Leprosy: Difference between revisions

Latest revision as of 10:16, 22 March 2026

Background

Also known as Hansen's Disease^[1]
Infectious disease caused by Mycobacterium leprae
Most new cases found in developing countries
- Level 3 Countries with higher numbers of cases include: India, Brazil, Indonesia, Bangladesh, Nigeria
Means of transmission not fully understood - likely respiratory.
Has variety of clinical and histopathologic manifestations due to broad range of cellular immune response

Classification

Disease spectrum ranges from strong immune reaction and few organisms (tuberculoid) to weak immune reaction and numerous organisms (lepromatous)
Categories
- Tuberculoid (TT)
- Borderline tuberculoid (BT)
- Mid-borderline (BB)
- Borderline lepromatous (BL)
- Lepromatous (LL)
- Indeterminate (I)

Risk Factors

Close contact with infected person
- Type of leprosy in the contact (lepromatous may be more contagious than tuberculoid)
Armadillo exposure
Increased age
Genetic influences

Clinical Features

Hypopigmented or red patches of skin
- Diminished sensation or lost sensation within patches
Paresthesias
Painless wounds on hands or feet
Lumps on earlobes or face
Tender, enlarged peripheral nerves

Consider leprosy in patients who have skin lesions that do not respond to conventional treatments or when there are associated sensory disturbances

Differential Diagnosis

SLE
Sarcoidosis
Syphilis
Erythema nodosum
Erythema multiforme
Cutaneous tuberculosis
Vitiligo
Scleroderma
Tinea versicolor
Mycosis fungoides
Diffuse cutaneous leishmaniasis
Neuropathy of other etiology

Evaluation

Diagnosis made by skin biopsy

Management

Tuberculoid: TT and BT
- Treat for twelve months with both:
  - Dapsone 100mg daily + Rifampin 600mg daily
Lepromatous: LL, BL, BB
- Treat for twenty-four months with all three:
  - Dapsone 100mg daily + Rifampin 600mg daily + Clofazimine 50mg daily
Refer patient: National Hansen’s Disease Programs 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/

Antibiotic Dosing

Adult

Rifampin Paucibacillary, single lesion; 600 mg PO x1 with ofloxacin and minocycline; Paucibacillary; 600 mg PO qmo x 6mo with dapsone; Multibacillary; 600 mg PO qmo x 12mo with dapsone and clofazimine
Dapsone paucibacillary: 100mg PO QD x6mo; Use with rifampin; multibacillary: 100mg PO QD x12mo; Use with rifampin, clofazimine

Pediatric

Rifampin Paucibacillary, 10-14 yo; 450mg PO qmo x6mo with dapsone; Paucibacillary, 15+ yo; 600 mg PO qmo x 6mo with dapsone; Multibacillary, 10-14 yo; 450mg PO qmo x 12mo with dapsone and clofazimine; Multibacillary, 15+ yo; 600 mg PO qmo x 12mo with dapsone and clofazimine

Disposition

Complications

Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms

External Links

National Hansen's Disease Program

References

↑ White C, Franco-Paredes C. Leprosy in the 21st century. Clin Microbiol Rev. 2015;28(1):80-94. PMID 25567223

Authors:

[1] White C, Franco-Paredes C. Leprosy in the 21st century. Clin Microbiol Rev. 2015;28(1):80-94. PMID 25567223

[1]

