eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Leprosy: Follow-up

Author: Benjamin Estrada, MD, Professor, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine, University of South Alabama Children's and Women's Hospital
Contributor Information and Disclosures

Updated: May 22, 2009

Follow-up

Further Outpatient Care

  • The WHO has recommended that patients undergoing treatment for leprosy should be evaluated monthly.
  • In addition, patients should be informed about the potential signs and symptoms of recurrences and be advised to seek medical care if any of them are observed after treatment or after the initial episode has been completed.

Deterrence/Prevention

  • One of the most important aspects in the elimination of leprosy is to develop programs to reach pockets of high prevalence. Evaluation of individuals in the families of index cases is crucial.
  • The widespread administration of bacille Calmette-Guérin (BCG) vaccine has been associated with the decrease in the number of leprosy cases. A single dose of BCG vaccine appears to be 50% protective in preventing leprosy.18

Complications

  • Visible deformities in children with leprosy have been associated with increasing age at the time of diagnosis, multibacillary disease, lack of access to health care, and multiple nerve involvement.19

Miscellaneous

Medicolegal Pitfalls

  • Patients with leprosy should not be the subjects of social discrimination.
  • An issue of medicolegal importance in the management of leprosy resides on the use of thalidomide for the treatment of erythema nodosum leprosum (ENL).
    • Patients, male and female, receiving therapy with this drug should be made aware of its significant teratogenic complications.
    • Thalidomide should not be prescribed to women with childbearing potential.
    • In addition, males undergoing treatment with thalidomide must avoid sexual intercourse with women who can become pregnant.

Special Concerns

  • While in contact with patients with leprosy, standard precautions are indicated. It has been suggested that M leprae is sensitive to ultraviolet light, which may be useful in sterilization and disinfection practices.20
  • Leprosy should be considered as a diagnostic possibility among internationally adopted children who develop clinical findings suggestive of associated to this infection and who are originally from areas of the world where the disease is endemic.21
 


More on Leprosy

Overview: Leprosy
Differential Diagnoses & Workup: Leprosy
Treatment & Medication: Leprosy
Follow-up: Leprosy
Multimedia: Leprosy
References
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References

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  2. McNabb SJ, Jajosky RA, Hall-Baker PA, Adams DA, Sharp P, Worshams C, et al. Summary of notifiable diseases--United States, 2006. MMWR Morb Mortal Wkly Rep. Mar 21 2008;55(53):1-92. [Medline].

  3. Imbiriba EB, Hurtado-Guerrero JC, Garnelo L, Levino A, Cunha Mda G, Pedrosa V. Epidemiological profile of leprosy in children under 15 in Manaus (Northern Brazil), 1998-2005. Rev Saude Publica. Dec 2008;42(6):1021-6. [Medline].

  4. Fakhouri R, Sotto MN, Manini MI, Margarido LC. Nodular leprosy of childhood and tuberculoid leprosy: a comparative, morphologic, immunopathologic and quantitative study of skin tissue reaction. Int J Lepr Other Mycobact Dis. Sep 2003;71(3):218-26. [Medline].

  5. Pandhi D, Mehta S, Agrawal S, Singal A. Erythema nodosum leprosum necroticans in a child--an unusual manifestation. Int J Lepr Other Mycobact Dis. Jun 2005;73(2):122-6. [Medline].

  6. Saunderson P, Bizuneh E, Leekassa R. Neuropathic pain in people treated for multibacillary leprosy more than ten years previously. Lepr Rev. Sep 2008;79(3):270-6. [Medline].

  7. Lawn SD, Lipman MC, Easterbrook PJ. Immune reconstitution disease associated with mycobacterial infections. Curr Opin HIV AIDS. Jul 2008;3(4):425-431. [Medline].

  8. Kamal R, Dayal R, Katoch VM, Katoch K. Analysis of gene probes and gene amplification techniques for diagnosis and monitoring of treatment in childhood leprosy. Lepr Rev. Jun 2006;77(2):141-6. [Medline].

  9. Job CK, Drain V, Williams DL, et al. Comparison of polymerase chain reaction technique with other method for detection of Mycobacterium leprae in tissues of wild nine-banded armadillos. Int J Lepr Other Mycobact Dis. 2000;68(1):23-6. [Medline].

  10. Dayal R, Agarwal M, Natrajan M, et al. PCR and in-situ hybridization for diagnosis of leprosy. Indian J Pediatr. Jul 2007;74(7):645-8. [Medline].

  11. Dayal R, Gupta R, Mathur PP. Study of gene probes in childhood leprosy. Indian J Pediatr. Jan-Feb 1998;65(1):99-105. [Medline].

