Leprosy: Causes, Symptoms, Treatment and Prevention
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This document provides an overview of leprosy (Hansen's disease), including: - It is caused by Mycobacterium leprae bacteria and primarily affects nerves and skin. - Signs include pale skin lesions with reduced sensation. Advanced cases show disfigurements like clawing of hands/feet. - Leprosy has affected humans for thousands of years and treatments now cure most cases. - It is classified and treated differently depending on bacterial load and symptoms. Multi-drug regimens including rifampin are usually effective. - Prevention relies on early detection, treatment, health education, and social support for those affected. While rates have declined greatly, ongoing efforts are needed for full control
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Leprosy: Causes, Symptoms, Treatment and Prevention
- 1. LEPROSY By Sriloy Mohanty B.N.Y.S
- 3. INTRODUCTION ο Chronic infectious disease ο Surface infection ο Caused by M leprae ο Affects mainly the peripheral nerves
- 4. Cardinal features ο Hypo-pigmented patches ο Loss of cutaneous sensations ο Thickened nerves ο Presence of acid-fast bacilli in the skin or nasal smear Signs of advanced disease are: ο Lumps in the skin of the face and ears ο Plantar ulcers ο Loss of fingers or toes ο Nasal depression ο Foot drop and claw toes
- 5. History ο Oldest disease known to mankind ο Leper - Greek word β scaly ο Confused with psoriasis, elephantitis and pellagra ο Known as kushta roga ο 1873 β Hansen of Norway discovered M. leprae ο 1943 β sulphone drugs used in the treatment
- 6. Problem Statement ο 1991 β WHO Member State resolved to decrease the level of leprosy by over 90% ο Fall in prevalence rate largely is due to ο Improvement in management of cases ο Low rates of relapse ο High cure rate ο Absence of drug resistance ο Short duration treatment ο WHO global strategy for further reducing the leprosy burden and sustaining leprosy control activities(2006-10)
- 7. ο Main elements of the strategy are ο Sustain leprosy control activities in all endemic countries ο Use case detection as the main indicator to monitor progress ο Ensure high-quality diagnosis, case management, recording and reporting and reporting in all endemic communities ο Strengthen routine and referral services ο Discontinue the campaign approach ο Develop tools and procedures that are home/community based, integrated and locally appropriate for the prevention of disabilities/impairments and for provision of rehabilitation services ο Promote operational research in order to improve implementation of a sustainable strategy ο Encourage supportive walking arrangements with partners at all levels
- 8. India ο Leprosy was widely prevalent in India ο Now out of 611 districts,487 are free from leprosy ο A total of 0.87 lakh cases are recorded on 1st April 2008 ο Prevalence rate is 0.74 leprosy cases/10,000 population
- 9. Epidemiological determinants ο Agent : ο Caused by M. leprae ο They have affinity for Schwann cells and cells of the reticulo-endocrine system ο The bacterial load is the highest in the lepromatous cases (2 to 7 billion were estimated in one gram of leproma) ο Phenolic glycolipid (PGL) is the specific M. leprae ο Source of infection ο Multibacillary cases imp source of infection ο All patients with βactive leprosyβ must be considered infectious ο Man is the only source and host
- 10. ο Portal of exit ο Nose is a major portal of exit ο M. leprae are discharged in the nasal mucosa ο Can also exit through ulcerated or broken skin ο Infectivity ο Highly infectious but of low pathogenicity ο Can be rendered non β infectious by treatment of 3 weeks ο Local application of rifampicin can destroy bacilli within 8 days ο Attack Rate ο In households 4.4% to 12% is expected to show signs of leprosy within 5 years
- 11. Host factors ο Age ο Infection can take place at any time depending upon the opportunity for exposure ο Incidence rates peak between 10 and 20 years of age and then fall ο A high prevalence of infection among children means that the disease is active and spreading ο Sex ο Incidence and prevalence higher in males than in females ο Migration ο Mostly a rural problem ο Due to migration it is causing a problem in urban areas also
- 12. ο Genetic factors ο Human lymphocyte antigen (HLA) linked genes influence the type of immune response that develops
- 13. Environmental Factors ο Humidity favors survival of M.leprae ο Can remain viable in dried nasal secretion at least 9 days ο In moist soil at room temp. for 46 days
- 14. Modes of transmission ο Droplet infection ο Aerosols containing M. leprae ο Contact transmission ο Person to person by close contact (direct or indirect) ο Other routes ο Insect vectors ο Tattooing needles
- 15. Incubation period ο 3 to 5 years or more
- 16. Classification ο Three types of classification ο Ridly and jopling classification ο Madrid classification ο Indian Classification ο Indian classification ο Indeterminate type ο Tuberculoid type ο Borderline type ο Lepromatus type ο Pure neuritic type
- 17. ο Ridly and jopling classification ο Indeterminate type ο Tuberculoid type ο Borderline type ο Lepromatus type ο Pure neuritic type ο Madrid classification ο Indeterminate type ο Tuberculoid type ο Borderline type ο Lepromatus type
