Leprosy (Hansen’s Disease)

ByN.SRAVANTHI REDDY (O9DH1ROO34)

Under the supervision of

K.RAMANJANEYULU(Ph.D)

Dept of pharmaceutical chemistry

VIPER

ContentsleprosyCausesClassificationSymptomsRisksTreatment(chemotherapy)DosageAdverse effectsGlobal situationR & DReferences

What is Leprosy?Chronic infectious disease. World's oldest recorded disease ( 600B.C )was well-recognized in the civilizations of

ancient China, Egypt, and India.Gerhard Armauer Hansen

Every year January 27 is World Leprosy Day

CausesCauses

Mycobacterium lepraeRod ShapedFirst bacterium disease in humansHumans and Armadillos are only known natural hosts

M. leprae appear red when a Ziehl-Neelsen stain is used,helps in finding out the acid fast organisms

Classification

Tuberculoid Leprosy (TL)

Borderline Tuberculoid Leprosy (BT)

Borderline borderline Leprosy (BB)

Borderline lepromatous Leprosy (BL)

Lepromatous leprosy(LL)

BASED ON SIZE :

Paucibacillary Leprosy (PB) : skin lesions with no bacilli(M.Leprae) seen in the skin smear

Multibacillary Leprosy (MB): skin lesions with bacilli (M.Leprae)seen in the skin smear

Tuberculoid leprosy:Can be either one large red patch with well-defined

raised borders or a large hypopigmented asymmetrical spot

Lesions become dry and hairless

Loss of sensation may occur at site of some lesions

Enlargement of nerves with subsequent loss of function are common

Spontaneous resolution may occur in a few years or it may progress to borderline or rarely lepromatous types

Borderline tuberculoid

Similar to tuberculoid type except that lesions are smaller and more numerous

Disease may stay in this stage or convert back to tuberculoid form, or progress

Borderline borderline

Numerous, red, irregularly shaped plaques

Sensory loss is moderate

Disease may stay in this stage, improve or worsen

Numerous lesions of all kinds, plaques, macules, papules and nodules. Lesions looking like inverted saucers are common

Hair growth and sensation are usually not impaired over the lesions

Borderline lepromatous

Numerous lesions of all kinds, plaques, macules, papules and nodules

Early symptoms include nasal stuffiness, discharge and bleeding, and swelling of the legs and ankles

Lepromatous leprosy

Left untreated, the following problems may occur:

Skin thickens over forehead (leonine facies), eyebrows and eyelashes are lost, nose becomes misshapen or collapses, ear lobes thicken, upper incisor teeth fall out

Eye involvement causing photophobia (light sensitivity), glaucoma and blindness

Skin on legs thickens and forms ulcers when nodules break down

Internal organ infection causing enlarged liver and lymph nodes

Voice becomes hoarse

What are the symptoms?Paucibacillary (PB) Leprosy

symptoms are:Well defined skin lesions that

are numb

Multibacillary (MB) Leprosy symptoms are:

– Chronically stuffy nose and many skin lesions and nodules on both sides of the body

• Mycobacterium leprare multiplies very slowly• Symptoms can take as long as 20 years to appear

Who is at risk?

Mainly affects:SkinEyes The peripheral nervesMucosa of the upper

respiratory tract

• It can affect all ages and both sexes

Who is at risk?

A 24-year-old man infected with leprosy

Pharmaceutical TreatmentMultiple Drug Treatment (MDT)

•Effective chemotherapeutic agents:Dapsone (diamino diphenyl sulfone, DDS) which was discovered in early 1940’s

Rifampicin (RFP), Clofazimine (CLF) discovered in 1960’s

Ofloxacin (OFLX), and Minocycline (MINO) constitute the backbone of the multidrug therapy (MDT) regimen.

Structure of Dapsone (DDS)

http://images.google.com/imgres?imgurl=http://upload.wikimedia.org/wikipedia/commons/thumb/c/c2/Dapsone.svg/671px-Dapsone.svg.png&imgrefurl=http://commons.wikimedia.org/wiki/Image:Dapsone.svg&h=290&w=671&sz=11&hl=en&start=13&um=1&tbnid=ihM5GO42l13LYM:&tbnh=60&tbnw=138&prev=/images%3Fq%3Ddapsone%26um%3D1%26hl%3Den

About DapsoneIt was dicovered by German chemists

Fromm and Wittmann in 1908Was not utilized as a treatment until

decades laterAvailable in 25mg & 100 mg tabletsRated a pregnancy risk category C by the

American Food and Drug Administration

About RifampicinIn the U.S. Rifampicin is

marketed as:Rifadin (Aventis)Rifater ( in combination with

isoniazid and pyrazinamide) (Aventis)

