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LEPROSY IN

PREGNANCY
Devi Noviana Saputri
Surya Doriska
Pembimbing: dr. Resati Nando
Panonsih, Sp.KK

INTRODUCTION
Leprosy is an infectious disease which is
caused by the bacillus Mycobacterium leprae.
It affects the skin and nerves and can cause
paralysis, muscle weakness and loss of sensation.

Pregnancy has long been associated with the


first presentation of clinical leprosy or worsening of
existing disease.

DEFINITION
Leprosy, also known as Hansens disease, is a
chronic cutaneous infectious disease caused by an
obligate intracellular bacillus, M. leprae.
This organism grows best in the cooler areas of the
body, including skin, peripheral nerves, testes, anterior
chamber of the eye and upper respiratory tract.

EPIDEMIOLOGY
Leprosy is found sporadically in developing countries
and most cases of leprosy in the United States of
America occur in immigrants. Leprosy is distributed
worldwide, as a result of travel and migration, but it is
endemic in tropical countries.
A retrospective and longitudinal study of 149 cases of
pregnant women with leprosy in Par, Brazil, within a
3-year period between 2007 and 2009, showed that
the age group with the highest incidence of the
pregnancy-leprosy association was 20 to 39 year-olds.
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RISK FACTORS

People living in areas with polluted water

People consuming a poor diet or bad nutrition

TYPES OF LEPROSY
There are three systems for classifying leprosy :
The first system recognizes two types of
leprosy based on a persons immune response to
the disease:
Tuberculoid
leprosy

Lepromatoid
leprosy

The second classification system is based on that by


the World Health Organization (WHO), which categorizes
leprosy based on type and number of skin areas affected
by the disease:
Paucibacillary
(PB) type

Multibacillary (MB)
type

The third classification system is the Ridley-Jopling,


which is used globally in clinical studies. In this system
the six classes of leprosy, are:
Intermediate leprosy.
Tuberculoid/PB leprosy
Borderline tuberculoid (BT) leprosy
Mid-borderline leprosy
Borderline lepromatous (BL) leprosy
Lepromatous/MB leprosy

Diagnosis

Polymerase Chain
Reaction (PCR)
Matsuda
Reactions

CLINICAL FEATURES

Tuberculoid leprosy occurs in individuals who have good cellmediated immunity. These patients develop a granulomatous
response.
Lepromatous leprosy occurs in individuals who have poor cellmediated immunity. These patients do not develop a
granulomatous response.
Borderline leprosy is a form of leprosy that is intermediate
between tuberculoid and lepromatous leprosy.
Leprosy is transmitted by nasal discharge and digital
impregnation of the skin, as bacilli can be carried under nails and
then inoculated under the skin by scratching.
Plantar leprosy lesions are thought to be a high risk for the
development of squamous cell carcinoma.
In pregnancy, painful erythematous lesions of the skin on the face
and limbs have been reported.

COMPLICATIONS
There is an increased risk of premature birth
Delivery of small-for-gestational age infants
Permanent nerve damage
Neuritis affects
Children born to mothers with leprosy have low
birthweights, small placentae and grow slowly

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LEPROSY MEDICATIONS USED IN PREGNANCY


Leprosy is usually well controlled with a
combination of drugs known as MDT. This is also
recommended by WHO. These drugs include
dapsone, rifampicin and clofazimine. The
treatment varies according to whether the leprosy
has been classified as PB or MB.

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Multidrug therapy for PB leprosy 6 month regimen


Monthly dose under supervision Rifampisin 600mg
Daily dose

Dapsone 100mg

Multidrug therapy for MB leprosy 12 month regimen


Monthly dose

Rifampisin 600mg
Clofazimine 300mg

Daily dose

Dapsone 100mg
Clofazimine 50mg

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CONCLUSIONS

Pregnancy induces a state of immunological change


which may lead to worsening of leprosy in the
mother.
Leprosy in pregnancy can be safely and
successfully treated with MDT
Leprosy in pregnancy has implications for:

The physician
The obstetrician/gynaecologist
The leprosy health worker, and
The paediatrician, as well as, the family and friends of the
pregnant woman, all of whom provide support and care to
the patient.
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Thank You