Department of Health Library Services ePublications - Historical Collection
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Northern Territory Department of Health Library Services Historical Collection
LEPROSY
ITS TREATMENT AND MANAGEMENT
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HISTORICAL COLLECTION
IN THE NORTHERN TERRITORY OF AUSTRALIA
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L E P R O S Y
SHORT NOTES ON
Epidemiology
Leprosy Management Deformity in Leprosy Leprosy Control
Hansolar Medication
Use of Selsun for Pityriasis
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IDEPARTMENT OF HEALTH, Northern Ter ritory, DARWIN
1981
E P I D E M I O L O G Y Leprosy is caused by a bacillus - MYCOBACTERIUM LEPRAE.
Most people who come in contact with infectious leprosy are capable of controlling its spread within the body.
Droplet spread from infectious cases is probably responsible for most secondary cases although some may occur from skin to skin contact.
Opportunity for infection is the most important factor in determining who becomes infected.
Patients are quickly rendered non-infectious after short courses of bacteri- cidal drugs. Spread therefore occurs BEFORE diagnosis. Isolation does not achieve control.
Vaccination against leprosy is a hope for the future although B.C.G. may have modified some endemics.
L E P R O S Y M A N A G E M E N T
Most pati_ents treated qt periphery as outpatients
Admit to H.D. Hospital
Contacts surveiilance -
Pregnancy - delivery
Any diet
C Patients for investigation ( Patients in reaction
( Pati'ents drug staoi'lisation or changes·
( Drug sen.s-i'tivity.-
( Reconstructive surgery patients
( Patients with peripheral neFve lesions
Review 3/12 - 6/12 - 1 year Children BC G vaccination
Continue treatment
Physiological depression 0f cell-mediated :immunity during pregnancy
Upsurge of cell-mediated immunity after delivery may result in Type I (Lepra) reactions
Correct anaemia, parasitic infecti'on, any intercurrent disease
2
DRUGS SUL PHONES
DDS - Dapsone - Di-Amino+ Di-phenyl+ Sulphones
Usual Adult dose 50 - 100 mgm daily for 7 days of the week
(
DADDS( Acedapsone
( Hansolar (Parke Davis)
Repository sulphone, Suspended in
Usual dose
every 6
(benzyl (castor 1.5 ml=
Children 12 weeks
Di-Acetyl
benzoate
releases oil
225 mgm
1.0 ml = 150 rngm
Blood levels of 30 - 50 Nanograms/rnl
Sulphone resistance occurs with DD s and DADD s
Side Effects : Haemolytic anaemia Agranulocytosis Methaemoglobinaemia Dermatitis
D D S
( D D s
( M A D D S
"Reactions" are NOT toxic side effects but due to immunological complications
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CLOFAZIMINE A widely used, valuable anti-inflammatory, anti-leprosy drug.
Synonyms: B66J or LAMPRENE
Rimino-phenazine nucleus (phenazine dye).
Bacteriostatic in doses 100 mgm daily same as DDS
Steroid effect after 2 - 3 months in doses of 300 - 400 mgm
Discolouration of mucous membranes and skin. No problem in dark pigmented races. Half life in mice approximately 70 days.
Deposited throughout the body as intra-cellular micro crystals.
Prolonged treatment with JOO - 400 mgm ( 10 - 12 months) ·may result in tropical sprue symptoms with fatty diarrhoea and collicky type
intermittent pain from intestinal tract. Symptoms disappear within a few weeks after medication ceased and treatment for tropical sprue.
4
RIFAMPIC IN
Bactericidal, much "faster" than DDS Penetrates into nerves and,
crosses the blood-brain barrier (like Isonazid).
Capsules Capsules
150 mgm 300 mgm
Usual daily dose 450 - 600 rngm
BUT, for: impaired renal function impaired liver function elderly
underweight
USE: 8mgm/per Kg body weight
otherwise: 10 mgm/ per Kg body weight
Absorption better if taken t hour before breakfast on empty stomach.
