Leprosy:WHO Classification ,WHO Disability grading

Leprosy:WHO Classification ,WHO Disability grading


WHO Clasiification

  • Paucibacillary(tuberculiod)
  • Multibacillary(lepromatous

Paucibacillary (PB)

Multibacillary (MB)

Tuberculoid Leprosy

Lepromatous Leprosy

Severity

Mild

  • Can be extreme
  • Without treatment, the patient will die

Unique Signs and Symptoms

  • Few erythematous or hypopigmented plaques
  • flat centres and raised,demarcated borders
  • peripheral nerve damage with complete sensory loss
  • visible enlargement of nerves.
  • Many erythematous macules,papules or nodule
  • extensive tissue destruction(e.g:nasal cartilage,bones,ears)
  • diffuse nerve involvement with patchy sensory loss
  • lack of nerve enlargement.

Distribution of lesions

  • Asymmetrical
  • Symmetrical

Occurs When

  • Infected person  able to mount a robust, cell-mediated immune response to the bacterium
  • Infected person unable to mount a cell-mediated immune response to the bacterium

Defined by WHO as

  • 1-5 patches associated with leprosy
  •  >5 patches associated with leprosy.

Person Infectious?

No

 Possibly

PROGNOSIS

Good

Cure from disease possible, however, underlying disease complications (such as limb damage due to infection) may not be reversible or require reconstructive surgery

Lepromin test

Positive

 

Negative

Erythema Nodosum Leprosum

Absent

 

Usually present

 Treatment

Paucibacillary leprosy

  • should be treated for 6 months with dapsone 100 mg/day unsupervised plus rifampin 600 mg/ month supervised.

Multibacillary leprosy

  • should be treated for 12 months with dapsone 100 mg/day unsupervised, clofazimine 50 mg/day unsupervised, and rifampin 600 mg plus clofazimine 300 mg/month supervised.
  • In paucibacillary leprosy, the multidrug therapy is stopped after 6 months of treatment regardless of the presence of clinically active disease”

Surveillance after treatment

  • Clinical surveillance of cases after completion of treatment is an important part of the current recommendations for multidrug therapy.
  • Essential for the assurance of long term success of treatment and for the early detection of any relapses.
  • The recommendations are –

Paucibacillary leprosy

  •  clinical examination at least once a year for a minimum period of 2 years after completion of treatment.

Multibacillary leprosy 

  • clinical examination at least once a year for a minimum period of 5 years after completion of treatment. 

WHO DISABILITY GRADING FOR LEPROSY

Hand and Feet
  • Grade0:no anaesthesia,no visibledeformityordamage.
  • Grade1:anaesthesia present,but novisibledeformity ordamage.
  • Grade2:visible deformityor damagepresent.
Eyes
  • Grade0:no eyeproblem dueto leprosy;no evidenceof visualloss.
  • Grade 1:eye problems dueto leprosy present,but visionnotseverely affected asa result ofthese(vision: 6/60 or better)
  • Grade2:severevisualimpairment(vision:worset THAN 6/60.Lagopathalmos, iridocyclitis and coroneal opacities
Exam Question
 

WHO Clasiification

  • Paucibacillary(tuberculiod)
  • Multibacillary(lepromatous)

Paucibacillary (PB)

Multibacillary (MB)

Tuberculoid Leprosy

Lepromatous Leprosy

Severity

Mild

Can be extreme

Without treatment, the patient will die

Unique Signs and Symptoms

Few erythematous or hypopigmented plaques

flat centres and raised,demarcated borders

peripheral nerve damage with complete sensory loss

visible enlargement of nerves.

Many erythematous macules,papules or nodule

extensive tissue destruction(e.g:nasal cartilage,bones,ears)

diffuse nerve involvement with patchy sensory loss

lack of nerve enlargement.

Distribution of lesions

Asymmetrical

  Symmetrical

Occurs When

 Infected person  able to mount a robust, cell-mediated immune response to the bacterium

 Infected person unable to mount a cell-mediated immune response to the bacterium

Defined by WHO as

1-5 patches associated with leprosy

 

>5 patches associated with leprosy.

Person Infectious?

No

 

Possibly

PROGNOSIS

Good

Cure from disease possible, however, underlying disease complications (such as limb damage due to infection) may not be reversible or require reconstructive surgery

Lepromin test

Positive

 

Negative

Erythema Nodosum Leprosum

Absent

 

Usually present

Treatment

Paucibacillary leprosy

  • should be treated for 6 months with dapsone 100 mg/day unsupervised plus rifampin 600 mg/ month supervised.

Multibacillary leprosy

  • should be treated for 12 months with dapsone 100 mg/day unsupervised, clofazimine 50 mg/day unsupervised, and rifampin 600 mg plus clofazimine 300 mg/month supervised.
  • Follow-up in paucibacillary leprosy → 2 years
  • Follow-up in multibacillary leprosy → 5 years
  • In paucibacillary leprosy, the multidrug therapy is stopped after 6 months of treatment regardless of the presence of clinically active disease”.
WHO DISABILITY GRADING FOR LEPROSY
Hand and Feet
  • Grade0:no anaesthesia,no visibledeformityordamage.
  • Grade1:anaesthesia present,but novisibledeformity ordamage.
  • Grade2:visible deformityor damagepresent.
Eyes
  • Grade0:no eyeproblem dueto leprosy;no evidenceof visualloss.
  • Grade 1:eye problems dueto leprosy present,but visionnotseverely affected asa result ofthese(vision: 6/60 or better)
  • Grade2:severevisualimpairment(vision:worset THAN 6/60.Lagopathalmos, iridocyclitis and coroneal opacities
Don’t Forget to Solve all the previous Year Question asked on Leprosy:WHO Classification ,WHO Disability grading

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this:
Malcare WordPress Security