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 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

• Rifampin 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
• Dapsone paucibacillary: 100mg PO QD x6mo; Use with rifampin; multibacillary: 100mg PO QD x12mo; Use with rifampin, clofazimine

Pediatric

• Rifampin 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

Complications

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

External Links

• National Hansen's Disease Program