This is my first seminar took in front of 200 members...i dedicated this to A.P.J Abdul kalam sir...now i am studying M.Pharm pharmaceutics..

1. MY FIRST SEMINAR IS DEDICATED TO
MY INSPIRATION
DR.A.P.J.ABDUL KALAM

2. ERADICATION OF LEPROSY
¨Leprosy is curable ¨
BY
Mathivanan Selvam
B.PHARM –III YR

3. INTRODUCTION
Chronic infectious disease caused by a
bacteria, Mycobacterium leprae.
Organism – predilection site: skin and
nerves.
Not a fatal disease
It is one of the reason for non traumatic
peripheral neuropathy.
 It is one of the oldest diseases recorded.

4. HISTORY
• Gerhard Henrik Armauer
Hansen was a physician which
first identified Mycobacterium
leprae as the cause of leprosy
in 1873

5. THE LITTLE
HISTORY…..
• There had been bony
changes of leprosy in
skeletons dating
• Evidence suggested that it
spread east from India to
China at around 500 B.C.
and
• Then to Greece in the west
by the soldiers of Alexander
the Great after their Indian
Campaign in the third
century B.C.

6. VILLAIN OF OUR TOPIC

7. Mycobacterium leprae
Taxonomy
Kingdom Bacteria
Phylum Actinobacteria
Order Actinomycetales
Suborder Corynebacterineae
Family Mycobacteriaceae
Genus Mycobacterium
Species leprae

8. Features of organism
Gram-positive
Facultative Intracellular parasite
Aerobic rod shaped bacillus with waxy coating
Unable to grow invitro
Because of its inability to grow in agar,mice
and armidillas were used as laboratory
animals.

10. TRANSMISSION
• Via respiratory tract
• Droplet infection
• Exact mechanism of infection not known
• The main reservoir is human being
• Risk group: children, people living in endemic
areas, poor conditions,insufficient
diet,Immuno-suppressive diseases like HIV

11. LIFE CYCLE
M.leprae has difficult time replicating outside
host cell
Very slow replicating bacteria(13 days for one
replication cycle)
Replication inside intracellular vesicles of
macrophages,schwann cells and endothelial
cells
M.leprae prefers such cells at lower
temperature than that of human body

12. Stages of life cycle:
i. Binding to receptor on the host cell surface
ii. Bacterial replication(invitro)
Cell binding:
Receptors of schwann cells:
 Phenolic glycolipid -1(PG-1) or LBP21
 α-dystroglycon
 M.Leprae binds to α-2 side chain of laminin-
2.
 Histone like protein (Hlp) secreted by
M.leprae enhances schwann cell binding

13. Receptor of macrophages:
• The terminal trisaccharide of M.leprae binds
to complement receptors (CR1)
• Once binding occured M.leprae taken into
host cell by phagocytosis
• Encapsulated by phagosome
• Via replication inside host cell,bundle of
microorganis, produced
• It burst out and cause infection

14. CLASSIFICATION
Based on Clinical, histopathological and
immunological criteria:
• leprosy: tuberculoid polar leprosy (TT),
• borderline tuberculoid(BT),
• midborderline (BB),
• borderline lepromatous (BL),
• and lepromatous polar leprosy (LL)
.

15. Therapeutic purposes:
• paucibacillary (TT,BT) and
• multibacillary (midborderline (BB), BL, LL)
Classification based on the number of skin
lesions,
• less than or equal to five for
paucibacillary (PB)
• greater than five for the multibacillary

16. EFFECTIVE DRUG TREATMENT
–Multidrug therapy (MDT)
•Is a combination of 2 / 3 drugs
(clofazimine, rifampicin, dapsone)
•Cures patients in 6 months / 12
months depending on form of
leprosy
•Kills the leprosy bacilli and stops its
transmission
•Is available free of charge from WHO

17. • Multibacillary (MB) leprosy-adult dose
–Rifampicin: 600 mg once a month
Dapsone: 100 mg daily Clofazimine:
300 mg once a month and 50 mg daily
Duration= 12 months.
• Paucibacillary (PB) leprosy –adult dose
–Rifampicin: 600 mg once a month
Dapsone: 100 mg daily Duration= six
months
• Single Skin Lesion PB leprosy –adult
dose
–Single dose ofRifampicin: 600 mg
Ofloxacin: 400 mg Minocycline: 100 mg

