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"Gandhi ji said he was unwilling to come to open
leprosium but would be happy to come close it."
Mahatma Gandhi |
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"Leprosy work is not merely medical relief; it is
transforming frustration of life in to joy of dedication,
personal ambition into selfless service"
Mahatma Gandhi |
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Leprosy :
Medical and Social aspects |
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"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, 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 |
MEDICAL ASPECTS:
Leprosy is a chronic infectious disease caused by
Mycobacterium leprae, a slender, acid-fast,
rod-shaped bacillus discovered by Albert Hansen in
1873. The disease mainly affects the skin,
peripheral nerves, and mucosa of upper respiratory
tract, eyes, and also some internal organs such as
bones, testes, etc. leprosy affects all age groups
and both sexes. The incubation period is quite long
extending into several years but usually 3-5 years.
Infected human being is the only important source of
transmitting the disease to another via the skin
and/or the respiratory tract.
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 neuritic pain, varying grades of sensory loss and
weakness of muscles supplied by the affected nerves.
Recurrent painless blisters and trophic 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
andor 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. |
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