management of Leprosy Reaction|Full Knowledge 2021|prevention is better than cure

Hello, Friends, I have come again with a new knowledge base article. As you know that in my previous articles I have told about the history of leprosy, its causes, origin, stigma in leprosy, which type of disability develops in leprosy, and how it is prevented.

Now in this article, I am going to tell you about the Management Of Leprosy Reaction2021. The reaction occurs in leprosy disease which can occur any time in leprosy patients. It can occur before treatment, between treatment, and even after treatment, which means when a patient completed his full course of treatment.

This does not mean that the patient of the reaction will not recover. But if the reaction is not treated on time then the patient can become disabled. If the patient gets treatment for the reaction in time, then he can avoid becoming disabled.

And you will be surprised to know that the treatment of reaction is very cheap and its medicine is made available free of cost by the government. But still, most of the patients suffer the reaction and they become disabled.

This happens only and only due to a lack of knowledge. The patient is not aware of its seriousness and by the time he realizes it is too late. So it is very necessary to know about Leprosy Reaction Symptoms to prevent disability.

As you must have seen in my title, I have included the words prevention is better than cure. It means if If the patient is conscious and takes the precautions prescribed by the doctor and as soon as any symptoms are seen, contact his doctor and get treatment, so he can avoid being handicapped.

So, friends, I request you to read this article completely so that you take full knowledge about Management Of Leprosy Reaction. and can tell others also. So friends, without wasting too much time, I start talking about the topic. Cookie I think you are getting bored. Let’s begin.

The reaction in leprosy is not due to the drug. Rather, when the immunity of the patient of leprosy suddenly increases, then some inflammatory responses occur in the leprosy patient’s body, and due to this lepra reaction may occur. so it is very important to counsel the patient about lepra reaction So that the patient does not break the treatment and is saved from becoming disabled.

Note: Leprosy is not a contagious disease it is completely curable with MDT (Multidrug therapy).

You may also read:

• History of Leprosy(hansens disease)

• Stigma in Leprosy

• Role of refempicin in Leprosy

• NLEP programms

• Milestones in Leprosy

• Voluntary Muscle Testing in Leprosy

• Disability Prevention and Management in Leprosy 

Definition of Leprosy Reaction.(Reaction in Leprosy):-

The term “reaction” refers to an acute inflammatory response that occurs during a disease. Reactions might happen before, during, or after therapy. It is very important to begin treatment of the reaction case as soon as possible to prevent the patient from becoming disabled.

Types of lepra Reaction:

There are two types of lepra reactions:

Type 1 lepra reaction:-

It is also known as a reversal reaction. This reaction may occur in both PB AND MB Leprosy.

Type 2lepra reaction:-

It is also known as Erythema Nodosum Leprosum(ENL). This reaction only occurs in MB Leprosy.

Sign and symptoms of lepra reaction |Management Of Leprosy Reaction:

Features:-

1. Skin

2. Nerves

3. Other organs

4. general symptoms

Type 1 lepra reaction (reversal reaction) | Management Of Leprosy Reaction:

1. Skin:- In type 1 Lepra reaction Existing lesions suddenly become red, swollen, warm, margins of the lesion become elevated. New lesions may occur.

2. Nerves:- Nerves close skin may become thick and tender(painful when touches the nerve termed as neuritis).in later stage may present with loss of nerve function.

3. Other organs:- Rarely affected.

4. general symptoms:- Not common.

Type 2 lepra reaction(ENL Reaction) |Management Of Leprosy Reaction:

1. Skin:- painful, red, tender subcutaneous nodules(ENL) appears commonly on the face, ear lobes, arms, and legs. they appear in groups and may subside within a few days even without treatment.

2. Nerves:- Nerves may be affected but not as common or severe as in type 1.

3. Other organs:- In this type of reaction bones, joints, eyes, testes, kidneys may be affected.

4. General symptoms:- Fever, fatigue ness, and joint pain.

Management of lepra reaction :

The reaction requires immediate attention and treatment otherwise it can lead to irreversible deformities. That is why it is very important to know about Leprosy Reaction Symptoms to detect the patient’s earliest and get him treated as soon as possible. Leprosy Reaction And Management are very important.

The prescribed dose of corticosteroid (prednisolone) are as follows:-

1. 40mg daily for week 1and 2
2. 30mg daily for week 3and 4
3. 20mg daily for week 5and6
4. 15mg daily for week 7amd 8
5. 10mg daily for week 9 and 10
6. 5mg daily for week 11 and 12 and then stop corticosteroid (prednisolone).

It is very important to examine the Patient and review the progress of corticosteroid (prednisolone) every two weeks and that the dose of corticosteroid (prednisolone) is reduced every 2weeks according to the guideline of a standard dose of corticosteroid (prednisolone).

Management of Type1 lepra reaction:-

1. The drug of choice is prednisolone (corticosteroid).
   
2. The usual course of prednisolone begins with 40 mg. daily in a single dose preferably in the morning.
   
3. The reaction is generally controlled within a few days.
   The dose of prednisolone is then gradually reduced and then eventually stopped.
   
