This presentation is made by Dr Ashok Jaisingani for study purpose if any one like this than please give your comments.

1. Leprosy
Dr. Ashok Jaisingani

2. Introduction
► Leprosy is also called as “Hansen's disease”
► It is chronic curable infectious disease caused by
mycobacterium leprae.
► It occurs mainly in tropical regions and developing
countries.
► The majority of the cases are located in Indian
subcontinents
► Patient suffer not only from the primary affect of
disease but also from the social discrimination,
sadly compounded by inappropriate term ‘leper’
for one who afflicted with that disease.

3. Pathology
► The transmission occurs through nasal secretion
► It is attributed to poor hygiene and unsanitary
conditions
► The incubation period is several years
► The disease present with skin, upper respiratory
and neurological symptoms
► The infection occur in childhood or early
adolescence
► The bacillus is acid fast but so weakly when
compared with mycobacterium tuberculosis.

4. Classification Of Disease
► Thedisease is broadly classified into two
groups.
1- Lepromatous
2- Tuberculoid

5. Lepromatous Leprosy
► In lepromatous leprosy there is wide spread
dissemination of abundant bacilli in the
tissues with the macrophages and a few
lymphocytes.
► This denote a poor host immune reaction.

6. Tuberculoid Leprosy
► In tuberculoid leprosy the pts show strong
immune response with scant bacilli in
tissues, epithelioid granuloma, numerous
lymphocytes and giant cells.
► Thus that condition occurs when host
resistance is stronger than virulence of
organisms.

7. Clinical Features
► Disease is slowly progressive affecting skin, upper
respiratory tract and peripheral nerves.
► Tuberculoid Leprosy: There is damage to tissues occurs
early and is localized to one part of the body, which limited
deformity of that organ.
► Neural involvement is characterized by thickening of the
nerves which are tenders.
► There may be asymmetrical well defined anesthetic
hypopigmented or erythamatous macules with elevated
edges and dry and rough surface lesion called “leprids”.
► Lepromatous Leprosy: There is disease is symmetrical
and extensive. Cutanous involvement occurs in the form of
the several pale macules that form plaques called
‘lepromas’.

8. Deformities
► The deformities produced by the disease
which are divided into
► Primary: These are caused by the leprosy
or by its reactions
► Secondary: These resulting from effects
such as anesthesia of hands and feet.

9. Lesion involving Face
► In the acute phase of lepromatous variety the nodular
lesion on the face are known as “Leonine facies” (looking
like lion)
► Later there is wrinkling of skin and aged appearance to
young individuals.
► There is loss of eyebrows
► Destruction of lateral cartilage and septum of nose with
collapse of nasal bridge and lifting of tip of nose.
► There may be paralysis of branches of facial nerves in
bony canal or of zygomatous branches.
► Paralysis of orbicularis occuli cause incomplete closure of
eyes, epiphoras and conjunctivae.

10. Lesion Involve Hands & Feet
► Lesions Involving Hands: The hands are
typically clawed because of involvement of ulner
nerve at elbow and median nerve at wrist.
► Anesthesia of hands makes these pts susceptible
to frequent burns and injuries.
► Lesion Involving Feet: There is clawing of toes
occurring as result of involvement of posterior
tibial nerve. When lateral popliteal nerve is
affected it leads to foot drop and nerve can be felt
to be thickened behind the upper end of fibulae
► Anesthesia of feet predispose to trophic ulceration,
chronic infection, contraction and autoimputation.

11. Leprosy Diagnosis
► Typical clinical features and awareness of
the disease should help to make a diagnosis
► The face has an aged look about it with
collapse of nasal bridge and eyes changes.
► Thickened peripheral nerves, patches of
anesthetic skin, claws hands, foot drop and
trophic ulcer are characteristic.
► Microbiological examination of acid – fast
bacillus and typical history on skin biopsy.

12. Treatment
► Multiple drug therapy for 12 – months is key to treatment,
this is carried out by WHO guideline using.
1- Rifampicin
2- Dapsone
3- Clofazimine
► During treatment, pts may develop acute manifestation,
which controlled by steroids
► Surgical treatment is indicated in advance stage of disease
for functional disability of limbs, cosmetic disfigurement of
face and visual problems.
► Surgical reconstruction requires the expertise of hand
surgeon, orthopedic surgeon and plastic surgeon.
► General surgeon may be called upon, when it require
amputation or in emergency situation abscess drainage.

13. Prevention Of Disease
► Educating the patient about the dreadful
sequelae of the disease so that they seek
medical help early as important.
► Education of general public should be the
keystone in prevention.