LEPROSYINTRODUCTION

By MD ZAFAR EQEUBAL

2009 Batch JNMC,AMUModeratorsDr M. Haroon KhanDr Malik ShehnawazDr Srikant KanoogoDr Khushboo

DEFINITION A CHRONIC INFECTIOUS DISEASE CAUSED BY

MYCOBACTERIUM LEPRAE. IT MAINLY AFFECTS PERIPHERAL NERVES. IT ALSO AFFECTS THE SKIN,MUSCLES, EYES, BONE & INTERNAL ORGANS.

DISEASE IS CLINICALLY CHARACTERISED BY ONE OR MORE OF THE FOLLOWING::

o HYPOPIGMENTED PATCHESo PARTIAL OR TOTAL LOSS OF CUTANEOUS

SENSATIONo PRESENCE OF THICKENED NERVESo PRESENCE OF ACID FAST BACILI IN THE SKIN OR

NASAL SMEAR

[PARK’S 21ST]

HISTORY FOR A LONG TIME LEPROSY

WAS THOUGHT TO BE HEREDITARY DISEASE , A CURSE OR A PUNISHMENT FROM GOD.

DUE TO DR HANSEN’S EVOLUTIONARY WORK IT IS ALSO KNOWN AS HANSEN’S DISEASE.

LEPROSY IS KNOWN TO BE “KUSHTHA ROG” SINCE VEDIC ERA.

HOLY BIBLE ALSO DESCRIBE LEPROSY CURE AS A MIRACLE OF HZ. ISA A.S.

PROBLEM STATEMENT

WORLWIDE IN 1991 WHO MEMBER STATES RESOLVED TO

DECREASE GLOBAL LEPROSY BURDEN BY 90%. TILL TODAY HIGH ENDEMIC COUNTRIES

ARE::BRAZIL, INDONESIA, PHILIPINES, INDIA, NEPAL, CONGO, TANZANIA.

INDIA LEPROSY IS WIDELY PREVALENT IN INDIA INDIA HAS ACHIEVED GOAL OF LEPROSY ELIMINATION

AT NATIONAL LEVEL BUT STILL 3 STATE/UT VIZ. BIHAR, CHATTISGARH AND D&N HAVELI WITH

PREVALANCE RATE OF 1-2.5 PER 10,000 POPULATON YET TO ACHIEVED.

PREVALENCE RATE :0.74 LEPROSY CASE PER 10,000 POPULATION.

LEPROSY PREVALENCE RATES,DATA REPORTED TO WHO AS OF BEGINNING JANUARY 2011

EPIDEMIOLOGICAL DETERMINANTS AGENT FACTOR: M.LEPRAE

. MAN IS THE ONLY SOURCE AND HOST OF LEPROSY INFECTION ( MULTIBCILLARY CASE). .HOST FACTOR:. ALL AGE GROUP ARE AT RISK. M>>F. CELL MEDIATED IMMUNITY IS RESPONSIBLE FOR RESISTANCE TO INFECTION WITH M.LEPRAE.

MODES OF TRANSMISSION

EXACT MECHANISM OF TRANSMISSION OF LEPROSY IS NOT KNOWN FOLLOWING ARE WIDELY DEBATED 1.DROPLET INFECTION 2.CONTACT TRANSMISSION 3.OTHER ROUTES, E.G. TATTOING NEEDLE

CLASSIFICATION

RIDLEY-JOPLING CLASSIFICATION::5 CLASSES ACCORDING TO IMMUNE STATUS OF PATIENT

I. TUBERCULOID(TT) II. BORDERLINE(BL) III. BORDERLINE(BB)IV. BORDERLINE LEPROMATOUS(BL) V. LEPROMATOUS(LL).

CLINICAL CLASSIFICATION FOR CHEMOTHERAPY BY WHO:

I. MULTIBACILLARYII. PAUCIBACILLARY

SIGNS OF ADVANCED DISEASE

• LUMP IN THE SKIN OF FACE AND EARS

• PLANTER ULCERS• LOSS OF FINGERS

AND TOES• NASAL DEPRESSIN• FOOT DROP AND

CLAW TOES

TREATMENTDRUGS RIFAMPICIN DAPSONE CLOFAZAMINE ETIONAMIDE & PROTINAMIDE CLARITHROMYCIN MINOCYCLIN

WHO RECOMMENDED CHEMTHERAPY MULTIBACILLARY 1.RIFAMPICIN -600 mg MONTHLY

2.DAPSONE -100mg DAILY

3. CLOFAZAMINE-300mg ONCE

MONTHLY -50 mgDAILY

PAUCIBACILLARY:: 1. RIFAMPICIN-600mg ONCE MONTHLY

2. DAPSONE -100 mg

PREVENTION AND CONTROL NLEP 1983 WITH A GOAL TO REDUCE CASE LOAD TO

<1 PER 10,000 POPULATION.

EDUCATE THE PEOPLE TRUE FACTS ABOUT ABOUT THE LEPROSY AND REMOVE WRONG SOCIAL BELIEFS AND SOCIAL STIGMA ASSOCIATED WITH LEPROSY.

THANK YOU

REFERENCES:

1.PARK’S 21ST EDITION2.WWW.WHO.INT