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Child with leprosy Today, the diagnosis and treatment of leprosy is easy and most endemic countries are striving to fully integrate leprosy services into existing general health services. This is especially important for those under-served and marginalised communities most at risk from leprosy, often the poorest of the poor.
Access to information, diagnosis and treatment with multidrug therapy (MDT) remain key elements in the strategy to eliminate the disease as a public health problem, defined as reaching a prevalence of less than 1 leprosy case per 10,000 population. MDT treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy. According to official reports received during 2010 from 141 countries and territories, the global registered prevalence of leprosy at the beginning of 2010 stood at 211,903 cases, while the number of new cases detected during 2009 was 244,796 (excluding the small number of cases in Europe). Most previously highly endemic countries have now reached elimination (defined as a registered prevalence rate of <1 case/10 000 population). During 2007, both the Democratic Republic of the Congo and Mozambique reached this important stage. Those few countries that remain are very close to eliminating the disease. However, pockets of high endemicity still remain in some areas of Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, and the United Republic of Tanzania. These countries remain highly committed to eliminating the disease, and continue to intensify their leprosy control activities. Information campaigns about leprosy in high risk areas are crucial so that patients and their families, who were historically ostracized from their communities, are encouraged to come forward and receive treatment. The most effective way of preventing disabilities in leprosy, as well as preventing further transmission of the disease, lies in early diagnosis and treatment with MDT.
and has few side-effects and low relapse rates. Information campaigns about leprosy in high risk areas are crucial so that patients and their families. As the latest individual country data becomes available it will be posted on this page. as well as preventing further transmission of the disease. Egypt and India. Leprosy has afflicted humanity since time immemorial. It once affected every continent and it has left behind a terrifying image in history and human memory . Leprosy bacilli resistant to dapsone gradually appeared and became widespread. The disease mainly affects the skin. Leprosy can be easily treated with a 6±12-month course of multidrug therapy. It is transmitted via droplets from the nose and mouth of untreated patients with severe disease. leprosy has been regarded by the community as a contagious. mutilating and incurable disease. However. Leprosy has struck fear into human beings for thousands of years. . Rates of prevalence and new case detection are for 1 case per 10.latest data Every year WHO receives official data on leprosy from more than 120 national programmes in Member States worldwide. There are many countries in Asia.of mutilation. The treatment is highly effective.Leprosy Leprosy is caused by a slow-growing bacillus. Africa and Latin America with a significant number of leprosy cases. rejection and exclusion from society. and permanent disabilities. over the millennia. rod-shaped bacillus. leading to muscle weakness and atrophy. However. the disease can cause nerve damage. Leprosy statistics . there is no known drug resistance. who were historically ostracized from their communities. and was well recognized in the oldest civilizations of China.A. When M. Leprosy: the disease Leprosy is a chronic infectious disease caused by Mycobacterium leprae. but is not highly infectious. treatment for leprosy only appeared in the late 1940s with the introduction of dapsone. apart from some other structures. A cumulative total of the number of individuals who. are encouraged to come forward and receive treatment. If left untreated. and reflects the situation during and at the end of the preceding year. the peripheral nerves. an acid-fast. Mycobacterium leprae. have suffered its chronic course of incurable disfigurement and physical disabilities can never be calculated. Hansen in 1873. The most effective way of preventing disabilities in leprosy. it was the first bacterium to be identified as causing disease in man. this data generally only becomes available in July of each year. Since ancient times.000 population. and its derivatives.leprae was discovered by G. It is estimated that there are between one and two million people visibly and irreversibly disabled due to past and present leprosy who require to be cared for by the community in which they live.000 and per 100. mucosa of the upper respiratory tract and also the eyes. lies in early diagnosis and treatment with MDT. respectively.
