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LEPROSY-Details of the disease and treatment
Leprosy is a chronic infectious disease caused by the b bacillus, Mycobacterium Leprae, a slow growing member of the mycobacterium family.
Most people have a natural immunity to the disease, but approximately 4% of any populations have a relative or total lack of such immunity, and if exposed to the germ enough will eventually show some signs of the disease-the degree of involvement depending on the amount of immunity still intact. The immunity is conferred by specific T-cell lymphocytes, which can stimulate the macrophages to produce the necessary chemicals to kill the bacilli. If the T-cells or the macrophages are abnormal or lazy, the bacilli survive and commence multiplying, whilst also producing substances which suppress further efforts to control their growth.
The leprosy bacillus has a preference for cooler temperatures, and for tissues rich in dopamine-namely, skin, nerves and iris. Hence, the ears, nose and peripheral limbs are more heavily invaded by the bacilli, and nerves close to skin are especially vulnerable. Because the host may try to respond to the presence of this invasion, a local tissue inflammatory reaction may occur and this frequently leads to nerve damage, or swelling and redness of the skin. Consequently, the early signs and symptoms of leprosy are skin patches or a rash, or related to nerve involvement-loss of feeling, nerve pain, muscle weakness, dryness.
A wide spectrum of symptoms is possible depending on the immune capabilities-for some patients, there may be only one patch-a dry, anesthetic and hypopigmented area, of ten with a thin lumpy edge. This very localized form is referred to as Tuberculoid leprosy (TT) so named because a biopsy from such a patch resembles the picture seen in tuberculosis. For other patients, with no immune response at all, the bacilli will spread all over the body without hindrance. These patients will suffer from a generalized infiltration, with thickening of ears, nose, and peripheral skin. This is referred to as Lepromatous leprosy (LL). Between the two extremes, there are all sorts of possible skin and nerve patterns produced by a variable but inadequate immune response, and this group may show features of both types simultaneously. It is called Borderline leprosy and it is usually possible to subdivide it into BT or BL types depending on which extreme it more closely resembles.
For convenience of therapy, it is now recommended that only two groups be recognized-a paucibacillary(PB) group consisting of TT and those BT patients with very localized lesions and no bacilli found on skin smear, and a multibacillary groupn(MB), which includes positive-smear BT, widespread BT (even if negative), BL and LL varieties. The current therapy regiment from the WHO expert committee specify that 6 months of MDT (multi-drug therapy) is sufficient for PB cases, whereas a minimum of 12 months treatment is needed for MB cases.
Multidrug therapy (MDT) consists of using 2-3 drugs simultaneously to prevent the emergence of drug-resistant mutants as has occurred in leprosy and tuberculosis over the past 40 years when monotherapy was being used, or dosages wee allowed to drop to inadequate levels. The MDT used for leprosy is Dapsone(DDS), Clofazimine (Lamprene), and Rifampicin.
After contracting leprosy, or after commencing treatment a few patients may suffer from a reaction involving raised nodules on the skin, nerve pain, and fever. They should continue taking MDT but need immediate treatment with anti-inflammatory medicines as prescribed by a knowledgeable leprosy doctor or worker.
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