Leprosy

Leprosy is a chronic infection of the skin and nerves by Mycobacterium leprae. It is spread by droplet infection and has a long incubation period (anything from two months to 40 years). There is a spectrum of clinical disease depending on the patient's cell mediated immunity to the organism.

Diagnosis

• Typical clinical findings:

(a) In tuberculoid leprosy (TT) there is a single anaesthetic patch or plaque with a raised border.

Spectrum of clinical disease in leprosy. (BB = borderline leprosy,

BL = borderline lepromatous leprosy, BT = borderline tuberculoid leprosy,

LL = lepromatous leprosy, TT = tuberculoid leprosy)

Tuberculoid leprosy

-Resistance (cell mediated Immunity) to M. Leprae

-Resistance (cell mediated Immunity) to M. Leprae

Clinical spectrum of disease

Borderline leprosy

(b) In lepromatous leprosy (LL) there are widespread symmetrical shiny papules, nodules, and plaques which are not anaesthetic.

(c) In borderline leprosy (BT, BB, BL) there are varying numbers of lesions, few in BT and numerous in BL. They may be widespread but are asymmetrical.

(d) Palpably enlarged cutaneous nerves (great auricular nerve in the neck, the superficial branch of the radial nerve at the wrist, the ulnar nerve at the elbow, the lateral popliteal nerve at the knee, and the sural nerve on the lower leg).

(e) Glove and stocking sensory loss causing blisters, ulcers or both on anaesthetic fingers or toes.

(f) Deformity due to invasion of the peripheral nerves with leprosy bacilli, a leprosy reaction or recurrent trauma to anaesthetic limbs.

Slit skin smears measure the numbers of bacilli in the skin

(Bacterial Index (BI)) and the % of these that are living

(Morphological Index (MI)).

Treatment

Paucibacillary leprosy (BI of 0 or 1 + ):

Rifampicin 600 mg once a month (supervised) Dapsone 100 mg daily Multibacillary leprosy (BI of 2+ or more):

Rifampicin 600 mg once a month (supervised) Clofazamine 300 mg once a month

(supervised) Clofazamine 50 mg/day Dapsone 100 mg/day

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