LEPROSY IN ENGLISH

                                                       

                                                                                 LEPROSY IN ENGLISH

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LEPROSY

}  Lerprosy is a communicable disease which is caused by a bacteria  Micobacterium leprae. The disease mainly affects peripheral nerves. It may also affects the skin, muscles, eyes, bones, testes and internal organs.

CAUSATIVE AGENT

}  Leprosy is caused by M. leprae. They are acid-fast bacillus and occur in the human host. They have an affinity for Schwann cells and cells of the reticulo-endothelial system.

SOURCE OF INFECTION-

}  All patients with "active leprosy" are considered infectious. Human cases of leprosy are main source of infection.

HOW IT SPREADS-

}  Nose is a major portal of exit. Lepromatous cases harbour millions of M. leprae in their nasal mucosa which are discharged when they sneeze or blow the nose. The bacilli can also exit through ulcerated or broken skin of bacteriologically positive cases of leprosy

}  So it is clear that mode of transmission of leprosy is-

}  Droplet infection - leprosy may be transmitted via aerosols containing M. leprae .

}  Direct contact - direct skin to skin contact with patient

}  Indirect contact.- contact with soil, and fomites such as contaminated clothes and linen

INCUBATION PERIOD-

}  Leprosy has a long incubation period, an average of 3 to 5 years or more for lepromatous cases. The tuberculoid leprosy is thought to have a shorter incubation period

SIGN AND SYMPTOMS-

}  a. hypo-pigmented patches

}  b. partial or total loss of cutaneous sensation in the affected areas (the earliest sensation to be affected is usually light touch)

}  c. presence of thickened nerves, and

}  d. presence of nodules or lumps especially in the skin of the face and ears.

}  e. presence of deformities such as plantar ulcers loss of fingers or toes, nasal depression, foot-drop, claw toes etc.

CLASSIFICATION-

Leprosy is classified as-

}  Indeterminate

}  Tuberculoid;  

}  Borderline

}  Lepromatous

}  Indeterminate - In this types of leprosy cases are in early stage with one or two vague hypopigmented macules and definite sensory impairment. The lesions are bacteriologically negative.

}  Tuberculoid- In this types of leprosy cases are in slight advance stage with one or two well-defined lesions, which may be flat or raised, hypopigmented or erythematous and are anaesthetic. The lesions are bacteriologically negative.

}  Borderline - In this types of leprosy cases are in slight more advance stage with four or more lesions which may be flat or raised, well or illdefined, hypopigmented or erythematous and show sensory impairment or loss. The bacteriological positivity of these lesions is variable.

}  Lepromatous - In this types of leprosy cases are in advance stage with diffuse infiltration or numerous flat or raised, poorly defined, shiny, smooth, symmetrically distributed lesions. These lesions are bacteriologically positive,

DIAGNOSITC INVESTIGATIONS-

}  (i) Physical examination :   Presence of sign and symptoms such as hypopigmented leisons, loss of sensations may provide an idea for leprosy.

}  (ii) Bacteriological Examination : skin smear, nasal smear or nasal scraping examination by zeihl neelsen method will provide clear indication about leprosy.

}  (iii) other tests : other tests includes-

}  Histamine test

}  Lepromin test

}  Skin Biopsy etc.

TREATMENT-

}  Leprosy is treated by MDT.

}  Multi drug therapy includes antibacterial drugs such as rifampicin, dapsone, clofazimine, ethionamide and protionamide

}  For providing MDT leprosy cases are divided in two groups as per sign and symptoms as:

}  (i) Paucibacillary leprosy : A person having 1-5 skin

    lesions and/or only one nerve involvement 

    ( 6 month treatment)

}  Rifampicin- 600 mg once a month, supervised

}  • Dapsone- 100 mg daily, self-administered

}  (ii) Multibacillary leprosy : A person having 6 or more skin lesions and/or more than one nerve involvement   

}  ( 12 month treatment)

}  • Rifampicin-600 mg, once monthly, given under supervision

}  • Dapsone-100 mg daily, self-administered

}  • Clofazimine -300 mg once monthly supervised; and 50 mg daily, self-administered.

}   Rehabilitation is the part of treatment of leprosy it means "the physical and mental restoration, as far as possible, of all treated patients to normal activity, so that they may be able ta resume their place in the home, society and industry".