leprosy in Indonesia, a review

1. Leprosy in Indonesia
Fadel Muhammad Garishah, MD
Department of General Medicine

2. Overview of Leprosy
 Leprosy is a disease caused by Mycobacterium leprae, a bacterium
which primarily affects the skin and peripheral nerves.
 Mode of transmission is considered to be air-borne, through
droplets discharged from the respiratory tract of untreated
infectious cases
 The disease causes stigma and those affected can be victims of
discrimination and often displacement.
 Physical and neurological damage may be irreversible even if cured.

3. Epidemiology
 In 2011, the Ministry of Health Republic of
Indonesia reported 20.023 new leprosy cases or
8.3 in 100,000 population

5. Mycobacterium leprae
• Mycobacteria genus
• Acid-Fast Bacili
• Difficult to be cultured;
Inoculated in Armadillo skin

6. Spectrum of Disease

7. Immunity Profile to Disease Outcome
Leprosy
Lepromatous
Borderline
Tuberculoid
Humoral
Immunity
Cellular
Immunity

8. Treatment
Leprosy
Paucibacillary (PB)
Multibacillary
(MB)

9.  Paucibacillary (PB): the number of M. leprae in the
body is small (less than 1 million) and a skin smear test
is negative. The patient presents five or fewer skin
lesions. Most cases of leprosy are PB.
 Multibacillary (MB): M. leprae can multiple in the
body almost without any check and is thus present in
high numbers. The bacillus has likely spread to almost
all areas of skin and peripheral nerves. A skin smear
test is positive and the patient presents more than five
skin lesions.

10. Bacterial Index
Acid Fast Bacilli Bacterial Index
> 1000 > immersion field 6 +
100 – 1000/field 5 +
10 – 100/field 4 +
1 – 10 3 +
1 – 10/10 field 2 +
1 – 10/100 1 +
0/100 0

11. Skin Lesion: Hypopigmented
Hypoesthesia Maculae

13. Disability

14. Diagnostic
 Hypopigmented or reddish patches with definite
loss of sensation
 Thickened peripheral nerves
 Acid-fast bacilli on skin smears or biopsy material

15. Pharmacology
 Dapsone (Bactericidal) by preventing of formation
of folic acid, inhibiting bacterial growth.
 Rifampicine Inhibits DNA-dependent bacterial RNA
polymerase.
 Clofazimine (Lamprene) Inhibits mycobacterial
growth, binds preferentially to mycobacterial DNA.

16. After 6 months MDT Tx
However, damaged nerves and tissues cannot regrow. Thus, if left
untreated for too long, disfigurment from leprosy can be permanent,
unless it can be repaired with reconstructive surgery.

18. PB Single Lesion
 Rifampicin 600 mg
 Ofloxacin 400mg
 Minocycline 100 mg
Single Dose

19. PB >5 Lesions
 6 – 9 months
 Day 1 Rifampicin 600mg and Dapson 100 mg
 Day 2 – 28 Dapson 100 mg

20. MB
 12-18 months
 Day 1: Rifampicin 600 mg, Dapson 100 mg/
Clofazimine 300 mg
 Day 2 -28: Dapson 100 mg, Clofazimine 50mg

21. Leprosy Reactions
 Reversal reactions
 Erythema Nodosum Leprosum

22. Reversal Reaction
 Mild: analgesics, sedatives, Chloroquin base
150mg TID 3-5 days
 Severe: Prednison/prednisolon/analgesics,
sedatives

23. Prednisolon 10 mg TID or
 Week 1 and 2 : 40 mg/day
 Week 3 and 4: 30 mg/day
 Week 5 and 6: 20 mg/day
 Week 7 and 8: 15 mg/day
 Week 9 and 10: 10 mg/day
 Week 11 and 12: 5 mg/day

24. Prednison 40-60 mg/day
 2 weeks I 30 mg/day (1x 6 tab)
 2 weeks II 20 mg/day (1x4 tab)
 2 weeks III 15 mg/day (1x3 tab)
 2 weeks IV 10 mg/day (1x2 tab)
 2 weeks V 5mg/day (1x1 tab)

25. Erythema Nodosum Leprosum
 Thalidomide 100-400mg/day
 Prednisolon
 30-40 mg/day 1-2 weeks
 Decrease 5-10 mg/2 weeks
 Clofazimine 300mg (3x100mg) 1 months 4-6
weeks, no more than 3 months
 Decrease 2 x 100 mg/ day 1 months
 1 x 100mg/day 1 months
 50 mg/day