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1. Investigations for M. Leprae
Bacteriological examination
Skin smears:
Made by slit and scrape method from the most active
looking edge of skin lesion and stained with Ziehl-
Neelsen method.
Reading of smears:
Bacteriological index- Indicates density of leprosy
bacilli (live & dead) in the smears and ranges from 0 to
6+
Morphological index- It is the percentage of
presumably living bacilli in relation to total number of
bacilli in the smear

2. Investigations
 Histopathological examination
 Nerve biopsy
 Sweat function test
 Lepromin test
 Animal Models: Armadillo, Thymectomised,
irradiated nude mice, Korean chipmunk etc.

3. Newer Investigations
 Serological assays: FLA-ABS, RIA, ELISA
 PGL, PCR
 Other techniques: Chemical, Immunological,
Molecular biological, Bioluminescent techniques,
Strain specific probes
Indications:
- To confirm diagnosis in c/o inconclusive
histopathological/smear reports.
- To distinguish between reaction and relapse
- To demonstrate M. leprae or its components
- To elicit strain differentiation for molecular
epidemiology
- To detect drug susceptibility or resistance

4. MDT-WHO
 Paucibacillary leprosy (6 months)
- Cap. Rifampicin (600 mg) monthly, supervised
- Tab. Dapsone (100 mg) daily
 Multibacillary leprosy (1 year)
- Cap. Rifampicin (600mg) monthly, supervised
- Cap. Clofazimine (300mg) monthly, supervised
- Tab. Dapsone (100mg) daily
- Cap. Clofazimine (50mg) daily

5. Blister packets for MDT
 Easy to use, handy and of convenient size
 Provide complete treatment
 Improve clinical attendance
 Drugs are better protected against moisture,heat
and accidental damage
 Ensures quicker dispensing of the drugs
 Can be dispensed by non medical person

6. Other Regimens
 ROM
Comprises Rifampicin - 600 mgs,
Ofloxacin - 400 mgs,
Minocycline - 100mg
Single dose – single patch (WHO accepted)
ROM -6 (Monthly for 6 months) - Paucibacillary
ROM -12 (Monthly for 12 months) – Multibacillary

7. Newer Drugs / Regimens
 RO - 28
 Fluoroquinlones - Nalidixic acid
 Macrolides (Clarithromycin)
 Ansamycin-Rifabutin, Rifapentine
 Dihydrofolate reductase inhibitors-Brodimoprim, K-
130
 Fusidic acid
 Beta-lactam antibiotics
 Cephalosporins
 Quinolones (Pefloxacin and Sparfloxacin

8. Immunomodulatory Drugs
 Drugs- Levamisole, Zinc
 Antigenically related mycobacteria- B.C.G vaccine,
M.leprae +B.C.G vaccine, Mycobacterium welchii
vaccine, ICRC vaccine.
 Other immunomodulators-Gamma
interferons,interleukin

9. Lepra Reactions
 Acute episodes or bouts of exacerbations occurring
in course of chronic disease
 Sudden increase in activity of existing lesions,
appearance of fresh lesions with or without
constitutional symptoms
 Type I reaction - all borderline cases (BT, BB,BL)
 Type II reaction - BL & LL cases

10. Precipitating factors
 Physiological conditions like pregnancy
 Drugs: anti-leprosy drugs, iodides
 Severe physical or mental stress
 Infections

11. Type I Reaction
 Sub-types
- Upgrading (Reversal)
- Downgrading
 Type IV hypersensitivity reaction.
 Existing lesions worsen/New lesions may appear
 Neuritis / Nerve abscesses
 Systemic disturbances: Unusual

12. Type I reaction - complications
 Neuritis
 Dactylitis, edema of hands & feet, inflammation of
small joints of fingers
 Corneal anesthesia, Conjunctivitis
 Sudden occurrence of claw hand, foot-drop, facial
palsy

13. Type II Reaction
 Occurs in BL and LL cases
 Type III hypersensitivity reaction
 Erythema Nodosum Leprosum-crops of painful,
recurrent, erythematous, papulonodular lesions.
 Fever and malaise
 Iridocyclitis, episcleritis, epididymo-orchitis, arthritis,
neuritis, lymphadenitis

14. Type II Reaction - complications
 Frozen hand
 Laryngitis
 Non-paralytic deformity
 Polyarthritis/ RA-like syndrome
 Multiple dactylitis
 Leucocytosis, Anaemia, raised ESR
 Albuminuria/ nephrotic syndrome
 Liver/spleen enlargement
 Epididimytis/ orchitis, Testicular atrophy/sterility
 Gynaecomastia
 Adrenal gland hypofunction
 Eye involvement

15. Treatment of Lepra reactions
Principles of treatment
 Early initiation of treatment for reaction
 Continuation / initiation of MDT
 Removal of precipitating factor
 Rest, physical and mental

16. Treatment modalities
 Analgesics
 Corticosteroids
 Antimalarials
 Clofazimine
 Thalidomide
 Miscellaneous – colchicine, zinc, cetrizine,
antimonials
 Supportive management – for eye complications,
splints etc.

