Leprosy I

LEPROSY – HANSEN’S DISEASE Part One : 

LEPROSY – HANSEN’S DISEASE Part One Daisy Dharmaraj, ACS medical college Ref:Park and Park http://www.who.int/lep/situation/LEPPRATEJAN2009.pdf

Leprosy : 

Leprosy

Main features : 

Main features Chronic inf disease – m.leprae Affects peripheral nerves / skin muscles. Eyes, bones, testes and internal organs 2 polar forms Lepromatous……borderline….indeterminate…..tuberculoid

Signs : 

Signs Hypo pigmented patches Partial or total loss of cutaneous sensation in affected areas Thickened nerve Acid fast bacilli in skin or nasal smears Advanced disease; lumps in face ears/ plantar ulcers/loss of fingers and toes/ nasal depression/ foot drop / claw toes etc

history : 

history Oldest disease Lepra = scaly Kushta roga- curse 1837 M leprae discovered by Hansen/ norway 60s and 70s Mice foot ////armadillos 1980s mono to multi drug therapy

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90% reduction in prevalence

Reasons for decrease in prevalence since 1966 : 

Reasons for decrease in prevalence since 1966 Improved management of cases Very low relapse rate High cure rates Absence of drug resistance Shorter duration of treatment with MDT Global Leprosy program moved from Geneva to delhi in 2005 for SEAR has the highest numbers

WHO global strategy for decreasing disease burden and sustain leprosy control activities : 

WHO global strategy for decreasing disease burden and sustain leprosy control activities Sustain leprosy control activities in all endemic countries Use case detection as the main indicator to monitor progress Ensure high quality diagnosis, case management, recording and reporting in endemic countries Strengthen routine referral services Discontinue campaign approach Tools and procedures that are home / community based, integrated and socially appropriate for prevention of disabilities etc Promote Operational Research to improve implementation Supportive working arrangements with partners at all levels

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http://mohfw.nic.in/National_Leprosy_Eradication_Programme/CURR_SIT.htm

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Level of Elimination of leprosy (<1 case / 10K) on 31 Dec 2005 Annual new case detection rate 1.43 / 10K Focus on High priority districts and blocks> 5 / 10K, Disability rate 1.9% Child proportion 10% (TN,AP, Bihar, Gujar, Jharkand, Maharashtra, kerala, karnataka)

Epidemiological determinants- agent : 

Epidemiological determinants- agent M leprae= acid fast. Extra and intra cellular Bacterial load 1 gm of leproma- 2-7 billion Pathogenic Non pathogenic- M tb, BCG etc Grows in animal= mouse / armadillos but not in artificial medium Source- all active cases. Esp lepromatous leprosy Portal of exit- nose. Also ulcerated skin Highly infections. Low pathogenic Attack rate- 4.4 to 12% symptomatic in 5 yrs

Epidemiological determinants- host : 

Epidemiological determinants- host Any age. Both sexes. 2.5yr baby too (active and spreading) Prevalence pool/ migration Inactivation of the disease Immunity – cell mediated Genetic factors- HLA linked genes influence the type of response

Epidemiological determinants- environment : 

Epidemiological determinants- environment Presence of infectious cases Overcrowding and lack of ventilation Mode of transmission Droplet Contact ? Insect vectors/ tattooing needles Inc period 3- 5 yrs for lepromatous and less for Tuberculoid leprosy

Indian Classification : 

Indian Classification

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MADRID Indeterminate Tuberculoid -flat/ raised Borderline Lepromatous RIDLEY JOPLING ( immuno histological) Tuberculoid TL Borderline Tuberculoid BT Borderline BB Borderline Lepromatous BL Lepromatous LL

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Clinical classification Pauci bacillary :1-5 lesions Multi bacillary: : More than 5 lesions

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Obstacles lack of a specific and sensitive diagnostic tool, social stigma and the potential reservoir in armadilloes

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CONTINUED……..Leprosy II