Leprosy Elimination

Leprosy Basics - The Ancient Affliction

• Chronic infectious disease; caused by Mycobacterium leprae (Hansen’s bacillus).
• Targets: Skin, peripheral nerves, URT, eyes, testes.
• Transmission: Respiratory droplets (untreated MB cases); prolonged close contact.
• Incubation: Avg. 2-5 yrs (up to 20 yrs).
• Cardinal Signs (WHO, ≥1 for diagnosis):
  • Skin patch (hypopigmented/reddish) with definite sensory loss.
  • Thickened/tender peripheral nerve(s) + sensory loss/muscle weakness.
  • Positive skin smear for AFB.

⭐ M. leprae: Obligate intracellular, acid-fast bacillus; not culturable in vitro.

Classifying Leprosy - Spectrum Showdown

• WHO Classification (Operational):
  • Paucibacillary (PB): ≤ 5 skin lesions AND Slit-Skin Smear (SSS) negative; 0-1 nerve trunk.
  • Multibacillary (MB): > 5 skin lesions OR SSS positive OR > 1 nerve trunk involved.
• Ridley-Jopling (Immunological): Spectrum: Tuberculoid (TT: high CMI, few bacilli) ↔ Lepromatous (LL: low CMI, many bacilli). BT, BB, BL intermediates.

  ⭐ LL pole shows numerous acid-fast bacilli (AFB) on slit-skin smear, often forming globi.

Diagnosing Leprosy - Spotting the Signs

• Cardinal Signs (WHO): ≥1 required.
  • Skin patch(es) (hypopigmented/erythematous) + definite sensory loss.
  • Thickened peripheral nerve(s) + sensory/motor loss.
  • Positive Slit-Skin Smear (SSS) for Acid-Fast Bacilli (AFB).
• Investigations:
  • SSS: From earlobes, lesions. Bacteriological Index (BI) 0-6+. Morphological Index (MI) for viability.
  • Skin Biopsy: Confirmatory (esp. PB). Shows granulomas, nerve infiltration.
  • Lepromin Test: Not diagnostic. Assesses Cell-Mediated Immunity (CMI). Positive in TT/BT; negative in LL/BL.

⭐ Definite sensory loss in a skin patch, tested with cotton wisp or monofilament, is a hallmark sign of leprosy diagnosis.

MDT Magic - Conquering the Curse

• Goal: Interrupt leprosy transmission & prevent disabilities.
• WHO MDT Regimens (Blister Packs):
  • Paucibacillary (PB): Rifampicin + Dapsone. Duration: 6 months. (📌 RD for PB)
  • Multibacillary (MB): Rifampicin + Dapsone + Clofazimine. Duration: 12 months. (📌 RDC for MB)
• Drug Details:
  • Rifampicin: Monthly, supervised; potent bactericidal.
  • Dapsone: Daily; bacteriostatic.
  • Clofazimine (MB only): Daily + monthly supervised; anti-inflammatory, causes pigmentation.

⭐ Single Dose Rifampicin-Ofloxacin-Minocycline (ROM) is recommended for single skin lesion paucibacillary (SSL PB) leprosy. oka

Elimination Endgame - NLEP & Beyond

• NLEP Goal: Sustained leprosy elimination (prevalence <1 case per 10,000 population nationally; <1 case per 10,000 in all districts).
• Key Pillars:
  • Early detection: Active Case Detection (ACD), Leprosy Case Detection Campaigns (LCDC).
  • Prompt MDT: Free of cost, ensuring completion.
  • Contact Management: Tracing & SDR-PEP (Single Dose Rifampicin Post-Exposure Prophylaxis).
  • DPMR: Disability Prevention & Medical Rehabilitation.
  • IEC: Reducing stigma, promoting self-reporting.
• Current Focus: Last mile efforts, ASHA involvement, monitoring drug resistance.

⭐ India achieved national leprosy elimination (prevalence <1/10,000) in 2005.

High‑Yield Points - ⚡ Biggest Takeaways

• National Leprosy Eradication Programme (NLEP) launched 1983; elimination goal by 2000.
• Elimination of Leprosy: Prevalence Rate <1 case per 10,000 population.
• India achieved national elimination in December 2005.
• Multi-Drug Therapy (MDT) is the cornerstone: Rifampicin, Dapsone, Clofazimine.
• Paucibacillary (PB) Leprosy: Rifampicin + Dapsone for 6 months.
• Multibacillary (MB) Leprosy: Rifampicin + Dapsone + Clofazimine for 12 months.
• NIKUSHTHA portal for leprosy case management and surveillance.