All About LEPROSY
All About LEPROSY
Second Edition
Prasad PVS MD DD DV FIAD FIMSA
Professor Department of Dermatology, Venereology and Leprosy Former Dean Rajah Muthiah Medical College and Hospital Annamalai University Tamil Nadu, India E-mail: prasaderm@hotmail.com
Forewords
Patrick Yesudian
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All About Leprosy
First Edition: 2005
Second Edition: 2016
9789385891960
Printed at
My teacher, Professor, Rachel Mathai
My wife, Mrs Chellam
My postgraduate students
and
All my leprosy patients
- Anandhi V MSC PHD
- Professor
- Department of Microbiology
- Vinayaka Missions Medical College and Hospital
- Karaikal, Puducherry, India
- Chapter 4: Microbiology
- Chapter 5: Immunology
- Kaviarasan PK MD (DVL)
- Professor and Head
- Department of Dermatology, Venereology and Leprosy
- Rajah Muthiah Medical College and Hospital, Annamalai University, Tamil Nadu, India
- Chapter 9: Differential Diagnosis of Various Conditions
- Chapter 10: Reactions and Relapse in Leprosy
- Chapter 16: Chemotherapy
- Chapter 18: Treatment and Elimination Strategies
- Nandakumar Nair MBBS DPMR DNB (PMR)
- Former Professor
- Department of Physical Medicine and Rehabilitation
- Rajah Muthiah Medical College and Hospital
- Annamalai University, Tamil Nadu, India
- Chapter 20: Rehabilitation of Leprosy
- Prasad PVS MD DD DV FIAD FIMSA
- Professor
- Department of Dermatology, Venereology and Leprosy
- Former Dean
- Rajah Muthiah Medical College and Hospital
- Annamalai University, Tamil Nadu, India
- Chapter 1: Historical Aspects
- Chapter 2: Global Scenario
- Chapter 3: Epidemiology
- Chapter 4: Microbiology
- Chapter 5: Immunology
- Chapter 7: Classification
- Chapter 8: Clinical Scenario
- Chapter 9: Differential Diagnosis of Various Conditions
- Chapter 10: Reactions and Relapse in Leprosy
- Chapter 11: Leprous Neuritis
- Chapter 12: Systemic Involvement
- Chapter 13: Deformities
- Chapter 14: Leprosy in Special Scenario
- Chapter 15: Animal Experiments
- Chapter 16: Chemotherapy
- Chapter 17: Vaccines in Leprosy
- Chapter 18: Treatment and Elimination Strategies
- Chapter 21: What's New in Leprosy?
- Chapter 22: Leprosy Issues: Panel Discussion Held at Various Conferences
- Rehana Tippoo MD
- Professor
- Department of Pathology
- Rajah Muthiah Medical College and Hospital, Annamalai University, Tamil Nadu, India
- Chapter 6: Pathology
- Sandeep Zacharia Ullas MD (DVL)
- Former Senior Resident
- Department of Dermatology, Venereology and Leprosy
- Rajah Muthiah Medical College and Hospital
- Annamalai University, Tamil Nadu, India
- Chapter 4: Systemic Involvement
- Chapter 13: Deformities
- Chapter 15: Animal Experiments
- Chapter 17: Vaccines in Leprosy
- Satyanarayan Mishra ms dnb mch
- Professor
- Department of Plastic Surgery
- Mahatma Gandhi Medical
- College and Research Institute
- Puducherry, India
- Chapter 19: Surgical Aspects
- Viswanathan P MD
- Professor and Head
- Department of Pathology
- Rajah Muthiah Medical College and Hospital Annamalai University, Tamil Nadu, India
- Chapter 6: Pathology
It has been a while since a major textbook on leprosy has been published. ‘All About Leprosy’ is an appropriate title for the book since it comprehensively covers all aspects of this ancient disease—from history to the latest therapeutic approach—including surgical aspects and the future scenario.
There is at present, a tendency on the part of government and non-government organizations dealing with leprosy control to become complaisant saying that the disease has been eradicated from our country. This is far from true as can be seen by the statistics given in this book and also in my consulting chamber I still see from time to time florid cases of lepromatous leprosy who must be spewing the bacilli around. So this book is a wake-up call to those dealing with the disease never to let leprosy sink below the diagnostic horizon. Early diagnosis is a must in containment of the disease.
This book is invaluable to postgraduate students in dermatology because it is presented with key points in each chapter and also the viva voce questions and answers, which the students can easily memorize at the time of their final examination.
This book should be a definite addition to all libraries, particularly dermatological libraries and I recommend all PG students to own their personal copies.
Patrick Yesudian FRCP FAMS
Patron and Chief Consultant
Chennai Skin Foundation and
Yesudian Research Institute
Chennai, Tamil Nadu, India
Preface to Second Edition
I deem it a great honor that I am able to complete the task of writing a second edition of my book in a short span of time. I hesitated for a long time due to my other commitments, but when I got the feedback from many postgraduate students about the usefulness of first edition, I wanted to contribute to the readers what they deserve. This edition is completely changed when compared to previous edition. The vast knowledge since the last edition is incorporated to a large extent. Many new chapters are included in this edition such as Global Scenario, new concepts in Immunology, Leprosy in Special Scenario, Vaccines in Leprosy and Rehabilitation. The chapter ‘What's New in Leprosy?’ should be helpful to answer questions in the postgraduate examinations and also tried to retain questions at the end of chapters to a possible extend. Finally, a chapter on panel discussion has been added incorporating various questions and answers discussed in various forums during the last several years. I am sure that this will be thought-provoking segment to the young generation. Questions from various universities also have been updated in Appendices. This book will be interesting and useful for various kinds of readers such as undergraduate to postgraduate students and consultants.
