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Thursday, April 19, 2007

Gandhi ji said he was unwilling to come to open leprosium but would be happy to come close it."

What is Leprosy
Leprosy (Hansen's disease) is a chronic infection, contagious disease caused by Mycobacterium leprae.
It affects mainly the peripheral nerves.
It also affects the skin, the muscles, eyebrows, eyes, bones, testes and internal organs. The disease manifests in two Polar forms, namely - Lepromatous Leprosy affecting the skin and multiple organs (multibacillary) tuberculoid leprosy - affecting mainly the nerves (paucibacillary)
Clinically the disease characterized by one or more of the following cardinal features:-
1. Hypo pigmented patches.
2. Partial or total loss of coetaneous sensation in the affected areas (the earlier sensation to be affected is usually thermal) hot, cold or pain.
3. Presence of thickened nerves.
4. Presence of acid-fast bacilli in the skin or nasal smears. Signs of chronic disease are striking (which we mostly come across)
Presence of nodules or lumps in the skin of the face and ears.
Plantar ulcers.
Loss of fingers or loss of toes.
Nasal depression
Foot Drop
Claw toes.
It is a communicable disease with a social stigma.
Modern day Leprosy dates from 1873 when Hansen of Norway discovered M.Leprae.
For long years there was no effective treatment for leprosy. Introduction of Sulphone Drugs in treatment of Leprosy in 1943 marked the beginning of a new era - the era of case finding and domiciliary treatment.
Recent years have witnessed a change in the strategy of Leprosy control from dapsone monotherapy to multi drug therapy due to widespread emergence of resistance
Leprosy is major health problem in our country.
Estimated number of cases in our country is approximately four million with an average prevalence rate of 5.7/1000 populations.
The disease is communicable but curable.
It spreads through contact and droplet infection of the tract secretions.

Leprosy Facts: -

At present leprosy is endemic in South East Asian Countries. India has more than 3.45,000 cases of leprosy. As per the report received from all the states and UT (Union Teritorys) for the month of March 2007, carrying information for the year 2006-2007, following is the current leprosy situation in India.

Fifteen states/UTs have achieved the level of leprosy elimination ie.e PR<1 case 10,000 population and they include: Nagaland, Haryana, Meghalaya, Himanchal Pradesh, Mizoram, Tripura, Punjab, Sikkim, Jammu and Kashmir, Assam, Manipur, Rajasthan, Kerela, Arunanchal Pradesh and Daman and Diu.

Another 6 states/UTs are very near towards his goal of leprosy elimination i.e Madhya Pradesh, Karnataka, Uttranchal, Gujrat, Andaman & Nicobar Islands and Pondicherry.
Only 4 states (Bihar, Orissa, Chattisgarh, Jharkhand) and a one UT of D& N haveli have reported the leprosy PR ranging between 5-9 cases per 10,000 populations.
Of the total 590 districts in country,218 (37%) district have achieved the level of leprosy elimination while another 80 (14%) districts are near to this goal and only 121 (20.5%) district in country remain with leprosy PR of more than 5 per 10,000 population.

Leprosy : Medical and Social aspects

"Leprosy work is not merely medical relief: it is transforming frustration of life in to joy of dedication, personal ambition into selfless services:" Mahatma Gandhi.

Leprosy is one of the ancient diseases known to humankind. It existed practically in every continent at one time leaving behind terrifying image of mutilation, rejection, and exclusion from society.

Present Scenario:

Implementation of WHO multi drug treatment (MDT Drugs) regimens in the treatment of leprosy globally for the last two decades has resulted in a dramatic decline in the prevalence of leprosy although there is no decline in the detection of new cases. Currently. There are an estimated one million cases of leprosy in the world, most of them concentrated in South-East Asia, Africa, and South Americas, among 122 countries where the disease was considered endemic 1985, 108 countries have now reached the goal of elimination at the country level; however, much work needs to be done in several countries including India, Nepal and Myanmar. The number of new cases detected world wide each year is about half a million. According to recent WHO report (2003), the global leprosy prevalence rate is 0.84% per 10,000 populations? Of the 52, 3605 registered cases, 90%of the them are found in India, Brazil, Nepal, Madagascar, Mozambique and Myanmar in order of priority. Two countries India and Brazil account for nearly 2/3rd (80%)of this global burden of leprosy. India, leprosy continues to be a major public health with a prevalence rate of 3.3/ 10,000 populations and detection rate of 4.6%. Most of these cases are present in the States of Bihar, Chattisgarh, Jharkhand, Orissa, West Bengal, Uttar Pradesh and Delhi, which together account for 62.3% of leprosy cases in India. The dubious endemicity of leprosy in 6 of 8 districts in the National capital territory of Delhi (NCTD) appears to be due influx of temporary residence immigrants from the highly endemic areas

Diagnosis of leprosy:
The disease can manifest in various ways. The patients may present with skin eruption such as flat (macules, patches) or raised (papules, plaques, nodules) lesions and often hypo pigmented with erythematous borders. They vary in size, shape and number with varying grades of definite loss of sensation to pin prick and/ or light touch. The peripheral nerve trunks may be thickened resulting in neurotic pain, varying grades of sensory loss and weakness of muscles supplied by the affected nerves. Recurrent painless blisters and tropic ulcers over the hands and feet due to the sensory deficit, muscle weakness (dragging the feet while walking, difficulty in closing the eyes, wrist drop, foot drop), and deformities may be the presenting features. Nasal stuffiness & epistaxis my occur. Redness, swelling, tenderness of the skin lesions and nerves, redness of the eyes and diminished vision may occur during react ional episodes.

Clinical examination:

History should focus attention on the nature of the initial lesion or symptom and its subsequent progress. Leprosy lesions usually develop slowly over a period of several months and often are not troublesome. Treatment taken in the past should be asked to assess the need for further treatment. Significant past for present illnesses must be enquired to know contra-indications to start MDT for leprosy. Examination of the patient should be carried out preferably in daylight or adequate source of light. The entire integument has to be examined for skin lesions after providing adequate privacy to the patients and the skin lesions must be recorded on a body outline chart properly after testing sensations for temperature (test tubes with hot and cold water) pain (pinprick), and light touch (cotton tip or feather).

Testing the sensations:

Inform the patient what you are going to do and make him acclimatized by demonstrating it to the patient. The person may be asked to close the eyes or blind folded with a cloth. Touch the center of the lesion with a clean sharp pin for needle without causing bleeding. Ask the patient whether pain sensation could be appreciated. Compare it with the normal area by testing with both sharp and of the pin. All major peripheral nerve trunks should be palpated to assess thickening and tenderness of nerves. Muscles of the upper and lower extremities must be examined and any weakness present should be noted. Eyes, nose, hands and feet should be examined. Disability and or deformity if any must be noted down.

Cardinal Signs of Leprosy:

Hypo pigmented or erythematous skin lesion(s) with definite sensory loss.
Enlargement of peripheral nerves associated with signs of nerve damage such as neutric pain, sensory loss, painless ulcers and weakness of muscles of hands, feet and face.
Positive slit skin smears for acid fast basili (AFB)

Leprosy can be diagnosed in a patient if any one or more of the above features present and has not been received a full course of treatment. The diagnosis of leprosy is usually based on clinical signs and symptoms, which are easily recognizable and can be elicited by any health personnel with a short course of training. Patients with such complaints usually report to the clinic on their own. Rarely there may be a need to use laboratory and other investigations to confirm the diagnosis of leprosy.

Santosh More.
Manager (Public Relations)
Children’s Future, India