Cure Leprosy

Leprosy, also known as Hansen's disease, is a chronic bacterial skin infection caused by Mycobacterium leprae or the more recently discovered Mycobacterium lepromatosis. Leprosy mainly affects the skin, peripheral nerves, upper respiratory tract, eyes, and testes. Left untreated, leprosy will progress to cause permanent damage to skin, nerves, limbs, and eyes; body parts will become numb and disfigured.

Leprosy has afflicted mankind from antiquity and is well-recognized in the ancient civilizations of China, Egypt, and India; with the introduction of antibiotics against leprosy in the twentieth century, leprosy is now a curable disease.

Steps

 * 1) Seek care early. If left untreated, leprosy may progress to cause permanent damage to the skin, nerves, limbs and eyes.
 * 2)  [[Image:Dapsone_83.JPG|thumb|Dapsone]]Take dapsone, rifampicin, and clofazimine for twelve months. This regimen is known as multidrug therapy (MDT), which is necessary to minimize the risk of antibiotic resistance. When dapsone was used alone to treat leprosy, resistance soon developed and became widespread. This combined drug regimen is highly effective, with low relapse rate, and no known resistance cases. Paucibacillary, or tuberculoid, leprosy may be treated by dapsone and rifampicin alone, for a shorter duration of six months. The specific recommended MDT dosing regimen per the World Health Organisation (WHO) is as follows:
 * 3) *Paucibacillary, or tuberculoid, leprosy: ≤ 5 skin lesions with no bacteria detected on samples from those areas. Tuberculoid leprosy is characterized by one or more hypopigmented skin macules (macules are flat lesions on skin distinguished from surrounding normal skin only by colour), anaesthetic patches, where skin sensations are lost due to peripheral nerve damage from attack by human host's immune cells, positive Lepromin test, and few acid-fast bacilli on skin biopsies.
 * 4) **Adult: Dapsone 100 mg daily; Rifampicin 600 mg once a month; for six months.
 * 5) **Child: Dapsone 50 mg daily; Rifampicin 450 mg once a month; for six months.
 * 6) *[[Image:Leprosy.jpg|thumb|A 24-year-old man infected with leprosy. In lepromatous leprosy, affected individuals characteristically have "leonine facies".]]Multibacillary, or lepromatous, leprosy: ≥ 6 skin lesions, bacteria detected on samples from skin lesions, or both. Lepromatous leprosy is characterized by widespread symmetric skin lesions of nodules, plaques, thickened dermis, frequent involvement of the nasal mucosa resulting in nasal congestion and nose bleeding, negative Lepromin test, and many acid-fast bacilli on skin biopsies.
 * 7) **Adult: Dapsone 100 mg daily; Clofazamine 50 mg daily and 300 mg once a month; Rifampicin 600 mg once a month; for twelve months.
 * 8) **Child: Dapsone 50 mg daily; Clofazamine 50 mg daily and 150 mg once a month; Rifampicin 450 mg once a month; for twelve months.
 * 9) In the United States, you may treat leprosy with a different regimen:
 * 10) * For multibacillary leprosy: take rifampicin 600 mg daily and dapsone 100 mg daily for three years, then continue dapsone indefinitely for lepromatous leprosy and for ten years for borderline leprosy.
 * 11) * For paucibacillary leprosy: take rifampicin 600 mg daily and dapsone 100 mg daily for six months, then continue dapsone for three years for tuberculoid leprosy and for five years for borderline leprosy.
 * 12)  Optionally, treat single lesion leprosy with a single dose consisting of rifampicin, ofloxacin, and minocycline (ROM). This is efficacious and cost-effective.
 * 13) Drink plenty of water. Drinking plenty of water helps the body eliminate the toxins produced by the leprosy-causing bacteria.
 * 14) Treat leprosy relapse. The relapse rate varies from 0.65-3.0% for paucibacillary leprosy and 0.02-0.8% for multibacillary leprosy. Treat relapse as follows:
 * 15) *If relapse after a course of MDT: start another course of MDT.
 * 16) *If relapse after dapsone monotherapy: start MDT.
 * 17) *If relapse after dapsone monotherapy followed by MDT using dapsone and rifampicin only: take clofazimine 50 mg daily for 24 months, plus two of the following drugs for six months: ofloxacin 400 mg daily, minocycline 100 mg daily, or clarithromycin 500 mg daily; followed by ofloxacin 400 mg daily or minocycline 100 mg daily for the remaining 18 months.