Prasad PVS
Preface to First Edition
This book is designed to help the undergraduate, postgraduate medical students, medical practitioners and healthcare providers in leprosy. I have covered all the aspects on leprosy from its historical days to the latest research. Though India is one of the few countries with high prevalence of leprosy there is paucity of books on leprosy by Indian authors and hence this attempt. This book aims to be a user-friendly guide to the postgraduate students as it incorporates many viva questions. I welcome suggestions and criticisms from the readers, which may help to improve the further editions. I wish to thank M/s Jaypee Brothers Medical Publishers (P) Ltd, for their constant efforts throughout the production of this book.
Prasad PVS
Acknowledgments
I would like to thank Professor Dr Patrick Yesudian for his foreword. I wish to acknowledge my teachers, Professor Mrs Rachel Mathai and Professor Mrs Mary Jacob for teaching me the basic skills in leprosy. I also acknowledge my parents, wife and children for their constant and untiring support in my profession.
My thanks are due to contributors for incorporating new developments in their chapters. I wish to acknowledge all my postgraduate students over the last 17 years for showing keen interest in learning leprosy and its associated problems. I am grateful to all my colleagues in the department, including Mr S Muthukumaran for their constant support.
My sincere thanks to all my patients not only for providing clinical material but also for permitting us to take photographs and for providing the learning material.
I am sure the readers will appreciate the vast changes made in this edition when compared to the previous edition of this book and will benefit from this second edition.
My special thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Mr Tarun Duneja (Director–Publishing) and Mr Jayanandan (Senior Commissioning Editor, Chennai Branch) and staffs of Bengaluru Production Unit/Bengaluru Branch of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India.
Abbreviations
ADP
Adenosine diphosphate
AFB
Acid-fast bacilli
AFO
Ankle-foot orthosis
ANA
Antinuclear antibody
ATP
Adenosine triphosphate
BB
Borderline leprosy
BCG
Bacille Calmetti-Guérin
BI
Bacteriological index
CBR
Community-based rehabilitation
CD
Cluster of differentiation
CDR
Case detection rate
CMI
Cell-mediated immunity
CPN
Common peroneal nerve
DMFT
Decayed missing filled teeth
DOPA
Dihydroxyphenylalanine
DTH
Delayed-type hypersensitivity
ELISA
Enzyme-linked immunosorbent assay
ENL
Erythema nodosum leprosum
FCU
Flexor carpi ulnaris
FDT
Fixed duration therapy
FLA-ABS
Fluorescent leprosy antibody absorption
GI
Gastrointestinal
GM-CSF
Granulocyte Microphage colony stimulating factor
GMLF
Gandhi Memorial Leprosy Foundation
H&E
Hematoxylin and eosin
HPE
Histopathological examination
HRUS
High-resolution ultrasound
ICRC
Indian Cancer Research Center
IL
Interleukins
IRIS
Immune reconstitution inflammatory syndrome
LAMMS
Laser microprobe mass spectrometry
LC
Langerhans’ cell
LDC
Leprosy-derived corynebacteria
LL
Lepromatous leprosy
LLp
Polar lepromatous
M2PD
Moving 2-point discrimination
Mab
Monoclonal antibody
MAF
Macrophage-activating factor
MC
Molluscum contagiosum
MDT
Multidrug therapy
MFP
Mouse foot pad
MHC
Major histocompatibility complex
MIF
Migration inhibitory factor
MI
Morphological index
MP
Metacarpophalangeal
MRI
Magnetic resonance imaging
NCDR
New case detection rate
NCS
Nerve conduction study
NCV
Nerve conduction velocity
NGOs
Non-governmental organizations
NLEP
National Leprosy Eradication Program
NSAIDs
Non-steroidal anti-inflammatory drugs
PABA
Para-aminobenzoic acid
PAS
Periodic acid-Schiff
PCR
Polymerase chain reaction
PDIM
Phthiocerol dimycocerosate
PGL-1
Phenolic glycolipid-1
PMH
Progressive macular hypomelanosis
PMNL
Polymorphonuclear leukocyte
PPD
Purified protein derivative
RF
Rheumatoid factor
RFT
Release from treatment
RT-PCR
Reverse transcription polymerase chain reaction
SACT
Serum antibody competition test
SET
Survey education and treatment
SLE
Systemic lupus erythematosus
SLPB
Single lesion paucibacillary
SSS
Slit-skin smear
SWMT
Semmes-Weinstein monofilament testing
TAP
Transporter associated with antigen processing
TB
Tuberculosis
TLR
Toll-like receptor
TNF
Tumor necrosis factor
TTp
Polar tuberculoid
VNTR
Variable number tandem repeat
WHA
World Health Assembly
WHO
World Health Organization
ZN
Ziehl-Neelsen