Peak serum level after 2 4 hours.
Metabolised in the liver to its Di-acetyl form.
Excreted in the bile.
Side Effects: Connnonest: Dyspepsia, nausea, vomiting
Hepato-toxicity - jaundice - abnormal liver function tests alcoholics - previous liver disease elderly.
"Flu-like" symptoms - fever, nausea, myalgia Purpura, leucopenia, thrombocytopenia.
Not advisable to use intennittently.
Allergic skin rashes - pyrexia.
May colour urine and body fluids red (Pleural effusion)
The "Pill" effect is reduced (breakdown of estrogen component 4 times faster). Increased doses of anticoagulants may be necessary to maintain anticoagulation i.e. effects the prothrombin time.
PAS and phenobarb decrease serum levels of Rifampicin.
SULPHONE RESISTANCE (20% of Carville's 300 patients)
(3% of Northern Territory's multibacillary cases)
Danons tra ted by: Mouse footpad technique (Charles Shepard 1960)
Causes: Irregular + intermittent treatment Inadequate drug intake
Size of dose comes in
e.g. DDS resistance at 0.1 mgm/Kg of body weight DDS sensitivity at 1 mgm/Kg of body weight
Multiple drug therapy is recorrrnended: e.g. Rifampicin Clofazimine DDS
Some countries also use:
6
Thiacetazone
Thiosemicarbazone ethionamide Thiambutasine (DPT)
/
AETIOLOGY
PRIMARY
DEFCBfITIES
SEXXN)ARY
DEFCEMITIES
MANAGEMENT
D E F O R M I T Y I N L E P R O S Y Aetiology and Management
Deformity in leprosy has been classified according to its pathogenesis as primary and secondary. Primary deformity has been attributed directly to the disease process. Secondary deformity is the consequence of primary damage to nerves.
Nerve
I
Involvement
Paralysis
Contractures
Cosme 1c
It.
IEye D e ormf
I
i ies ·t·· Deformities Complications in reaction
Anae thesia
Callosities Absorption of digits
Trophic ulcers Neuropathic
joints
Anhid osis
Ichthyotic skin
Early detection and treatment heals leprosy and prevents deformities. Most primary deformities occurring during the active phase of the disease like leprides,nodules and eye complications subside with proper treatment. The more permanent cosnetic deformities, such as loss of eyebrows and various deformities of the nose, are correctable by plastic surgery.
Leprosy neuritis is amenable to chemotherapy. Surgical fntervention in selected cases and can be aided by physiotherapeutic methods.
Secondary deformities following established paralysis is managed largely by physiotherapy and reconstructive surgery.
Contractures are prevented by exercises and corrected by serial splinting.
need to learn simple methods of prevention by insulation, protection and distribution of pressure. Treatment of wounds in insensitive hands and feet is based on the principle of rest. Splinting the wounded finger and immobilising the wounded foot is essential to healing.
Protective footwear such as microcellular rubber sandals are provided to prevent recurrence of plantar ulcers.
Long periods of immobilisation should be tried on the neuropathic foot before surgical intervention.
Dry, ichthyotic skin needs to be hydrated, callouses pared down and the water sealed in with oil or grease.
Leprosy can be cured, deformity can be prevented and corrected.
8
LEPROSY CONTROL
The Leprosy Control Unit of the Northern Territory is situated in Darwin.
Records of all past and present registered leprosy patients, their families and contacts, together with those of people with any suspicious signs who are under surveillance or investigation for leprosy are kept there.
Although patients are classified as cured when there are no signs of active disease, they are maintained on an "inactive" register. "Active" cases are kept on an active register. Details of their current treatment are also maintained in the same office.
Aboriginal Health Workers and nursing sisters throughout the Northern
Territory conduct regular screening· of the population and data is processed by the Leprosy Control Unit. However, it ranains the responsibility of the regions to look after their own patients and to ensure regular screening and surveillance.
