leprosy dr akbar

7/25/2019 Leprosy DR Akbar

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LEPROSY

1

Dr. MD AKBAR KHANMS (ORTHO) ASSISTANT PROFESSOR

A C S R Government medic! co!!e"e#

ne!!ore

Recon$tr%ctive Hnd & Foot S%r"eon

Dmien Fo%ndtion indi tr%$t

Ne!!ore


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Leprosy is a chronic granulomatous disease,caused by mycobacterium leprae, which affects

principally the skin and peripheral nervous

system

2

DEFINITION

Every year January 27 is World Leprosy Day


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Hi$tor' o e*ro$' e*ro$' +$ e,i$ted $ince -i-!ic!

time$

Once e,i$ted in E%ro*e rom /0111 BC# it +$ $incedi$**ered in E%ro*e

e*ro$' $ti!! e,i$t$ in mn'co%ntrie$ in A$i# tin Americ#nd Aric

3


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Modern Hi$tor' o e*ro$'

2345 Doctor Arm%rHn$en o Nor6'di$cover$ M. Leprae

-ci!!i 781$5 Doctor$ -e"in

%$in" D*$one to tret!e*ro$'

7205 e*ro$' deve!o*$re$i$tnce to D*$one96+o recommend$ m%!ti:

dr%" tretment 4


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E*idemio!o"'

Total No of Leprosy cases in the world 1.5 Millions ndemic areas ! "#$ of Leprosy cases concentrated in

only 5 countries ! %ndia, &ra'il, Nigeria, Myanmar (

%ndonesia.

Nearly )5$ of world*s Leprosy patients are in +outh ast

sia.

-ighest No of Leprosy ! %n %ndia &ihar, /ttar 0radesh


6/1026


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Bcterio!o"'

Mor*+o!o"' 5 P!eomor*+ic $tri"+t or

$!i"+t!' c%rved rod !i;e# "rm *o$itive-cteri


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Mode of transmission The exact rout of transmission is not fully known .

Although human-to-human transmission is

the primary soure o! in!etion

"he spread o! leprosy is #elieved to #e via

nasal disharge $Droplets in!etion%& 'esults in s(in lesions and de!ormities) most

o!ten a!!eting the cooler places on thebody$eyes) nose) earlo#es) hands) !eet) and

testiles% that an #e very dis!iguring&

Every 1 cc of nasal secretion contains 1- 2millions lepra bacilli


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Other modes of transmissions

1. Contact through the skin (rare).

2. Arthropod-born infection (rare).3. Through placenta and milk.


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The nine - banded armadillo

1*


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+igns and +ymptoms

arly signs and symptoms of leprosy arevery subtle and occur slowly usually

over years.

First symptoms 2

Numbness and loss of temperaturesensation cannot sense very hot or

cold temperatures

As the disease progresses2

The sensations of touch, then pain,

and eventually deep pressure are

decreased or lost.

11


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Long-term developing sequence of

events2

3elatively painless ulcers,

skin lesions of

hypopigmented macules

flat, pale areas of skin, andeye damage dryness,

reduced blinking

Late stage2 large

ulcerations, loss of digits,

and facial disfigurement.(for example, hands, feet, face, and

knees)12


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edi$*o$in" or ri$; ctor$

. Re$idence in n endemic area.

2. Poverty(m!n%trition).

4. Contct 6it+ @ected armadillo.

4. Immunity

13


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!$$i>ction & C!inic! Pre$enttion

Ridley &Jopling Classification

Based on Host Immunity

TT BL LL

BT BB BL

14


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C!$$i>ction & C!inic! Pre$enttion

WHO Classification

Based on Bacterial Load

aucibacillary

1-5s!in lesions

"ultibacillary


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EPROS

aucibacillary B' "ultibacillary "B'

Indeterminate Leprosy IL'

Tuberculoid Leprosy TL'

Borderline Tuberculoid BT'

Borderline Borderline BB'

Borderline LepromatousBL'

Lepromatous Leprosy LL'

16


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Indeterminte e*ro$' (I)

$%!!' $in"!e (m%!ti*!e) mc%!e *tc+

H'*o*i"mented or int!' er't+emto%$

Sen$tion norm! -%t $ometime$im*ried.

