LEPROSY.

1
LEPROSY.

• A chronic contagious disease primarily
  affecting the peripheral nerves secondarily
  involving skin, mucosa of mouth and upper
  respiratory tract, reticulo-endothelial
  system, eyes, bones and testes.

2

• Causative agent Mycobacterium leprae.
•  
• Mode of infection close contact with an
  open case of leprosy.
•  
• Incubation period average 3-5 years.
•  

3
CLASSIFICATION

•         Lepromatous leprosy.
•        Tuberculoid leprosy.
•        Borderline leprosy.
•        Indeterminate leprosy.

4
LEPROMATOUS LEPROSY.

•  Develops in infected persons with low
  resistance.
•  Clinicaly. The skin, nerves, bones and
  internal organs are involved in this type.
•  

5
Skin lesions.

• Consist of ill-defined multiple erythematos
  macules, papules, nodules or plaques. The
  lesions are symmetrically distributed on the
  face, limbs and trunk. The outer third of
  eye brows are usually lost

6
Other organs

•  
• liver, testicles, lymph nodes and bones may
  be involved. Eye affection with keratitis,
  iridocyclitis and iris atrophy.
• Lepromin test is negative, indicating low
  degree of immunity.

7
TUBERCULOID LEPROSY.

• Develops in persons with good immunity.
•  
• Clinically.
• The skin and peripheral nerves are the
  only tissues showing clinical evidence of
  involvement

8
Skin lesions

• . Consist of erythematous or hypopigmented
  plaques with well-defined edges and
  anaesthetic dry hairless surface. The
  lesions are few, large and asymmetrically
  distributed.

9
Peripheral nerves

• are early involved in tuberculoid leprosy
  resulting in wasting and paralysis of the
  small muscles of the hands and feet,
  anaesthesia of limbs and trophic changes.
  In some cases the condition may be limited
  to peripheral nerves only (neural type).
  The ulnar nerve is the most commonly
  affected, less frequently the posterior
  tibial and the great auricular.

10
Lepromin test is strongly positive
indicating high degree of cell mediated
immunity. 
11
BORDERLINE LEPROSY

• This type is immunologicaly unstable and
  usually evolves into one of the previous
  two polar types. It is intermediate between
  lepromatous and tuberculoid types and
  therefore a wide range of pathological and
  clinical manifestations can be encountered

12

• Skin lesions. Consist of erythematous
  macules and plaques, intermediate between
  lepromatous and tuberculoid in number, size
  and anaesthesia. They are asymmetrically
  distributed.
• Lepromin test is weakly positive or
  negative.

13
INDETERMINATE LEPROSY

• .
•  
• This type occurs in those whose
  immunological status has not yet been
  determined. It is a transitory phase in
  the disease process. The skin lesions
  consist of hypopigmented macules which are
  nonspecific in appearance.

14
DIAGNOSTIC PROCEDURES

• .
•  
• 1.      Skin smear.
• 2.      Nasal smear.
• 3.      Skin biopsy.
• 4.      Nerve biopsy.
• 5.      Lepromin test.
•  

15
TREATMENT OF LEPROSY

• .
• 1.      General measures
•         Good nourishing diet.
•         Tonics and vitamins.
• 2.      Chemotherapy
•         SULPHONES dapsone tablets are given
  usually in a dose of 100 mg/day.
•         Rifampicin is given in a dose of
  600 mg/m daily on an empty stomach.
•         CLOFAZIMINE (LAMPRENE) dose is
  100mg/m daily.

16
COMBINED THERAPY

• various regmins of combined therapy are
  now recommended to decrease the possibility
  of emmergence of resistant strains. Combined
  therapy is particularly recommended in
  lepromatous leprosy.
•  

17
DURATION OF TREATMENT

•  
• . It depends on the type of leprosy.
  Tuberculoid leprosy requires treatment for
  three years or until all signs of activity
  have seized. Lepromatous leprosy requires
  treatment for life. In border line leprosy
  the period of treatment varies betwen 6-9
  year and depends on the evolution of the
  disease.
• Causative agent Mycobacterium leprae.
•