These may be loss of sensation in the skin and weakness of muscles supplied by the affected nerve. rod-shaped. in practice. may be seen in the smears taken from the affected skin when examined under a microscope after appropriate staining. The clinical system of classification for the purpose of treatment includes the use of number of skin lesions and nerves involved as the basis for grouping leprosy patients into multibacillary (MB) and paucibacillary (PB) leprosy. Only in rare instances is there a need to use laboratory and other investigations to confirm a diagnosis of leprosy. without sensory loss and/or muscle weakness is often not a reliable sign of leprosy. A thickened nerve is often accompanied by other signs as a result of damage to the nerve. particularly in view of the non-availability or non-dependability of the skin-smear services. In practice. A variety of skin lesions may be seen but macules (flat). Thickened nerves. usually less pigmented than the surrounding normal skin. red-stained leprosy bacilli. or nodules are common. In the absence of these signs. These are easy to observe and elicit by any health worker after a short period of training. While classifying leprosy. most programmes use clinical criteria for classifying and deciding the appropriate treatment regimen for individual patients. Such individuals should be told the basic facts of leprosy and advised to return to the centre if signs persist for more than six months or if at any time worsening is noticed. most often persons with such complaints report on their own to the health centre. while those showing positive smears at any site are grouped as having multibacillary leprosy (MB). patients showing negative smears at all sites are grouped as paucibacillary leprosy (PB). Positive skin smears: In a small proportion of cases. In the classification based on skin smears. However.Diagnosis of leprosy Diagnosis of leprosy is most commonly based on the clinical signs and symptoms. with or without thickened nerves positive skin smears The skin lesion can be single or multiple. The skin lesion may show loss of sensation to pin pick and/or light touch. an individual should be regarded as having leprosy if he or she shows ONE of the following cardinal signs: skin lesion consistent with leprosy and with definite sensory loss. Suspect cases may be also sent to referral clinics with more facilities for diagnosis. papules (raised). A person presenting with skin lesions or with symptoms suggestive of nerve damage. y y Classification of leprosy Leprosy can be classified on the basis of clinical manifestations and skin smear results. In an endemic country or area. mainly peripheral nerve trunks constitute another feature of leprosy. nerve thickening by itself. . Sometimes the lesion is reddish or copper-coloured. it is particularly important to ensure that patients with multibacillary disease are not treated with the regimen for the paucibacillary form of the disease. Sensory loss is a typical feature of leprosy. in whom the cardinal signs are absent or doubtful should be called a `suspect case' in the absence of any immediately obvious alternate diagnosis . which are diagnostic of the disease.
Transmission of leprosy Leprosy is known to occur at all ages ranging from early infancy to very old age. Method of transmission of leprosy The exact mechanism of transmission of leprosy is not known. particularly in Africa. Thailand and Japan. the sex-specific prevalence could be different even with the same sex-specific incidence. The youngest age reported for occurrence of leprosy is three weeks in Martinique (Montestruc & Berdonneau. Such situations have been observed in Uganda. The youngest case seen by the author was in an infant of two-and-a-half months. Hawaii. Venezuela and Cameroon. and not due to differing duration of disease for the two sexes. Burkina Faso. It is a strongly acid-fast rod-shaped organism with parallel sides and rounded ends. At least until recently. Zambia. 1954). or occasionally even a higher prevalence among females. Occurrence of leprosy. Nigeria. is not uncommon even after the age of seventy. Doull et al (1942) from their studies in the Philippines have also pointed out that the difference as a true difference due to higher incidence among males. In size and shape it closely resembles the tubercle bacillus. There are also other possibilities such as transmission through insects which cannot be completely ruled out. presumably for the first time. Microbiology of M. in most parts of the world males are affected more frequently than females often in the ratio of 2:1. It should be pointed out that the male preponderance in leprosy is not universal and there are several areas. where the diagnosis of leprosy was confirmed by histopathology. Gambia. where there is either equal occurrence of leprosy in the two sexes. Sex distribution Although leprosy affects both sexes. Malawi. It it were the latter case.leprae M. the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. the Philippines. More recently the possibility of transmission by the respiratory route is gaining ground. This preponderance of males is observed in as diverse geographic situations as India.leprae The aetiological agent of leprosy is Mycobacterium leprae. It occurs .
