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A walk in the Park

This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

Feedback is crucial for the success of this endeavour, so you are encouraged to comment and criticize if you cannot understand something.

If you want a topic to be discussed sooner rather than later, please let me know via

Facebook: http://www.facebook.com/pages/Community-Medicine-for-ASSES/429533760433198  

[Alternatively, you may join the group communitymedicine4asses: 

http://www.facebook.com/groups/456698611060927/%5D

Twitter: @DocRoopesh

In addition, you could take a short survey to help improve this blog:

http://drroopesh.polldaddy.com/s/reader-survey

A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

If something doesn’t seem right:

a. Write to me about it (at communitymedicine4asses@yahoo.com), and

b. Cross check with another source (textbook, expert, etc.)

I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

Note 1. Those who wish to contact me on facebook are requested to kindly send a personal message introducing themselves along with the request. This will help save time and effort of all concerned. Please do not expect me to visit your page to try and identify you/ your areas of work/ interest, etc. It is common courtesy to introduce oneself to another when interacting for the first time. I am merely requesting that the same civil courtesy be extended here, too. Henceforth, I may not accept any friend requests/ requests to join the group on facebook unless accompanied by a note of introduction (except when I already know the sender).  

Note 2. Please understand that this blog (and the corresponding facebook page/ group) is maintained in my spare time. I have a full time job, and am available to pursue these activities only after regular working hours (after 5 pm Indian Standard Time). However urgently you may wish to receive a response from me, I will be able to respond only upon returning home from work (I am offline the rest of the time).

Note 3. Please mind your language when interacting with me/ in the group linked to this blog. Rude/ offensive language will result in expulsion from both my friends list and the said group.

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WHO’s Evidence-based guidelines for diagnosis, treatment and prevention of Leprosy

World Leprosy Day is celebrated on the last Sunday in January each year (except in India, where it is celebrated on 30 January to coincide with Mahatma Gandhi’s death anniversary).

Despite the status of an eliminated disease in many countries, leprosy remains a public health problem, and is re-emerging in many areas.

In 2018, the World Health Organization (WHO) released the first evidence-based guidelines for the diagnosis, treatment and prevention of leprosy. This article will briefly describe the same.

Background Information:

Leprosy is a disease that predominantly affects the skin and peripheral nerves, resulting in neuropathy and associated long-term consequences, including deformities and disabilities.
The disease is associated with stigma, especially when deformities are present. Despite the elimination of leprosy as a public health problem (defined as achieving a point prevalence of below 1 per 10 000 population) globally in 2000 and at a national level in most countries by 2005, leprosy cases continue to occur.

India achieved goal of leprosy elimination in December 2005, but contributes more than 50% of new cases detected globally every year.

Diagnosis

At least one of the following cardinal (unique & very important) signs must be
present to diagnose leprosy:

  1. Hypopigmented or reddish skin lesion(s) with definite sensory deficit
  2. Involvement of the peripheral nerves, as demonstrated by definite thickening with loss of sensation and weakness of the corresponding muscles of the hands, feet or eyes,
  3. Demonstration of M leprae in the lesions.

The first two cardinal signs can be identified by clinical examination alone while the
third can be identified by examination of the slit skin smear.

A person with cardinal signs of leprosy and yet to complete full course of Multi Drug Therapy (MDT) may be called as “case of leprosy”.

Differential Diagnoses

The common skin diseases under differential diagnosis may be

  • psoriasis,
  • secondary syphilis,
  • vitiligo,
  • birth marks,
  • PKDL,
  • lupus vulgaris

Management

Disease classification

classification of leprosy

Grading of Disability

grading of disability in leprosy

Multi Drug Therapy (MDT)

multi drug therapy in leprosy

*RFT: Release From Treatment

The Multi Drug Therapy (MDT) regimens vary by type of leprosy, with Multibacillary leprosy treated with three drugs- Rifampicin, Dapsone and Clofazimine; and Paucibacillary leprosy treated with two drugs- Rifampicin and Dapsone.

Key Messages:

Recommendations for Diagnosis 

Leprosy: Diagnosis of leprosy may be based on clinical examination with or without slit-skin smear or examination of pathological biopsies

Leprosy infection: Currently no test is recommended for the diagnosis of latent leprosy infection

Recommendations for Treatment

As opposed to the practice of prescribing three drug MDT for Multibacillary leprosy, and two drug MDT for paucibacillary leprosy, the recommendation is for using three drug MDT for all leprosy patients. However, the duration of treatment would remain unchanged for Paucibacillary leprosy (6 months in a 9 month period) and Multibacillary leprosy (12 months in an 18 month period).

evidence-based guidance for leprosy (who)

Recommendation for Prevention of Leprosy

To prevent leprosy in healthy close contacts of leprosy patients, the recommendation is for Single Dose Rifampicin (SDR) to be administered if the contacts are two years or older; and both leprosy and tuberculosis have been ruled out.

Useful Links:

Link to the full guidance document (English) [PDF]:

http://apps.who.int/iris/handle/10665/274127

Link to the Executive Summary of the guidelines (English) [PDF]:

http://www.searo.who.int/entity/global_leprosy_programme/approved-guidelines-leprosy-executives-summary.pdf?ua=1

Link to National Leprosy Eradication Programme (NLEP) Training Manual for Medical Officers (English) [PDF]:

http://nlep.nic.in/pdf/MO%20training%20Manual.pdf

Link to NLEP common flow chart for Kala Azar and Leprosy workers (English) [PDF]:

http://nlep.nic.in/pdf/Common%20Flow%20chart%20for%20Leprosy%20and%20Kala%20Azar%20workers.pdf

Link to NLEP guidance on Post Exposure Prophylaxis of leprosy (English) [PDF]:

http://nlep.nic.in/pdf/OG_PEP_F.pdf

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