Diagnosis and Management of Leprosy

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which tends to attack peripheral nerves and skin. The diagnosis of leprosy is based on the presence of one of three cardinal signs. Early diagnosis of leprosy is critical and is made through clinical examination and investigation. Purpose: To discuss the diagnosis, laboratory examination, and treatment of leprosy, considering that early diagnosis and appropriate treatment are the key elements in breaking the chain of transmission and preventing leprosy patients' disabilities. Review: Leprosy is a chronic granulomatous infectious disease caused by the Mycobacterium leprae. Based on clinical appearance, histopathology findings, and immunological, leprosy is grouped into six forms using the Ridley-Jopling classification, namely Tuberculoid (TT), Borderline Tuberculoid (BT), Borderline-borderline Mid-borderline (BB), Borderline-lepromatous (BL), Subpolar Lepromatous (LLs), and Polar Lepromatous (LLp). Based on the treatment category, leprosy is grouped into paucibacillary (PB) and multibacillary (MB). Leprosy is often diagnosed clinically, and skin scraping smear remains the preferred laboratory method. The negative results of smear skin scraping may not necessarily exclude leprosy. Therefore, a higher sensitivity test might be needed to detect M. leprae. Treatment with Multi-Drug Therapy (MDT) is adjusted based on the type of leprosy, whether it belongs to the PB or MB group. Treatment of PB type, regimens are rifampicin and dapsone, while in MB type, the patients received rifampicin, dapsone, and clofazimine regimens. Conclusion: A proper diagnosis for leprosy, both through physical examination and laboratory examination, is required to determine an effective MDT treatment and break the chain of disease transmission

Risk Factors For Disability In Leprosy Patients: A Cross-Sectional Study

Abstract Background: The disability in leprosy is caused by M. leprae invasion and infiltration into the skin and the mucous membrane that results in nerve damage and deformities, loss of sensation, paralysis, and ocular manifestation. The risk of disability can be influenced by several factors, including the type of leprosy, disease duration, the number of nerves affected, leprosy reactions, gender, age, type of treatment, socioeconomic factors, and leprosy case detection methods. This study aimed to evaluate the risk factor of disability in leprosy patients. Methods: It was a cross-sectional retrospective analytical study to discover the correlation between risk factors with the grade of disability in leprosy patients who were treated in Dermatovenerology Outpatient Clinic Dr. Soetomo General Hospital Surabaya from 2017 to 2019. Result: This study found a total of 275 leprosy patients with disabilities, consisting of 76 patients (27,6%) with grade-1 disability and 199 patients (72,4%) with grade 2 disability. There was a statistically significant correlation between age (p=0,025), duration of disease (p=0,001), and multidrug therapy (MDT) history (p=0,001) with the incidence of disability. Gender, bacterial index, type of leprosy, and leprosy reaction were not significantly related to disability. Conclusion: This study showed that age, duration of disease, and the history of MDT treatment were related to the incidence of disability. The longer the disease's duration despite the patient having received MDT, the more risk of the patient having a disability