Leprosy presentation uploaded by Samrat Gurung

1. PRESENTORS
H E L A N PA N T ( 11 )
K A M A L B I S H O W K A R M A ( 1 2 )
K H U S H I S A R A R A N A ( 1 3 )
K S H I T I J G U R U N G ( 1 4 )
N A B I N S U B E D I ( 1 5 )
B P H 3 R D S E M E S T E R
LEPROSY

2. INTRODUCTION
 Leprosy is a chronic disease caused by the bacteria
Mycobacterium leprae and Mycobacterium lepromatosis.

• M. leprae multiplies very slowly and the incubation
period of the disease is about five years. Symptoms can
take as long as 20 years to appear.
• Contrary to the common belief leprosy is not highly
infectious. It is transmitted via droplets, from the nose and
mouth, during prolonged contacts with untreated cases.

3. • Leprosy mainly affects the skin and nerves.
• If untreated, there can be progressive and permanent
damage to the skin, nerves, limbs and eyes.

4. EPIDEMIOLOGICAL FACTORS
Agent:
 M. leprae, an acid fast bacilli which occurs intercellular
and intracellular
 Grows at 30°C-33°C, has a doubling time of 12 days and
withstands drying for up to 5 months
 Long incubation period as long as 20 years.
Source of infection:
 Leprosy infected person

5. Contd..
Host factor:
 Infection starts at infancy and childhood (commonly)
peak incidence at 10-14 years of age
 More in males (in case of adults), equal in children
Mode of transmission:
 Droplet infection
 Contact transmission: direct contact, fomites, contact with
soil
 Other routes (less common): breast milk, insect vector,
tattooing needles

6. Contd..
Portal of exit:
 Nose
 Ulcerated or broken skin, hair follicle (bacteriologically
+ve)

7. CLASSIFICATION
 Leprosy can be classified on the basis of clinical
manifestations and skin smear results.
 In the classification based on skin smears:
Patients showing negative smears at all sites are grouped
as paucibacillary leprosy (PB).
Patients showing positive smears at any site are grouped
as having multibacillary leprosy (MB).

8. Contd..
 The clinical system of classification for the purpose of
treatment includes the use of number of skin lesions and
nerves involved for grouping leprosy patients into
multibacillary (MB) and paucibacillary (PB) leprosy.

9. Multi Drug Therapy against Leprosy
• Leprosy is a curable disease and treatment provided in the
early stages averts disability.
• With minimal training, leprosy can be easily diagnosed on
clinical signs alone.
• A WHO study group recommended multidrug therapy
(MDT) in 1981. MDT consists of three drugs: Dapsone,
Rifampicin and Clofazimine.
• This drug combination kills the pathogen and cures the
patient.

10. Leprosy MDT Regimen
 Multibacillary (MB) leprosy
For adults the standard regimen is: 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
For adults the standard regimen is: Rifampicin: 600 mg once a
month Dapsone: 100 mg daily Duration - six months
 Single Skin Lesion Paucibacillary leprosy
For adults the standard regimen is a single dose of:
Rifampicin: 600 mg Ofloxacin: 400 mg Minocycline: 100 mg

11. FINDINGS
 Endemic in all continents except Antarctica.
 Over the past 20 years, more than 14 million leprosy
patients have been cured, about 4 million since 2000.
 The prevalence rate of the disease has dropped by 90%
from 21.1 per 10 000 inhabitants to less than 1 per 10 000
inhabitants in 2000.
 Dramatic decrease in the global disease burden although
once considered a major health problem.
 Leprosy has been eliminated from 119 countries.

12. Contd..
 2/3rd of world’s leprosy burden in Indian subcontinent.
 Pockets of high endemicity still remain in some areas of
Angola, Brazil, Central African Republic, Democratic
Republic of Congo, India, Madagascar, Mozambique,
Nepal, and the United Republic of Tanzania.
 During the past three years, the number of new cases
detected globally has also decreased steadily, by about
20% per year.

14. LEPROSY CONTROL PROGRAM NEPAL
Vision:
 To make leprosy free society where there is no new leprosy
cases and all the needs of existing leprosy affected persons
having been fully met.
Mission:
 To provide accessible and acceptable cost effective quality
leprosy services including rehabilitation and continue to
provide such services as long as and wherever needed.
Goal:
 Reduce further the burden of leprosy and to break channel of
transmission of leprosy from person to persons by providing
quality service to all affected community.

15. National Leprosy Control Objectives
 To eliminate leprosy (Prevalence Rate below 1 per
10,000 population) and further reduce disease burden
at district level.
 To reduce disability due to leprosy.
 To reduce stigma in the community against leprosy.
 To provide high quality service for all persons affected
by leprosy.
 To integrate leprosy in the integrated health care
delivery set‐up for provision of quality services.

16. National Leprosy Control Strategies
 Early new case detection and their timely and complete
management
 Quality leprosy services in an integrated setup by qualified
health workers
 Prevention of leprosy associated impairment and
disability
 Rehabilitation of people affected by leprosy, including
medical and community based rehabilitation
 Reduce stigma and discrimination through advocacy,
social mobilization and IEC activities and address gender
equality and social inclusion

17.  Strengthen referral centers for complications management
 Meaningful involvement of people affected by leprosy in
leprosy services, and address human right issues
 Promote and conduct operational researches/studies
 Monitoring, supportive supervision including onsite
coaching, surveillance and evaluation to ensure/strengthen
quality leprosy services
 Strengthen partnership, co‐operation and coordination
with local government, external development partners,
civil society and community based organizations.

18. National Leprosy Control Targets
 Reduce New Case Detection Rate (NCDR) by
25 % at national level by the end of 2015 in comparison
to 2010
 Reduce Prevalence Rate (PR) by 35 % at national level by
the end of 2015 in comparison to 2010
 Reduce by 35% Grade 2 disability (G2D) amongst newly
detected cases per 100,000 populations by the end of 2015
in comparison to 2010

19. CONCLUSION
 Nepal has achieved the elimination of leprosy as a
public health problem in December 2009.
 Although significant progress has been made in
reducing the disease burden at national level,
sustaining the achievement & further reducing the
disease burden through delivering quality leprosy
services still remain as major challenges.
 Even though we had achieved so much in combating
leprosy, still there are various social stigmas related
to it.

20.  But due to the increase in the literacy rate, good
health education and increased exposure to the
information these beliefs are being changed little by
little.
 All thanks to modern therapy with a number of
effective drugs, the disease is now entirely curable,
and the term leper, denoting somebody who has
leprosy no longer has meaning.

21. THANK YOU