Under the electron microscope the bacillus appears to have a great variety of forms. Short rod-shaped structures can also be seen (identical with the rod-shaped inclusions within the filaments) and also dense spherical forms. y y y y y y Prevalence of leprosy The global registered prevalence of leprosy at the beginning of 2006 was 219. The morphological index (MI) This is calculated by counting the numbers of solid-staining acid-fast rods. It is important to recognize that measurement of MI is liable for observer variations and therefore not always reliable. We therefore need drugs which will help the body to dispose of dead but still intact leprosy bacilli. Two indices which depend on observation of M.826 cases. Chains are never seen. chiefly in masses within the lepra cells. leprae in smears from skin or nasal smears are useful in assessing the amount of infection. 2+ At least 1 bacillus in every 10 fields. in a smear made by nicking the skin with a sharp scalpel and scraping it. which consist of clumps of bacilli in capsular material. at the . The bacteriological index is valuable because it is simple and is representative of many lesions but is affected by the depth of the skin incision. 1+ At least 1 bacillus in every 100 fields. leprae to reappear for short periods in patients being successfully treated with drugs. The commonest is a slightly curved filament 3-10 m in length containing irregular arrangements of dense material sometimes in the shape of rods. Most striking are the intracellular and extra-cellular masses. A more accurate and reliable index of the bacillary content of a lesion is given by the logarithmic index of biopsies (LIB. including reactions of the erythema nodosum type. There are now only six countries that have still to reach the elimination target of 1 case per 10. and the viability of the organisms and also the progress of the patient under treatment. They are the morphological index and the bacteriological index. The bacteriological index (BI) This is an expression of the extent of bacterial loads.in large numbers in the lesions of lepromatous leprosy. which suggests that many of the manifestations of leprosy. often grouped together like bundles of cigars or arranged in a palisade. 6+ At least 1000 bacilli in every field. which follow initial treatment. the thoroughness of the scrape and the thickness of the film. known as globi. the fluid and tissue obtained are spread fairly thickly on a slide and stained by the ZiehlNeelsen method and decolorized (but not completely) which 1% acid alcohol. must be due in part to antigens from dead organisms rather than living bacilli.000 population. Some of the groups of bacilli can be seen to have a limiting membrane. It is believed that only leprosy bacilli which stain with carbol-fuchsin as solid acid-fast rods are viable and that bacilli which stain irregularly are probably dead and degenerating. The differences are valuable pointers in biopsy specimens to the effects of treatment. It is not unusual for solid-staining M. 4+ At least 10 bacilli in every field. a very high proportion of bacilli are killed within days. In patients receiving standard multidrug therapy (MDT). Only the solid-staining bacilli are viable. It is calculated by counting six to eight stained smears under the 100 x oil immersion lens. These indices help to assess the state of patients at the beginning of treatment and to assess progress. 5+ At least 100 bacilli in every field. 3+ At least 1 bacillus in every field. The results are expressed on a logarithmic scale.
