Geetanjali medical college and hospital,

Udaipur

Department of CommunityMedicine

Presented By-
Dr. KAMLESH SHARMA (Intern Batch 2013)

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Objectives:-
 Definition.
 Overview.  Clinical presentation.
 History.  Invastigations
 Clinical features.  Diagnosis.
 Epidemiology: world & India.  Control of leprosy.
 Leprosy organization inindia.
 Reservoirs.
 Global leprosystrategy.
 Factors.  NLEP
 Modes oftransmission.  World leprosyday.
 Classification.

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Whatis Leprosy ?

InGreek “Leper” means ‘Scaly’.

Leprosy is a chronic, granulomatous, infectious disease.
 Caused by “Mycobacteriumleprae”.
Mainly involve skin and peripheral subcutaneous
nerves.

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 Whatcauses it ..??
Mycobacterium Laprae bacilli.
It is:

 An intracellular, pleomorphic, Gram +ve &

acid fast bacilli.

 Discovered by GH Armaer Hansen in 1873.

 It was the first bacterium to be identified as
causing disease inhumans.

m. laprae 5
 History…
One of the oldest and most dreaded disease known
to mankind.

In India it is described as Kushta roga in sushruta

Samhita.

In 1873, the pathogen M. Leprae was discovered by

GH HANSEN. So this is oftencalled Hansen disease.
GH ArmaerHansen

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 Epidemiology
World &India

 As per WHO guideline, Leprosy is considered as a major public health problem in

those areas, where its prevalence rate is at least 1per 1000 population.

 South Asia and Africa are considered to represent the ancestral home of leprosy,
tracing back to 2500 years BC.
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 During 1981, the prevalence rate was 57per 10,000 population.
 it reduced dramatically, due to thechange in the strategy of leprosy
control from Monodrug therapy to multidrug therapy.

 The disease is said to be eliminated when the prevalence rate is reduced to less
than 1per 10,000 population.

 During 2005, the prevalence rate was 1.3/10,000 population, 0.84/10,000

population during 2006 and during 2011 it was reduced to 0.69/10,000
population.

 So leprosy is now said to be eliminated. 12

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Age Incidence:
All the age groups, but max b/w 20 to 30 years of age.

Sex Incidence:
• Leprosy is twice as common among males than among females
(in the ratio of 2:1).

Malnutrition:
• Malnutrition lowers the cell mediated immunity and
thereby increases the susceptibility for the disease.
Environmental Factors:
• High humidity, overcrowding and poorly ventilated living
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conditions favor the transmission of leprosy.
Social Factors:
 Poverty,
 Illiteracy,
 Ignorance,
 Over-crowding,
 Poor standard of living conditions
 Lack of knowledge, etc.

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 Reservoir of Infection
 Main Reservoir: Human being.

 Animal Reservoir:  9-Banded Armadillos.(Best)

 Mangby monkeys.
 Rhesus monkeys.
 African green monkeys.
 Chimpanzees.

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9-BandedArmadillos.
Facts….
Not all the cases of leprosy are infectious.
Those cases,who are shedding bacilli either from the nose
and throat or from the ulcerative, cutaneous lesions are
infectious to others.
Generally 95 to 97 percent of human beings are not
susceptible to leprosy. Only 3 to 5 percent are susceptible to
leprosy.
Among the susceptibles 80 to 85 percent patients get self-
healing.Only remaining 15 to 20 percent develop the disease.

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Modes of Transmission:-

Direct modes:
By droplet mode(Major route): Major route of transmission.
By direct skin-to skin contact: with the ulcerative lesions of
leprosy patients.

 Indirect modes:
Through fomites are based upon the fact that the organisms
are capable of surviving outside the body for about Hours
to days.
The other hypothetical modes of transmission are vector
borne, soil borne.
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 Incubation Period:
-Itis very long and variable.
- Average it is about 3 to 5 years.
-Minimum side it is 2 to 3 years and the maximum side it is 20 years or
even more.

