Leprosy is a chronic infectious disease caused by Mycobacterium leprae that attacks the nervous system and skin. It causes numbness and visible deformities as it destroys nerves and cartilage in affected areas over time. The diagnosis is made based on sensory loss and skin lesions. Treatment involves multidrug regimens containing dapsone, clofazimine, and rifampicin over the course of 6 months to 2 years depending on the classification of paucibacillary or multibacillary leprosy. Side effects of the drugs include rashes, discolored skin, and severe itching which usually resolve after treatment completion.

1. 1
PREPARED BY: PUNIT PATEL

2. Leprosy is a chronic granulomatous
infectious disease that attacks the nervous
system caused by acid fast bacilli
Mycobacterium leprae
M. leprae lies within the macrophages and
remain dormant
Leprosy cause deficiency in cell mediated
immunity
2

3. 3

4. Leprosy attacks the different parts of the body
Leprosy destroys neurons in these areas, taking
feeling away from them
Leprosy also causes cartilage in those areas to
get absorbed back into the body, causing
fingers, toes, ears and nose to disappear
Leprosy also causes large bumps in the skin
that do not feel pain and do not heal
4

5. Infection usually transmitted from person to person
due to shedding of bacilli
To avoid leprosy, avoid close contact with someone
who has untreated leprosy
5

6. In the first stages of Leprosy, people’s lives are
not very affected, but eventually, people lose
their fingers and toes and become disfigured
Not only are the victims of Leprosy physically
disabled, but emotionally as well
In the later stages of leprosy, people lose their
sight, as well as most of the feeling in their
body
6

7. Nerve is
damaged and
broken by
leprosy
infection.
Large bumps (legions)
on the skin that do not
heel and cannot feel
pain.
Nerve
Leprosy infection
7

8. Examine skin
Check for patches
Count the number of patches
Test for sensation
Check for damage to nerves
8

9. Pale or slightly reddish patch
Loss of sensation in the patch
Signs of damage to nerves
Loss of sensation in hands/feet
weakness of muscles of hands/feet/face
visible deformity of hands/feet/face
9

10. The diagnosis is made based on finding definite
loss of sensation in one or more patches.
1-5 patches is paucibacillary (PB), more than 5
patches is multibacillary (MB) leprosy
10

11.  Sulfones
 Dapsone, Sulfoxone, Acedapsone
 Phenazine derivative
 Clofazimine
Antitubercular drug
 Rifampicin
Antibiotics
 Fluoroquinolones – Ofloxacin, Sparfloxacin
 Macrolides – Clarithromycin
 Tetracyclines - Minocycline
11

12.  M.O.A.
 Inhibition of bacterial folic acid synthesis
 Dapsone acts against bacteria and protozoa in the
same way as sulphonamides.
 That is by inhibiting the synthesis of dihydrofolic acid
through competition with para-amino-benzoate for the
active site of dihydropteroate synthetase
 Has antiinflammatory properties
12

13. 13

14.  Pharmacokinetics
 Well absorbed orally
 widely distributed throughout the body fluids and tissues
 acetylated in liver excreted in bile, undergoes
enterohepatic circulation
 It tends to remain in skin,muscle,kidney and liver up to the
three weeks after the therapy is stopped
 70% excreted through urine
 Plasma half life 1-2 days
14

15.  Uses
 In treatment and prevention of Pneumocystis carinii
pneumonia in AIDS patient
15

16.  Side effect
 During treatment of lepromatous laprosy some reactive
episodes may occur called as lepra reactions
 (1)Type 1 lepra reaction
 (2)Type 2 lepra reactions(erythema nodosum
leprosum)
 Type 1 reactions delayed hypersensitivity reactions due
to M leprae antigens [type 4 hypersensitivity reactions]
 Type 2 reactions represent a humoral antibody
response[type 3 hypersensitivity reaction]
16

17.  Adverse effects
 Nonhaemolytic anaemia and methaemoglobinaemia in
G6PD deficient
 Mild – nausea
 loss of appetite
 pruritus
 reversible neuropathy & hepatotoxicity
 drug fever
 Not given when hb% is below 7
17

18.  M.O.A.
 Phenazine dye which binds with mycobacterial DNA &
Inhibit mycobacterial growth
 Leprostatic with anti-inflammatory action
 It bind to mycobacterial DNA leading to disruption of
the cell cycle and eventually prevents the growth of
the bacterium.
18

19.  Pharmacokinetics-
 Oral absorption variable
 excreted in feces
 plasma half life 60-70hrs
19

20.  Side effect
 Red brown discolouration of skin
 Abdominal pain with loose stools due to deposition of
crystals in intestinal mucosa
 Avoided in pregnancy
 Mild – Conjunctival pigmentation & phototoxicity
20

21.  MOA-
 It binds to and inhibits bacterial DNA dependent RNA polymerase
so that it can not synthesize new RNA
 Mammalian RNA does not binds with drug , host cells unaffected
 The drug is bactericidal
 Pharmacokinetics-
 well absorbed on oral administration.
 Penetrates all tissue, tubercular cavities, placenta & protein
binding.
 Excreted through liver into bile & undergo enterohepatic
circulation.
21

22.  Side effect
 Hepatitis –major adverse effect
 Ocasionally- rashes, Gi disturbances, dizziness &
fatigue.
 Flu like syndromes- fever, chills,myalgias &
thrombocytopenia.
 Imparts harmless red colour urine.
 Resistance devlop after prolong use
22

23. Category and
Type of patient
Duration of
Treatment
Drug regimen
Multibacillary
Leprosy
(Lepromatous)
For 24 months
If RMP
resistance
Dapsone 100 mg daily +
Clofazimine 50 mg daily with
300 mg once a month +
Rifampicin 600 mg once a
month
Clofazimine 50 mg daily +
Ofloxacin 400 mg daily +
Minocycline 100 mg daily for 6
m
Then Clofazimine + Ofloxacin
for 18 months
Paucibacillary
Leprosy
(Tuberculoid)
6 months
If Dapsone not
tolerated
Dapsone 100 mg daily +
Rifampicin 600 mg once a
month
Clofazimine 50 mg daily and
300 mg once a month may be
substituted in place of Dapsone23

24. • Red coloured urine
• Darkening of skin
• Severe itching of skin
• This is due to rifampicin. Lasts
only for few hours Reassure the
patient that this is harmless
• This is due to clofazimine.
Reassure the patient that this will
disappear after treatment is
completed
• This is due to allergy to one of the
drugs (commonly to dapsone).
Stop all medicines and refer to
hospital
24

25. 25