4. Proper precaution should be taken with the patient of diabetes, peptic ulcer, hypertension, etc.
   
5. Response to steroid therapy( prednisolone ) is generally seen within two weeks.
   
6. Review the progress every two weeks.
   
7. If there is no response and the problem persists then the same dose of prednisolone may be continued for further two weeks.
   
8. After two weeks again review the progress and if there is a good response then the dose of prednisolone may be tapered according to the schedule.

When starting prednisolone it is very important to counsel the patient and tell him that it is necessary to give rest to the affected nerve. until the symptoms subside. Apply a padded splint to immobilize the joints near the affected nerve. The AIM of immobilizing the limb is to reduce pain and swelling and prevent nerve damage.

Management of Type 2 lepra reaction:-

There are two ways of management of type 2lepra reaction:-

Management with corticosteroid(prednisolone):-

If the patient is taking MDT, it will not stop. Start standard course of prednisolone at daily doses for a total duration of 12 weeks. To control fever and pain use an adequate dose of analgesic.

Management with clofazimine and corticosteroid (prednisolone):-

In case of severe ENL Reaction (Type 2 reaction) as If a patient is not getting satisfactory results from corticosteroids or the risk of toxicity of corticosteroid is high in leprosy patients. If the patient is taking MDT, it will not stop.

Start standard course of prednisolone at daily doses for a total duration of 12 weeks. To control fever and pain use an adequate dose of analgesic.

Start clofazimine 100mg. three times a day and continue it for a maximum of 12weeks. After 12weeks dose of clofazimine taper to 100mg twice a day for 12weeks.

After 12 weeks dose of clofazimine again taper to 100mg once a day for 12 to 24 weeks.

Management with clofazimine alone:-It is to be done when corticosteroids are contraindicated:

If the patient is taking MDT, it will not stop. To control fever and pain use an adequate dose of analgesic.

Start clofazimine 100mg. three times a day and continue it for a maximum of 12weeks. After 12weeks dose of clofazimine taper to 100mg twice a day for 12weeks.

After 12 weeks dose of clofazimine again taper to 100mg once a day for 12 to 24 weeks.

Important notes about Leprosy Reaction And Management:

If the patient has completed the full course of MDT then only treat the lepra reaction. There is no need to restart MDT. The total duration of the course of corticosteroid (prednisolone) is 12 weeks.

The total duration of clofazimine therapy should not exceed 12months. Clofazimine often takes 4to 6 weeks to develop its full effect in controlling ENL.

Contraindications of Corticosteroid (Prednisolone):

1. Diabetes.
2. High Cholesterol.
3. Fungal infection.
4. Herpes simplex infection.
5. Tuberculosis.
6. Psychotic disorders.
7. Glaucoma.
8. Cataracts(clouding of lens of eye)
9. Chronic heart disease(CHD).
10. High Blood Pressure.
11. Peptic Ulcer.
12. Gastritis(stomah irritation)
13. Diverticulitis.
14. Tendon rupture.
15. Osteoporosis(weak bones)
16. Seizures.
17. In water retention condition.(because steroid can enhance water retention)
18. Measles 
19. Chicken pox.
20. Osteonecrosis(death of bone tissue due to lack of blood supply)
21. Muscle waisting.

Short note on Citrullinemia:

Short note on citrullinemia: It is an autosomal recessive urea cycle disorder. In this, there is an accumulation of urea and other toxic substances in the blood.

Short note on Diverticulitis:

Diverticula is a small bulging pouch that can form in the lining of the Intestines. They are mostly found in the lower part of the large intestine ( colon). Diverticula commonly occur after the age of 40. When one or more pouches become inflamed and infected then this condition is termed Diverticulitis.

Sign and symptoms of Diverticulitis:

• Abdominal pain,
• Fever.
• Nausea, vomiting.
• Constipation.
• Less commonly may be diarrhea.

Mild diverticulitis gets cured with rest, diet changes, and antibiotics. But in severe diverticulitis or recurring diverticulitis surgery may require.

Doctors are not sure about the cause of diverticulitis. But some doctors think that muscle spasm or muscle strain, which develops when you have a bowel movement can make pressure build in your colon and push against the digestive lining and And it can be a cause of diverticulitis.

So it is thought a low fiber diet can create this condition because fiber makes strong to the digestive muscle and helps in easy bowel movement.

Important key points:

1. Early detection and early treatment are very important to prevent deformity.

2. proper counseling of the patient is very necessary so that the patient completes his course and is saved from becoming disabled.

3. Tell the patient about the side effects of clofazimine and rifampicin so that the patient completes his course.

4. proper monitoring of the patient is very necessary so that if the patient shows the symptoms of Lepra reaction, then his treatment can be started immediately and the patient is saved from becoming disabled.

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FAQs for Leprosy Reaction and Management :