Leprosy Management & Rehabilitation

1. LeprosyManagement & Rehabilitation

2. Management • Diagnosis • Skin Slit Smear • Skin Biopsy • Nerve Biopsy

3. LABORATORY EXAMINATIONS • Slit-Skin Smears • The bacterial index (BI) is computed

5. 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.

8. 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

9. Treatment • Pancibacillary – Dapsone + Rifampicin • Multibacillary – Dapsone + Rifampicin + Clofazemine

10. Dapsone • Competitive inhibition with PABA for dihydropteroate syntheses • Blocks – dihydrofolic acid

11. Adverse effects: • Haemolytic anaemia • Hepatitis • Agranulocytosis • Methemoglobinemia • Dapsone syndrome • Exfoliative Dermatitis • Lymphadenopathy • Hepatitis

12. 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

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

14. Newer drugs: • Ciprofloxacin • Minocycline bacteriocidal • Clarithromycin

15. 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

16. 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

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

18. Type II • Bed Rest • Steroids • NSAIDS • Clofazemine 100 tid • Thalidomide • Care of eyes • Care of testis

19. 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

20. 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

21. Leprosy related problems • Nerve abscess – excision • Insensitivity and injuries • Diminished sweating • Arthalgia • Periostitis • Ear, nose, Throat • Vaccines: Mycobacterium W

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

23. Thank You