T+e *eri*+er! nerve$ norm!. S!it $;in $mer ne"tive.


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Indeterminate leprosy (Hypopigmented patch) sensation normal) no

palpable peripheral ner$e and slit s!in smear negati$e.

1


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T%-erc%!oid e*ro$' (T)

$%!!' $in"!e -%t m' -e e6 (8).

H'*o*i"mented er't+emto%$ *!%e. r'in" in $ie rom e6 mmto $ever!

cm.

e!! de>ned -order$. Sen$tion mr;ed!' im*ried. En!r"ed *eri*+er! nerve.

S!it $;in $mer ne"tive


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Tuberculoid leprosy( T*o hypopigmented patches) hypoasthetic

*ell defined borders) palpable peripheral ner$e and ### negati$e.

2*


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Tuberculoid Leprosy( +nnular) erythematous) anasthetic patch *ith

*ell defined and raised borders and ### %egati$e.

21


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22


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Border!ine e*ro$'(BT#BB#B)

Fe6 mn' $'mmetric! *tc+e$.

Prt!' 6e!!:de>ned -order$. Sen$or' im*irment$ rn"e rom $!i"+t

to mr;ed.

S!it $;in $mer %$%!!' *o$itive. P. nerve$ $'mmetric!!' en!r"ed.


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B BB BT

Mn' Some Fe6(8) e$ion no&

Ro%"+!' e$$ e!! e$ion$ -order$

S!i"+t Moderte Mr;ed Sen$or'im*irment

Ro%"+!'

$'mmetric!

A$'mmetric!

A$'mmetric! Di$tri-%tion

o $;in!e$ion$

e$$$'mmetric! A$'mmetric!

A$'mmetric! Peri*+er!nerve$

M%!ti-ci!!r' M%!ti-ci!!r' P%ci-ci!!r' T'*e o !e*ro$'

? 2. /3/ : S!it $;in $mer

%ote( #ometimes patients may ha$e BT,BB or BB,BL or BL,LL

24


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Borderline Tuberculoid Leprosy( Well-defined large anaesthetic patches

*ith satellite lesions. ### %egati$e.

2,


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Borderline Borderline Leprosy( Less defined) asymmetrically distributed

hypoaesthetic patches. ### positi$e.26


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Borderline Lepromatous Leprosy( %umerous) hypoaesthetic almost

symmetrically distributed patches . ### positi$e.27


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e*romto%$ e*ro$' ()

er' n%mero%$ i!! de>ned !e$ion$. (mc%!e$# *tc+e$# **%!e$#nd

nod%!e$). S'mmetric!!' di$tri-%ted !!over t+e

-od' o$$ o e'e-ro6$ nd e'e!$+e$. No $en$or' im*irment$ in !e$ion$ . Peri*+er! nerve$ $'mmetric!!'

en!r"ed.

S!it $;in $mer !6'$ *o$itive.


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20


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3*


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Lepromatous Leprosy( Leonin /ace 31


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ia!nosis of "eprosy

1. Clinical Eamination.2. !lit !kin !mear.

3. !kin "iops#.

40


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.C!inic! e,mintion5

#hat are the cardinal skin si!ns of leprosy $

1. $#popigmented or er#thematus patch % pla&ue

2. Complete % partial loss of sensation.

3. Thickening of peripheral ner'es.

44


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0.S!it S;in Smer

%imple and valuable test.

&t is needed for dia!nosis.

Monitor the pro!ress of thetreatment.

4?


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S!it S;in Smer (met+od).

Pinc+ t+e $ite ti"+t.

Inci$e.

Scr*e & co!!ect mteri! Smer on $!ide.

Air dr' & >,.

