Brief description on "Leprosy" Reactions

Brief description on Leprosy Reactions,

1. What is a relapse?

2. Definition
•Return of active disease after
completion of prescribed treatment
•When the BI at any site increases by
at least 2+
•Detection of active disease 2 years
after completion of treatment

3. Relapse rate
•Relapse rate mono therapy era 20 -
27%
•Relapse with combination
treatment 4-20%
•Relapse after MDT less than 1%
with the 2 years of MDT/ MB
•Relapse after 1year MDT/MB not
yet known

4. How to recognize relapse
•Active lesion
•Increase in BI
•New lesion
•Erythema
•Neuritis
•Deterioration of nerve functions

5. Active lesions
•Clinical features
•Bacteriology
•Histopathology

6. Clinical features
•New lesions
•Extension of existing lesions
•Change in morphology of lesions
•Increase in number of lesions
•Erythema of lesions
•Neuritis
•New nerve function loss
•Eye symptomse.g iritis

7. Bacteriological
•A previously BI negative
becomes positive
•BI> or = 2+
•A single 1+ finding is
not enough

8. Histopathology
•Signs of active leprosy
in a skin or nerve
biopsy

9. Management of relapse
•Distinguish misclassified cases
and defaulter
•Treat all relapses with full
WHO/MDT regimen

10. What complications occur in
leprosy?

11. Complications due to reaction
and nerve damage
•Neuropathy
•Paralysis
•Absorption
•Ulceration and deformity

12. Complication due to leprosy
•Atrophy /scarring of skin
•Mucous membranes atrophy and ulceration
•Nose collapse and perforated palate
•Cataract
•Gyecomastia
•Maderosis
•Blindness
•Atrophy of testis
•Amyloidosis

13. What are leprosy
reactions?

14. Immunological complications of leprosy
presenting as acute inflammatory
episodes
Occur at any time before, after or during
leprosy treatment
Cause nerve damage and disability
About 65% of MB cases develop reactions
Reactions are:

15. When are reactions suspected?
When a leprosy patient:
•Develops pain
•Inflamed lesion
•Swelling of the extremities
•Loss of nerve function or decrease
in VMT/ ST

16. •Type I (Reversal Reactions )
•Type II (Erythema Nodosum
Leprosum)
Two types of reaction

17. •Common in borderline leprosy (BT, BB,
BL)
•Cell mediated delayed hypersensitivity
(high CMI)
•Redness, swelling and tenderness of
existing leprosy lesions
•New lesion may appear or vague ones
become visible
Clinical feature of Type I (RR

18. Clinical feature of type I (RR) reaction
Erythema of existing leprosy lesions, new lesion
may occur or vague lesions become prominent

19. Type I (RR)
Erythema and edema of skin lesions
(macules become plaques)

20. Type I (RR)
Erythema , edema & tenderness of skin
lesions (macules become plaques)

21. Erythema, edema & tenderness of skin lesions
( macules become plaques)

22. Isolated edema of face & hands

23. Edema of feet

24. •Enlargement and tenderness of peripheral nerves
with or without deterioration of functions

25. Type II (ENL)
•Immune complex reaction due to excess
production of antibody to M. leprae
antigens
•Common in lepromatous spectrum (BB, BL
& LL)
•Panniculitis and vasculitis ( tender
subcutaneous nodules)
•Mild to moderate inflammation of nerves
•Generalized systemic manifestation

26. •Sudden eruption of
erythematous subcutaneous
nodules, tender and appearing in
crops
•Site: face trunk and extremities
•Sever case lesions may ulcerate
Type II (ENL) reactions

27. •Fever, malaise occur
•Eye (iritis, iridocyclitis)
•Mucous membranes( ulceration, edema)
•Testis (acute orchitis)
•Joints, bone & muscle (arthritis,
periostitis)
•Liver (hepatitis, jaundice)
•Kidney (nephritis, edema)
Type II (ENL) reactions

28. TypeII (ENL) reaction

29. Type II (ENL) reaction

30. Type II (ENL) reaction

31. How are leprosy reactions
managed?

32. General principle
•Lab investigation
•Grading severity of reaction into mild and sever
Mild
•inflammation of skin lesions without nerve
involvement
Sever
•Reactional lesion overlying major nerves
•Nerve involvement
•Edema of hand and feet
•Mild RR persisting over 4 weeks
Management of Type I (RR)

33. •Prednisone tapering dose starting 40 to
60 mg, depending on severity of reaction
•Other drugs: azathopurine, cyclosporine
•Nerve abscess: surgical release
•Prevention of secondary disabilities by
health education (eye, hand & foot care)
Specific treatment

34. General
•Lab investigation
•Grading of severity
Mild
•Skin eruption without nerve
tenderness or loss of function
Sever
•Multiple and ulcerating lesion
•Iritis, orchitis, nephritis or hepatitis
•Nerve tenderness and loss of function
Treatment of ENL

35. What are key messages for some one
completing MDT?
•Awareness of reaction and neuritis
•Awareness of slow nerve damage
and disability
•Awareness of reaction and relapse
•Self care practice to avoid
disability