17. Deformities in leprosy
 Primary:
Are caused by the tissue reaction to infection with
M.Lepra e.g. leonine facies, flat-nose, claw hand.
 Secondary:
Occur as a result of damage to the anesthetic parts
of the body e.g. planter ulcers, corneal ulcers.

18. Grading of Deformities/Disabilities: WHO
Classification
 Grade 0
No anaesthesia, no visible deformity or damage in
hands and feet, or no problems in eye or no visual
loss
 Grade 1
Anaesthesia present, but no visible deformity or
damage, eye problems present but vision 6/60 or
better.
 Grade 2
Visible deformity or damage present in hands or feet ,
and vision worse than 6/60

19. Primary deformities
 Leonine Facies
 Loss of eyebrows and eyelashes
 Depressed nose
 Gynaecomastia
 Palatal Perforation

20. Secondary deformities
 Corneal ulcers and opacities
 Plantar ulcers
 Palmar ulcers and ulcers on tips of fingers
 Resorption
 Charcot joints

21. Deformities: Nerve damage
 Claw hand (ulnar, median)
 Clawing of the toes (posterior tibial)
 Wrist-drop (radial)
 Foot-drop (lateral popliteal)
 Lagophthalmos, facial palsy (facial)

22. Trophic ulcer: stages
 Threatened ulcer- slight puffiness and warmth in
region of metatarsal head with associated
tenderness
 Concealed ulcer - Necrosis, blisters at the site of
damage.
 Open ulceration - Frank ulcer
 Types of ulcers - Acute ulcer
Chronic ulcer
Complicated ulcer

23. Prevention of deformities
 Early detection of nerve damage
 Adequate treatment of leprosy patient
 Use of protective footwear
 Adequate hydration of skin
 Physiotherapy

24. Management of deformities
 Education of patient regarding prevention of injuries
 Daily examination of hands and feet and prompt
treatment for minor injuries
 Using adapted tools and appliances after training
 Reconstructive surgery
 Rehabilitation

25. Physiotherapy
Oil massage/Wax Therapy-Uses
 To make the skin soft and supple and loosen stiff
joints
 As a preliminary to exercises
 To strengthen muscles and keep joints mobile
 To reduce pain in acute neuritis
 To stimulate innervated sweat glands to increase
blood flow

26. Physiotherapy
Splints-Indication
 Acute neuritis
 Mobile deformities(to prevent fixed deformities),
 Fixed deformities(to correct the deformities).
Splints used
 For radial neuritis-Static or dynamic wrist drop splint
 For mobile deformity- Static or dynamic splint
 For fixed deformity-Gutter splints,finger loops etc.

27. Physiotherapy
Electric stimulation - Uses
 To maintain the tone of denervated muscle
 Helpful in breaking post operative adhesions
 After tendon surgery could be used as a means of
documenting nerve damage and the progress of the
nerve recovery with treatment.

28. Prevention and Control of leprosy
 Prevention of leprosy
Early detection through survey and initiation treatment
Families of patients to be kept under surveillance
Immunoprophylaxis -Use of leprosy vaccines
Improvement in socio-economic conditions
 Control of leprosy
Three activities of a leprosy control unit
Case detection
Case holding, including treatment
Health education of public and patients

29. Prevention and Control of leprosy
 Leprosy Organizations
UNICEF LEPRA , DANIDA, SIDA ,CIDA ,Leprosy mission,
American leprosy mission, German leprosy relief
association
 Leprosy control Programmes
National leprosy control programme (NLCP)1954
Triad of survey, education and treatment (S.E.T).
National leprosy eradication programme (NLEP)1982

30. Prevention and Control of leprosy
National Leprosy Eradication Programme (NLEP),1982
 Eradicate leprosy from the country by 2000
 ‘Vertical’ health programme- In areas where
prevalence of leprosy is more than 5 per 1000.
 ‘Horizontal’ programme- In areas where the
prevalence rate is less than 5 per 1000

31. NLEP
Three main units for programme operation:
 Basic tier- Survey, education and treatment unit,
leprosy control unit and urban leprosy control unit.
 Second tier-District/zonal leprosy office
 Third tier-Leprosy division of the state directorate of
the health services.

32. Rehabilitation in leprosy
 Rehabilitation:
Physical and mental restoration of patients to normal
activities, so that they are able to assume their place
in the home, society and industry.
 Treatment of physical disability
 Education of patient, family and public
 Rehabilitation in special homes or institutional
rehabilitation
 Community based rehabilitation

33. Thank you