Rimactane (Novartis)Rated a pregnancy risk

category C by the American Food and Drug Administration

About Clofazimine

Brand Name: Lamprene Generic Name: Clofazimine

Initially known as B663, was first synthesized in 1954 by Dr. Vincent Barry and his team as an anti-tuberculosis drug

Is marketed under the trade name Lamprene® by Novartis

Dosage

http://images.google.com/imgres?imgurl=http://upload.wikimedia.org/wikipedia/commons/thumb/7/71/MDTRegimens.jpg/400px-MDTRegimens.jpg&imgrefurl=http://en.wikipedia.org/wiki/Leprosy&h=258&w=400&sz=24&hl=en&start=15&um=1&tbnid=wA9E8CWvT_HvoM:&tbnh=80&tbnw=124&prev=/images%3Fq%3DMultidrug%2Btherapy%2B(MDT)%2Bregimen%26um%3D1%26hl%3Den

Dosage Cont’d......

RFP Dapsone

Adult 50-70kg

600mg/m* 100mg/d

Child10-14 years

450mg/m* 50mg/d

Less than 10 years

300mg/m* 25mg/d

Multidrug Therapy for Paucibacillary (PB) Leprosy

PB patients treated with MDT are cured within six months*RFP monthly doses are given under supervision

Dosage Cont’d......

RFP Dapsone

CLF

Adult 50-70kg

600mg/m*

100mg/d

50mg/d &300mg/

m* Child10-14 years

450mg/m*

50mg/d

50mg/d &150mg/

m* Less than 10 years

300mg/m*

25mg/d

50mg twice/d

&100mg/m*

Multidrug Therapy for Multibacillary (MB) Leprosy

*RFP and CLF monthly doses are given under supervision

MB patients treated with MDT are cured within 12 months

Cost of MDT

Since 1995, WHO has supplied MDT FREE of cost to all leprosy patients in the world.

Initially drug funds were provided by Nippon FoundationSince 2000, donations are provided by Novartis and the

Novartis Foundation for Sustainable Development

Side EffectsDapsone (DDS)

Rifampicin (RFP)

Clofazimine (CLF)

Occasional cutaneous eruptions

A slight reddish coloration of urine, sweat, and tears

Brownish Black discoloration and dryness of skin

Cases around the World

A 20% annual decrease in new cases detected globally since 2001. the disease has been eliminated from 108 out of 122.

A Day in the Patient’s Life

AN AFFECTIONATE HAND FOR THE NEEDY……….

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JALANETI:

Technique related to yoga.It is the best remedy for nasal stiffness.Normal saline is passed through one nostril and is collected from other , which flushes the micro organisms.

The disease was known in Ancient Greece as elephantiasis

A common pre-modern treatment of leprosy was chaulmoogra oil.The oil has long been used in India as an Ayurvedic medicine for the treatment of leprosy and various skin conditions. It has also been used in China and Burma, and was introduced to the West by Frederic John , a professor at Bengal Medical College. He tried the oil as an oral and topical agent in two cases of leprosy and reported significant improvements in an 1854 paper.

REFERENCES:

Sasaki S, Takeshita F, Okuda K, Ishii N (2001). "Mycobacterium leprae and leprosy: a compendium". Microbiol Immunol 45 (11): 729–36. PMID 11791665. http://www.jstage.jst.go.jp/article/mandi/45/11/729/_pdf.  ^ a b c "New Leprosy Bacterium: Scientists Use Genetic Fingerprint To Nail 'Killing Organism'". ScienceDaily. 2008-11-28. http://www.sciencedaily.com/releases/2008/11/081124141047.htm. Retrieved 2010-01-31.  ^ a b c Kenneth J. Ryan, C. George Ray, editors. (2004). Ryan KJ, Ray CG. ed. Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 451–3. ISBN 0838585299. OCLC 61405904 52358530 61405904.  ^ a b "Lifting the stigma of leprosy: a new vaccine offers hope against an ancient disease". Time 119 (19): 87. May 1982. PMID 10255067. http://www.time.com/time/magazine/article/0,9171,925377,00.html.  ^ Kulkarni GS (2008). Textbook of Orthopedics and Trauma (2 ed.). Jaypee Brothers Publishers. p. 779. ISBN 8184482426, 9788184482423.  ^ "Q and A about leprosy". American Leprosy Missions. http://www.leprosy.org/getinformed/aboutleprosy/leprosyfaq.php. Retrieved 2011-01-22.

17 - PRABHAKAR, M.C.; APPA RAO, A.V.N.; KRISHNA,D.R.; RAMANAKAR, T.V. How much noninfectious

are the"non-infectious" lepromatous leprosy patients?

Leprosy- India, 55(3): 576-583, 1983.ESSENTIALS OF MEDICAL PHARMACOLOGY BY K.D.TRIPATHI.