REVIEW ON LEPROSY by

D. Santhi KrupaAssistant Professor,

Department of pharmacologyVIJAYA INSTITUTE OF PHARMACEUTICAL SCIENCES FOR WOMEN

VV

Introduction Epidemiology Causative Agent Classification of Leprosy Cardinal Features of Leprosy Diagnosis of Leprosy Treatment MultidrugTherapy In Leprosy Complications of MDT Relapses Preventive Measures Conclusion

Leprosy is a chronic infectious disease caused by

Mycobacterium leprae, discovered by Norwegian physician

in 1873.

The first known written reference to the disease was found

on Egyptian papyrus in about 1550 B.C. The disease was

well recognized in ancient China, Egypt, and India.

According to the WHO research, India continues to

record the highest number of new leprosy cases in

the world.

It currently has about 54% of all the new leprosy

cases in that 48,000 women and 13,610 children are

newly detected with leprosy

Leprosy is a chronic infectious disease caused by

Mycobacterium leprae, an acid-fast, rod-shaped bacilli.Different forms of existence of Mycobacterium

leprae Solid

Granular

Fragments Globi

The maximum incubation period reported

is as long as 30 years

The average incubation period is between

three and ten years

Nasal secretions Skin

Ridley Jopling Classification

Lepromatous leprosy -Involvement of skin, nerves,

reticuloendothelial system Tuberculoid leprosy - Involvement of skin or nerves or both

Borderline leprosy -Skin lesions are macular, infiltrated, or

both, with the earliest lesions being macules that are erythematous or hypopigmented

Indeterminate leprosy -single macule with uncharacteristic histologyWHO classification of Leprosy :

a) Paucibacillary (PB)

b) Multibacillary (MB)

According to WHO, features of Leprosy include

a) PAUCIBACILLARY (PB) PATCHES:

• Hypopigmentation

• Anesthesia (Loss of sensation)

• Dryness (Loss of sweating)

• Loss of hair growth (Not scalp hair)

• Macular/ Elevated/ Erythematous

b) MULTIBACILLARY (MB):

• Nasal stuffiness

• Involvement of peripheral nerves

• Upper palate perforation

• Loss of eyebrows (Madarosis)

• Lagopthalmos (unilateral/bilateral)

• Gynecomastia

Skin Smears Test

Bacteriological Examination

The Bacteriological index (BI)

The Morphological index (MI)

Thin Layer Chromatography profiles

In MB patients, there will be decreased levels of SOD,

glutathione .

They are unable to produce sufficient amount of antioxidant to

cope up with the increased oxidative stress in them.

Providing nutritional supplementation may present a novel

approach for fast recovery. Administration of exogenous

antioxidants like vitamin C, tocopherols would prevent tissue

damage and make the patient therapeutically benefited.

Classification of Antileprotic drugs:

1) Sulfone - Dapsone(DDS)

2) Phenazine derivative - Clofazimine

3) Antitubercular drugs – Rifampicin, Ethionamide

4) Other antibiotics – Ofloxacin, Minocycline

Dapsone Dapsone is a competitive antagonist of

paraminobenzoic acid (PABA)

Prevents normal bacterial utilization Of PABA for the Synthesis Of Folic Acid

Bacteriostatic or weakly bactericidal against M. leprae

Clofazimine (CLF):CLF was a phenazine dye, which

preferentially binds to mycobacterial DNA inhibits both mycobacterial growth and exerts a slow bactericidal effect on M. leprae.

Rifampicin :

It’s a highly bactericidal against M. leprae by inhibiting bacterial RNA synthesis and blocks RNA transcription.

Ofloxacin (OFLX): OFLX, a synthetic fluoroquinolone, acts as a

specific inhibitor of bacterial DNA gyrase and has shown efficiency in the treatment of M. leprae .

Minocycline :

It inhibits bacterial protein synthesis by binding into 30s and 50s ribosomal subunits of susceptible bacteria.

Type of Leprosy

Daily, Self-Administered

Monthly Supervised

Months of Treatment

Multibacillary Dapsone 100 mg Rifampicin 600 mg

12

6

Paucibacillary Dapsone 100 mg Rifampicin 600 mg

Clofazimine 300 mg

MDT and Drug-resistance Leprosy reaction and its treatment

Type 1 lepra reactions or reversal reactions are associated with the development of M. leprae antigenic determinants.Type 2 lepra reactions (erythema nodosum leprosum), are associated with circulation and tissue deposition of immune complexes.

The relapse rates after release from Dapsone have varied from 1% to 17% for tuberculoid leprosy and from 2% to 30% for lepromatous leprosy.

Vaccination against the leprosy bacillus may be considered. BCG vaccination is reported to be partially effective for protection against leprosy

A mixed vaccine containing BCG and ICRC bacilli is under trails for clinical use.

Throughout the history, the badly affected leprosy patients are hated by the families and communities. In present scenario with the advancement in the treatment, most cases are recovered. If there are new cases in India, in future they can be reduced by using the mixed vaccines and the severity can be decreased by detecting the disease in the early stages by simple techniques like TLC.

Ahmad RA and Rogers HJ (1980). Plasma and salivary pharmacokinetics of dapsone estimated by a thin layer chromatographic method. Eur J Clin. Pharmacol; 17:129-33

Amuda P (2003). A study on the infectivity among the Relieved From treatment (RFT) Leprosy patients in Warangal. Dissertation submitted to Kakatiya University for the partial fulfillment for the award of M.Pharm (Pharmacology).

Anton ES, Sandrock AW, Matthew WD (1994). A 21kDa protein of M. leprae

Cochrane RG (1964). Leprosy in theory and practice, (Cochrane RG and Davey TF, Eds) p. 613.

Cole ST, Eiglmeier K, Parkhill J, James KD, Thomson NR, Wheeler PR (2001). Massive gene decay in the leprosy bacillus. Nature; 409: 1007-11.

Cornbrooks CJ, Carey DJ, McDonald JA, Timply R, Bunge RP (1983). Differentiation of axon-related Schwann cells in vitro. I. Ascorbic acid regulates basal lamina assembly and myelin formation. Proc Nat Acad Sci., USA 80:3850–3854.

Davey TF (1974). The nose in Leprosy: Steps to a better understanding (editorial) Lepr. Rev., 45:97.

Prabhakar MC (1987a). Investigation into cultivation of M.leprae in a nasal mucous medium. A preliminary report. Intl J Lepr.55: 561-562.

Prabhakar MC (1987b). Uneven distribution of M. leprae in the skin of LL patients. China. Lepr J., 3: 27-32.

Prabhakar MC (1994). Comparative evaluation of AAFB from the nose and the skin of Lepromatous Leprosy patients. China Lepr J., 10: 84-86.

Prabhakar MC, Appa Rao AVN, Krishna DR and Ramanakar TV (1983) How much non-infectious are the “non-infectious” Lepromatous Leprosy patients? Lepr. India. 55: 576-583.

Prabhakar MC, Appa Rao AVN, Krishna DR and Ramanakar TV (1983). How much non-infectious are the “non-infectious” Lepromatous Leprosy patients? Lepr. India. 55: 576-583.

Prasad N (2003). Bacteraemia among the relieved from treatment (RFT) Dissertation submitted in partial fullfillment for the award of the degree of the master of Pharmacy in Pharmacology by Kakatiya University, Warangal. A.P.506009.

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