Tag Archives: Leprosy

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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