Stin (


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S!it S;in Smer (Re*ortin" t+e $mer).Ridley lo!arit"mic

cale#$acteriolo!ical

inde%

01no -ci!!i in 11 >e!d$231-1*-ci!!i in 11 >e!d$

431-1*-ci!!i in 1 >e!d$

531-1*-ci!!i in >e!d

631*-1**-ci!!i in >e!d

731**-1***in >e!d

3


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BI i$ c!c%!ted -' ddin"%* t+e inde, rom $ite

e,mined nd dividin" -'t+e tot! n%m-er


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&or'"olo!icalinde%

T+e *ercent"e

o !ivin"-ci!!i($o!id$tnin" -ci!!i)to t+e tot!

n%m-er o-ci!!i in t+e$mer&


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Ot"ermear

tec"ni(ueN$! $mer

N$!$cr*in"$


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Clinical spectrum of lepros#


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TTBT BB BL LL

#!in Lesions

%o. of Bacilli

#lit s!in test

Immunity

Clinical spectrum of lepros#

41


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S)in $io'y


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T%-erc%!oid e*ro$' (TT).

Hi$to!o"ic!!' TT reem*letu*erculoi.

C+rcteried -' tu*erculoid!ranuloma# mde %* o e'it"eloidcell in t+e center $%rro%nded -'

-%ndnt Lan!"an "int ce!!$#lym'"ocyte nd oci o caeatin!necroi.


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e*romto%$ e*ro$' ()

C+rcteried -' di@%$e in>!trtion o,oamy macro'"a!e in t"e

dermi. -cid+,at *acill are 'reentin$ide

t+e$e om' ce!!$ ei"+ter $in"!' or in"!o-i.

T+ere i$ ree $%-e*iderm! one(!ren one#.

'm*+oc'te$ re $cnt' nd !iant


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Ot+er te$t$5

Hi$tmine te$t5 or t+edi"no$i$ o indeterminte!e*ro$'

Imm%no!o"ic! te$t$

Te$t or detectin" CMITe$t or detectin"

nti-o-ie$

T t d t ti CMI


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e*romin $;in te$t 5To di@erentite t+e t6o

di@erent orm$ o !e*ro$'

*rt# -%t it i$ not %$ed todi"no$e t+e di$e$e

Bec%$e5!$e ne"tive nd!$e *o$itive

Te$t or detectin" CMI

e*romin S;in Te$t


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Procedure to Le'romin S)in Tet

A tin' $m*!e o !e*ro$' nti"en i$inJected %nder t+e $;in# %$%!!' in t+eorerm.

T+e $;in "et$ *%$+ed %*# ormin"

$m!! -%m*.T+i$ i$ n indiction t+t t+e nti"en

+$ -een inJected to t+e correct de*t+.

T+e $ite o t+e inJection i$ mr;ed# nd

i$ e,mined or rection# /rt a,ter 0day1early reaction+Fernandereaction+redne and induration#and t"en a!ain a,ter 23 day1late

reaction+&ituda reaction+

Te$t or detectin"


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e$ o de ec "nti-o-ie$

.F!%ore$cent !e*ro$' nti-od'-$or*tion te$t(FA:ABSte$t)5:

No6 6ide!' %$ed oridenti>ction o $%-c!inic!c$e$

70.4 Sen$itive & 11$*eci>c

0.Monoc!on! nti-odie$


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TRE-T&ENT

Tod'# t+e


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Tod'# t+edi"no$i$ nd

tretment o!e*ro$' i$ eaynd mo$t

endemicco%ntrie$ re$trivin" to %!!'inte!ratele'royervice intoe%itin!

eneral "ealt"

E*+!, ! A C*A"E


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E*+!, ! A C*A"E/!EA!E

ru!s used in "eprosy treatment

0hat are the three commonl# used drugs

1. /apson.2. *ifampicine.

3. Clofaimine.

The combination of these three drugs is knon as 4ulti /rug Therap# (4/T)

HISTOR OF TREATMENT In 7? 'romin $%!one dr%" $+o6ed eLcc'


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In 7?#'romin# $%!one dr%"# $+o6ed eLcc'-%t re%ired mn' *in%! inJection$.

Da'one*i!!$ 6ere o%nd to -e e@ective in t+e781$

B%t $oon (7=1$:731$)# M. leprae develo'edreitance to d*$one.

. In t+e er!' 7=1$# Rim*icin nd c!oimine# t+eot+er t6o com*onent$ o MDT# 6ere di$covered.

T+i$ multi+dru! treatment 1&DT# 6$recommended -' t+e HO in 3673nd remin$#

6it+ minor c+n"e$# t+e t+er*' o c+oice.Since 36658 9:O 'rovide ,ree &DTor !!

