Is a chronic disease principally affecting the skin and
peripheral nervous system. Leprosy is named after Gerhard Armauer Hansen, the
first Norwegian physician who identified the micro- organism that cause the
disease in 1873.
CAUSATIVE AGENT: Mycobacterium leprae
INCUBATION PERIOD: 2- 20 years.
Children are more susceptible to leprosy. Generally more
common in males than in females (Ratio 2:1)
MODE OF TRANSMISSION
The exact mechanism of transmission of leprosy is not known.
But it can be also transmitted
1.
Through contact with nasal discharges and
droplets from untreated patients with severe disease.
2.
Also via skin contact with an infected person.
CLASSIFICATIONS OF LEPROSY
There are 2 major classifications of leprosy;
·
Ridley- Jopling system
·
WHO standard/ system
RIDLEY- JOPLING SYSTEM
This system is classified based on gradually weakened
cellular immune response with increasing bacilli load. There are 2 main sub-
groups;
1.
TUBERCULOID
A tuberculoid form of the disease is as a result of a good
immune response of the person. There are limited skin lesions and some
asymmetric nerve involvement.
2.
LEPROMATOUS
Lepromatous form is also caused by a poor immune response of
the patient. It is characterized by extensive skin and symmetric nerve involvement.
CLASSIFICATIONS OF RIDLEY- JOPLING SYSTEM
1.
INTERMEDIATE SYSTEM
a.
Few hypo pigmented macules.
b.
They can heal spontaneously.
c.
It can persist/ advance to other forms.
2.
TUBERCULOID (TT)
a.
Few lesions.
b.
Well- defined margins.
c.
Acid- fast bacteria are rarely detected.
d.
Some neural involvement in which nerves become
enlarged.
e.
May even heal spontaneously in few years.
f.
It may persist to other forms
3.
BODERLINE TUBERCULOID (BT)
a.
Lesions like tuberculoid but smaller and
numerous.
b.
Less nerve enlargement.
c.
Small number bacilli found on skin.
d.
May persist/ revert to tuberculoid leprosy or
other forms.
4.
MID- BODERLINE LEPROSY (BB)
a.
Numerous lesions asymmetrically distributed.
b.
Swollen lymph nodes.
c.
Nerve involvement is common.
d.
Moderate number bacilli found on skin.
e.
It may progress to other forms.
5.
BODERLINE LEPROMATOUS LEPROSY (BL)
a.
Many skin lesions
b.
Nerve involvement
c.
Many bacilli present on skin.
6.
LEPROMATOUS
a.
Mulitple lesions
b.
Symmetric in distribution
c.
Acid- fast bacilli are numerous
d.
Progress of disease is uncontrollable
e.
Alopecia occurs
f.
Often no eyebrows/ eyelashes.
g.
Nerve involvement may lead to anesthetic areas
and limb weakness.
h.
Aseptic necrosis (a condition that occurs when
there is loss of blood to the bone)
i.
Skin nodules (lepromas)
j.
Disfigurement of many areas including the face.
WHO SYSTEM
The WHO classification based on the number of skin lesions.
There are 2 types;
1.
PAUCIBACILLARY
This leprosy is characterized by fewer lesion. There is the
absence of bacilli on skin smear. It includes tuberculoid and borderline
tuberculoid of the Ridley- Jopling system.
2.
MULTIBACILLARY
It has more lesions and there is the presence of bacilli on
skin smear. It also includes Lepromatous, borderline Lepromatous and
midboderline leprosies.
CLININCAL FEATURES OF LEPROSY
1.
Painless skin patch (with loss of sensation but
not itchiness)
2.
Paresthesia (Is an abnormal dermal sensation on
the skin eg. Tingling, prickling and chilling with no apparent physical cause).
3.
Numbness in the hands, arms, feet and legs.
4.
Wasting and muscle weakness.
5.
Foot drop or clawed hands.
6.
Ulcerations on hands or feet.
7.
Lagophthalmos, iridocyclitis, corneal ulceration
and/ or secondary cataract due to nerve damage.
[ Lagophthalmos:
Is the inability to close the yelids completely
Iridocyclitis; Is an inflammation of the iris
and of the ciliary body that is muscles
and tissue involved in focusing the eye.]
REACTIONS IN LEPROSY
There are 2 types of reactions in leprosy;
TYPE I (REVERSAL)
1.
Sudden onset of skin redness and new lesions.
2.
Swelling
3.
Acute pain and tenderness over skin and nerve lesions.
4.
Loss of nerve function
5.
Found in borderline tuberculoid.
6.
Can occur during/ after Multiple Drug Therapy.
7.
Treatment requires oral corticosteroids and
NSAIDS.
TYPE 2 (ERYTHEMA
NODOSUM LEPROSUM)
1.
Many skin nodules
2.
Fever
3.
Redness of eyes.
4.
Muscle pain and joint pain
5.
Found in Lepromatous leprosy patients.
6.
Treatment may include clofazimine, thalidomide,
corticosteroids, colchicine, cidosporin.
DIAGNOSIS
By using any of the three cardinal signs
Ø
One or more hypopigmented patch or lesions on
skin
Ø
One or more thickened nerve
Ø
A positive skin smear.
Laboratory testing
Ø
Skin smear/ biopsy of suspected skin lesion.
Ø
Lepromin test to distinguish between Lepromatous
from tuberculoid form.
MANAGEMENT
1.
PAUCIBACILLARY/ TUBERCULOID
Ø
Dapsone 100mg (daily self administration)
Ø
Rifampicin 600mg (monthly supervised) 6- 12
months.
2.
MULTIBACILLARY/ LEPROMATOUS
Ø
Dappsone 100mg, Clofazimine 50mg(daily self administered)
Ø
Rifampicin 600mg, Clofazimine 300mg (monthly supervised) 24
months.
Recently WHO suggested that single – dose treatment of
patients with only one skin lesion with rifampicin, minocycline (Minocin), or
Ofloxacin (Floxin) is effective.
PREVENTION
The most effective way to avoid the disease is preventing
contact with droplets from nasal and other secretions from patients with
untreated Mycobacterium lepare inefection.
COMPLICATIONS
1.
Sensory loss
2.
Permanent nerve damage
3.
Muscle weakness
4.
Progressive disfigurement
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