Leprosy: Difference between revisions
ClaireLewis (talk | contribs) |
(Add Rifampin and Dapsone AntibioticDose entries) |
||
| Line 59: | Line 59: | ||
***[[Dapsone]] 100mg daily + [[Rifampin]] 600mg daily + [[Clofazimine]] 50mg daily | ***[[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/ | *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== | ==Disposition== | ||
Revision as of 10:59, 20 March 2026
Background
- Also known as Hansen's Disease
- 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
- Lepromatous: LL, BL, BB
- Treat for twenty-four months with all three:
- Dapsone 100mg daily + Rifampin 600mg daily + Clofazimine 50mg daily
- Treat for twenty-four months with all three:
- 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