sakjkkl

1
Leprosy (Hansens Disease)

• Hitaa Gandhi

2
What is Leprosy?

• It is a disease
• World's oldest recorded disease
• Stigmatized disease
• Gerhard Henrick Armauer Hansen

Every year January 27 is World Leprosy Day
3
What causes it?

• Mycobacterium leprare
• Rod Shaped
• First bacterium disease in humans
• Humans and Armadillos are only known natural hosts

http//www.aaas.org/news/releases/2005/images/0512
leprosy.jpg
http//www.worldproutassembly.org/leprosy20patien
t20holding20flower.jpg
http//genomenewsnetwork.org/articles/02_01/Lepros
y.shtml
4
Types of Leprosy

• Depending on clinical features, leprosy is
  classified as
• Indeterminate Leprosy (IL)
• Paucibacillary Leprosy (PB)
• Borderline Tuberculoid Leprosy (BT)
• Borderline borderline Leprosy (BB)
• Borderline lepromatous Leprosy (BL)
• Multibacillary Leprosy (MB)

5
What are the symptoms?

• Paucibacillary (PB) Leprosy symptoms are
• Well defined skin lesions that are numb
• Multibacillary (MB) Leprosy symptoms are
• Chronically stuffy nose and many skin lesions and
  nodules on both sides of the body

• Mycobacterium leprare multiplies very slowly
• Symptoms can take as long as 20 years to appear

6
Who is at risk?

• It can affect all ages and both sexes

• 95 of people who are exposed do not develop

• Mainly affects
• Skin
• Eyes
• The peripheral nerves
• Mucosa of the upper respiratory tract

7
Who is at risk?
bp2.blogger.com/.../s320/lepromatous_leprosy.jpg
http//www.leprosymission.org/web/pages/leprosy/im
ages/girlwithleprosypatch.jpg
http//microbes.historique.net/images/lep3.jpg
http//www.leprosymission.org/web/pages/leprosy/le
prosy.html
8
Goals of Treatment

• Major goals of treatments are

1. Early detection of patients
2. Appropriate treatment
3. Adequate care for the prevention of disabilities
   and rehabilitation

9
Pharmaceutical Treatment

• Multiple Drug Treatment (MDT)

• There are several effective chemotherapeutic
  agents
• Dapsone (diaphenylsulfone, DDS), Rifampicin
  (RFP), Clofazimine (CLF), Ofloxacin (OFLX), and
  Minocycline (MINO) constitute the backbone of the
  multidrug therapy (MDT) regimen.

10
Treatment

• Drug Dapsone was introduced in early 1940s.
• In the early 1950s resistance to Dapsone was
  discovered
• In the early 1960s the other two (2) components
  of MDT Rifampicin and Clofazimine were discovered
  and later introduced as part of the treatment

11
Structure of Dapsone (DDS)
http//images.google.com/imgres?imgurlhttp//uplo
ad.wikimedia.org/wikipedia/commons/thumb/c/c2/Daps
one.svg/671px-Dapsone.svg.pngimgrefurlhttp//com
mons.wikimedia.org/wiki/ImageDapsone.svgh290w
671sz11hlenstart13um1tbnidihM5GO42l13LYM
tbnh60tbnw138prev/images3Fq3Ddapsone26um
3D126hl3Den
12
About Dapsone

• It was dicovered by German chemists Fromm and
  Wittmann in 1908
• Was not utilized as a treatment until decades
  later
• Available in 25mg 100 mg tablets
• Rated a pregnancy risk category C by the American
  Food and Drug Administration

13
Structure of Rifampicin
http//images.google.com/imgres?imgurlhttp//www.
bmb.leeds.ac.uk/mbiology/ug/ugteach/icu8/images/an
tibiotics/nitrofurantoin.gifimgrefurlhttp//www.
bmb.leeds.ac.uk/mbiology/ug/ugteach/icu8/antibioti
cs/rna.htmlh120w270sz2hlenstart2um1tb
nid6Kti75Nx9GPsVMtbnh50tbnw113prev/images
3Fq3Dchemical2Bstructure2Bof2B2BRifampicin26
um3D126hl3Den
14
About Rifampicin

• In the U.S. Rifampicin is marketed as
• Rifadin (Aventis)
• Rifater ( in combination with isoniazid and
  pyrazinamide) (Aventis)
• Rimactane (Novartis)
• Do not wear contact lenses while taking
  Rifampicin
• Rated a pregnancy risk category C by the American
  Food and Drug Administration

15
Structure of Clofazimine
http//www.rxlist.com/images/rxlist/clofazimine_s.
gif
16
About Clofazimine

• Brand Name Lamprene Generic Name Clofazimine
• Initially known as B663, was first synthesized in
  1954 by Dr. Vincent Barry and his team as an
  anti-tuberculosis drug
• Is marketed under the trade name Lamprene by
  Novartis
• Rated a pregnancy risk category C by the American
  Food and Drug Administration

17
Dosage
http//images.google.com/imgres?imgurlhttp//uplo
ad.wikimedia.org/wikipedia/commons/thumb/7/71/MDTR
egimens.jpg/400px-MDTRegimens.jpgimgrefurlhttp/
/en.wikipedia.org/wiki/Leprosyh258w400sz24h
lenstart15um1tbnidwA9E8CWvT_HvoMtbnh80t
bnw124prev/images3Fq3DMultidrug2Btherapy2B(
MDT)2Bregimen26um3D126hl3Den
18
Dosage Contd......
Multidrug Therapy for Paucibacillary (PB) Leprosy
RFP Dapsone
Adult 50-70kg 600mg/m 100mg/d
Child10-14 years 450mg/m 50mg/d
Less than 10 years 300mg/m 25mg/d
PB patients treated with MDT are cured within six
months
RFP monthly doses are given under supervision
19
Dosage Contd......
Multidrug Therapy for Multibacillary (MB) Leprosy
RFP Dapsone CLF
Adult 50-70kg 600mg/m 100mg/d 50mg/d 300mg/m
Child10-14 years 450mg/m 50mg/d 50mg/d 150mg/m
Less than 10 years 300mg/m 25mg/d 50mg twice/d 100mg/m
MB patients treated with MDT are cured within 12
months
RFP and CLF monthly doses are given under
supervision
20
Cost of MDT

• Since 1995, WHO has supplied MDT FREE of cost to
  all leprosy patients in the world.
• Initially drug funds were provided by Nippon
  Foundation
• Since 2000, donations are provided by Novartis
  and the Novartis Foundation for Sustainable
  Development

FREE
21
Side Effects

• Occasional cutaneous eruptions
• A slight reddish coloration of urine, sweat, and
  tears
• Brownish Black discoloration and dryness of skin

• Dapsone (DDS)
• Rifampicin (RFP)
• Clofazimine (CLF)

22
Cases in US
http//www.hrsa.gov/hansens/images/30years.gif
23
Cases around the World
http//upload.wikimedia.org/wikipedia/commons/9/91
/Lepra_2003.png
A 20 annual decrease in new cases detected
globally since 2001
24
A Day in the Patients Life
Mother Teresa
http//i193.photobucket.com/albums/z96/whengzky/FR
20Joy20pix/641c.jpg
25
To Be Researched.....

• Interview a doctor who recently started
  treatment for a Leprosy patient
• How the drugs work?
• How does all the 3 drugs work in conjunction?

26
Leprosy (Hansens Disease)
Questions

• Hitaa Gandhi