It is transmitted via droplets. Click on one of the links below to start the download. both for MB and PB leprosy) KEY FACTS y y y y Leprosy is a chronic disease caused by a bacillus. Untreated. the chemotherapy of leprosy consisted of using dapsone monotherapy for the control of the disease. limbs and eyes.national level. leprosy can cause progressive and permanent damage to the skin. The map and document below are in portable document format (. from the nose and mouth.000 population. Dapsone being a slow acting and weak bactericidal drug. The recommendations on MDT received enthusiastic support from most of the leprosy-endemic countries. Note that rates shown for prevalence is for 1 case per 10. international and non-governmental organizations (NGOs). lead to wide-spread poor patient compliance and the emergence of dapsone resistant strains of Mycobacterium leprae. These regimens include a combination of rifampicin. WHO regional committees. (A cumulative risk of less than 1% over a nine year period. Leprosy is not highly infectious. Follow-up based on sufficiently large number of patients has revealed very low relapse rates following stopping treatment. To view either document. M.pdf reader is required. clofazimine and dapsone for multibacillary leprosy and rifampicin plus dapsone for paucibacillary leprosy. Mycobacterium leprae. leprae multiplies very slowly and the incubation period of the disease is about five years. nerves. This period of failure and frustration changed dramatically with the introduction of greatly improved treatment through the application of combinations of drugs referred to as multidrug therapy (MDT).pdf). . Rates of prevalence and new case detection (shown in parenthesis) were calculated based on population data for the year 2005 from United Nations Population Division ) (2004 Revision: POP/DB/WPP/Rev. which was first recommended by a WHO Study Group in 1981. Symptoms can take as long as 20 years to appear. Early diagnosis and treatment with multidrug therapy (MDT) remain the key elements in eliminating the disease as a public health concern. a . with approximately 249 000 new cases reported in 2008. and for life long to treat multibacillary leprosy. This therapy has proved to be the most reliable and practical method of treating leprosy. This was usually administered as 100 mg daily for a minimum period of 5 years to treat paucibacillary leprosy. Official figures show that more than 213 000 people mainly in Asia and Africa are infected. The table below shows the registered prevalence of these six countries over the period 2004-2006. during close and frequent contacts with untreated cases. donor agencies and professional bodies alike.2004/2/F1) Research Until the early 1980s.
int Related links Leprosy elimination Global leprosy situation.1 per 10 000 inhabitants to less than 1 per 10 000 inhabitants in 2000. about 4 million since 2000. Partners in leprosy elimination also need to continue to ensure that human and financial resources are made available for the elimination of leprosy. national and local levels. Leprosy has been eliminated from 119 countries out of 122 countries where the disease was considered as a public health problem in 1985. Efforts currently focus on eliminating leprosy at a national level in the remaining endemic countries and at a sub-national level from the others. must be created. encouraging self-reporting and early treatment by promoting community awareness and changing the image of leprosy.2 million in 1985 to 805 000 in 1995 to 753 000 at the end of 1999 to 213 036 cases at the end of 2008. Elimination of leprosy as a public health problem is defined as a prevalence rate of less than one case per 10 000 persons. The target was achieved on time and the widespread use of MDT reduced the disease burden dramatically.Elimination of leprosy as a public health problem In 1991 WHO's governing body. the World Health Assembly (WHA) passed a resolution to eliminate leprosy as a public health problem by the year 2000. Dramatic decrease in the global disease burden: from 5. political commitment needs to be sustained in countries where leprosy remains a public health problem. The prevalence rate of the disease has dropped by 90% ± from 21. So far. the quality of patients¶ care and the progress being made towards elimination through national disease surveillance systems. treatment of leprosy needs to be fully integrated into general health services. Over the past 20 years. in which patients will not hesitate to come forward for diagnosis and treatment at any health facility. The age-old stigma associated with the disease remains an obstacle to self-reporting and early treatment. monitoring the performance of MDT services. 2009 WHO Leprosy Forum Report [pdf 230kb] y y y . A new environment. This is a key to successful elimination of the disease. there has been no resistance to antileprosy treatment when used as MDT. Strategy for leprosy elimination y y y y y y y y y y y y The following actions are part of the ongoing leprosy elimination campaign: ensuring accessible and uninterrupted MDT services available to all patients through flexible and patientfriendly drug delivery systems. Actions and resources required In order to reach all patients. ensuring the sustainability of MDT services by integrating leprosy services into the general health services and building the ability of general health workers to treat leprosy. more than 14 million leprosy patients have been cured. Moreover. E-mail Print For more information contact: WHO Media centre Telephone: +41 22 791 2222 E-mail: mediainquiries@who. The image of leprosy has to be changed at the global.
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