*tient$ in t+e 6or!d

NB5 MDT# +o6ever# doe not alter t"e dama!e

done to n individ%! - M. le rae-eore MDT i$


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4/T (Chemotherap#) renders epros#patients non-infectious.after threemonths of continuous treatment with dapsone

or clofa'imine( or after two to three weeks oftreatment with rifampicin.


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4/T for "lepros#

5 months

"onthly doseRifampicin

800mg

9aily dose9apsone 200

mg,4

4ultidrug Therap# (4/T) for aucibacillar# epros# (")


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88


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4/T for 4"lepros#

12 months

"onthly doseRifampicin

800mg

Clofa:imine 500mg

9aily dose

9apson 200mg

Clofa:imine 70 mg,6

4ultidrug Therap# (4/T) for 4ultibacillar# epros# (4")


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g p# # p #

83

4ulti /rug Therap#


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46 months

8 months

82

OTHER DRGS 5:


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OTHER DRGS 5

Et+inmide nd*rotionmide

%ino!one$ Minoc'c!ine

C!rit+rom'cin

87


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O&PLI;-TIONS

F LEPROSY cnt deormitie$ nd

6,

TPES OF DEFORMITIES5


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) S*eci>c deormitie$5

: -c o localin,ection 6it+

M.e*re : $een mo$t oten in

t+e ce9 cie$!e*ro$(!o$$ oe'e-ro6#n$!deormit')#"'necom$ti#!e$$

oten in t+e +nd

66


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0) Pr!'ticdeormitie$5

: re$%!t rom dama!eto motor nerve.

:$een mo$t oten in t+e+nd(c!6 >n"er)#!e$$

oten in t+e eet&occ$$ion!' in t+ece(!"o*t+!omo$#

ci! !$

67


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0#-net"etic de,ormity

- Occ%r $ con$e%ence one"!ected inJ%rie$ in *rtrendered in$en$itive -c o

dama!e to enory nerve.

: Fo%nd mo$t oten on t+e eet

nd +nd(%!certion#$crcontrt%re#$+ortenin" odi"it$#&$;e!et! di$or"nitiono oot) 6

HO GRADING OF DISABIITIES IN EPROS

9:O =rade =rade 3 =rade 2


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9:O =rade@

=rade 3 =rade 2

EES Norm!vi$ion#!id"*#-!in;in".

Corne! reQe,6e;

Red%cedvi$ion#!"o*+t+!mo$.

HANDS Norm!

$en$tion &m.*o6er.

o$$ o

ee!in" in t+e*!m

i$i-!e

dm"e56o%nd$#c!6+nd#!o$$ oti$$%e etc.

FEET Norm!$en$tion &m.*o6er.

o$$ oee!in" in t+e$o!e

i$i-!edm"e56o%nd#ootdro*#!o$$ oti$$%e.60

eripheral ner$es


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#ensory "otor +utonomic

Hypoaestesia , anaestesia "uscle paralysis Lac! of s*eating & sebum

;lcers ;lnar ner$e Cla* hand

Radial ner$e Wrist drop

Lt. popliteal /oot drop

ost. tibial Cla* toes

/acial lagophthalmous

9ry s!in

Crac!ed s!in

;lcers

7*


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71

C!en 6it+ $o* & 6ter

FOOT -ND :-ND ;-REPR-;TI;E


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Inected %!cerCrc;$

o%nd$inJ%r'

6e;ne$$*r!'$i$

* Re$t & **!' nti$e*tic

dre$$in" A**!' coo;in" oi!$e!ine

So; in 6ter C!en nd **!' c!en

-nd"e Protect 6+en

6or;in"coo;in"

Oi! m$$"e E,erci$e$

72


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)OM*"&)+T&O,%O

EE

In$ol$ment of the ophthalmic di$ision of the 7th.' trigeminal ner$e

C l ti i t


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Corneal sensation imparment

atients ignore in


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7,

Cre o e'e$R d d i A i i


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Redne and 'ain

InBury to cornea

DiCculty in cloin!

eye

A$*irin or

*rcetmo! Atro*ine nd $teroidointment

Cover 6it+ e'e *d A**!' nti-ioticointment

Reer

Ter $%-$tit%te e'edro*$

E,erci$e$ Dr; "!$$e$ to

76

PSCHO: SOCIAPROBEMS


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:re re!ted to 6ide!' +e!d *elie, and'reBudiceconcernin" !e*ro$' & it$c%$e$.

