Pharmacotherapy of Leprosy
PST 06106
Basic Pharmacotherapy
Session 6: Pharmacotherapy of Leprosy
11/11/2020
Pharmacotherapy of Leprosy
Learning Task
By the end of this session students are expected to be able to:
Define leprosy
Explain pathophysiology of leprosy
Explain the clinical presentation of leprosy
Outline diagnosis of leprosy
Describe pharmacological treatment of leprosy
Describe monitoring of leprosy therapy
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Pharmacotherapy of Leprosy
Activity: Small Group Discussion
•
What
is the first line treatment of Pneumonia?
Definition of Leprosy
Leprosy is a chronic infectious disease caused by
Mycobacterium
leprae
(M.
leprae
).
It mainly affects the
skin, peripheral nerves, and mucous membranes.
It is a disease mainly of human beings, which affects
people of all races, all ages, and both sexes.
Similar to TB, leprosy bacilli are mainly transmitted through
infectious droplets that are spread by an infectious individual through coughing and sneezing.
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Pharmacotherapy of Leprosy
Definition
of Leprosy
Cont.…
Patients
carrying many leprosy bacilli are called multibacillary (MB) patients. They are the main source of infection.
People may carry the bacilli but not develop the disease.
These people, called healthy carriers, are also probably able to transmit the bacilli to others.
Individuals with few bacilli in their body are called paucibacillary (PB).
Like healthy carriers, they are not a significant source of infection
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Pharmacotherapy of Leprosy
Pathophysiology of Leprosy
Onset of leprosy is insidious.
The disease affects nerves, skin and eyes.
It may also affect mucosa (mouth, nose, pharynx), testes, kidney, voluntary/smooth muscles,
reticulo
-endothelial system, and vascular endothelium.
Bacilli enter the body usually through respiratory system.
It has low
pathogenicity,
only a small proportion of infected people develop signs of the disease.
Though infected, majority of the population do not develop the disease.
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Pharmacotherapy of Leprosy
Pathophysiology of
Leprosy Cont.…..
After entering the body, bacilli migrate towards the neural tissue and enter the Schwann cells. Bacteria can also be found in, macrophages, muscle cells and endothelial cells of blood vessels. After entering the Schwann cells /macrophage; fate of the bacterium depends on the resistance of the infected individual towards the infecting organism.
Bacilli start multiplying slowly (about 12-14 days for one bacterium to divide into two) within the cells, get liberated from the destroyed cells and enter other unaffected cells.
Till this stage person remains free from signs and symptoms of leprosy
.
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Pharmacotherapy of Leprosy
Pathophysiology of
Leprosy Cont
.…..
As the bacilli multiply, bacterial load increases in the body and infection is recognized by the immunological system.
Lymphocytes and
histiocytes
(macrophages) invade the infected tissue.
At this stage clinical manifestation may appear as involvement of nerves with impairment of sensation &/ or skin patch.
If it is not diagnosed and treated in the early stages, further progress of the diseases is determined by the strength of the patient’s immune response
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Pharmacotherapy of Leprosy
Pathophysiology of Leprosy Cont.…..
Specific and effective cell mediated immunity (CMI) provides protection to a person against leprosy.
When specific CMI is effective in eliminating/ controlling the infection in the body, lesions heal spontaneously or it produces
pauci
-bacillary (PB) type of leprosy.
If CMI is deficient; the disease spreads uncontrolled and produces multi bacillary (MB) leprosy with multiple system involvement.
Some times, the immune response is abruptly altered, either following multiple drug treatment (MDT) or due to improvement of immunological status, which results in – 12 – the inflammation of skin or / and nerves and even others tissue, called as leprosy reaction
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Pharmacotherapy of Leprosy
Clinical presentation and Diagnosis of Leprosy
The diagnosis of leprosy
The diagnosis of leprosy relies on both passive and active case-finding.
Clinical diagnosis.
This is achieved through observation of signs or symptoms of leprosy which includes;
One or more pale or reddish, hypo-pigmented patch(
es
) on the skin with diminished or loss of sensation.
Painless swelling or lumps in the face and/or earlobes.
Enlarged and/or tender nerves.
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Pharmacotherapy of Leprosy
Clinical presentation
Cont.….
Burning sensation of the skin.
Numbness or tingling of hands and/or feet.
Weakness of eyelids, hands, and/or feet.
Painless wounds or burns on the hands and/or feet.
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Pharmacotherapy of Leprosy
Clinical presentation and Diagnosis of
Leprosy Cont.…
Examination of other organs
:
Leprosy can affect a few organs other than skin and peripheral nerves.
Depending on the duration of the disease and the spread of leprosy through the body, various other organs may show signs typical for leprosy
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Pharmacotherapy of Leprosy
Activity: Small Group Discussion
•
What
is the first line treatment of Leprosy??
Pharmacological Treatment Of Leprosy
Treatment regimens
The drugs and dosages for PB and MB for both adults and children are shown below
:
Adults (MB)
Monthly treatment: Day 1
Clofazimine
Dapsone
100
mg
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Pharmacotherapy of Leprosy
Pharmacological Treatment Of
Leprosy Cont.….