Video
Video about leprosy patients in India

Video
Informative video about the impact of leprosy and the importance of early treatment

Tips

 * MDT is safe, effective, and available free of charge to all lepers from anywhere in the world.
 * It is extremely important to take all three drugs during treatment period to cure leprosy. Taking only one drug could lead to rapid development of resistance.
 * The three drugs in the MDT act via different mechanisms against M. leprae:
 * Dapsone is a sulfonamide that acts by inhibition of bacterial synthesis of dihydrofolate (DHF) (a necessary substrate for DNA synthesis), through competition with para-amino-benzoate for the active site of dihydropteroate synthetase. Dapsone also has anti-inflammatory effects via inhibition of neutrophilic myeloperoxidase.
 * Rifampicin inhibits the DNA-dependent RNA polymerase in M. leprae, by binding its beta subunit, thus preventing transcription to RNA and subsequent translation to proteins.
 * Clofazimine works by binding to the guanine bases of DNA in M. leprae, thereby blocking the template function of the DNA and inhibiting bacterial proliferation. It also increases activity of bacterial phospholipase A2, leading to release and accumulation of lysophospholipids,  which are toxic and inhibit bacterial proliferation.
 * Note that the alternative therapy used in the United States differs from the standard regimen recommended in that rifampicin is used daily instead of monthly. Unlike dapsone, which is cheap, rifampicin is too expensive to use daily in most countries of the world outside the United States.
 * Also note that for the alternative regimen used in the United States, dapsone monotherapy is used after completion of MDT. According to the WHO, this is wholly unnecessary, and is used mainly to ensure follow-up and satisfy those patients unwilling to discontinue treatment. Although dapsone monotherapy after MDT completion may be used in certain treatment centers, it is to be discouraged.
 * Leprosy is transmitted via droplets from the nose and mouth during close and frequent contacts with untreated lepers. Avoid contact with bodily fluids from and the rash on lepers.
 * The leprosy incubation time (from contact with lepers to start of symptoms) ranges between six months to ten years, with an average of 5 to 7 years. The causative organism of leprosy, M. leprae, has a very slow growth rate (doubling time of 2 weeks).
 * With adequate treatment, quarantine is unnecessary, as the disease is made much less contagious with treatment, and no longer contagious after one month of therapy.
 * To prevent leprosy after contact with lepers, you may take a single dose of rifampicin, which has been found to reduce the rate of leprosy in contacts by 57% in two years, with a number needed to treat of 265 (i.e. 265 persons are needed to be treated to prevent one case of leprosy).
 * BCG may offer some protection against leprosy and tuberculosis, and is useful in places where either disease is prevalent.
 * Due to longstanding stigma associated with leprosy (in biblical times, for instance, lepers are pronounced as uncleaned, quarantined, and shunned), leprosy may cause significant anxiety and social problems in those afflicted with this disease. Seek support from family and friends, and seek psychological therapy if necessary.
 * [[Image:Prednisone 2D skeletal.png|thumb|right|200px|Structure of prednisone. Use of corticosteroids, such as prednisone 40-60 mg per day, is first-line treatment for Type 1 lepra reactions.]]Be aware that leprosy reactions may develop in both untreated and treated cases of leprosy. Type 1 reactions, which result from a spontaneous increase in cell-mediated immunity, can cause fever and inflammation of pre-existent skin and peripheral nerve lesions, resulting in swelling, redness, and tenderness and worsening nerve function. Type 1 reactions are also known as reversal reactions, as the immune system is increased in this reaction, as opposed to decreased in the natural progression of leprosy from tuberculoid to lepromatous. Treat Type 1 reactions with systemic corticosteroid, such as prednisone 40-60 mg (adults) or 1 mg/kg (child) per day initially, then maintain at a lower dose of 10-15 mg per day for a few months. For Type 1 reactions unresponsive to prednisone, consider applying tacrolimus 0.1% ointment to affected skin, which has documented efficacy.
 * Type 2 reactions, also known as erythema nodosum leprosum (ENL), are systemic inflammatory reactions affecting vessels and fatty layer under the skin, probably involving deposition of immune complex or increased T-helper cell function. ENL has become less common since the addition of clofazimine to the drug regimen. Type 2 reactions can cause red, painful, elevated skin lesions that may express pus and ulcerate, fever, inflammation of nerves, lymph nodes, testes, joints (particularly in large joints, usually knees), and kidneys, destruction of red cells or bone marrow suppression, leading to anemia, and liver inflammation, which may cause mild abnormalities in liver function tests. Treat mild cases of ENL with aspirin, and severe cases with prednisone 40-60 mg per day plus antibiotics. For recurrent cases, take thalidomide 100-300 mg per day. Avoid thalidomide in pregnancy, as it is a potent teratogen. Side effects of thalidomide includes mild constipation, mild leukopenia (decrease in white cell count), and sedation.
 * The rationale for the treatment of leprosy relapse is as follows. It is often difficult to test for drug resistance, especially in resource-poor countries. Thus, if monotherapy was ever used, such as treatment by dapsone alone, the leprosy relapse is assumed to be resistant to the monotherapy used. MDT is considered adequate, if leprosy is treated with two or more drugs, to which the case is not resistant, simultaneously. If leprosy recurs, or relapses, after adequate MDT, it may simply be treated by MDT again, just as a new leprosy infection. In the case of relapse following dapsone monotherapy, the relapse is considered dapsone-resistant, but MDT containing rifampicin and clofazimine can be used, because neither of these agents have been used before. For relapse after dapsone monotherapy, followed by MDT using dapsone and rifampicin only, the leprosy is considered dapsone-resistant, because dapsone monotherapy was used. Furthermore, since MDT using dapsone and rifampicin only was used after dapsone monotherapy, the course of treatment with MDT using dapsone and rifampicin only was essentially rifampicin monotherapy, because the case was already dapsone resistant. This render the leprosy relapse rifampicin-resistant as well, so a new set of three-drug regimen is needed.
 * You may call the National Hansen's Disease Program in Baton Rouge, LA. at 1-800-642-2477 for questions about diagnosis and treatment.

