Leprosy Management

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LeprosyManagement Rehabilitation
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Management

• Diagnosis
• Skin Slit Smear
• Skin Biopsy
• Nerve Biopsy

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LABORATORY EXAMINATIONS

• Slit-Skin Smears
• The bacterial index (BI) is computed

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• Culture
• M. leprae has not been cultured in vitro
  however, it does grow when inoculated into the
  mouse foot pad.
• Dermatopathology
• TT shows epithelioid cell granulomas forming
  around dermal nerves acid-fast bacilli are
  sparse or absent. LL shows an extensive cellular
  infiltrate separated from the epidermis by a
  narrow zone of normal collagen.

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MANAGEMENT

• General principles of management include
• Eradicate infection with antilepromatous therapy,
• Prevent and treat reactions,
• Reduce the risk of nerve damage,
• Educate patient to deal with neuropathy and
  anesthesia,
• Treat complications of nerve damage,
• Rehabilitate patient into society

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Treatment

• Pancibacillary Dapsone Rifampicin
• Multibacillary Dapsone Rifampicin
  Clofazemine

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• Dapsone
• Competitive inhibition with PABA for
  dihydropteroate syntheses
• Blocks dihydrofolic acid

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• Adverse effects
• Haemolytic anaemia
• Hepatitis
• Agranulocytosis
• Methemoglobinemia
• Dapsone syndrome
• Exfoliative Dermatitis
• Lymphadenopathy
• Hepatitis

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Rifampicin

• Inhibits DNA dependent RNA polymerase of micro
  organisms thus interfering with bacterial RNA
  synthesis
• Adverse effects / side effects
• Discoloration of mine, tears
• Flu like syndrome
• Hepatoxicity

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Clofazemine

• Rimino-phenazinc dye Anti-inflammatory action
• Weakly bactericidal
• Side/Adverse effects
• Discoloration of skin
• GI complication
• Dryness of skin

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Newer drugs

• Ciprofloxacin
• Minocycline bacteriocidal
• Clarithromycin

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• Paucibacillary Disease (TT and BT)
• Monthly, supervised Rifampin, 600 mg
• Daily, Dapsone, 100 mg
• Daily Dapsone 100mg
• Duration 6 months all treatments then stop
• Follow-up after Minimum of 2 years stopping
  treatment with clinical exams at least every 12
• months

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• Multibacillary Disease (LL, BL, and BB)
• Monthly, supervised Rifampin, 600 mg
• Clofazimine, 300
  mg
• Dapsone, 100 mg
• Daily, unsupervised Dapsone, 100 mg
• Clofazimine, 50
  mg
• Duration Minimum of 2 years, but whenever
  possible until slit skin smears are negative
• Follow-up after Minimum of 5 years stopping
  treatment with clinical and bacteriologic
  examinations at least every 12 months

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Complication

• Type I
• Only skin lesions NSAIDS Rest
• If Neuritis Steroids
• Cont Anti-leprosy Treatment

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• Type II
• Bed Rest
• Steroids
• NSAIDS
• Clofazemine 100 tid
• Thalidomide
• Care of eyes
• Care of testis

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Therapy of Reactions

• Lepra Type 1 Reactions Prednisone, 40 to 60 mg/d
  the dosage is gradually reduced over a 2- to
  3-month period. Indications for prednisone
  neuritis, lesions that threaten to ulcerate,
  lesions appearing at cosmetically important sites
  (face)
• Lepra Type 2 Reactions (ENL) Prednisone, 40
• to 60 mg/d, tapered fairly rapidly
  Thalidomide for recurrent ENL, 100 to 300 mg/d

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• Systemic Antimicrobial Agents
• Secondary infection of ulcerations should be
  identified and treated with appropriate
  antibiotics to prevent deeper infections such as
  osteomyelitis.
• Orthopedic Care
• Splints should be supplied to prevent
  contractures of denervated regions. Careful
  attention to foot care to prevent neuropathic
  ulceration.
• Eye care and care of the anaesthetic sites

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• Leprosy related problems
• Nerve abscess excision
• Insensitivity and injuries
• Diminished sweating
• Arthalgia
• Periostitis
• Ear, nose, Throat
• Vaccines Mycobacterium W

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Rehabilitation

• Disability
• Inability or difficulty in carrying out certain
  backs
• Impairment
• Anatomic, physiologic and psychologic
  abnormalities or losses resulting from the
  disease or disorder

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Thank You