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    Leprosy

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    mahmudbebeji

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    Leprosy

    Uploaded by

    mahmudbebeji
    8 views29 pages

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    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    8 views29 pages

    Leprosy

    Uploaded by

    mahmudbebeji

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    You are on page 1of 29

    Leprosy reactions: diagnosis and

    management
    Two types of reactions

     Type 1 or reversal reaction


     Cell-mediated immunity
     Local signs
     Long duration
     Type 2 or ENL reaction
     Humoral immunity
     Systemic signs
     Short episodes, but often chronic recurrence.
    Severity

    Mild Severe
     Red raised skin plaques  Ulcerating skin lesions
     Red, tender  Painful or tender nerves
    subcutaneous nodules  Recent ( 6 mts) NFI
     Enlarged, non-tender  Reaction lesions in the
    nerves face
     Severe oedema
     Involvement of other
    organs.
    Type 1 Reaction
    (1)
    Type 1 Reaction
    (2)
    Type 1 Reaction (3)
    Type 1 Reaction (4)
    Type 1 Reaction (5)
    Type 1 Reaction (6)
    Type 1 Reaction (7)
    ENL Reaction (1)
    ENL Reaction (2)
    ENL Reaction (3)
    ENL Reaction (4)
    ENL Reaction: Iritis
    Making the diagnosis

     History
     Physical examination
     Skin signs
     Nerve palpation
     NFA – sensory or motor impairment?
     Systemic signs (edema, fever, other organs)
     Criteria for sensory and motor impairment
     Criteria for reaction and severe neuritis.
    Management of nerve damage

     Medical
     Surgical
     Supportive.
    Medical management

     NFI ‘recent’ or ‘old’


     Corticosteroids – prednisolone
     WHO recommends 12-week course
     Evidence suggests longer course is needed
    for MB patients (24 weeks)
     High-dose clofazimine in ENL
     Thalidomide drug of choice for ENL in men.
    Prednisolone regimens

     Adults
     PB: starting dose 40 mg daily, duration 12 weeks
     MB: starting dose 40 mg daily, duration 24 weeks

     Children
     30 mg daily for one week, then alternate days,
    tapering as above (12 weeks).
    Patients over 15 years

    PB: MB:
     40 mg od for 2 weeks  40 mg od for 4 weeks
     30 mg od for 2 weeks  30 mg od for 4 weeks
     20 mg od for 2 weeks  20 mg od for 4 weeks
     15 mg od for 2 weeks  15 mg od for 4 weeks
     10 mg od for 2 weeks  10 mg od for 4 weeks
     5 mg od for 2 weeks  5 mg od for 4 weeks
     Total: 16 weeks  Total: 24 weeks
    Children up to 15

     30 mg od for 1 week
     30 mg alternate days for 1 week
     25 mg alternate days for 2 weeks
     20 mg alternate days for 2 weeks
     15 mg alternate days for 2 weeks
     10 mg alternate days for 2 weeks
     5 mg alternate days for 2 weeks
     Total: 12 weeks
    Contraindications
     Acute or chronic untreated bacterial or parasitic
    infection, e.g.
     TB
     Corneal ulcer
     Worm infestation
     Scabies
     Fungal infection
     Current peptic ulcer or recent history of
    haematemesis or melaena
     Past history of psychosis or endogenous depression.
    Relative contraindications

     Age under 15 or over 60


     Diabetes mellitus
     Hypertension
     Glaucoma
     Pregnancy
     Lack of cooperation
     Mature cataract
     Suspected peptic ulcer
    Steroid side effects – major

    Side effect Cases (401) Controls (414)


    Diabetes 0.7% 0.2%

    Peptic ulcer 0.5% 0.2%

    Infections 0.7% 1.2%

    Psychosis 0 0

    Glaucoma 0 0

    TB 0 0

    Richardus et al., TRIPOD trials


    Steroid side effects – minor

    Side effect Cases (401) Controls (414)


    Moon face 3% 2%

    Acne 2% 0.7%

    Fungal infections 1% 0

    Gastric pain 18% 12%

    Richardus et al., TRIPOD trials


    Surgical management

     Different neurolysis techniques available


     Indications
     Nerve pain not responding to steroids
     Nerve abscess
     NFI not responding to steroids
     Benefit to be established through controlled
    trial.
    Neurolysis
    Supportive management

     Analgesics – not aspirin or other NSAIDs


     Splinting
     Rest.
    Comments and Questions.

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