View source for Leprosy

==Background==
*Also known as Hansen's Disease
*Infectious disease caused by Mycobacterium leprae 
*Most new cases found in developing countries
**Level 3 Countries with higher numbers of cases include: India, Brazil, Indonesia, Bangladesh, Nigeria 
*Means of transmission not fully understood - likely respiratory. 
*Has variety of clinical and histopathologic manifestations due to broad range of cellular immune response

===Classification===
*Disease spectrum ranges from strong immune reaction and few organisms (tuberculoid) to weak immune reaction and numerous organisms (lepromatous)
*Categories 
**Tuberculoid (TT)
**Borderline tuberculoid (BT)
**Mid-borderline (BB)
**Borderline lepromatous (BL)
**Lepromatous (LL)
**Indeterminate (I)

===Risk Factors===
*Close contact with infected person
**Type of leprosy in the contact (lepromatous may be more contagious than tuberculoid)
*Armadillo exposure
*Increased age
*Genetic influences

==Clinical Features==
*Hypopigmented or red [[rash|patches]] of skin
**Diminished sensation or lost sensation within patches 
*[[Paresthesias]]
*Painless wounds on hands or feet
*Lumps on earlobes or face
*Tender, enlarged peripheral nerves 

''Consider leprosy in patients who have skin lesions that do not respond to conventional treatments or when there are associated sensory disturbances''

==Differential Diagnosis==
*[[SLE]]
*[[Sarcoidosis]]
*[[Syphilis]]
*[[Erythema nodosum]]
*[[Erythema multiforme]]
*Cutaneous [[tuberculosis]]
*[[Vitiligo]]
*[[Scleroderma]]
*[[Tinea versicolor]]
*Mycosis fungoides
*Diffuse cutaneous [[leishmaniasis]]
*[[Neuropathy]] of other etiology

==Evaluation==
*Diagnosis made by skin biopsy

==Management==
*Tuberculoid: TT and BT
**Treat for twelve months with both:
***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily 
*Lepromatous: LL, BL, BB
**Treat for twenty-four months with all three:
***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily + [[Clofazimine]] 50mg daily
*Refer patient: National Hansen’s Disease Programs 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/


===Antibiotic Dosing===
====Adult====
*{{AntibioticDose|drug=Rifampin|dose=Paucibacillary, single lesion; 600 mg PO x1 with [[ofloxacin]] and [[minocycline]]; Paucibacillary; 600 mg PO qmo x 6mo with [[dapsone]]; Multibacillary; 600 mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]]|context=Hansen Disease|disease=Leprosy|population=Adult}}
*{{AntibioticDose|drug=Dapsone|dose=paucibacillary: 100mg PO QD x6mo; Use with rifampin; multibacillary: 100mg PO QD x12mo; Use with rifampin, clofazimine|context=Hansen's disease (leprosy)|disease=Leprosy|population=Adult}}
====Pediatric====
*{{AntibioticDose|drug=Rifampin|dose=Paucibacillary, 10-14 yo; 450mg PO qmo x6mo with [[dapsone]]; Paucibacillary, 15+ yo; 600 mg PO qmo x 6mo with [[dapsone]]; Multibacillary, 10-14 yo; 450mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]]; Multibacillary, 15+ yo; 600 mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]]|context=Hansen Disease|disease=Leprosy|population=Pediatric}}

==Disposition==


==Complications==
*Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms

==External Links==
*[http://www.hrsa.gov/hansensdisease/ National Hansen's Disease Program]

==See Also==


==References==
<References/>


[[Category:Tropical Medicine]]
[[Category:ID]]