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

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
Treatment
 Pancibacillary
 Multibacillary
Clofazemine
– Dapsone + Rifampicin
– Dapsone + Rifampicin +
 Dapsone
 Competitive
inhibition with PABA for
dihydropteroate syntheses
 Blocks
– dihydrofolic acid
 Adverse
effects:

Haemolytic anaemia

Hepatitis

Agranulocytosis

Methemoglobinemia

Dapsone syndrome
• Exfoliative Dermatitis
• Lymphadenopathy
• Hepatitis
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
 Minocycline
 Clarithromycin
bacteriocidal


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
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
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

Steroids

NSAIDS

Clofazemine 100 tid

Thalidomide

Care of eyes

Care of testis
Therapy of Reactions

Lepra Type 1 Reactions Prednisone, 40 to 60
mg/d; the dosage is gradually reduced over a 2to 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

Insensitivity and injuries

Diminished sweating

Arthalgia

Periostitis

Ear, nose, Throat
 Vaccines:
Mycobacterium W
Rehabilitation
 Disability:

Inability or difficulty in carrying out certain
backs
 Impairment:

Anatomic, physiologic and psychologic
abnormalities or losses resulting from the
disease or disorder