@@ Line 1: / Line 1: @@
 ==Background==
+*Also known as Hansen's Disease<ref>White C, Franco-Paredes C. Leprosy in the 21st century. Clin Microbiol Rev. 2015;28(1):80-94. PMID 25567223</ref>
 *Infectious disease caused by Mycobacterium leprae
 *Most new cases found in developing countries
-*Level 3 Countries with higher numbers of cases include: India, Brazil, Indonesia, Bangladesh, Nigeria
+**Level 3 Countries with higher numbers of cases include: India, Brazil, Indonesia, Bangladesh, Nigeria
-*Means of transmission not fully understood; likely respiratory.
+*Means of transmission not fully understood - likely respiratory.
 *Has variety of clinical and histopathologic manifestations due to broad range of cellular immune response
+===Classification===
+*Disease spectrum ranges from strong immune reaction and few organisms (tuberculoid) to weak immune reaction and numerous organisms (lepromatous)
+*Categories
+**Tuberculoid (TT)
+**Borderline tuberculoid (BT)
+**Mid-borderline (BB)
+**Borderline lepromatous (BL)
+**Lepromatous (LL)
+**Indeterminate (I)
+===Risk Factors===
+*Close contact with infected person
+**Type of leprosy in the contact (lepromatous may be more contagious than tuberculoid)
+*Armadillo exposure
+*Increased age
+*Genetic influences
 ==Clinical Features==
+*Hypopigmented or red [[rash|patches]] of skin
+**Diminished sensation or lost sensation within patches
+*[[Paresthesias]]
+*Painless wounds on hands or feet
+*Lumps on earlobes or face
+*Tender, enlarged peripheral nerves
+''Consider leprosy in patients who have skin lesions that do not respond to conventional treatments or when there are associated sensory disturbances''
 ==Differential Diagnosis==
+*[[SLE]]
+*[[Sarcoidosis]]
+*[[Syphilis]]
+*[[Erythema nodosum]]
+*[[Erythema multiforme]]
+*Cutaneous [[tuberculosis]]
+*[[Vitiligo]]
+*[[Scleroderma]]
+*[[Tinea versicolor]]
+*Mycosis fungoides
+*Diffuse cutaneous [[leishmaniasis]]
+*[[Neuropathy]] of other etiology
-==Workup==
+==Evaluation==
+*Diagnosis made by skin biopsy
 ==Management==
+*Tuberculoid: TT and BT
+**Treat for twelve months with both:
+***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily
+*Lepromatous: LL, BL, BB
+**Treat for twenty-four months with all three:
+***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily + [[Clofazimine]] 50mg daily
+*Refer patient: National Hansen’s Disease Programs 1-800-642-2477 Http://www.hrsa.gov/hansensdisease/
+===Antibiotic Dosing===
+====Adult====
+*{{AntibioticDose|drug=Rifampin|dose=Paucibacillary, single lesion; 600 mg PO x1 with [[ofloxacin]] and [[minocycline]]; Paucibacillary; 600 mg PO qmo x 6mo with [[dapsone]]; Multibacillary; 600 mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]]|context=Hansen Disease|disease=Leprosy|population=Adult}}
+*{{AntibioticDose|drug=Dapsone|dose=paucibacillary: 100mg PO QD x6mo; Use with rifampin; multibacillary: 100mg PO QD x12mo; Use with rifampin, clofazimine|context=Hansen's disease (leprosy)|disease=Leprosy|population=Adult}}
+====Pediatric====
+*{{AntibioticDose|drug=Rifampin|dose=Paucibacillary, 10-14 yo; 450mg PO qmo x6mo with [[dapsone]]; Paucibacillary, 15+ yo; 600 mg PO qmo x 6mo with [[dapsone]]; Multibacillary, 10-14 yo; 450mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]]; Multibacillary, 15+ yo; 600 mg PO qmo x 12mo with [[dapsone]] and [[clofazimine]]|context=Hansen Disease|disease=Leprosy|population=Pediatric}}
 ==Disposition==
+==Complications==
+*Immunologic reaction that can occur before or during treatment. Presentation can include: fatigue, malaise, fever, neuritis, arthritis, iritis, nasopharyngeal symptoms
+==External Links==
+*[http://www.hrsa.gov/hansensdisease/ National Hansen's Disease Program]
 ==See Also==
-==External Links==
-==Sources==
+==References==
-<references/>
+<References/>
+[[Category:Tropical Medicine]]
+[[Category:ID]]