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HANSEN’S DISEASE LEPROSY         chronic granulomatous disease skin, peripheral nerves,upper respiratory tract eyes First discovered

in 1873 by Norweigan physician, Gerhard, Henrik, Armauer Hansen Swan cell of peripheral and cutaneous nerves Prevalence in endemic areas reduce but continuous to be the same Philippines is the largest contributor of new leprosy cases in 2005 MB cases account for 94.3%

To prematurely consign leprosy to history books guarantees unnecessary future morbidity-K. J. Thompson YEAR 2002 2003 2004 2005 2006 2007 RANK 2 4 2 2 5 2 NUMBERS 1752 971 1067 1224 990 1224

DEFINITION OF A CASE LEPROSY  A person having one or more of the following features, and who has still to complete a full course of treatment THE THREE CARDINAL SIGNS OF LEPROSY  Hypopigmented or reddish skin lesions with definite loss of sensation  Involvement of peripheral nerves( thickening, loss of sensation  Skin smear positive for acid fast bacilli

 Retrieve defaulters with signs of active disease  Relapse patient who previously completed a full course treatment  Does not include - Cured persons with late reactions - Or residual disabilities

CLINICAL SPECTRUM TT (cell mediated immunity) BT BB BL LL( antibody response) WHO MULTI-DRUG THERAPY PAUCIBACILLARY (I or TT OR BT)  Rifampicin 600 mg monthly  Dapsone 100 mg daily  6-9 month treatment MULTIBACILLARY     Rifampicin 600 mg monthly Dapsone 100 mg daily Clofazimine 300 mg monthly +50 mg daily 1 year treatment ROM REGIMEN Single Lesion Paucibacillary (SLPB)     Rifampicin 600mg Ofloxacin 400 mg Minocyclin 100 mg Single dose Nerve Function Assessment   Monofilament (sensory )testing/ ballpen testing. nylon monofilament testing Voluntary muscle testing Nerve examination sites         Sensory Zygomatic Marginal mandibular Cervical Facial Trigeminal Median Ulnar .

paralyzed  Strengthening exercise for loss of function  Loss of function within 6 months must be treated with steroids MOTOR NERVE TESTED KEY MOVEMENT Facial Tight eye closure Ulnar Little finger out Median Thumps up Radial wrist up Common Peroneal Foot up  VOLUNTARY MUSCLE GRADING SCALE Muscle grade SWP scale MRC scale STRONG 5 4 3 WEAK 2 Range of motion Resistance Intervention Complete Complete Complete Reduced Muscle Flicker none Full Reduced None None None None Normal Muscle. no intervention needed Monitor patient for possible NFI If < 12 mos.: prednisolone treatment and rest/ splinting If > 12 mos. do passive ROM exercises to prevent joint stiffness 1 PARALYZED 0 WHO GRADING OF DISABILITIES HANDS AND FEET Grade 0 Grade 1 Grade 3 No anesthesia No visible deformity/damage Anesthesia No visible deformity/damage Anesthesia Visible Deformity/ damage .Sensory testing  Cornea (Surface of the eye)  Blinking  < 5 blinks per minute= loss of sensation of cornea  Self-care (sun glasses)  Stopped blinking within 6 months--steroids Voluntary Muscle testing  Test motor function by resistance  Strong (normal) weak.

TREATMENT OF LEPROSY IN SPECIAL SITUATIONS: Patient cannot take rifampicin Length of treatment 6 months Drug Clofazimine Ofloxacin Minocyclin Clofazimine + either Ofloxacin or minocycline Dose 50 mg daily 400 mg daily 100 mg daily 50 mg daily 400 mg daily 100 mg daily followed by additional 18 mos Patient cannot take clofazimine:  24 month regimen MDT  Rifampicin 600 mg once a month  Ofloxacin 100 mg once a month  Dapsone 100 mg daily Patient cannot take dapsone: Rifampicin 600 mg once a month with supervision Clomazipine 300 mg once a month under supervision and 50 mg daily without supervision Pregnancy and lactation  Continue MDT  Do not start MDT during first trimester of pregnancy  Single dose treatment for single lesion PB leprosy deffered until delivery Reactions in leprosy      Rapid shift from pole to the other produces an inflammatory reaction May occur in any type but more commonly in multi-bacillary type Response to dead bacteria May develop after treatment is completed 30% of leprosy cases will have reactions .

ulcerations COMPLICATION -skin ulceration. fever pain present -neuritis. anesthesia  Major cause of nerve damage in leprosy ENL (TYPE II REACTION) Erythema nodosum leprosum with the appearance of multiple papulomodules in a patient with lepromatous leprosy. arthritis. Leprae -associated increase in specific CMI in those patient sundergoing a shift in communication whether slight or marked MANIFESTATIONS -lesions gradually become swollen and erythematous -last weeks or months -fever rare ERYTHEMA NODOSUM (TYPE II) MB only -immune complex disease -crops of painful papules developing in a few hours and lasting for a few days . paralysis.REVERSAL REACTION TYPE I TYPE/CLASSIFICATION PB AND MB ETIOLOGY -change in delayed hypersensitivity to M. TYPE 1 REACTION increased edema presence of satellite lesions nerve tenderness TREATMENT OF LEPRAE REACTIONS TYPE I: Prednisone (20-60 mg per day) TYPE II: Thalidomide (100.successive crops occur over months/ years. proteinuria. laceration. LAD. orchitis.200 mg per day) . iritis.

deformity--STIGMA SEQUELAE OF LEPROSY          Madarosis. may give Clofazimine    300 mg/ day during the first month 200 mg/ day during the second month 100 mg/ day during the third month NERVE FUNCTION IMPAIRMENT Nerve damage (anesthesia. ulnar nerve movement hand flexion contraction of all fingers Orchitis leading to sterility Shortening of digits Foot drop Neuropathic ulcers of plantar surface (sensory neuropathy) SUMMARY      Leprosy is curable with MDT if taken regularly and continuously Leprosy becomes non. free of charge During the course of treatment leprosy may occur Impairments of eyes. contracture of 4th and 5th fingers. pain. muscle weakness. Manual workers. dryness of the skin)---misuse of limb--- Ulceration. infection.If prednisone is contraindicated or insufficient to control recurrence. hands and feet are preventable MIMICKERS OF LEPROSY Is it really leprosy?   Hyposthethic skin lesions  Chronic dermatitis (thickened skin) Enlarged peripheral Nerve  Poor examination technique  Nonspecific enlargement ex. athletes .infectious after taking MDT MDT packs are available in government rural health units.loss of eye brow Lagopthalmos Gynecomastia Papal hand sign.

post inflammatory hypopigmentation Tinea corporis Leukemia cutis=ENL Borderline tuberculoid= Psoriasis Histoid leprosy= Neurofibromatosis Lupus Vulgaris= borderline leprosy .        Pityriasis versicolor-lepromatous leprosy Pityriasis alba-indeterminate leprosy Tuberculoid leprosy.