Leprosy_Notes_MPT for physiotherapists.pptx

Leprosy_Notes_MPT for physiotherapists.pptx

1. Leprosy (Hansen's Disease)

2. Definition Leprosy, or Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae. It primarily affects the skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes . Its not only physical and but social.

3. Epidemiology - Prevalence: More common in tropical and subtropical regions. - Global burden: Over 200,000 new cases annually (WHO). - Endemic countries: India, Brazil, and Indonesia contribute ~80% of cases.

4. Etiology and Pathogenesis - Causative Agent: Mycobacterium leprae (acid-fast bacillus). - Transmission: - Prolonged close contact with an infected person. - Likely via respiratory droplets. - Pathogenesis: - Invades Schwann cells, causing nerve damage. - Elicits a spectrum of immune responses, leading to varied clinical presentations.

5. Clinical Types (Ridley-Jopling Classification) 1. Tuberculoid Leprosy : - Strong cell-mediated immunity. - Few skin lesions, asymmetrical nerve involvement. 2. Lepromatous Leprosy : - Weak cell-mediated immunity. - Numerous skin lesions, symmetrical nerve involvement. 3. Borderline Types : - Intermediate immunological responses. 4. Indeterminate Leprosy: - Early form with non-specific manifestations. Multi Bacillary Cases Paucibacillary Cases

6. Clinical Features - Cutaneous: - Hypopigmented or erythematous macules. - Loss of sensation over lesions. - Neurological: - Peripheral nerve thickening. - Sensory, motor, and autonomic nerve dysfunction. - Systemic: - Eye involvement: Lagophthalmos, keratitis. - Nasal involvement: Chronic rhinitis, nasal septum perforation . Musculoskeletal Foot Drop Partial & Total Claw Trophic Ulcer (Plantar Ulcer)

7. Diagnosis - Clinical: - Sensory testing over skin lesions. - Nerve palpation. - Laboratory: - Skin smears for acid-fast bacilli (AFB). - Biopsy: Granulomatous inflammation, AFB detection . Mucosa smears - Molecular: - PCR ( polymerase chain reaction) for Mycobacterium leprae DNA (specific but less accessible).

8. Medical Management - Multidrug Therapy (MDT) (WHO Guidelines): - Paucibacillary (PB): Rifampicin, Dapsone (6 months). - Multibacillary (MB): Rifampicin, Dapsone, Clofazimine (12 months). - Supportive Care: - Management of reactions (Type 1 and Type 2 Immune hypersensitivity reactions ): - Corticosteroids, thalidomide. - Nerve pain: NSAIDs, gabapentin

9. Advanced Surgical Procedures 1. Reconstructive Surgery: - Tendon transfer for claw hand correction. - Lagophthalmos correction: Tarsorrhaphy or gold weight implantation. 2. Amputation: - Indicated in severe, non-repairable deformities or infections. 3. Nerve Decompression: - For severe nerve pain or early nerve function loss.

10. Rehabilitation - Physiotherapy: - Joint mobilization and muscle strengthening. - Splints for deformity correction. - Occupational Therapy: - Vocational training and adaptive tools. - Psychosocial Support: - Addressing stigma and promoting social reintegration.

11. Recent Advances - Diagnostic Tools: - Development of rapid molecular tests. - Vaccines: - BCG shows partial protection. - LepVax under trial for improved efficacy. - Genomic Studies: - Better understanding of Mycobacterium leprae and drug resistance.

12. References 1. WHO Guidelines on Leprosy. 2018. 2. Scollard DM, Adams LB, Gillis TP, et al. The Continuing Challenges of Leprosy. Clin Microbiol Rev. 2006;19(2):338-381. doi:10.1128/CMR.19.2.338-381.2006. 3. Britton WJ, Lockwood DN. Leprosy. Lancet. 2004;363(9416):1209-1219. doi:10.1016/S0140-6736(04)15952-7.