Leprosy


Leprosy usually involves the skin and peripheral nerves, and the clinical features depend on the body's immune response to the organism Mycobacterium leprae.

Indeterminate leprosy is the commonest clinical type, especially in children. This presents as hypopigmented or erythematous circular macules with occasional mild anesthesia and scaling. This may resolve spontaneously or progress to one of the other types. Biopsy reveals a perineural granulomatous infiltrate and scant acid-fast bacilli.

Tuberculoid leprosy presents with a few hypopigmented or erythematous plaques with an active erythematous, raised rim. Lesions are usually markedly anesthetic, dry and hairless reflecting the nerve damage. Nerves may be enlarged and palpable. Biopsy shows a granulomatous infiltrate centered on nerves, but no organisms.

Lepromatous leprosy presents with multiple inflammatory papules, plaques and nodules. Loss of the eyebrows ('madarosis') and nasal stuffiness are common. Skin thickening and severe disfigurement may follow. Anesthesia is much less prominent. Biopsy shows numerous acid-fast bacilli.

Diagnosis

The diagnosis of leprosy is essentially clinical with:

  • hypopigmented/reddish patches with loss of sensation
  • thickening of peripheral nerves
  • acid-fast bacilli (AFB) seen on skin-slit smears/biopsy. Occasionally nerve biopsies are helpful. Detection of M. leprae DNA is possible in all forms of leprosy using the polymerase chain reaction, and can be used to assess the efficacy of treatment.

Management

Recommended treatment regimens for leprosy in adults (modified WHO guidelines)

Multibacillary leprosy (LL, BL, BB)

  • Rifampicin 600 mg once-monthly, supervised
  • Clofazimine 300 mg once-monthly, supervised
  • Clofazimine 50 mg daily, self-administered
  • Dapsone 100 mg daily, self-administered

Treatment continued for 12 months

Paucibacillary leprosy (BT, TT)

  • Rifampicin 600 mg once-monthly, supervised
  • Dapsone 100 mg daily, self-administered

Treatment continued for 6 months.


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