3. Specific learning objectives
+To list the prevalence of leprosy in India and the world
+To identify and interpret clinical manifestations of leprosy
+To list the management strategies of leprosy under NLEP
4. Geographical
distribution
+ All six WHO regions
+ Brazil, India and Indonesia
+ Africa, Myanmar, Nepal, Sri lanka,
Phillipines
+ Prevalence: 0.45/10000 (2021-22)
5. +Vision: leprosy free India
+Mission: to provide quality leprosy services free of cost to all sections
of the population, with easy accessibility, through the integrated
healthcare system, including care for disability after cure of the
disease.
+Objectives:
reduce the prevalence rate(<1/10000) @district
grade II disability(<1%) among new cases @national
grade II disability(<1/million) @national
zero disabilities among new child cases
zero stigma and discrimination
6. Strategies
+Decentralized integrated leprosy services
+Early detection and complete Rx of all new cases
+Household contact survey
+Capacity building
+Involve ASHA: ABSULS- n250/pb400/mb600
+Strengthen DPMR services
+IEC to help self reporting nad reduce stigma
+Monitoring and supervision @HWC, PHC/CHC
7. Newer strategies
+ Focused Leprosy Campaign(FLC):
low endemic areas, hard to reach
areas, child cases +, cases with
disability
+ Leprosy Case Detection
Campaign(LCDC): high endemic
+ Sparsh Leprosy Awareness
Campaign(SLAC)
+ PEP–SDR (Single Dose Rifampicin
600 mg)
+ MIP Vaccine
+ Nikusth: online reporting system
+ Grade II cases finding
+ AMR surveillance
+ ACD and RS
+ Modelling studies
+ District Award schemes for
achievements
10. Host factors
+Any age possible(bimodal)
+Young adults in endemic
countries
+Child cases?
+Males more than females
+Immunological status
Other factors
+Socioeconomic factors
+Disabilities and stigma
+Genetics(NOD2)
+Temp of 27-33℃
11. Symptoms and signs
+ Hypo-pigmented (pale) or erythematous (reddish) patches on the skin
+ Loss, or decrease, of sensation to temperature, touch or pain in the skin patch
+ Shiny or oily or smooth appearance of the skin (infiltration)
+ Nodules on a shiny, erythematous skin
+ Numbness or tingling of the hands or feet
+ Weakness of the hands, feet or eyelids
+ Presence of deformity in hands or feet or eyes
+ Loss of sweating in an area of skin
+ Painful or tender nerves
+ Painless wounds or burns on the hands or feet
12.
13. Reaction Clinical features Manifested as
LEPRA 1 (reversal
reaction)
Acute/ silent neuritis;
some generalized
symptoms
Hypopigmented patches and
nerves become red, swollen
and tender; loss of function;
new lesions; ulceration of skin
lesions; edema of hands and
feet.
LEPRA 2 (erythema
nodosum leprosum)
ENL, other organ
involvement and
general symptoms
Sudden erupting nodules which
blanches on pressure;
iridicyclitis, arthritis, epididymo-
orchitis, lymphadenopathy;
fever joint pains and fatigue
15. Clinical Assessment
+History: how long? How did it start? Has it changed? Are the
patches itchy or painful? Visible deformities? Any one in the
family affected? Social problems?
+Examine the patches
+Test for sensation
+Feel the nerves: ulnar, common peroneal
+Examine hands and feet for dryness
16. Nerve function assessment
+Sensory testing: Semmes Weinstein Monofilaments
+Voluntary muscle testing
Facial nerve: Orbicularis oculi- lid gap and eye closure
Ulnar nerve: Little finger out testing
Median nerve: Thumbs up
Radial nerve: Fist up
Common peroneal nerve: Foot up
17. WHO grading of Disability for Leprosy
GRADE Hands and Feet Eye
0 No disability found No eye problems due to
leprosy; no evidence of
visual loss
1 Loss of sensation+
No visible deformity/ damage
Eye problems+ ; but
vision not severely
affected(6/60 or better)
2 Visible deformity/ damage present Severe visual
impairment,
lagophthalmos,
iridocyclitis, corneal
opacities
18. 3 cardinal signs =
+One or More Hypopigmented,
Skin Patches with loss of sensation
+One or More Thickened Peripheral Nerve
and with loss of sensation in the area supplied
by the nerve, and/or weakness of the muscle
supplied by that nerve
+A Positive Slit Skin Smear for Mycobacterium
leprae
19. Classification
+PB and MB
+Determines the duration of the treatment
+PB: A case of leprosy, with one to 5 skin patches with loss of sensation
and without demonstrated presence of bacilli in a slit skin smear
+MB: 6 or more skin patches with loss or impairment of sensation; or with
nerve involvement
Demonstrated presence of bacilli in a slit skin smear irrespective of
the number of skin lesions
20. SN TYPES Duration of
the treatment
Dapsone Clofazamine Rifampicine
1 PAUCIBACILLARY ADULT 6 months 100 mg daily 300 mg once
a month and
50 mg daily
600 mg once
a month
CHILD 6 months 50 mg daily 150 mg once
and 50 mg
alternate day
450 mg once
a month
2 MULTIBACILLARY ADULT 12 months 100 mg daily 300 mg once
a month and
50 mg daily
600 mg once
a month
CHILD 12 months 50 mg daily 150 mg once
and 50 mg
alternate day
450 mg once
a month
