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PREPARED BY: PUNIT PATEL

WHAT IS LEPROSY?

Leprosy is a chronic granulomatous

infectious disease that attacks the

nervous system caused by acid fast

bacilli Mycobacterium leprae

M. leprae lies within the

macrophages and remain dormant

Leprosy cause deficiency in cell

mediated immunity2

MYCOBACTERIUM LEPRAE

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WHAT CAN LEPROSY DO TO PEOPLE?

Leprosy attacks the different parts of the

body

Leprosy destroys neurons in these areas,

taking feeling away from them

Leprosy also causes cartilage in those areas

to get absorbed back into the body, causing

fingers, toes, ears and nose to disappear

Leprosy also causes large bumps in the skin

that do not feel pain and do not heal4

HOW CAN YOU AVOID GETTING LEPROSY?

Infection usually transmitted from person to

person due to shedding of bacilli

To avoid leprosy, avoid close contact with

someone who has untreated leprosy

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HOW CAN LEPROSY AFFECT LIFE?

In the first stages of Leprosy, people’s

lives are not very affected, but eventually,

people lose their fingers and toes and

become disfigured

Not only are the victims of Leprosy

physically disabled, but emotionally as

well

In the later stages of leprosy, people lose

their sight, as well as most of the feeling

in their body

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HOW THE HUMAN BODY IS AFFECTED BY LEPROSY

Nerve is damaged and broken by leprosy infection.

Large bumps (legions) on the skin that do not heel and cannot feel pain.

NerveLeprosy infection

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HOW TO DIAGNOSE LEPROSY

Examine skin

Check for patches

Count the number of patches

Test for sensation

Check for damage to nerves

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SIGNS OF LEPROSY

Pale or slightly reddish patch

Loss of sensation in the patch

Signs of damage to nerves

Loss of sensation in hands/feet

weakness of muscles of hands/feet/face

visible deformity of hands/feet/face

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CLASSIFICATION FOR TREATMENT

The diagnosis is made based on finding

definite loss of sensation in one or more

patches.

1-5 patches is paucibacillary (PB), more

than 5 patches is multibacillary (MB)

leprosy

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TREATMENT

Sulfones Dapsone, Sulfoxone, Acedapsone

Phenazine derivative Clofazimine

Antitubercular drug Rifampicin

Antibiotics Fluoroquinolones – Ofloxacin, Sparfloxacin Macrolides – Clarithromycin Tetracyclines - Minocycline

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DAPSONE M.O.A.

Inhibition of bacterial folic acid synthesis

Dapsone acts against bacteria and protozoa in

the same way as sulphonamides.

That is by inhibiting the synthesis of dihydrofolic

acid through competition with para-amino-

benzoate for the active site of dihydropteroate

synthetase

Has antiinflammatory properties

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CONT…

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Pharmacokinetics

Well absorbed orally

widely distributed throughout the body fluids and

tissues

acetylated in liver excreted in bile, undergoes

enterohepatic circulation

It tends to remain in skin,muscle,kidney and liver up

to the three weeks after the therapy is stopped

70% excreted through urine

Plasma half life 1-2 days

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Uses

In treatment and prevention of Pneumocystis

carinii pneumonia in AIDS patient

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Side effect

During treatment of lepromatous laprosy some

reactive episodes may occur called as lepra reactions

(1)Type 1 lepra reaction

(2)Type 2 lepra reactions(erythema nodosum

leprosum)

Type 1 reactions delayed hypersensitivity reactions

due to M leprae antigens [type 4 hypersensitivity

reactions]

Type 2 reactions represent a humoral antibody

response[type 3 hypersensitivity reaction]16

Adverse effects

Nonhaemolytic anaemia and

methaemoglobinaemia in G6PD deficient

Mild – nausea

loss of appetite

pruritus

reversible neuropathy & hepatotoxicity

drug fever

Not given when hb% is below 7

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CLOFAZIMINE

M.O.A. Phenazine dye which binds with mycobacterial

DNA & Inhibit mycobacterial growth

Leprostatic with anti-inflammatory action

It bind to mycobacterial DNA leading to

disruption of the cell cycle and eventually

prevents the growth of the bacterium.

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Pharmacokinetics- Oral absorption variable

excreted in feces

plasma half life 60-70hrs

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Side effect Red brown discolouration of skin

Abdominal pain with loose stools due to

deposition of crystals in intestinal mucosa

Avoided in pregnancy

Mild – Conjunctival pigmentation & phototoxicity

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RIFAMPICIN MOA-

It binds to and inhibits bacterial DNA dependent RNA

polymerase so that it can not synthesize new RNA

Mammalian RNA does not binds with drug , host cells

unaffected

The drug is bactericidal Pharmacokinetics-

well absorbed on oral administration.

Penetrates all tissue, tubercular cavities, placenta &

protein binding.

Excreted through liver into bile & undergo

enterohepatic circulation. 21

Side effect

Hepatitis –major adverse effect

Ocasionally- rashes, Gi disturbances, dizziness

& fatigue.

Flu like syndromes- fever, chills,myalgias &

thrombocytopenia.

Imparts harmless red colour urine.

Resistance devlop after prolong use

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Category and Type of patient

Duration of Treatment

Drug regimen

Multibacillary Leprosy(Lepromatous)

For 24 months

If RMP resistance

Dapsone 100 mg daily + Clofazimine 50 mg daily with 300 mg once a month + Rifampicin 600 mg once a month

Clofazimine 50 mg daily + Ofloxacin 400 mg daily + Minocycline 100 mg daily for 6 m

Then Clofazimine + Ofloxacin for 18 months

Paucibacillary Leprosy(Tuberculoid)

6 months

If Dapsone not tolerated

Dapsone 100 mg daily + Rifampicin 600 mg once a month

Clofazimine 50 mg daily and 300 mg once a month may be substituted in place of Dapsone 23

MDT SIDE-EFFECTS

• Red coloured urine

• Darkening of skin

• Severe itching of skin

• This is due to rifampicin. Lasts only for few hours Reassure the patient that this is harmless

• This is due to clofazimine. Reassure the patient that this will disappear after treatment is completed

• This is due to allergy to one of the drugs (commonly to dapsone). Stop all medicines and refer to hospital

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Thank you