Leprosy Follow-up

Updated: Aug 24, 2018
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Michael Stuart Bronze, MD  more...
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Follow-up

Further Outpatient Care

The WHO recommends that the monthly doses of rifampin be administered under direct observation during the visit.

Monthly outpatient follow-up is recommended during treatment, although weekly visits may be necessary if the patient experiences a leprosy reaction.

Follow-up laboratory studies during treatment include the following:

  • Urinalyses

  • CBC count

  • Creatinine

  • Liver function tests

Yearly skin scrapings taken from the 3 or 4 most active lesions are recommended.

Response to treatment

Successful treatment can result in flattening and elimination of nodules, papules, and plaques, as well as improved nerve function. Bacillary load is rarely a convenient method of assessing response to treatment. Noncompliance or drug resistance should be suspected if intact organisms are present after several months of treatment.

Once treatment is completed, the patient should be monitored for the next 5-10 years to evaluate for signs of relapse. To date, the relapse rate following completion of multidrug therapy has been 1% for both types of leprosy. In such cases, new bacillus-positive lesions may develop and should be treated with a thorough US regimen that incorporates once-daily rifampin (see Treatment).

Patients who have been successfully treated occasionally develop reversal reactions and further neuropathy. If skin biopsy samples are bacillus-negative, these patients are deemed to have a reversal reaction (see Complications).

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Deterrence/Prevention

Information campaigns about leprosy in high-risk areas are essential so that patients and their families, who were historically shunned from their communities, are encouraged to come forward and receive treatment.

Early diagnosis and treatment with multidrug therapy is the most effective way of preventing disabilities from leprosy, as well as preventing further transmission of the disease. [7]

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Prognosis

Recovery from neurologic impairment is limited, but skin lesions generally clear within the first year of therapy. Discoloration and skin damage typically persist.

Physical therapy, reconstructive surgery, nerve and tendon transplants, and surgical release of contractures have all contributed to increasing the functional ability in patients with leprosy. A common residual deformity is insensitive feet, as seen in persons with diabetes.

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Patient Education

Regional ambulatory clinics: The National Hansen's Disease Programs (NHDP) provide outpatient services and medical care to patients with leprosy in the United States and Puerto Rico. With the goals of prevention and early detection, the program supports delivery of services in areas with considerable populations of patients with leprosy. For additional information about these free services, contact the NHDP directly at 1-800-642-2477. The NHDP Center in Baton Rouge, La, provides free histopathologic services to facilitate diagnosis. Eleven outpatient HD clinics are located at hospitals, universities, and public health departments in Arizona, California, Florida, Illinois, Massachusetts, New York, Puerto Rico, Texas, and Washington. These clinics provide the following services:

  • Skin biopsy diagnostic confirmation

  • Additional medical care

  • Hospitalization for treatment complications

  • Consultations

  • Materials for professional and patient education

Patients with leprosy should be advised about the importance of continuing long-term therapy until the course of antibiotics is completed. The WHO recommends that the monthly administration of rifampin be directly observed.

In patient with leprosy who have advanced nerve damage, self-care techniques are of utmost importance in maintaining function and preventing further disability. The use of visual input to regulate activity, self-inspection, hygiene, and proper footwear can help prevent ulcer formation and tissue damage.

The WHO recommends examination of all household contacts of patients with leprosy, with careful instructions to seek medical care if signs and symptoms of leprosy appear.

Pregnancy in patients with leprosy can result in hormonal changes that lead to suppression of cell-mediated immunity, which may exacerbate symptoms of leprosy. Furthermore, pregnant women with leprosy are at greater risk of developing reactions and relapses. Type 1 reactions are more likely during the first few months following childbirth, whereas type 2 reactions typically occur during the third trimester of pregnancy and during lactation. [12]

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