Leprosy and pregnancy

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Leprosy and pregnancy

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Leprosy and pregnancy

  1. 1. Short Case LEPROSY IN PREGNANCY Dr. Ayomi Piyasena
  2. 2. • Leprosy is caused by – Mycobacterium leprae, a slow-growing intracellular bacillus infiltrates the skin, the peripheral nerves, the nasal and other mucosa, and the eyes. • The incubation period - 2 to 10 years • Affect all ages and both sexes.
  3. 3. 4 A little taxonomy …. Kingdom Bacteria Phylum Actinobacteria Order Actinomycetales Suborder Corynebacterineae Family Mycobacteriaceae Genus Mycobacterium Species M. leprae
  4. 4. How get infected? Bacillus Host Virulance Immunity
  5. 5. Pregnancy • 2000 diagnosed of leprosy annually • Only 2-3 of them is pregnant • 12th post patum week increased risk of leprae reactions
  6. 6. CASE HISTORY Introduction 23 yrs, a House wife, married for 1 year Presented to the ANC on 6/3/2014 LRMP- 20/9/2013 EDD- 27/6/2014 POA- 23+6 Wks
  7. 7. • History of the disease – Hypo pigmented skin patch over left knee joint for 1 year( gradually increased in size ) – Raised edge for 3 months – Sensory Impairment – less hair growth – not painful – Dry – Not itching – No other lesions – no weakness – No change in sensation – No redness of eyes or vision impairment
  8. 8. • PMHx - No History of anaemia, jaundice • PSHx - NAD • DHx- Routine Anti natal drugs • Allergic History - No any allergy for sulpha drugs • Contact Hx - diagnosed patient with lepromatous leprosy in the village
  9. 9. 0n Examination • Not pale • Hypopigmented skin patch over left knee joint • Indurated edge • Sensory impairment • No papules/ nodules • No thickned/ tender nerves(common peroneal) • No crainial nerve palsies(V, VII) • UL & LL sensory and motor system examination normal
  10. 10. DIAGNOSIS • The three cardinal signs for diagnosis of Leprosy are: 1. Hypo-pigmented or reddish skin lesion(s) with definite sensory deficit 2. A thickened or enlarged peripheral nerve with loss of sensation and/or weakness of the muscles supplied by that nerve 3. The presence of Acid-fast bacilli in slit skin smears or histopathology
  11. 11. Invest. on this patient • Hb- 13.7 g/dl • Skin slit test not done • LFT- Normal TUBERCULOID LEPROSY
  12. 12. 15 Multibacillary (MB or lepromatous) is a 12-month treatment of rifampicin, clofazimine, and dapsone. Paucibacillary (PB or tuberculoid) is a six-month treatment of rifampicin and dapsone.
  13. 13. Patient was not aware of pregnancy - Started on PB Regimen After confirmation of Pregnancy – Started on MB regimen After 4 months of treatment.
  14. 14. LEPROSY ON FETUS • Prematurity • Fetal demise • Low birth weight • Increased risk of developing the disease. • WHO recommends - MDT during pregnancy.
  15. 15. LEPROSY DRUGS ON FETUS • High doses of rifampicin – Teratogenic ? • Dapsone – neonatal haemolysis – methaemoglobinaemia. + Folic acid • Clofazimine – discoloration of the skin of breast-fed infants.
  16. 16. REFERENCES. 1.) Consequences of the interaction between the leprosy and pregnancy, Paula Sacha, J Nurs UFPE on line. 2012 Sept;6(9):2243-9 2.) Pregnancy and Leprosy,A Comprehensive Literature Review1,Diana N. J. Lockwood and Hemali H. Sinha‘, 12th November 1998. 3.) Patient.co.uk ,Original Author: Dr Hayley Willacy Current Version: Dr Colin Tidy 4.)Leprosy in Pregnancy,E. Duncan, Springer, 2012

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