Leprosy
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A chronic infectious disease caused by Mycobacterium leprae / Hansens bacillus - an acid-fast bacillus. It mainly affects the skin, peripheral nerves and mucous membranes. It is transmitted from one person to another via the respiratory tract (possibly, very rarely, through broken skin). It is classified into paucibacillary (PB) or Multibacillary (MB) Leprosy.
Clinical features
- Pale or reddish patches on the skin (The most common sign of leprosy)
- Loss or decrease in feeling in the skin patch
- Numbness or tingling of the hands or feet.
- Weakness of the hands, feet or eyelids
- Painful or tender nerves
- Swelling or lamps in the face or earlobes
- Painless wounds or burns on the hands or feet
- One or more hypopigmented (pale) skin patches with definite loss of sensation
Case definition
A case of leprosy is a person with clinical signs of leprosy who requires chemotherapy.
Diagnosis of leprosy
Diagnosis of Leprosy must be based on careful clinical examination of the patient and when necessary, backed by bacteriological examination
Leprosy is diagnosed by finding at least one of the three cardinal signs:
- Hypopigmented patches with definite loss of sensation in them
- Thickened or enlarged peripheral nerves, with loss of sensation and/or weakness of the muscles supplied by those nerves
- The presence of acid-fast bacilli in a slit skin smear
Classification of leprosy
Paucibacillary (PB) leprosy: 1-5 patches
Multibacillary (MB) Leprosy: More than 5 patches
Differential diagnosis
Hypopigmentation e.g. birthmark, early vitiligo
Fungal infections of the skin
Other nodular conditions, e.g. Kaposi’s sarcoma, neurofibromatosis, secondary syphilis
Other causes of peripheral nerve damage, e.g. diabetes mellitus
Psoriasis, molluscum contagiosum
Investigations
In most cases, a definite diagnosis of leprosy can be made using clinical signs alone
At referral centre: stain slit skin smears for Acid Fast Bacilli (AFB)
Skin biopsies NOT recommended as a routine procedure
Management
Multi-drug therapy (MDT) for leprosy is presented in the form of various monthly dose blister packs. The same drugs are used for both PB leprosy and MB leprosy, with special packs for children.
Summary of Treatment of Leprosy
| PB Leprosy | MP Leprosy |
| Rifampicin | Rifampicin |
| Dapsone | Dapsone |
| Clofazimine | Clofazimine |
| All for 6 months | All for 12 months |
Recommended treatment (drugs and their dose)
| Category | Drug | Dosage and frequency | Duration | |
|
|
|
PB | MB | |
| Adult |
Rifampicin |
600 mg once a month |
6 months | 12 months |
|
Clofazimine |
300 mg once a month and 50 mg daily |
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|
Dapsone |
100 mg daily |
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| Children (10–14 years) |
Rifampicin |
450 mg once a month |
6 months | 12 months |
|
Clofazimine |
150 mg once a month, 50 mg daily |
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|
Dapsone |
50 mg daily |
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| Children <10 years old or <40 kg |
Rifampicin |
10 mg/kg once month |
6 months | 12 months |
|
Clofazimine |
6 mg/kg once a month and 1 mg/kg daily |
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|
Dapsone |
2 mg/kg daily |
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|
Steroids for treatment of severe leprae reactions Prednisolone 40 mg once daily in morning Treat for 12 weeks in PB and 24 weeks in MB Reduce dose gradually by 10–5 mg once every 2 weeks (PB) or 3 weeks (MB) |
RR | |||
Note:
In patients co-infected with HIV, do not use dapsone. In PB leprosy, substitute dapsone with clofazimine in appropriate doses
Health worker should directly observe that the medicines taken once a month are actually swallowed
Treatment durations longer than 12 months and steroids for leprae reactions should only be prescribed by specialists at referral centres
Lepra reactions: sudden inflammation (pain, redness, swelling, new lesions, loss of nerve function) in skin lesions or nerves of a person with leprosy. They can occur before, during or after MDT completion.
Severe leprae reaction (Type 2) are also known as Erythema Nodosum Leprosum (ENL or Type 2 reactions)
All patients should undergo rehabilitation and physiotherapy
Counsel patient on: need to complete treatment, presence of residual signs after completion of treatment
Presence of residual signs or post-treatment reactions is NOT an indication to re-start the treatment
Refer to the National Tuberculosis and Leprosy Programme (NTLP) manual 2016 for more details
Prevention
Early diagnosis of cases and effective treatment
Screening of contacts of known patients
Administration of Single dose rifampicine in contacts of leprosy patients to prevent contacts of leprosy patients from developing leprosy disease
Rifampicine dose used in contacts of leprosy patiients
|
Age/weight |
Rifampicin single dose |
|
15 years and above |
600mg |
|
10-14years |
450mg |
|
Children 6-9years (weight 20kg) |
300mg |
|
Children 20kg ( 2years) |
10-15mg/kg |
BCG vaccination may be helpful