Leprosy

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Description

Leprosy is a chronic infectious disease of man caused by an acid-fast bacilli called Mycobacterium Leprae. It primarily affects the peripheral nerves, the skin and other organs. It can spread through nasal discharge in multi bacillary infected patients. It has been associated with the Armadillo animal as the zoonotic demonstrated transmission

According to World Health Organisation (WHO), patients with leprosy are classified as having either Multi Bacillary (MB) or Paucibacillary (PB) If there is doubt about the classification, the patient should be classified as MB and be treated accordingly.

Signs and Symptoms

  • Losses of sensation to cotton wool touch/needle prick on a hypopigmented skin patch.
  • Enlargement of the peripheral nerves.

Investigations

  • Presence of acid-fast bacilli in a slit-skin smear. (confirmatory test)

TreatmentTreatment uses the multi-drug therapy consisting of rifampicin, dapsone and clofazimine, the duration of treatment for PB leprosy is 6 months and 12 months for MB leprosy

Age Group

Drug

Dosage and Frequency

Duration

MB

PB

Adult

Rifampicin

600mg once a month

12 months

6 months

Clofazimine

300mg once a month and 50mg daily

Dapsone

100mg daily

Children (10-14 years)

Rifampicin

450mg once a month

12 months

6 months

Clofazimine

150mg once a month and 50mg daily

Dapsone

50mg daily

Children < 10 years old or < 40kg

Rifampicin

10mg/kg once a month

12 months

6 months

Clofazimine

100mg once a month, 50mg twice weekly

Dapsone

2mg/kg daily

Prevention

These guidelines recommend the use of single-dose rifampicin (SDR) as preventive treatment for adult and child (2 years of age and above) contacts of leprosy patients, after excluding leprosy and tuberculosis (TB) disease and in the absence of other contraindications.

Before giving prophylaxis to the contacts, ensure that you try and get consent of the index case to disclose his/her disease to the contacts.

Rifampicin is the drug of choice. Recommended dosage schedules for Single Dose Rifampicin (SDR) are given in Table below.

Dosage schedules for Single Dose Rifampicin (SDR)

Age/Weight

Rifampicin single dose

15 years and above

600mg

10-14 years

450mg

Children 6 – 9 years (weight ≥ 20kg)

300mg

Children < 20kg ( ≥2 years)

10-15mg/kg

ComplicationsThe following are some complications leprosy

  • Blindness
  • Infections (abscess around the nerves and limbs)
  • Bone stress
  • Neuritis (painful neuropathy)

Referral Criteria

  • Eyes symptoms worsening on treatment
  • A patient with severe erythema nodosum leprosum (ENL) reactions that affects the eyes and nerves during treatment