The Hansolar injection dates are done by computer. These are forwarded to the appropriate areas monthly. Their maintenance depends on a rapid feed- back of information from the rural areas about where patients are and when they had their last injections. Communication is the key word in such a vast area as the Northern Territory.
The Leprosy Control Unit functions as a clearing house for requests for special footwear, prostheses, general information, incoming skin smears, outgoing
laboratory results, etc.
Regular clinics are held each Friday morning at various urban health centres, thus local people can be seen close to their homes and these clinics also function as a reference point.
Another important function of the Leprosy Control Unit is to ensure regular surveillance of the whole Northern Territory although the two locally based sisters deal specifically with the northern region. They function on a
The major platform of leprosy control is directed towards responsibility for leprosy patients and for screening through the Aboriginal Health Worker system. This is important because they are the people who are long-term staff and who know the people in their areas adequately. However, they should not be pressurised into examining people with whom it is customarily and traditionally unacceptable for them to associate.
We stress to all Health Workers the need for confidentiality in dealing with all leprosy records.
10
H A N S O L A R M E D I C A T I O N F O R L E P R O S Y P A T I E N T S Not every leprosy patient needs medication. Some may only need observation and care of anaesthetic limbs and eyes. It is important that those on medication should receive it regularly.
RELAPSE has occurred in a small proportion of patients who have had prolonged irregular treatment. Bacilli, resistant to the drug may also develop if
treatment is irregular. When patients, who need to remain on continuing treatment become irregular with oral Dapsone, or other oral drugs, their medication is generally changed to long-acting IMI HANSOLAR by the
Leprologist.
HANSOLAR which releases only a small amount of sulphone into the blood stream, could produce resistance if given irregularly. It is therefore important that Hansolar injections be given within the time limits available
(6 - 12 weeks) although it is normally ordered 6 weekly in the Northern Territory.
HANSOLAR is distributed in multi-dose vfa·ls; due to the difficulty in obtaining Hansolar from overseas, and in an effort to economise, the life of Hansolar is to be considered to be ONE MONTH after withdrawal of the first dose. Hansolar does not need to be stored under refrigeration, and requires THOROUGH SHAKING to mix contents prior to injection.
The dosage is:
Age - 6 months to 7 years - 150 mgm (l.O ml).
Age - 7 years and older - 225 mgm (1. 5 ml)
The injection is a deep intramuscular one in the upper outer quadrant of the buttock.
Since the time limits in which Hansolar can be safely given are so wide, there should not be too much difficulty to ensure that patients are adequately treated. The main difficulty comes, of course, when patients
Sister in charge notifies the Sister in the area to which the patient has moved, and also the Leprosy Control Unit in Darwin.
Send your Hansolar Administration Notification Slips in as soon as possible after the injection, to:-
C O N F I D E N T I A L
Sister in charge Leprosy Control Department of Health
P O Box 1101
DARWIN NT 5794 Phone: 892 249
HANSOLAR ADMINISTRATION
NAM:E: ••...•.••...•... EA.S No ..••..••••
HANSOLAR REGISTRATION NO: ...•.••••...•.
DATE DUE DATE GIVEN AM:OUNT COMMENTS
=============== ================ =============== ==================== =
NEXT DUE
GIVEN BY (Sign) AT:
12
USE OF SELSUN FOR PITYRIASIS (TINEA) VERSICOLOR
In a shower or bath vigorously scrub affected areas with a washer or piece of cloth.
Firmly rub Selsun into the affected areas. Let the skin dry in air. Do not use a towel.
Keep Selsun out of the eyes. Selsun is poisonous if swallowed.
After using Selsun clean under the finger nails thoroughly so none remains there.
Shower or bath again in twenty-four hours.
Repeat the treatment in one week.
Do not repeat treatment again unless on medical advice .
The affected areas which are often lighter in colour may take several months to return to normal colour.
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