:t+e' oten deve!o* $e! $ti"m#!o6 $e!e$teem & de'reion$ re$%!t o

reJection nd +o$ti!it'#

:need to -e reerred or 'ro'er

counellin!

77


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Le'roycontrol

7

&et"od o, ;ontrol


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&edicalmet"od9 E$timtion o

*ro-!em9 Er!' detection

9 M%!ti dr%"t+er*'

9 S%rvei!!nce

9 Imm%no*ro*+'!,i$

Social

u''ort Pro!rammmana!eme

Evaluation

37

Re+-i!ittion


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Comm%nit' -$edre+-i!ittion i$recommended -' HO

I$ $trte"' 6it+in "ener!comm%nit' deve!o*ment ort+e re+-i!ittion#

e%!ition o o**%rt%nitie$nd $oci! inc!%$ion o !!*eo*!e 6it+ di$-i!itie$.

21

S%rvei!!nce


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For PB9 c!inic!!' t !e$tonce 'er or 0 'er$ter tretment

For MB9 t !e$t once 'er or 8 'er$ ter

tretment

2

Ev!%tion


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i. E'idemolo!icalindicator

Incidence$

Prev!ence

ii. &ain or core indicator,or monitorin! 'ro!re

No. nd rte o ne6 c$e$detected *er 'er

Rte o ne6 c$e$ 6it+"rde0 di$-ititie$ *er20

Ev!%tion(contin%ed)


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)

iii.&ain indicator ,or evaluatin!cae detection

Pro*ortion o ne6 c$e$ *re$entin"6it+ "rde 0 di$-i!itie$im*irement$

Pro*ortion o c+i!d(8'o) c$e$mon" ne6 c$e$

Pro*ortion o em!e c$e$ mon" ne6

c$e$ Pro*ortion o MB c$e$ mon" ne6

c$e$24

Evaluation1continued#


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iv . &ain indicator ,or aein! t"e(uality o, ervice

Pro*ortion o ne6 c$e$ veri>ed $correct!' di"no$ed

Pro*ortion o tretment de%!ter$

No. o re!*$e$

Pro*ortion o *tient$ 6+o deve!o*ne6ddition! di$-i!itie$ d%rin"MDT.

2?

WHO >nhanced ?lobal #trategy

4022 1 4027


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Early case detection and treatment

Prevention of disability

Community based rehabilitation

Priority: equality, human rights

Monitor the threat of drug resistance

,


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&ILESTONES

OF NLEP ININDI-

6

:ational Leprosy

Evolution of NLEP


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:ational Leprosy

ontrol ;rogramme

$10,,%

$10*% leprosy

$103% :ational LeprosyEradiation ;rogrammme

1007 - 5odi!ied Leprosy Elimination ampaign

$5LE%2**1 to *4 - +A;EL and LE

2**,- ?r#an Leprosy ontrol ;rogramme

2**0-2*1* -D;5'

7

National Le'roy ;ontrolPro!ramme


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Since 788# centr!!' idedTo control Leprosy through

@ Early detection of cases

@ Dapsone monotherapyFo%rt+ Five 'er *!n: centr!!'

$*on$ored721: Erdicte e*ro$' B' 0111 or;in" Gro%*

@ Revi$ed $trte"' -$ed on multi- drugchemotherapy

Aimed t Erdiction


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Erdiction 6$ *!nned t+ro%"+@ Red%ction in t+e %nt%m o inection in t+e

*o*%!tion

@ Red%ction in t+e $o%rce$@ Bre;in" t+e c+in o trn$mi$$ion

Ntion! e*ro$' ErdictionPro"rmme: 724

0

+trategies B :LE;-1% DeentraliCation and institutional development

- servies availa#le in all ;s


90/102

- Distrit nuleus to +upervise and monitor

- +tate leprosy soieties merge ith state health soiety

2% +trengthening and integration o! servie delivery

- Diagnosis and treatment- more easily availa#le

- Daily outdoor servies in ;

-

ounseling o! patient and Bamily

90

3% Disa#ility are and prevention

- 'eonstrutive surgery is promoted

- 'eha#ilitation institutions


91/102

- +upply o! 5' !ootear

- persons a!!eted #y Leprosy to reeive

Disa#ility erti!iate to ena#le them to get

the !ailities availa#le under shemes o!

