 Test for sensation
 Look for any visible deformities

14. Check for loss of sensation
 Take a pointed soft object (feather, cotton wick)
 Lightly touch alternately the patch & normal skin
 Ask the person to point where they were
touched
 Ask them to close their eyes and repeat the
procedure
 In case of loss of sensation the person will be
able to point to where they were touched on the
normal skin but not on the patch

15. Treating a case
with MDT

16. Classification for treatment
 The diagnosis is made based on finding
definite loss of sensation in one or more
patches.
 When you have examined the whole body,
count the number of patches.
 1-5 patches is paucibacillary (PB), more
than 5 patches is multibacillary (MB)
leprosy

17. Standard WHO-MDT for the
treatment of leprosy

18. Treatment regimens
 PB Adult
(6 blister packs)
 Rifampicin 600 mg once a month
 Dapsone 100 mg every day
 MB Adult
(12 blister packs)
 Rifampicin 600 mg once a month
 Clofazimine 300 mg once a month
 Clofazimine 50 mg and dapsone 100 mg every day

19. Multi Drug Therapy

21. Keeping good records
 Good records include:
 Patient identification (name, age, sex, address)
 Remark on history of complaint (what, how long,
progress)
 Remark on history of previous treatment (what,
where, how long, result)
 Current treatment (diagnosis, classification, any
visible disability, date of first dose, date of next
appointment)
 Record of special events (what event, date, how
managed, referral)
 Date of cure

22. Information to patients
About the disease
 Caused by a bacteria
 Affects skin and sometimes nerves
 Progresses slowly
 Easy to diagnose and cure
 Lead normal life, do not change life style

23. Information to patients
About the treatment
 MDT will cure you completely
 MDT is free of cost
 MDT is available in all health centres
 MDT should be taken as advised (regular,
full course)
 If you have problem or questions contact
your health centre

24. Information to patients
About possible problems
 Skin discoloration due to clofazimine
 Urine discoloration due to rifampicin
 In case of fever, pain in the nerves,
muscle weakness, joint pains they must
return immediately to the health centre
 In case of eye problems
 Appearance of new skin patches
 How to protect insensitive hands/feet

25. How to manage
complications

26. Some patients may develop
complications
 Leprosy reactions
 Side-effects
 Disabilities

27. Leprosy reactions
 1 or 2 patients in 10 may develop reactions
 Reactions are not a side effect of MDT. They are the
body’s response to leprosy
 More commonly seen in MB cases (more than 5
lesions)
 Signs and symptoms include
 Skin: patch/s becomes reddish and/or swollen; sometimes
painful reddish nodules appear
 Nerves: pain in the nerve and/or joint;
loss of sensation and weakness of muscles (commonly of
hands, feet and around eyes)
 General: fever, malaise, swelling of hands/feet

28. Managing reactions (1)
 Early diagnosis and prompt treatment of
reactions
 Every patient should be informed about the signs and
symptoms of reactions
 Inform them to go as soon as possible to the health
centre
 Reassure patients that:
 reactions can be treated
 they are not a side-effect to MDT
 does not mean that MDT is not working

29. Managing reactions (2)
 Rest is very important:
 Help to get leave from work or school for a
few days (e.g. medical certificate)
 Control of pain and fever
 Aspirin or paracetamol
 Continue MDT regularly

30. Managing reactions (3)
 Reactions which only involve the skin:
 rest and pain-killers are usually sufficient.
 If there is no improvement within few days or
worsening, then specific treatment is needed
 Reactions which involves the nerves
 start treatment with a course of corticosteroids (e.g.
prednisolone) as soon as possible
 will control all signs/symptoms of reaction

31. Before starting treatment with
prednisolone
 Make sure that you have adequate stock
 One course will require 336 tablets of 5 mg each
 The course lasts for 12 weeks
 It is better to examine the patient once every 14
days and reduce the dose
 Advise to take the total daily dose every morning
 If you do not have adequate stock, then start
treatment and refer to another centre/hospital
 Always send a written note with the patient,
when you refer

32. MDT side-effects
 Red coloured urine
 Darkening of skin
 Severe itching of skin
 This is due to rifampicin. Lasts
only for few hours Reassure
the patient that this is harmless
 This is due to clofazimine.
Reassure the patient that this
will disappear after treatment is
completed
 This is due to allergy to one of
the drugs (commonly to
dapsone). Stop all medicines
and refer to hospital

33. Why do disabilities occur?
 Disabilities such as loss of sensation and
deformities of hands/feet/eyes occur
because:
 Late diagnosis and late treatment with MDT
 Advanced disease (MB leprosy)
 Leprosy reactions which involve nerves
 Lack of information on how to protect
insensitive parts

34. Disabilities can be prevented
 The best way to prevent disabilities is:
 early diagnosis and prompt treatment with MDT
 Inform patients (specially MB) about common
signs/symptoms of reactions
 Ask them to come to the centre ASAP
 Start treatment for reaction ASAP
 Inform them how to protect insensitive hands/
feet /eyes
 Involve family members in helping patients

35. Care of feet
 Cracks and fissures
 Blisters
 Simple ulcer
 Soak in water
 Apply cooking
oil/Vaseline
 Use footwear
 Do not open blister
 Apply clean bandage
 Clean with soap & water
 Rest and clean bandage

36. Care of feet (2)
 Infected ulcer
 Wounds/injury
 Weakness/paralysis
 Clean with soap & water
 Rest & apply antiseptic dressing
 Soak in water
 Apply cooking oil/Vaseline
 Clean and apply clean bandage
 Protect when working/cooking
 Oil massage
 Exercises
 Refer

37. Care of eyes
 Redness and pain
 Injury to cornea
 Difficulty in closing eye
 Aspirin or paracetamol
 Atropine and steroid
ointment
 Cover with eye pad
 Apply antibiotic ointment
 Refer
 Tear substitute eye drops
 Exercises
 Dark glasses to protect
 Refer

38. When treatment is completed
 Congratulate the patient
 Thank family/friends for their support
 Reassure that MDT completely cures leprosy
 Any residual lesions will fade away slowly
 Show them how to protect anaesthetic areas
and/or disabilities
 Encourage to come back in case of any problem
 Tell that they are welcome to bring other members
of family or friends for consultation
 Remove the patient’s name from the treatment
register

39. YELLOW
FEVER