 Classification of Leprosy:-

 Two types of classification:

1. WHO Classification / Skin smear result classification

2. Clinical classification / Field Worker’s Classification /
Ridley Jopling
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1. WHO Classification:
This is based on number of skin lesions and bacteriological status.

a. Single skin lesion, paucibacillary leprosy

• Single skin lesion
• No nerve involvement
• Skin smear for AFB negative
b. Paucibacillary leprosy (PBL)
• 2–5 lesions (skin and nerves)
• Only one nerve trunk
• Skin smear for AFB negative
c. Multibacillary leprosy (MBL)
• More than 5 lesions (i.e. 6 and above)
• More than one nerve trunk involvement
• Skin smear positive.. 20
2.Clinical (Ridley Jopling) cassification:
1.Indeterminate leprosy (IL).
2.Tuberculoid leprosy (TL).
3. Lepromatous leprosy (LL).
4. Borderline leprosy (BL).
• Borderline tuberculoid leprosy (BTL).
• Borderline borderline leprosy (BBL).
• Borderline lepromatous leprosy (BLL).

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Clinical Features:-

 Hypopigmented patches.
 With loss of sensation.
 Thickening and enlargement of the nerves.
 Demonstration of M. leprae from the cutaneous lesions.

In the advanced stage-

 Nodules over the face.

 Claw hands, loss of fingers or toes, footdrop.
 Trophic ulceration giving rise to ugly disfigurement with
deformities leading to permanent disability and handicap of the 8

individual if not treated in time.

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 Borderline tuberculoid (BT)—
Borderline (BB)—classical
multiple, sharply-demarcated,
‘punched-out’ lesions of
scaly reddish-brown plaques;
borderline leprosy; central
these subsiding lesions are only
‘immune’ areas are anesthetic
partially anesthetic 26
Borderline lepromatous (BL)—numerous and
widespread borderline type plaques, annular
lesions, papules and macules; center of
large lesions show some loss of sensation.
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 Clinical Presentation:
-The changes are seen in the skin, mucous membrane,
nerves and bones.
Skin:
• Macules - hypopigmentedlesions
• Papules - infiltrated, may be erythematous lesions.
• Nodules - in advanced leprosy, mostly on the face, nose and
ears caused by deepening of furrows and wrinkles.
• Ulcers. Nodules may undergo superficial necrosis producing
ulcers, which serve as portals of exit for leprosy bacilli.
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 Mucous membranes:
Nodules may appear on the mucous membrane of nose, lips,
tongue, palate and larynx followed by ulceration. The
ulceration of nasal septum may advance to perforation and
destruction of the septal cartilage eventually leading to
saddle-nose deformity. Involvement of the larynx may result
in hoarse cough, husky voice and stridor.
Nerves:
loss of sensory, motor and autonomic .Sensations of light
touch and temperature first disappear followed by loss of
pain and pressure sense. later ending in paralysis and
atrophy. Paralysis of the muscles of hands and feet leads to
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deformities.
 Bones:

• Bone changes due to deposition of bacilli in the

medullary cavities and periosteum.

• Neurotrophic atrophy and resorption of bone tissue is

seen in the phalanges of hands and feet as well as in
metatarsals.

• Osteoporosis and ankylosis.

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Diagnosis:-
Diagnosis of leprosy is most commonly based on the
clinical sign andsymptoms.
A clinical diagnosis of leprosy is made by looking
for thecardinal signs:
• Skin lesions with partial or total loss of sensation,
• Thickened nerves with or without tenderness and
• Demonstration of lepra bacilli (AFB) in the smear
of cutaneouslesions.

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 Investigations:
1. Bacteriological examinations

2. Lepromin test

3. Histamine test

4. Histological examination (Biopsy of skin)

5. Foot-pad culture

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CONTROL OF LEPROSY
This can be discussed under the following :
• Medical measures
• Social measures
• Managerial aspects
• Evaluation.
1.Medical measures:-
General measures:- By doing surveys.
Information about
prevalence.
2. Early case detection.
3.Chemotherapy:-
MONOTHERAPY -Dapsone
MULTIDRUGTHERAPY(MDT)- Dapson.
Rifampicin. 41

Clofazimine.
Social Measures
Socialassistance should be promoted through voluntary agencies and
department of social welfare. Thus social measures consist of social
rehabilitation and health education of the public. Social support consists of
mainly acceptance of the patient by the family members, job placement and
abolishing the social evil of beggary.