+oial el!are department&

4% E ampaign

- ountry 9ide press advertisement on Anti

Leprosy Day i&e& 3*th January

- "he year 2**-*0 as o#served as a

ampaign on the theme =Leprosy Bree ndia>)

all over the ountry

,% "raining

91

DPMR


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T+e -e$t 6' to *revent di$-i!itie$ i$59 Secondary 'revention i.e.8early dia!noi and

'rom't treatment it" &DT

Inorm *tient$ ($*eci!!' MB) -o%t common

$$ o rection$ A$; t+em to come to t+e centre ($ $oon $*o$$i-!e)

Strt tretment or rection

Inorm t+em +o6 to *rotect in$en$itive +nd$eet e'e$

Invo!ve mi!' mem-er$

02

PARTNERS OF NEP


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HO# Ni**on Fo%ndtion#

Novrti$# or!d Bn; IEP "encie$

Ntion! Government$ &NGO$

03

Modi>ed e*ro$' E!imintionCm*i"n

Mid t i ! NEP i 773


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Mid term **ri$! o NEP in 773

T+o%"+ *ro"re$$ 6$ $ti$ctor' tntion! !eve!# it 6$ %neven in $ome$tte$

MEC invo!ved. Orienttion trinin" to +e!t+ $t@

0. Incre$e *%-!ic 6rene$$

4. Ho%$e to Ho%$e $erc+ in endemic di$trict$ to

detect ne6 !e*ro$' c$e$ t+ro%"+o%t t+e co%ntr'or = d'$

04

SAPE & EC


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In ddition to re"%!r $%rvei!!nce ctivitie$ R%r! re$: S*eci! Action ProJect or

e!imintion o e*ro$'

r-n Are$: e*ro$' E!imintion

Cm*i"n$. For er!' detection nd *rom*t tretment

0. IEC in r%r! tri-! $!%m re$

4. ??1 SAPEEC *roJect$ / decentr!ied

d%rin" 011:1?

0,

r-n e*ro$' Contro!Pro"rmme +ine 2**,


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+ine 2**,)


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suspecting leprosy cases and after

diagnosis, follow up till treatmentcompletion.

Incentive for confirmed leprosy cases

out of suspect roug!t y t!em "#s.$00%-& and for completion of

treatment in time "'(- #s. 200%-, )(

* #s. +00%-&. !e sc!eme was initially put on pilot

asis in maor states of /ttar

'rades!, (i!ar, !!attisgar!, 1est

(engal and !ar3!and07

Anti e*ro$' Activitie$ inIndi


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e*ro$' Mi$$ion (.B.): o%nded in 23? in H.P. Hind K%$+t Nivrn Sn"+

Gnd+iJi Memori! e*ro$' Fo%ndtion#Sev"rm# rd+

T+e Germn e*ro$' Re!ie A$$ocition Dmien Fo%ndtion

T+e Dni$+ Sve t+e C+i!d F%nd

AMA: t;en over -' ICMR in 738 Ntion! e*ro$' Or"ni$tion: 7=8

0


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e*ro$' 6or; i$ not mere!'medic! re!ie9 it i$

trn$ormin" r%$trtion o!ie into Jo' o dediction#*er$on! m-ition into

$e!Qe$$ $ervice MahatmaGandhi

Conclusion

Fortunately modern medicine has cured most


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Fortunately, modern medicine has cured mostof the world of Leprosy

People with Leprosy are being more acceptedby communities around the world

Leprosy still Remains a problem inundeveloped countries The World Health Organiation is putting a stop to

this !f they reach their goal, Leprosy should be

eliminated from the world within "# years

11


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1


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Join Hands for a better tomorrow...

102

leprosy dr akbar

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