How to Diagnose Leprosy

1. How to Diagnose Leprosy Dr Balu P.S. Reader – Dept Of Community Medicine –JJMMC.

2. How to Treat Leprosy Dr Balu P.S. Reader – Dept Of Community Medicine –JJMMC.

3. Learning Objective • Suspect and Diagnose leprosy. • Able to perform basic clinical examination. • Classify leprosy patients and start treatment.

4. Leprosy - one of the few diseases which can be eliminated • Leprosy meets the demanding criteria for elimination • practical and simple diagnostic tools: can be diagnosed on clinical signs alone; • the availability of an effective intervention to interrupt its transmission: multidrug therapy • a single significant reservoir of infection: humans.

5. How to recognize Leprosy?

6. Talk to the Patient • How long has the skin patch been there? How did it start? Has it changed? Leprosy patches usually appear slowly. • Do the patches itch? Is there pain? Leprosy patches do not itch and are not usually painful. • Does the person have unusual sensations in their hands or feet, such as numbness, tingling or a burning feeling? Unusual sensations in the hands or feet can be a sign of leprosy. • Does the person think that their hands or feet have become weaker? Do they have problems with holding or lifting things and with moving their hands and feet? Losing strength in hands or feet can be a sign of leprosy. • Has the person experienced any social problems? This may be more likely if the person already has some disability due to leprosy

7. Examine their Skin

9. What To Look In Skin Patches ?

10. Test the feeling in the skin patches

11. Feel the Nerves

12. How to Feel for Ulnar Nerve Hand Shake Method From Outside to Inside

13. How to feel for Peroneal Nerve ask the person to sit in a chair and then kneel down in front of patient. With your left hand , feel for the nerve on the outside of the right leg, just below the knee; the nerve comes from just behind the knee and curves around the head of the fibula.

14. Examine the hands and feet fornerve damage

15. Four Point Test

16. Four Point Test – Contd….

17. Are You Thinking About Skin Smear ?

18. Sites for taking skin smear • 2 sites are enough , previously recommended was 4 or 6 sites. • Take smear from the edge of the most active lesion (raised and reddish )

19. Importance of skin smear A skin smear may be useful for diagnosis: when positive it indicates leprosy but skin smears are used primarily for the surveillance of the patient's bacteriological status. Many leprosy patients will have a negative skin smear. This means that although they have leprosy bacilli in their body, there are too few to be seen in the smear. If the laboratory technician can see leprosy bacilli, it means that the patient is heavily infected.

20. Remember, if you see a skin condition that looks like leprosy, ALWAYS • Test the feeling in the skin patch. • Feel if the nerves are enlarged. • Test the feeling in the palms of the hand and the soles of the foot. • If possible, arrange for a skin smear.

21. If a person shows one or more of the following three signs, they have leprosy • Pale or reddish patches on the skin, with definite loss of feeling. • Involvement of the nerves, shown by enlargement and loss of feeling. • The presence of leprosy bacilli in the skin smear.

22. Conditions That May Mimic Leprosy

23. Pityriasis alba

24. Tinea faciei

25. Localized scleroderma

26. Tinea Versicolar

27. What to do after you have diagnosed a patient as leprosy ?

28. Count the skin patches. • Check for nerve damage. • check to see if the person has any weakness of the muscles in the hands, feet and eyelids

29. Test four muscles on each side • One muscle controlling the eyelids. • Two muscles in the hand. • One muscle controlling the foot. • Write down the result of your tests – • S (strong) if the muscle strength seems normal, • W (weak) if there is some movement but the muscle strength is reduced, or • P (paralysed) if the muscle has lost all strength and cannot produce any movement.

30. Testing the eyelid muscles

31. Testing Movement of Little Finger • ask the patient to move the finger sideways, away from the other fingers. • Now try to push the little finger back. • If you can push it back easily, there is muscle weakness. • If the patient cannot move the little finger at all, there is paralysis

32. Testing the movement of the thumb • ask the patient to hold their hand flat, with the palm upwards, and point the thumb upwards. • Now, support the patient's hand and try to push the thumb down to a flat position at the side of the palm. • If the patient does not resist and you can move the thumb down easily, there is muscle weakness. • If thepatientcannot point the thumb upwards at all, there is paralysis.

33. Testing the movement of the foot • support the patient's lower leg with your hand. Ask them to lift their foot. • Now try to push it down. If you can push the foot down easily, there is muscle weakness. • If the patient cannot lift the foot at all, there is paralysis.

34. Look also for signs of complications ?

35. Disability Grading /Impairment Grading / EHF Score

37. SMALL ACTS OF KINDNESS CAN CHANGE YOUR WORLD. TRY IT.

38. How to treat Leprosy Patient ?

39. Steps in MDT • Classify the lesion*           • Inform the patient* • Explain the MDT blister pack*            • Show drugs to be taken once a month and every day • Explain possible side effects and complications* • Give enough MDT blister packs to last until the next visit. • Fill out the patient treatment card .

40. How will you classify the patients in these pictures?

41. How to tell if someone has PB or MB leprosy ? • Count the skin patches • If you find five patches or less, classify the patient as PB. • If you find more than five patches, classify the patient as MB. • When a skin smear is taken • If the skin smear is negative and the patient has five patches or less, classify the patient as PB. • If the skin smear is positive, classify the patient as MB, whatever the number of skin patches

42. Explain the MDT Blister Pack Duration of treatment is 6 months.

43. Duration of treatment is 12 months

45. Single lesion paucibacillary leprosy (adults) • Single dose of: • Rifampicin: 600mg • Ofloxacin: 400mg • Minocycline: 100mg

46. What is Accompanied MDT (A-MDT) • A patient receives • a full course of MDT at the outset • receives information (verbal and printed materials) about the disease, its treatment and when and where to come for follow up, and • someone close to or important to the patient assumes the responsibility of ensuring that the patient completes a full course of treatment. • Note: In some areas (difficult to access, poor security etc) or for some patients (students,workers etc), this will ensure that all patients have adequate supply of MDT at home.

48. When To Re- Start Treatment • Reddish and or raised skin lesions. • Appearance of new lesions. • New nerve involvement. • New deformities. • Lepramotus nodules. • Signs of ENL or reversal reaction.

49. How to Recognize and ManageLeprosy Reactions?

50. What is leprosy reaction? • APPEARANCE OF SYMPTOMS AND SIGNS OF ACUTE INFLAMMATION IN LESIONS OF A PATIENT WITH LEPROSY Swelling • Redness • Heat • Pain • Loss of function