Managerial Aspects
Managerial and administrative support are essential ingredients for
effective implementation of any health program and leprosy control is no
exception. Availability of adequate infrastructure, trained personnel,
medicines, equipment, transportand finances must be ensured.

Evaluation
Proper evaluation of any health program is necessary to check whether the
desired results are achieved or not and if not, what modifications are needed. 42
 .Released inApril 2016.
 Based on the principle of initiating action,ensuring accountability and promoting inclusion.
 It is built around 3pillars:
- To strengthen govt. ownership, coordination and partnership;
- To stop leprosy and its complications ;
- And to stop discrimination and promote inclusion.
 3key targets have been agreed by all national programmes:
1.Zero grade 2 deformity (G2D) among children diagnosed with leprosy.

2. The reduction of new cases(<1 case/million population). 45

3.And early detection and complete treatment with MDT.

 “National Leprosy Eradication Program”
The National Leprosy Control Programme (NLCP) has been in operation since 1955.
In 1983 the control programme was redesignated National Leprosy "Eradication"
Programme with the goal of eradicating the disease by the turn of the century.
The aim was to reduce case load to 1or less than 1per 10,000 population.

The components of the programme are as follows :

(1)Decentralized integrated leprosy services through general health care system;
(2) Capacity building of all general health services functionaries;
(3)Intensified information, education and communication;
(4) Prevention of disability and medical rehabilitation; and
(5)Intensified monitoring and supervision.
After introduction of MDT, the recorded case load of leprosy came down from 57.6
cases per 10,000 population in 1981 to less than 1 at the national level in 47

December 2005.
 At national level as set by the National Health Policy (2002). 33
states/UTs achieved the status of leprosy elimination. Only 2 States/UTs
viz. Chattisgarh and Dadra & Nagar Haveli are yet to achieve
elimination.

Major initiatives taken are as follows :

(1)More focus has now been given to new case detection than prevalence.
(2)More emphasis is being given on providing disability prevention and
medical rehabilitation (DPMR) services to leprosy affected persons.
(a) Dressing materials,supportive medicine.
(b) Micro-cellular rubber footwear.
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(3) ASHAs have been involved in bringing out suspected
leprosy cases from their villages for diagnosis and
treatment at PHC and follow-up of confirmed cases for
their treatment completion.

(4) Intensive IEC campaign with a theme "Towards

Leprosy Free India" has been carried out towards
further reduction of leprosy burden in the
community,

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 “Leprosy Organizations in India”

•Leprosy mission: This was the first organization for leprosy

work founded by Baily in 1874, in Chamba, Himachal Pradesh.
Presently its headquarter is in Purulia, WestBengal.
•Hind Kusth Nivaran Sangh: This was established in Delhi,
about 100 year later, i.e. during 1974, as a branch of the
Association in London.
• Gandhi Memorial Leprosy Foundation, Sevagram, Wardha.
• Belgium Leprosy Centre (Polambakkam, Chennai).
• Danish Save the Children Fund.
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“WORLD LEP\ROSY DAY”

Celebrated as ‘World Leprosy Day’, since 1954

World Leprosy Day is observed internationally every year
on the last Sunday of January to increase the public
awareness of the Leprosy or Hansen's Disease.

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 QUESTIONS

1.which of the following is bacteriocidal agent in drug

treatment of leprosy ?
a.rifampicin
b.dapsone
c.penicillin
d.none of the above
2.In which of the following reaction erythema nodosum
leprosum IS SEEN ?
A.LEPRA 1
B.LEPRA 2
C.LEPRA 3
D.LEPRA 4
3.Mycobacterium leprae is cultivated in ?
a.blood agar
b.monkey kidney lines
c.9 banded armadillo
d.robertson cooked meat medium
Q4. green kit is used for which of the following ?

a.multibacillary leprosy
b.paucibacillary leprosy
c.tuberculosis
d.syphilis
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