Daily treatment: Days 2–28
Clofazimine
Dapsone
Duration of treatment
12 blister packs to be taken within a period of 12-18 months
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Pharmacotherapy of Leprosy
Pharmacological Treatment Of
Leprosy
Cont
…
Children 10-14 years (MB)
Monthly treatment: Day 1
Clofazimine
Dapsone
Daily treatment: Days 2–28
Clofazimine
Dapsone
Duration of treatment
12 blister packs to be taken within a period of 12-18 months
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Pharmacotherapy of Leprosy
Pharmacological Treatment Of Leprosy
Cont
…
Adults (PB)
Monthly treatment: Day 1
Dapsone
Daily treatment: Days 2–28
Dapsone
Duration of treatment
Six blister packs
to be taken within a period of 6–9 months.
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Pharmacotherapy of Leprosy
Pharmacological Treatment Of Leprosy
Cont
…
Children 10-14 years (PB)
Monthly treatment: Day 1
Dapsone
Daily Treatment: Days 2–28
Dapsone
Duration of treatment
Six blister packs to be taken within a period of 6–9 months.
Note:
Adjust the dose appropriately for a child (PB) younger than 10 years. For example,
dapsone
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Pharmacotherapy of Leprosy
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Pharmacotherapy of Leprosy
Monitoring of Leprosy Therapy
Treatment monitoring
Multi Drug Therapy
(MDT)
should be provided to the patient as close to the patient’s home as possible
Based
on
the geographic distribution of health facilities, the availability of trained staff, and the patient’s wish, the health worker and/or
District Tuberculosis and Leprosy Coordinator(DTLC)
decides where
Multi Drug Therapy
should be delivered. In principle, every health facility should be able to provide MDT
Staff need to be trained on leprosy management as described in the
National Tuberculosis and Leprosy Programme(NTLP)
training
manual for
health workers
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Pharmacotherapy of Leprosy
Monitoring of Leprosy
Therapy Cont.…
Patients should have access to treatment on any day immediately after finishing the blister pack, but they should be given an appointment to attend a fixed clinic day in order to be reviewed and assessed by a trained health worker or DTLC
The trained health worker or DTLC should arrange leprosy clinics every three months
The DTLC, in collaboration with the district pharmacist, is responsible for the supply of MDT drugs and drugs for treating reactions
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Pharmacotherapy of Leprosy
Monitoring of Leprosy Therapy Cont.…
There should always be a minimum of three blister packs in stock for every patient attending the clinic at any given time
Under normal circumstances patients should not be given more than a one-month drug supply (one blister pack)
Those patients who cannot come on monthly basis to a health facility due to problems such as long distance, impassable roads during the rainy season, nomadic lifestyle, etc., may be given drugs for more than one month, sufficient to cover the expected period of absence
Under exceptional circumstances, a full course supply can be
given
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Pharmacotherapy of Leprosy
Monitoring of Leprosy Therapy Cont.…
When patients are given more than a one-month supply, it is better to involve a formal or informal community leader or relative who will then be oriented to support the patient to complete the full course of treatment (accompanied MDT
Each
time a patient comes to a health facility to collect an MDT blister pack, a health worker should ask the patient about new complaints regarding nerve function impairment.
If there are any complaints, the health worker should conduct nerve function tests to assess for
damage
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Pharmacotherapy of Leprosy
Monitoring of Leprosy Therapy Cont.…
If there are indications of nerve damage, the patient should be managed appropriately
In case of uncertainty, the health worker should refer the patient to the DTLC
The health staff is also responsible for tracing a patient who does not attend for two consecutive months
When the patient is found, she/he should be persuaded to continue with treatment
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Pharmacotherapy of Leprosy
Key Points
Leprosy
is caused by a slow-growing type of bacteria called Mycobacterium
leprae
(M.
leprae
)
The disease mainly affects the skin, the peripheral nerves, mucosal surfaces of the upper respiratory tract and the eyes.
The main symptom of leprosy is disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored.
The disease was transmitted by contact between cases of leprosy and healthy persons.
Leprosy is curable with a combination of drugs known as multidrug therapy (MDT)
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Pharmacotherapy of Leprosy
Evaluation
What
is Leprosy?
What are the signs and symptoms of Leprosy?
What is the pathophysiology of Leprosy?
What is the treatment of leprosy?
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Pharmacotherapy of Leprosy
References
Wells
BG,
DiPiro
J,
Schwinghammer
T (2013),
Pharmacotherapy Handbook
(6
th
Ed). New York, NY: McGraw-Hill.
DiPiro
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach
(7
th
ed
): New York, NY: McGraw-Hill.
Katz
M D.,
Matthias KR.,
Chisholm-Burns M A.,
Pharmacotherapy(2011)
Principles & Practice Study Guide: A Case-Based Care Plan Approach
:
New York, NY:
McGraw-Hill.
Schwinghammer
TL, Koehler JM (2009)
Pharmacotherapy Casebook: A Patient-Focused Approach
(7
th
ed
): New York, NY: McGraw-Hill
.
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End
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Pharmacotherapy of Leprosy
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