Warnings

 * Do not take only one drug instead of the MDT combination, or else resistance may develop rapidly, making it much harder to cure.
 * Side effects of dapsone includes hemolytic anemia (which are generally mild, but potentially severe in persons with glucose-6-phosphate dehydrogenase deficiency), allergic dermatoses (which can be severe), and, rarely, dapsone syndrome, consisting of exfoliative dermatitis, high fever, mononucleosis-like white blood cell differential (predominance of lymphocytes).
 * Side effects of rifampicin include liver toxicity, flu-like illnesses, and, rarely, low platelets and kidney failure. Rifampicin can cause bodily fluids, such as urine and tears, to turn orange-red in colour, a benign but sometimes frightening side-effect. The orange-red colour may permanently stain soft contact lenses. Rifampin also induces microsomal cytochrome P-450 enzymes, liver enzymes that metabolize a variety of drugs, including corticosteroids, warfarin (Coumadin), and oral birth control pills, requiring increasing the doses of these drugs when taken concurrently with rifampicin. For example, if the dose of warfarin is not increased in a leper on long-term anti-coagulation with warfarin, the risk of thromboembolism may increase. Similarly, oral contraceptives may become less effective if their dosage is not increased when rifampicin is used concurrently.
 * The main side effect of clofazimine is temporary skin pigmentation. This may cause cosmetic problems in light-skinned lepers, as it tends to cause a red-black skin discoloration that accumulates particularly in areas of the skin affected by leprosy, making the leper's disease obvious to others.
 * This article is meant as a guide, and should not in any way replace the advice of your health care provider. If you think you have leprosy, please seek professional advice promptly.

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