LEPROSY

Presenter

Dr Praveen Aivalli

1st MPH KLE UniversityBelgaum

Overview

۩ Definition۩ Geographical distribution ۩ Epidemiological features ۩ Mode of transmission ۩ Incubation period ۩ Prevention and Control

Introduction

Leprosy :Hansen's disease :Chronic infectious disease :Caused by mycobacterium leprae.

Affects :Peripheral nerves, skin, Muscles, eyes, bones, testes, Internal organs.

Manifests in two polar forms :Lepromatous Leprosy :Tuberculoid Leprosy

Clinically characterized Cardinal features

Hypo pigmented patches

Partial or total loss of cutaneous sensation in the affected areas

Presence of thickened nerves

Presence of acid-fast bacilli the skin or nasal smears

HISTORY:

Oldest disease known to mankind.

“Leper” -- “Scaly” (Greek word)

Kushta roga (India) -- punishment from God.

Sushruta samhita (600BC) -- disease & treatment.

Hansen (Norway). -- discovered M.Leprae in 1873

New era -- Introduction of sulphone drugs in 1943

Problem Statement

WORLD

Prevalence rate : 8.4 per 10,000 population (1966)

: 12 per 10,000 population (1985)

:1 per 10,000 population (2006)

SEAR : 68% of newly detected cases (2005) : 60.9% of global prevalence (2006)

Problem Statement world

India

Widely prevalent

March 1998 → 5.03 lacks cases → 75% cases in world

Prevalence rate : 1.34 per 10,000 population (2005) :0.84 per 10,000 population (2006) :62% cases in W.B, Orissa, Bihar, M.P, U.P

India → target of <1 case per 10,000 population → March2006

Epidemiology determinants Agent -- Mycobacterium leprae

Characteristics of M. leprae -- gm +ve, acid fast bacillus. Clump or bundle (called

globi)

Source of infection – multibacillary cases(lepromatous leprosy& bodrline lepromatous)

Current view “active leprosy”Portal of exit – Nose

Infectivity – highly infection disease but low pathogenicity

Attack rate – 4.4 % to 12%

,

Host factors

Age -- depends upon opportunities (exposure to infection)

Sex -- Both but higher prevalence in males

Migration – Earlier rural problem --Now rural to Urban area

Immunity – few exposed to infection develop the disease Cell mediated immunity and Humoral

response

Genetic factors_--HLA linked genes influence the type of immune response

Mode of transmission

Droplet infection – aerosols containing M. lerprae

Contact transmission – person to person by close contact between infectious and healthy

but susceptible person( skin to skin, formites, soil)

Other routes -- breast milk, insect, vectors and tattooing needles.

Incubation period -- 3 to 5 years ( “latent period” due to long duration)

Classification (based on Clinical, bacteriological & immuno histological scale)

Indian classification: Indeterminate type Tuberculoid type Border line type

Lepromatous type Pure neuritic type

Madrid classification: Indeterminate type Tuberculoid type; flat ;raised Border line type

Lepromatous typeRidley Jopling classification: Tuberculoid (TT)

Border line tuberculoid (BL) Border line (BB)

Border line lepromatous (BL) Lepromatous (LL)

Indian classification Indeterminate type -- hypo pigmented macules, sensory

involvement, bacterilogically –ve lesion

Tuberculoid type -- well defined lesion which may flat or raised,hypo pigmented or

erythematous & are anesthetic , bacterilogically –ve lesion

Borderline type -- 4 or more lesions which may be flat or

raised, well or ill defined, hypo pigmented or erythematous & show sensory impairment or loss, bacterilogically + ve lesion, progress to lepromatous type.

Cont……

Lepromatous type -- diffuse infiltration or numerous flat or raised, poorly defined shiny, smooth, symmetrical distributed lesion and bacteriologically positive lesion

Pure neuritic type -- nerve involvement but have lesion in the skin, bacteriologically negative lesion

Diagnosis

1) Clinical examination

Process called “Case Taking”

a) interrogation – collection of biodata such as name,age etc; family history, present complaint

b) physical examination -- Thorough inspection of body surface (Skin), Palpation of the

commonly involved peripheral & cutaneous nerve, Testing for loss of sensation for heat, cold, pain & light touch in skin patches.

2.Bacteriological examination:

Skin smears :Diagnosing mulltibacillary leprosy :distinguishing between paucibacillary &

multibacillary

Skin & Nasal smear examination Skin smear : material from skin obtained by “slit

and scrap” method Nasal smears or blows : early morning mucus material

Nasal scraping : use nasal mucosal scrapper.

6) Immunological tests:

Classified

1. Tests for detecting cell mediated immunity (CMI)

2. Tests for humoral antibodies (serological tests)

Prevention and Control

Indian Council of the British Leprosy Relief Association– 1925

Hindu Kussht Nivaran Sangh (Renamed) -- 1947

National leprosy Control Programme -- 1955

Main Objectives domiciliary treatment with Dapsone

National Leprosy eradication Programme -- 1983

Elements for Leprosy Control Programme

1. Medical Measures

2. Social support

3. Programme Management

4. Evaluation

1.Medical measures

Estimation of the problem Early case detection Multi drug therapy (MDT) Surveillance Immunoprophylaxis Chemoprophylaxis Deformities Rehabilitation Health education Others

Drugs

• Rifampicin – single dose – 1500mg• Dapsone -- 1-2mg /kg of body weight• Ethionamide and protionamide• Quinolones• Minnocyline• Clarithromycin

MDT for multibacillary leprosy (WHO Recommended Regimens)

ADULTS

Rifampicin 600 mg (once monthly)

Clofazimine 300 mg (once monthly)

then 50mg daily

Dapsone 100 mg daily

Duration of treatment:

MB blister pack for 12 months

Children

Rifampicin 450 mg (once

monthly)

Clofazimine 150 mg (once monthly) then 50mg daily

Dapsone 50 mg daily

MDT for Paucibacillary leprosy

ADULTS

Rifampcin 600 mg (once monthly for 6

months)

Dapsone 100 mg (daily for six

months)

Duration of treatmentPB blister packs for 6 months

Children

Rifampcin 450 mg(once a day)

Daosone 50 mg daily

3.Programme management

۩ Long term activities ۩ Operational performance

National Leprosy eradication Programme ۩ Incorporates adequate infrastructure۩ Trained health personal ۩ Adequate supply of drugs and vehicles ۩ Financial allocation

Anti leprosy activities in India

UNICEF Leprosy Mission American Leprosy Mission Hind Kushta Nivarana Sangh Gandhi Memorial Leprosy Foundation Amici Di Lebrasi (Italy) Damien Foundation Sasakawa Memorial Health Foundation Danish Save the Child Found German Leprosy Relief Association Vidabha Maharogi Seva Mndal

WHO global strategy reducing leprosy burden

Sustain leprosy control activities in all endemic areas Case detection as indicator to monitor progress High quality diagnosis, case management, recording & reporting Strengthen routine and referral services Discontinue the campaign approach Tools and procedure (home/community based, integrated and

locally appropriate) for prevention of disabilities and provision of rehabilitation

Operational research to improve implementation of sustainable strategy

Encourage supportive working arrangements with partners at all levels

Summary

Chronic infectious disease caused by mycobacterium leprae.

Also called Hansen's disease

Oldest disease known to mankind.

Incubation period -- 3 to 5 years

Prevented and cured by Muti-drug therapy

Thank you