Professional Documents
Culture Documents
Hansens Disease
Hansens Disease
Hansens Disease
CONTENTS
History Differential diagnosis
Transmission of leprosy Diagnosis
Etiopathogenesis Treatment
Global and national scenario of Lepra reactions
leprosy Deformities
Immunity and leprosy Physiotherapy
Microbiology of M.Leprae Prevention
Classification of leprosy Rehabilitation in leprosy
Clinical spectrum MCQs
Systemic involvement in leprosy Photoquiz
History
Definition :
Leprosy is a chronic systemic disease caused by Mycobacterium leprae
manifesting as development of specific granulomatous or neurotrophic
lesions in the skin, mucous membrane, eyes nerves, bones and viscera.
Transmission of Leprosy
Invasion
Hematogenous spread
Immunological response
Mycobacterium Leprae
Indeterminate
Tuberculoid
Borderline
• borderline-tuberculoid
• mid-borderline
• borderline-lepromatous
Lepromatous
Classification
Indian Classification
Lepromatous
Tuberculoid
Maculoanesthetic
Borderline
Pure neuritic
Indeterminate
Classification
NLEP Classification
Nonlepromatous
• Tuberculoid
• Maculoanesthetic
• Polyneuritic
Indeterminate
• Borderline
• Indeterminate
Lepromatous
• Lepromatous
Tuberculoid (TT)
Annular lesions
Anular psoriasis
Erythema multiforme
Granuloma annulare
Sarcoidosis
Infiltrated lesions
Lupus vulgaris
Lupus erythematosus
Granuloma annulare
Annular syphilides
Post kala azar dermal leismaniasis (infiltrated lesions)
Sarcoidosis
Psoriasis
Differential diagnosis of annular lesions
Detailed history
Distribution
Size
Symmetrical appearance
Earlobe infiltration
Sensory impairment
Motor examination
Nerve examination
Trophic ulcers
Gynecomastia
Sensory
Touch : Tested with wisp of cotton
Temperature : Tested with two test tubes
one containing hot water and other cold
Pain : Tested by pin prick
Semmes-Weinstein monofilament testing
Corneal reflex : Tested with a wisp of
sterile cotton wool
Motor
Testing of motor power- Done clinically Monofilaments
Electro-diagnosis - Employed in very early cases. Electrical stimulator
using faradic and galvanic current used to test muscle power
Nerve Examination
Normal 0
Enlarged +
Moderately enlarged ++
Very much enlarged +++
Nerves
Ulnar
Median Sural
Enlarged greater
auricular nerve
Investigations for M. Leprae
Bacteriological examination
Skin smears :
Made by slit and scrape method from the most active looking edge of skin
lesion and stained with Ziehl-Neelsen method.
Reading of smears :
Bacteriological index - Indicates density of leprosy bacilli (live & dead) in the
smears and ranges from 0 to 6+
Morphological index - It is the percentage of presumably living bacilli in
relation to total number of bacilli in the smear
Other Investigations
Histopathological examination
Nerve biopsy
Sweat function test
Nasal mucosal smears
Nerve biopsy
Histamine tests
Lepromin test
FNAC
Animal Models : Armadillo, Thymectomised, irradiated nude mice, Korean
chipmunk etc.
Newer Investigations
Indications :
To confirm diagnosis in c/o inconclusive histopathological/smear reports.
To distinguish between reaction and relapse
To demonstrate M. leprae or its components
To elicit strain differentiation for molecular epidemiology
To detect drug susceptibility or resistance
Treatment
MDT-WHO
Paucibacillary leprosy (6 months)
• Cap. Rifampicin (600 mg) monthly, supervised
• Tab. Dapsone (100 mg) daily
Drugs are better protected against moisture, heat and accidental damage
Ensures quicker dispensing of the drugs
ROM
• Rifampicin - 600 mg
• Ofloxacin - 400 mg,
• Minocycline - 100mg
• Single dose - Single patch (WHO accepted)
ROM-6 (Monthly for 6 months)-Paucibacillary
ROM-12(Monthly for 12 months)-Multibacillary
Ofloxacin based regimes
RO (continuous treatment for 28 days)
ROM trial (intermittent therapy)
Moxifloxacin based regimes
Immunomodulatory Drugs
Pregnancy / lactation
Infections
Alcohol
Type I Reaction
Frozen hand
Laryngitis
Non-paralytic deformity
Polyarthritis / RA-like syndrome
Multiple dactylitis
Leucocytosis, anaemia, raised ESR
Albuminuria / nephrotic syndrome
Liver / spleen enlargement
Epididimytis / orchitis, testicular atrophy / sterility
Gynaecomastia
Adrenal gland hypofunction
Eye involvement
Type 3 reaction (Lucio phenomenon)
Mild reaction
Analgesics (aspirin or paracetamol)
Severe reaction
Corticosteroids
Antimalarials
Clofazimine
Thalidomide
Methotrexate
Cyclosporine
Azathioprine
Mycophenolate mofetil
Treatment Modalities
Supportive management
Surgical decompression of nerves, splints / padding, treatment of
steroids / atropine eye drops for iridocyclitis, steroids / scrotal support for
epipdidymoorchitis
Grade 0 :
No anaesthesia, no visible deformity or damage in hands and feet, or no
problems in eye or no visual loss.
Grade 1 :
Anaesthesia present, but no visible deformity or damage, eye problems
due to leprosy present but vision not severely affected (6/60 or better)
and can count fingers at 6 metres.
Grade 2 :
Visible deformity or damage present in hands or feet , and severe visual
impairment (vision worse than 6/60)i.e unable to count fingers at 6
metres or lagophthalmos or iridocyclitis or corneal opacities.
Deformities
Primary Deformities
Leonine facies
Loss of eyebrows and eyelashes
Depressed nose
Gynaecomastia
Palatal perforation
Secondary deformities
Corneal ulcers and opacities
Plantar ulcers
Palmar ulcers and ulcers on tips of fingers
Resorption
Plantar ulcer
Charcot joints
Deformities : Nerve Damage
Indication
Acute neuritis
Mobile deformities(to prevent fixed deformities),
Fixed deformities(to correct the deformities).
Various splints
For radial neuritis-Static or dynamic wrist drop splint
For mobile deformity- Static or dynamic splint
For fixed deformity-Gutter splints, finger loops etc.
Splints for various deformities
Hand deformities : Gutter splints, finger loop splints, opponens splints and
adductor bands
Foot deformity : “Y” strap with spring, single elastic strap
Prevention and Control of leprosy
Prevention of leprosy
Early detection through survey and initiation of treatment
Families of patients to be kept under surveillance
Immunoprophylaxis -Use of leprosy vaccines
Improvement in socio-economic conditions
Leprosy control
Three activities of a leprosy control unit
• Case detection
• Case holding, including treatment
• Health education of public and patients
Prevention and Control of leprosy
Leprosy Organizations
UNICEF LEPRA, DANIDA, SIDA, CIDA, Leprosy mission, American leprosy
mission (ALM), German leprosy relief association(GLRA), LEPRA,
Netherland leprosy relief (NLR)
Rehabilitation :
• Physical and mental restoration of patients to normal activities, so
that they are able to assume their place in the home, society and
industry.
• Treatment of physical disability
• Education of patient, family and public
• Rehabilitation in special homes or institutional rehabilitation
• Community based rehabilitation
MCQ’S
A 4 year old girl presented with aysmptomatic non scaly, whitish patch
with intact sensations. What is the likely differential diagnosis?
Thank You!