- 18. Drugs ο Only bactericidal drugs are used ο Rifampicin ο High bactericidal against M.leprae ο Single dose of 1500mg ο 3-4 consecutive daily doses of 600mg ο Side-effects are nausea,abdominal pain,vomiting ο Dapsone ο Used all over the world for 30years ο 1-2mg/kg of body weight ο Weakly bactericidal effect
- 19. ο Clofazimine ο Synthesized for treatment of TB ο Found to have greater value against M.leprae ο May give darkish coloration to the skin,urine,sweat ο Ethionamide and protionamide ο Bactericidal drugs killing 98% of M.leprae in 4-5 days ο More expensive and toxic ο Used as the 3rd durgs in multibacillary leprosy
- 20. ο Quinolones ο Inhibiting DNA synthesis during bacterial replication ο Ofloxacin is most preferable drug in this group ο 22 doses of Ofloxacin kill 99.9% of viable M.laprae
- 21. WHO Recommeneded ο For adults ο Multibacillary leprosy ο Rifampicin-600mg once monthly ο Dapsone-100mg daily ο Clofazimine-300mg once monthly 50 mg daily ο Paucibacillary leprosy ο Rifampicin-600mg once monthly ο Dapsone-100mg daily for 6 months
- 22. ο For children 10-14years ο Multibacillary leprosy ο Rifampicin-450mg once monthly ο Dapsone-50mg daily ο Clofazimine-150mg once monthly 50 mg daily ο Paucibacillary leprosy ο Rifampicin-400mg once a day ο Dapsone-50mg daily
- 23. Estimation of problem ο Disease load on the community has to be estimated by surveys ο Prevalence can be determined by examining school β age children
- 24. Diagnosis ο Clinical examination ο Integration ο Collection of bio data ο Family history ο History of contact with leprosy case ο Previous history of treatment ο Present complaint ο Physical examination ο Inspection of skin ο Palpation of commonly involved peripheral and cutaneous nerve ο Presence of thickening of nerves ο Testing for loss of sensation for heat, cold, pain and touch in skin patches
- 25. ο Bacteriological examination ο Skin smears ο Material from the skin obtained from an active lesion and also from both ear lobes ο Nasal smears ο Best preparation from early morning mucous material ο Nasal scraping ο Nasal mucosal scrapper is used
- 26. Biopsy ο When the examination do not yield diagnosis histo- pathological examination may be necessary ο It gives an accurate classification of the disease
- 27. Immunological tests ο Two types of tests ο Test for detecting cell mediated immunity ο Test for detecting humoral antibodies
- 28. Test for CMI ο Lepromin test ο Injecting 0.1ml of lepromin intradermally ο 2 types of reaction is seen ο Early reaction ο Late reaction
- 29. ο Early reaction ο Known as fernandez reaction ο Inflamatory reaction seen in 24-48hrs ο Tends to disappear in 3-4 days ο If the redness is more then 10mm at the end of 48hrs then the test is considered to be positive ο Indicates previous sensitisation ο Late reaction ο Reaction becomes apperent in 7-8 days ο Maximum in 3-4weeks ο If there is a nodule more then 5mm in diameter then test is positive
- 30. LTT & LMIT ο Newer in in vitro tests such as lymphocyte transformation test and leucocyte migration inhibition test has been developed ο They give a measure of CMI ο Used to detect sub clinical infection
- 31. Test for humoral response ο FLA-ABS test (Fluorescent Leprosy Antibody Absorption Test) ο Used to identify sub clinical infections ο It is 92% sensitive and 100% specific in detecting M.leprae ο Monoclonal antibodies ο These against M. leprae antigens have been produced ο If antibodies against specific antigens are found, they will become reagent of choice for identifying M. leprae ο ELISA test ο Based on a phenolic glycolipid (PGL) antigen
- 32. Surveillance ο Paucibacillary leprosy-recomended to be examined clinically atleast once a year for minimum 2 years ο Multibaccilary leprosy-leprosy-recommended to be examined clinically at least once a year for minimum 5 years
- 33. immunoprophylaxis ο BCG can provide some protection against leprosy ο Several alternative vaccines are under development ο Called as candidate vaccines ο None of them attained βvaccine hoodβ yet
- 34. deformities ο If leprosy not treated at an early stage develops deformities ο It is due to damage of peripheral nerve trunks or injury from infection to hand and feet's ο Paralysis may occur to some muscle
- 35. Health Education ο Anti-leprosy campaign is incomplete without education ο Health education aims at helping people to avoid this type of diseases ο It should be direct towards the patient and his/her family ο It should educate people on the true facts about leprosy and removes superstation and wrong beliefs and the social stigma associated with leprosy
- 36. Social support ο Chemotherapy alone is not likely to solve this problem ο It needs social support also ο Economic and social problems should be identified
- 37. Anti-leprosy activates in India ο 1874-Mission To Leprosy was found by Baily at Chamba in the Himachal Pradesh ο After that a lot of organizations are established ο Hindu Kusth Nivaran Sangha ο Gandhi Memorial Leprosy Foundation ο National Leprosy organization(1965) ο German Leprosy Relief Association ο Damien Foundation ο Danish save the child foundation ο National Leprosy Control Program(1954) was converted in to Eradication Programme(1983)
- 38. Thank youβ¦