Referral level

Suspected PB relapse: the diagnosis of a PB relapse can never be absolutely certain. A skin smear should be carried out, if at all possible, to ensure that an MB case is not being misclassified as PB. The evidence for either a relapse or a reaction must be weighed up and a decision made. If it is decided to treat someone as a PB relapse, they are given a normal sixmonth course of PB-MDT. MB relapse: criteria for diagnosing a relapse are the presence of new skin lesions and an increase by two or more units of the Bacillary Index.

5.6 Is drug resistance a problem?

Drug resistance is a potential problem when treatment has been irregular. Although resistance to dapsone was a serious problem in the past, when leprosy was treated with dapsone alone, clinically important drug resistance has not been reported with MDT. Failure to respond to treatment, especially the treatment of a relapse, should lead to suspicion of drug resistance. Because of the seriousness of the development of drug resistance, any suspicious case should be thoroughly investigated at a referral centre.

5.7 What complications occur in leprosy and how are they managed?
The complications of leprosy can be categorized as: Leprosy reactions (section 5.8) Effects of nerve damage (section 6.2) Adverse effects of MDT

Complications of advanced disease Psycho-social problems

Adverse effects of MDT MDT is remarkably safe and serious adverse effects are very rare. Minor problems Red urine Brown discoloration of the skin Gastro-intestinal upset Anaemia More serious problems Itchy skin rash Allergy, urticaria Jaundice Shock, purpura, renal failure Drug Rifampicin Clofazimine All three Dapsone Drug Dapsone Dapsone or Rifampicin Rifampicin Rifampicin Management Reassurance Counselling Give drugs with food Give iron & folic acid Management Stop dapsone, refer stop both, refer Stop rifampicin, refer Stop rifampicin, refer

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Global Strategy for Further Reducing the Leprosy Burden and Sustaining Leprosy Control Activities 2006-2010