18. MDT FOR MULTI-BACILLARY LEPROSY
ADULT CHILD 10-14 YRS CHILD 6-9 YRS
Day 1 Day 1 Day 1
Supervised monthly
treatment
Supervised monthly
treatment
Supervised monthly
treatment
Rifampicin 600mg 450 mg 300 mg
Clofazimine 300 mg 150 mg 100 mg
Dapsone 100 mg 50 mg 25 mg
Day 2-28 Day 2-28 Day 2-28
Clofazimine 50 mg.O.D 50 mg.O.D 50 mg.O.D
Dapsone 100mg.O.D 50 mg.O.D 25 mg.O.D

19. MDT FOR PAUBACILLARY LEPROSY
ADULT GHILD 10-14 YRS CHILD 6-9 YRS
Day 1 Day 1 Day 1
Supervised monthly
treatment
Supervised monthly
treatment
Supervised monthly
treatment
Rifampicin 600 mg Rifampicin 450mg Rifampicin 300mg
Dapsone 100mg Dapsone 50mg Dapsone 25mg
Day 2-28 Day 2-28 Day 2-28
Dapsone 100mg O.D Dapsone 50mg O.D Dapsone 25 mg O.D

21. VACCINES FOR LEPROSY
Current status and future prospects:
BCG VACCINE: first vaccine used against leprosy
Trial outcomes: -Uganda(80%);
-South India(28%);
- Burma (20%)
It shown that protective effect of BCG vaccine
is modest ; hence,used only for immuno-
prophylactic leprosy

22. Mixed vaccine(Convit et al): Produces
immunomogical changes both in leprotic and
normal health individuals.currently
undergoing trial in venezula and malawaii.
Heat killed
armidilla
derived
M.leprae
BCG
VACCINE
MIXED
VACCINE

23. VACCINE CONTAINING ICRC BACILLI:
• ICRC developed cultivable leprosy derived fro,
M.avium in 1979
• Exhibits antigenic and cross reactivity zith
reference to both B and T cells
• From M.velchii- induces lepromic conversion
in both BL/LL patients
Mahadevan et al: suggested delipidified cell
component of leprae activate macrophage
and kills M.leprae .Toxicity test in progress

24. WHO response
The WHO strategy for leprosy elimination
contains the following:
• Ensure accessible and uninterrupted MDT
services available to all patients;
• Ensuring the sustainability of MDT services
• encouraging self-reporting and early
treatment
• monitoring the performance of MDT services
and quality of patients’ care

25. Elimination of leprosy as a public health
problem
• World Health Assembly passed a resolution to
eliminate leprosy by the year 2000.
• Elimination of leprosy is defined as a
prevalence rate of less than 1 case per 10 000
persons.
• The widespread use of MDT reduced the
disease burden dramatically
• Over the past 20 years, more than 14 million
leprosy patients have been cured, about 4
million of them since 2000.

26. NAIONAL LEPROSY ERADICATION
PROGRAMME(NLEP)
• Started in 1955
• objective :early detection of cases and treatment
with Dapsone monotherapy
• It was made a centrally sponsored programme in
1980
• With the advent of Multi Drug Therapy (MDT) for
leprosy the cure rates increased
 It was changed into eradication programme in 1983
with the objective of eradicating the disease by the
end of 2000
 The ‘elimination’ was defined as attaining a
prevalence Rate (PR) of less than 1 case per 10,000
population

27. NEW STRATEGY OF NLEP
• To eliminate the following strategy adopted:
–Modified leprosy elimination campaigns (
MLEC): organizing camps for 1 or 2 weeks
duration for case detection, treatment and
referral
–Special action projects for the elimination of
leprosy ( SAPEL): initiative for providing
MDT services in special difficult to access
areas or to neglected population groups

28. From elimination to eradication
• Leprosy control is at a critical juncture due to
limited spreading of disease
• However,the disease still exists and can
resurge.
• The next step in leprosy control is to move
towards eradication.
• Working together with governments and
partners should make it possible to eradicate
leprosy and consign the disease to history.

29. SAY GOOD BYE TO LEPROSY
THANK YOU