leprosy and pregnancy
DESCRIPTION
Leprosy and pregnancyTRANSCRIPT
Short Case LEPROSY IN PREGNANCY
Dr. Ayomi Piyasena
• Leprosy is caused by– Mycobacterium leprae,
a slow-growing intracellular bacillus infiltrates the skin, the peripheral
nerves, the nasal and other mucosa, and the eyes.
• The incubation period - 2 to 10 years • Affect all ages and both sexes.
4
A little taxonomy ….
Kingdom Bacteria
Phylum Actinobacteria
Order Actinomycetales
Suborder Corynebacterineae
Family Mycobacteriaceae
Genus Mycobacterium
Species M. leprae
How get infected?
Bacillus
Host
Virulance
Immunity
Pregnancy
• 2000 diagnosed of leprosy annually• Only 2-3 of them is pregnant • 12th post patum week increased risk of leprae
reactions
CASE HISTORYIntroduction
23 yrs, a House wife, married for 1 year
Presented to the ANC on 6/3/2014 LRMP- 20/9/2013 EDD- 27/6/2014POA- 23+6 Wks
• History of the disease– Hypo pigmented skin patch over left knee joint for 1
year( gradually increased in size )– Raised edge for 3 months – Sensory Impairment – less hair growth – not painful– Dry– Not itching– No other lesions – no weakness– No change in sensation– No redness of eyes or vision impairment
• PMHx - No History of anaemia, jaundice• PSHx - NAD• DHx- Routine Anti natal drugs• Allergic History - No any allergy for sulpha
drugs• Contact Hx - diagnosed patient with
lepromatous leprosy in the village
0n Examination
• Not pale• Hypopigmented skin patch over left knee joint• Indurated edge• Sensory impairment• No papules/ nodules• No thickned/ tender nerves(common peroneal)• No crainial nerve palsies(V, VII)• UL & LL sensory and motor system examination
normal
DIAGNOSIS
• The three cardinal signs for diagnosis of Leprosy are:
1. Hypo-pigmented or reddish skin lesion(s) with definite sensory deficit
2. A thickened or enlarged peripheral nerve with loss of sensation and/or weakness of the muscles supplied by that nerve
3. The presence of Acid-fast bacilli in slit skin smears or histopathology
Invest. on this patient
• Hb- 13.7 g/dl• Skin slit test not done• LFT- Normal
TUBERCULOID LEPROSY
15
Multibacillary (MB or lepromatous) is a 12-month treatment of rifampicin, clofazimine, and dapsone. Paucibacillary (PB or tuberculoid) is a six-month treatment of rifampicin and dapsone.
Patient was not aware of pregnancy- Started on PB Regimen
After confirmation of Pregnancy– Started on MB regimen
After 4 months of treatment.
LEPROSY ON FETUS
• Prematurity • Fetal demise• Low birth weight• Increased risk of developing the disease.
• WHO recommends - MDT during pregnancy.
LEPROSY DRUGS ON FETUS
• High doses of rifampicin – Teratogenic ?
• Dapsone – neonatal haemolysis – methaemoglobinaemia.
+ Folic acid
• Clofazimine – discoloration of the skin of breast-fed infants.
REFERENCES.
1.) Consequences of the interaction between the leprosy and pregnancy, Paula Sacha, J Nurs UFPE on line. 2012 Sept;6(9):2243-9
2.) Pregnancy and Leprosy,A Comprehensive Literature Review1,Diana N. J. Lockwood and Hemali H. Sinha‘, 12th November 1998.
3.) Patient.co.uk ,Original Author: Dr Hayley Willacy Current Version: Dr Colin Tidy
4.)Leprosy in Pregnancy,E. Duncan, Springer, 2012
THANK YOU.