Leprosy and pregnancy

Short Case LEPROSY IN PREGNANCY

Dr. Ayomi Piyasena

• 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.

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A little taxonomy ….

Kingdom Bacteria

Phylum Actinobacteria

Order Actinomycetales

Suborder Corynebacterineae

Family Mycobacteriaceae

Genus Mycobacterium

Species M. leprae

How get infected?

Bacillus

Host

Virulance

Immunity

Pregnancy

• 2000 diagnosed of leprosy annually• Only 2-3 of them is pregnant • 12th post patum week increased risk of leprae

reactions

CASE HISTORYIntroduction

23 yrs, a House wife, married for 1 year

Presented to the ANC on 6/3/2014 LRMP- 20/9/2013 EDD- 27/6/2014POA- 23+6 Wks

• 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

• 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

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

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

Invest. on this patient

• Hb- 13.7 g/dl• Skin slit test not done• LFT- Normal

TUBERCULOID LEPROSY

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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.

Patient was not aware of pregnancy- Started on PB Regimen

After confirmation of Pregnancy– Started on MB regimen

After 4 months of treatment.

LEPROSY ON FETUS

• Prematurity • Fetal demise• Low birth weight• Increased risk of developing the disease.

• WHO recommends - MDT during pregnancy.

LEPROSY DRUGS ON FETUS

• High doses of rifampicin – Teratogenic ?

• Dapsone – neonatal haemolysis – methaemoglobinaemia.

+ Folic acid

• Clofazimine – discoloration of the skin of breast-fed infants.

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

THANK YOU.