Leprosy

Question 1

What causes leprosy?

Answer 1

Mycobacterium leprae

Question 2

Where is leprosy most prevalent?

Answer 2

India
Brazil
Indonesia
DRC
Bangladesh

Question 3

How is leprosy spread?

Answer 3

Droplet infection

Long incubation period two to twelve years

Question 4

What is the spectrum of leprosy?

Answer 4

Paucibacillary - tuberculoid
Multibacillary- borderline and lepromatous

Intermediate: small single lesion that self heals

Question 5

What is the triad to diagnose leprosy?

Answer 5

Hypopigmented skin lesion with reduced sensation
Enlarged peripheral nerve with loss of function
Positive slit skin smear

Question 6

What are the features of tuberculoid leprosy?

Answer 6

Well defined anaesthetic hypopigmented lesions

Possible central healing

Question 7

What are the features of borderline leprosy?

Answer 7

Erythematous, domed lesions with unclear borders
May have punched out unaffected areas
At risk of reactions

Question 8

What are the features of lepromatous leprosy?

Answer 8

Symmetrical macular lesions or nodules of thickened skin on cooler parts of body

Question 9

What can precipitate a leprosy reaction?

Answer 9

Change in immune status

Pregnancy

Question 10

What are the features of a type 1 leprosy reaction?

Answer 10

Skin lesions become red, painful and swollen
Worsening of nerve involvement
Generally unwell

Question 11

What are the features of a type 2 leprosy reaction?

Answer 11

New red painful subcut nodules
Erythema nodosum leprosum
Fever and malaise
Iritis

Question 12

How do you treat type 1 leprosy reactions?

Answer 12

Paracetamol and NSAIDS

Prednisolone 30mg wean over 20wks

Question 13

How do you treat type 2 leprosy reactions?

Answer 13

Paracetamol and NSAIDS
Prednisolone +/- thalidomide
+/- increase clofazimine

Question 14

How do you manage leprosy?

Answer 14

Rifampicin(monthly supervised) + dapsone + clofazimine
6month for PB, 12month for MB

Contact tracing: single dose Rifampicin

Prevent secondary impairment

Support groups

Question 15

What are the targets of the Towards Zero Leprosy strategy?

Answer 15

For 2030

• 120 countries with zero new cases
• 70% reduction in annual number new cases
• 90% reduction in rate/million population of new cases with grade 2 disability
• 90% reduction in rate/million population children of new child cases

Question 16

What are the key components of the Towards Zero Leprosy strategy?

Answer 16

Implement country owned Zero leprosy roadmaps in all endemic countries
Scale up leprosy prevention and active case detection
Manage leprosy and its complications and prevent new disabilities
Combat stigma and ensure human rights are respected