3. • Leprosy is caused by
– Mycobacterium leprae,
a slow-growing
intracellular bacillus
infiltrates the skin, the peripheral
nerves, the nasal and other
mucosa, and the eyes.
• The incubation period - 2 to 10 years
• Affect all ages and both sexes.
4. 4
A little taxonomy ….
Kingdom Bacteria
Phylum Actinobacteria
Order Actinomycetales
Suborder Corynebacterineae
Family Mycobacteriaceae
Genus Mycobacterium
Species M. leprae
7. Pregnancy
• 2000 diagnosed of leprosy annually
• Only 2-3 of them is pregnant
• 12th post patum week increased risk of leprae
reactions
8.
9. CASE HISTORY
Introduction
23 yrs, a House wife, married for 1 year
Presented to the ANC on 6/3/2014
LRMP- 20/9/2013
EDD- 27/6/2014
POA- 23+6 Wks
10. • History of the disease
– Hypo pigmented skin patch over left knee joint for 1
year( gradually increased in size )
– Raised edge for 3 months
– Sensory Impairment
– less hair growth
– not painful
– Dry
– Not itching
– No other lesions
– no weakness
– No change in sensation
– No redness of eyes or vision impairment
11. • PMHx - No History of anaemia, jaundice
• PSHx - NAD
• DHx- Routine Anti natal drugs
• Allergic History - No any allergy for sulpha
drugs
• Contact Hx - diagnosed patient with
lepromatous leprosy in the village
12. 0n Examination
• Not pale
• Hypopigmented skin patch over left knee joint
• Indurated edge
• Sensory impairment
• No papules/ nodules
• No thickned/ tender nerves(common
peroneal)
• No crainial nerve palsies(V, VII)
• UL & LL sensory and motor system
examination normal
13. DIAGNOSIS
• The three cardinal signs for diagnosis of Leprosy
are:
1. Hypo-pigmented or reddish skin lesion(s) with
definite sensory deficit
2. A thickened or enlarged peripheral nerve with
loss of sensation and/or weakness of the
muscles supplied by that nerve
3. The presence of Acid-fast bacilli in slit skin
smears or histopathology
14. Invest. on this patient
• Hb- 13.7 g/dl
• Skin slit test not done
• LFT- Normal
TUBERCULOID LEPROSY
15. 15
Multibacillary (MB or lepromatous) is a 12-month treatment of rifampicin, clofazimine, and dapsone.
Paucibacillary (PB or tuberculoid) is a six-month treatment of rifampicin and dapsone.
16. Patient was not aware of pregnancy
- Started on PB Regimen
After confirmation of Pregnancy
– Started on MB regimen
After 4 months of
treatment.
17. LEPROSY ON FETUS
• Prematurity
• Fetal demise
• Low birth weight
• Increased risk of developing the disease.
• WHO recommends - MDT during pregnancy.
18. LEPROSY DRUGS ON FETUS
• High doses of rifampicin
– Teratogenic ?
• Dapsone
– neonatal haemolysis
– methaemoglobinaemia.
+ Folic acid
• Clofazimine
– discoloration of the skin of breast-fed infants.
19. REFERENCES.
1.) Consequences of the interaction between the
leprosy and pregnancy, Paula Sacha, J Nurs UFPE
on line. 2012 Sept;6(9):2243-9
2.) Pregnancy and Leprosy,A Comprehensive
Literature Review1,Diana N. J. Lockwood and
Hemali H. Sinha‘, 12th November 1998.
3.) Patient.co.uk ,Original Author: Dr Hayley Willacy
Current Version: Dr Colin Tidy
4.)Leprosy in Pregnancy,E. Duncan, Springer, 2012
