Leprosy Management & Rehabilitation

Management  Diagnosis  Skin Slit Smear  Skin Biopsy  Nerve 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

 Dapsone  Competitive inhibition with PABA for dihydropteroate syntheses  Blocks – dihydrofolic acid

 Adverse effects: Haemolytic anaemia Haemolytic anaemia Hepatitis Hepatitis Agranulocytosis Agranulocytosis Methemoglobinemia Methemoglobinemia Dapsone syndrome Dapsone 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

Clofazemine  Rimino-phenazinc dye Anti-inflammatory action  Weakly bactericidal  Side/Adverse effects  Discoloration of skin  GI complication  Dryness of skin

Newer drugs:  Ciprofloxacin  Minocyclinebacteriocidal  Clarithromycin

  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

Complication Type – I Only skin lesions – NSAIDS Rest If Neuritis : Steroids Cont Anti-leprosy Treatment

Type II Bed Rest Bed Rest Steroids Steroids NSAIDS NSAIDS Clofazemine 100 tid Clofazemine 100 tid Thalidomide Thalidomide Care of eyes Care of eyes Care of testis Care 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 problems Nerve abscess – excision Nerve abscess – excision Insensitivity and injuries Insensitivity and injuries Diminished sweating Diminished sweating Arthalgia Arthalgia Periostitis Periostitis Ear, nose, Throat Ear, nose, Throat  Vaccines: Mycobacterium W

Rehabilitation   Disability: Inability or difficulty in carrying out certain backs Inability or difficulty in carrying out certain backs  Impairment: Anatomic, physiologic and psychologic abnormalities or losses resulting from the disease or disorder Anatomic, physiologic and psychologic abnormalities or losses resulting from the disease or disorder