  12. Dong L, Li F, Jiang J. Techniques for covering soft tissue defects resulting from plantar ulcers inleprosy: Part II--First toe web and dorsal foot flaps. Indian J Lepr. Jul-Sep 1999;71(3):297-309. [Medline].

  13. Gelber RH. Regimens to treat lepromatous leprosy. Antimicrob Agents Chemother. Jul 1997;41(7):1618-20. [Medline].

  14. Alangaden GJ, Lerner SA. The clinical use of fluoroquinolones for the treatment of mycobacterial diseases. Clin Infect Dis. Nov 1997;25(5):1213-21. [Medline].

  15. Ji B, Jamet P, Perani EG, et al. Powerful bactericidal activities of clarithromycin and minocycline against Mycobacterium leprae in lepromatous leprosy. J Infect Dis. 1993;168(1):188-90. [Medline].

  16. Cunha SS, Rodrigues LC, Pedrosa V. Neonatal BCG protection against leprosy: a study in Manaus, Brazilian Amazon. Lepr Rev. Dec 2004;75(4):357-66. [Medline].

  17. [Guideline] Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. Dec 30 2005;54:1-141. [Medline].

  18. Zodpey SP, Ambadekar NN, Thakur A. Effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of leprosy: a population-based case-control study in Yavatmal District, India. Public Health. Mar 2005;119(3):209-16. [Medline].

  19. Kar BR, Job CK. Visible deformity in childhood leprosy--a 10-year study. Int J Lepr Other Mycobact Dis. Dec 2005;73(4):243-8. [Medline].

  20. Truman RW, Gillis TP. The effect of ultraviolet light radiation on Mycobacterium leprae. Int J Lepr Other Mycobact Dis. Mar 2000;68(1):11-7. [Medline].

  21. King K, Browning JC, Metry DW, Prestigiacomo J, Scollard D, Schutze GE. Leprosy and international adoption: a case report and review of diagnostic and treatment dilemmas. Pediatr Infect Dis J. Apr 2009;28(4):322-5. [Medline].

  22. Anderson H, Stryjewska B, Boyanton BL, Schwartz MR. Hansen disease in the United States in the 21st century: a review of the literature. Arch Pathol Lab Med. Jun 2007;131(6):982-6. [Medline].

  23. Burman KD, Rijall A, Agrawal S. Childhood leprosy in eastern Nepal: a hospital-based study. Indian J Lepr. Jan-Mar 2003;75(1):47-52. [Medline].

  24. Gormus BJ, Baskin GB, Xu K, et al. Antileprosy protective vaccination of rhesus monkeys with BCG or BCG plus heat-killed Mycobacterium leprae: immunologic observations. Int J Lepr Other Mycobact Dis. Mar 2000;68(1):27-39. [Medline].

  25. Haimanot RT, Melaku Z. Leprosy. Curr Opin Neurol. Jun 2000;13(3):317-22. [Medline].

  26. Hoffner RJ, Esekogwu V, Mallon WK. Leprosy in the emergency department. Acad Emerg Med. Apr 2000;7(4):372-6. [Medline].

  27. Jacobson RR, Krahenbuhl JL. Leprosy. Lancet. Feb 20 1999;353(9153):655-60. [Medline].

  28. Levis WR, Vides EA, Cabrera A. Leprosy in the eastern United States. JAMA. Feb 23 2000;283(8):1004-5. [Medline].

  29. Mushatt DM, Wattanamano P, Alvarado FS. Lepromatous leprosy in a renal transplant recipient. Clin Infect Dis. Jan 1998;26(1):217-8. [Medline].

  30. Vara N. Profile of new cases of childhood leprosy in a hospital setting. Indian J Lepr. Jul-Sep 2006;78(3):231-6. [Medline].

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Further Reading

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Keywords

leprosy, Hansen's disease, Hansen disease, Mycobacterium leprae, M leprae, borderline leprosy, paucibacillary leprosy, tuberculoid leprosy, multibacillary leprosy, lepromatous leprosy, erythema nodosum leprosum, ENL, Lucio phenomenon, Lucio's phenomenon, lazarine leprosy, chronic granulomatous disease, , hypoesthesia, necrotizing erythema nodosum, leonine facies

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Contributor Information and Disclosures

Author

Benjamin Estrada, MD, Professor, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine, University of South Alabama Children's and Women's Hospital
Benjamin Estrada, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Sanofi-Pasteur Honoraria Speaking and teaching

Medical Editor

Gary J Noel, MD, Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University
Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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