LEPROSY

Leprosy is an infectious disease caused by Mycobacterium leprae. It is an
airborne infection (like tuberculosis) which affects skin and nerves. Leprosy
often presents with hypopigmented or slightly erythematous patches on the
skin with loss of sensation, and enlarged nerves. Loss of sensation is tested
with a whisk of cotton wool. The skin is touched, not stroked with it. The
patient is asked to close his or her eyes and to point at the spot which has
been touched. Misreference and certainly "not felt" are diagnostic for leprosy.
Nerves which should be checked for enlargement are the great auricular,
ulnar and radiocutaneous nerves. Enlarged nerves are pathognomonic
for leprosy. When there are infiltrated patches or papules and nodules skin
smears may be positive for M. leprae. Unlucky patients, those who are diagnosed
at later stages with nerve damage may show visible deformities such
as facial palsy (an eye cannot close, lagophthalmos, and that side of the
face sags) and loss of sensation of hands or feet which show dry skin with
or without ulcers. Sometimes fingers are bent or even lost, the grip is gone,
the feet drop.
For practical purposes two types of leprosy are recognised:
1. Paucibacillary (PB) leprosy or tuberculoid leprosy. These patients
do not have bacilli in their skin smears and have 5 or less skin lesions (in
some control programs 3). They are not infectious to others.
2. Multibacillary (MB) leprosy or lepromatous leprosy. These patients
have bacilli in their skin smear and more than 5 (3) lesions which may be flat
or raised patches, papules or nodules. Untreated lepromatous leprosy
patients discharge bacilli from their nose and are therefore infectious to
others.
Management of uncomplicated leprosy
1.PB-leprosy - Rifampicine 600 mg once a month under supervision plus dapsone
(DDS) 100 mg daily for 6 months unsupervised.
- When compliance is a problem, a 6 months dose taken within 9 months is
acceptable.
- Always check for complications!
2. MB-leprosy - Rifampicine 600 mg and clofazimine (Lampren) 300 mg once a month
under supervision plus dapsone (DDS) 100 mg daily plus clofazimine 50 mg daily
unsupervised for 12 or 24 months depending on the policy of the local leprosy
control programme.
- When compliance is a problem, a full treatment taken within 18 (for the 12 months
programme) resp. 36 months (for the 24 months programme) is acceptable.
- Always check for complications!