Today is our topic of discussion Definition of Leprosy
Definition of Leprosy
Definition:
Leprosy is an infectious disease characterized by disfiguring skin sores, nerve damage, and progressive debilitation.
Prevalence in Bangladesh:
Prevalence of leprosy is highest in Nilphamari, Dinajpur and Thakurgaon. Bangladesh has made appreciable progress in the control of leprosy by achieving the elimination goal by the end of December 1998.
The elimination goal is achieving leprosy prevalence of registered patient to below 1 per 10,000 populations’. According to estimation in 1998 by WHO, leprosy prevalence in our country is 0.87 per 10,000 populations.
Causative agent:
Mycobacterium leprae.
Mode of transmission:
Exposure to leprosy patient for prolonged period (direct or indirect)
Source of infection:
- Secretions per nose of leprosy patients through sneezing and blowing.
- Ulcerated or broken skin of bacteriologically positive cases of leprosy.
Incubation period:
3 to 5 years.
Types of leprosy:
- Tuberculoid (paucibacillary)
- Lepromatous (multibacillary)
[The types have further subdivisions. Both types produce sores on the skin, but the lepromatous form is most severe, producing large, disfiguring lumps and bumps (nodules)]
Predisposing factors
- Living in endemic areas with poor living conditions such as inadequate bedding, contaminated water and insufficient diet, or other diseases (HIV) that compromise immune function.
- Children are more susceptible than adults.
- Contaminated surgical tools can be a source of leprosy.
Clinical features:
- Damage to skin and peripheral nervous system: Skin lesions and deformities; affecting the cooler places of body (eyes, nose, earlobes, hands, feet, and testicles).
- Skin lesions are lighter than normal skin color.
- The skin lesions and deformities can be very disfiguring.
- Lesions have decreased sensation to touch, heat, or pain and do not heal after several weeks to months.
- Thickened peripheral nerve: Ulnar nerve behind medial epicondyle of humerus palpated as cord.
- Muscle weakness
Complication:
People with long-term leprosy may lose the use of their hands or feet due to repeated injury resulting from lack of sensation.
Investigation:
- Skin scraping examination for acid fast bacteria
- Skin lesion biopsy
Treatment:
A combination of three drugs (Dapsone, Clofazimine and Rifampicin) or multi-drug therapy (MDT) kills the bacilli. Treatment takes between 6 and 12 months –
a) Pauci-bacillary (PB) leprosy: 1-5 skin lesions – Regimen of two Dapsone for 6 months;
b) Multi-bacillary (MB) leprosy: >5 skin lesions – Regimen of three drugs – Rifampicin, Clofazimine and Dapsone for 12 months]
[Since 1995, WHO has supplied MDT free of charge to leprosy patients in all endemic countries including Bangladesh]
Prevention & control measures:
- Avoiding close physical contact with untreated people.
- Health education programme: Makes people aware that effective treatment is available and the disease is curable.
Availability of treatment:
Three leprosy hospitals run by government, one each at Dhaka, Sylhet and Nilphamari having a total of 130 beds, and 600 treatment centers all over the country. Few NGO’s are fighting against leprosy – Damien Foundation, Leprosy Mission New Zealand etc.
Disability care and follow-up:
The government should focus on the rehabilitation of individuals and families affected by the disease. Disability is often a consequence of leprosy, especially if it is not diagnosed and treated early enough, and many leprosy-affected people need medical care long after their treatment has finished. Common disabilities caused by leprosy include loss of mobility in hands and feet, painful ulcers and infections, and even blindness. Follow-up health services are provided to ensure there are no complications or symptoms of recurring leprosy.
Self-care:
Once treatment is finished leprosy-affected individuals and families should be taught about ‘self-care’ so they can prevent and manage disability. This allows leprosy-affected people to live independently, stay active and keep working or attending school.
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