LeprosyLeprosy

Management & RehabilitationManagement & Rehabilitation

ManagementManagement

DiagnosisDiagnosis

Skin Slit SmearSkin Slit Smear

Skin BiopsySkin Biopsy

Nerve BiopsyNerve Biopsy

LABORATORY EXAMINATIONS

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

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.

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

Treatment

Pancibacillary – Dapsone + Rifampicin

Multibacillary – Dapsone + Rifampicin +

Clofazemine

DapsoneDapsone

Competitive inhibition with PABA for Competitive inhibition with PABA for

dihydropteroate synthesesdihydropteroate syntheses

Blocks – dihydrofolic acidBlocks – dihydrofolic acid

Adverse effects:Adverse effects: Haemolytic anaemiaHaemolytic anaemia

HepatitisHepatitis

AgranulocytosisAgranulocytosis

MethemoglobinemiaMethemoglobinemia

Dapsone syndromeDapsone syndrome

• Exfoliative DermatitisExfoliative Dermatitis

• LymphadenopathyLymphadenopathy

• HepatitisHepatitis

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

ClofazemineClofazemine

Rimino-phenazinc dye Anti-inflammatory Rimino-phenazinc dye Anti-inflammatory

actionaction

Weakly bactericidalWeakly bactericidal

Side/Adverse effectsSide/Adverse effects

Discoloration of skin Discoloration of skin

GI complicationGI complication

Dryness of skinDryness of skin

Newer drugs:

CiprofloxacinCiprofloxacin

MinocyclineMinocycline bacteriocidalbacteriocidal

ClarithromycinClarithromycin

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

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

ComplicationComplication

Type – I

Only skin lesions – NSAIDS Rest

If Neuritis : Steroids

Cont Anti-leprosy Treatment

Type II Bed RestBed Rest

SteroidsSteroids

NSAIDSNSAIDS

Clofazemine 100 tidClofazemine 100 tid

ThalidomideThalidomide

Care of eyesCare of eyes

Care of testisCare of testis

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

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

Leprosy related problemsLeprosy related problems Nerve abscess – excisionNerve abscess – excision

Insensitivity and injuriesInsensitivity and injuries

Diminished sweatingDiminished sweating

ArthalgiaArthalgia

PeriostitisPeriostitis

Ear, nose, ThroatEar, nose, Throat

Vaccines: Mycobacterium WVaccines: Mycobacterium W

RehabilitationRehabilitation

Disability: Inability or difficulty in carrying out certain Inability or difficulty in carrying out certain

backsbacks

Impairment:Impairment: Anatomic, physiologic and psychologic Anatomic, physiologic and psychologic

abnormalities or losses resulting from the abnormalities or losses resulting from the

disease or disorderdisease or disorder