Leprosy - a chronic infectious disease

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Leprosy - a chronic infectious disease

Leprosy

Introduction

• Leprosy is a chronic infectious disease. It is both a medical and a social problem .Because of deformities & disability, it leads to social stigma.

• Leprosy, also known as Hansen disease, is a chronic infectious disease caused mainly by a type of bacteria called Mycobacterium leprae.

• The disease predominantly affects the skin and peripheral nerves. Left untreated, the disease may cause progressive and permanent disabilities.

 Historical Background

• It is one of the oldest known disease.

• It was first discovered by G.A Hansen in 1873.

• The term "Leper" comes from a Greek word meaning scaly.

• In Ayurveda it is described under Kushtha Roga, considered one of the most difficult to treat.

• Many countries in Asia, Africa, and America with a significant number of cases.

Epidemiology

• Due to Multidrug Therapy (MDT), prevalence has reduced.

• Still common in some Indian states:-

  •  Uttarpradesh
  • Bihar
  • Odisha
  • West Bengal

• Mostly affects 10-20 years age group.

• Male> Females.

• More common in rural areas than urban areas.

Factors

• Humidity and temperature help survival of bacteria.

• Overcrowding.

• Poor ventilation.

• Low socioeconomic conditions.

• Practises like:-

 * sleeping together

 * eating from same plate

 * sharing clothes or water

Pathophysiology

The disease primarily affects skin, peripheral nerves & mucosa of the URT

M.Laprea enters the body (skin, nose, etc)

-attack

Peripheral nerves

Binds to Schwann cells of axon

Demylenation of nerve

Loss of sensation (pain,touch,temp)

Muscle weakness &Deformity (claw hand, foot drop, ulcers)


1- Entry &Transmission-

2-Survival of M.Leprae-

3-Nerve Invasion

4- Role of Immune Response ~Severity depends on CMI-

A.Strong CMI- Tuberculoid -Th1 response

      paucibacillary

       localised

B.Weak CMI-Lepromatous-Th2 response

       multibacillary

          systemic spread 

5- Lepra reactions:-acute inflammatory reactions-

      ~Type 1- due to sudden increase in CMI

        borderline form

       ~Type 2- immune complex mediated type 

        (Hypersensitivity 3)

       lepromatous form

 6- Tissue damage & Deformities

Causative Agent

• Caused by Mycobacterium leprae, discovered by Hansen in 1873. 

Hence also called as Hansen's disease.

Mode of Transmission

• Droplet infection.

• Prolonged close contact.

• Direct and indirect contact.

• Risk increases with long duration of exposure

Incubation Period

• 3 to 5 years(may be longer).

Direct contact

Indirect contact

Types of Leprosy

There are 5 types of leprosy :-

  1.  Intermediate
  2.  Tuberculoid 
  3.  Borderline
  4.  Lepromatous
  5.  Pure neurotic

• These 5 types have been grouped into 2 main categories by WHO:-

 1.Paucibacilliary Leprosy - 

having 2 to 5 scars includes intermediate, tuberculoid and pure neurotic forms.

  2.Multibacillary Leprosy- 

having more than 5 spots, including lepromatous and borderline types.

Clinical Symptoms

• White patches(lesions) on skin.

• Partial or complete loss of sensation.

• Nerve involvement (thickened nerves).

• Thickening of ear lobes.

• Weakness or paralysis.

• Deformities

• Disability

Complications

  •  Deformities
  •  Amputations

Diagnostic Tests

• Skin smears

• Nasal smears

• Nasal scraping

Preventive measures

QUARANTINE

 Notification:- Leprosy is a notifiable disease, Health department must be informed immediately

   Isolation:- Patients with active infection should be isolated.

  Early diagnosis & Treatment :-prompt treatment with MDT (multiple drug therapy).

Treatment

• Multidrug therapy:-

rifampicin, dapsone, clofazimine, ethionamide, quinolones,minocycline, etc are used.

• Corticosteriods:-these are used to treat nerve damage associated with leprosy.

• Aspirin and thalidomide are used to control inflammation.

Regimen

• Adults with Multibacillary :- MDT for 12 months.

-Rifampicine 600 mg once a month

Dapsone 100 mg once a day

Clofazimine 50 mg once a day & 300 mg once a month

• Adults with Paucibacillary :-

Rifampicin 600mg once a month

Dapsone 100 mg once a month


Leprosy management program Overview & Vision

 * Definition: NLEP is a centrally sponsored public health scheme by the Government of India.

 * Vision & Mission: The ultimate goal is a "Leprosy-Free India" by providing high-quality, free services through an integrated healthcare system.

 * Symbolism: The NLEP emblem uses a lotus to represent purity, a rising sun for hope, and a hand (with a partially affected thumb) to show that patients can remain useful members of society.

Core Objectives & Components

 * Primary Goal: To provide comprehensive services, including early case detection and complete treatment, to prevent disability and reduce social stigma.

 * Key Components: The program focuses on case management, medical rehabilitation, disability prevention, and "Information, Education, and Communication" (IEC).

 * Institutional Framework: Management is decentralized across National, State, District, Block, and Village levels, involving entities like the Ministry of Health, State Leprosy Officers, and ASHA workers.

Treatment Strategies (MDT)

The program utilizes Multi-Drug Therapy (MDT) categorized by the severity of the case:

 * Multi-bacillary (MB): Requires an intensive 14-day phase followed by a continuation phase of two or more years using Rifampicin, Clofazimine, and Dapsone.

 * Paucibacillary (PB): Treated with a combination of Rifampicin (monthly supervised) and Dapsone (daily unsupervised).

 * Post-Exposure Prophylaxis: Implementation of a single dose of Rifampicin (PEP-SDR) to prevent the spread of the disease.

Major Milestones & Achievements

 * 1983: Introduction of Multi-Drug Therapy (MDT).

 * 2005: India officially achieved the elimination of leprosy as a public health problem at the national level.

 * 2017–2019: Launch of active case detection campaigns and the "Nikusth" real-time online reporting software.

 * 2020 Progress: Visible deformities (Grade II Disability) among new cases dropped to 2.39%, and the percentage of child cases reduced to 6.86%.

Recent Initiatives

 * Active Surveillance: Utilizing ASHA-based surveillance (ABSULS) and regular active case detection (ACD&RS).

 * Integrated Screening: Converging leprosy screening with other programs like Ayushman Bharat (for adults 30+) and Rashtriya Bal Swasthya Karyakram (for children 0-18).

 * Social Awareness: Conducting the 'Sparsh Leprosy Awareness Campaign' to promote the message "Haath Milaayen, Kushth Mitaayen" (Join hands, Eradicate Leprosy).

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