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Hensen’s
disease is a chronic granulomatous disease caused by infection with mycobacterium
leprae. Mrs. SAK 25 yrs old married housewife primigravida with 6 months
amenorrhoea was referred from peripheral hospital in view of well defined,
erythematous lesions on her hands. No further signs of leprosy in the
skin, the mucosae and the peripheral nerves were found. Fite-Faraco staining
of the skin biopsy showed sporadic acid - fast bacilli and con.rmed an
active tuberculoid leprosy. Outpatient treatment was immediately initiated
with oral rifampicin 600 mg monthly and Dapsone 100 mg daily.
However the patient went in labour at 35 wks period of gestation and delivered
vaginally on 15.7.2002 male child 2.1 kgs cried immediately after birth
Apgar 8,9,9.
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| INTRODUCTION
Hensen’s disease is a chronic granulomatous disease caused
by infection and mycobacterium leprae. The exact
mechanism of transmission of M. Lepra remains unknown. The hallmark
clinical .ndings in leprosy are hypopigmented skin lesions with loss
of sensation. Depending upon the number of lesions and the number of
bacillus observed on lesion’s smear.
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CASE
REPORT
Mrs. SAK 25 yrs old married housewife primigravida with six months amenorrhoea
was referred from peripheral hospital
in view of well defined, erythematous lesions on her hands. No specific
past signi.cant history. On examination: her vitals were in normal limits,
On local examination: well defined, elevated erythematous lesions on her
hands with central anaesthesia in the lesions. On per abdomen examination
: Uterus was 24 wks size, variable presentation, foetal movements present,
foetal heart sound present. No further signs of leprosy in the skin, the
mucosae and the peripheral nerves were found. Fite-Faraco staining of
the skin biopsy showed sporadic acid-fast bacilli and con.rmed an active
tuberculoid leprosy. Out patient treatment was immediately initiated with
oral rifampicin 600 mg monthly and Dapsone 100 mg daily. During the treatment
cycle the skin lesions vanished.
Additional leprosy reactions did not occur and the medication was well
tolerated. However the patient went in labour at
35 wks period of gestation and delivered vaginally on 15.7.2002 male child
2.1 kg cried immediately after birth Apgar 8,9,9. On 5th postnatal day
mother and baby were discharged and advised to follow up on OPD basis.
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DISCUSSION
Leprosy can be classified in 3 groups: 1) Borderline leprosy (2) Paucibacillary
or Tuberculoid leprosy (3) Multibacillary or Lepromatous leprosy. Skin
biopsy and smears are helpful in establishing the diagnosis of leprosy.
Pregnancy in women with leprosy is a hazardous undertaking.1 The pregnant
state causes a relative decrease in cellular immunity. This decrease allows
Mycobacterium leprae to pro.lerate, which may precipitate or worsen disease,
leading to permanent nerve damage.2 Careful management of reactional states
and treatment of patients with dapsone monotherapy can prevent this nerve
damage. Infants are usually much less affected than mothers; however,
selection of the mother’s antimicrobial regimen must ensure adequate
control of the bacteria while avoiding teratogenicity and in utero adverse
effects.1,2 Dapsone is the only drug which is comparatively safe in pregnancy.
Because of thalidomide’s potential for causing serious birth defects
it's again contraindicated in pregnancy. Various studies have concluded
that leprosy in pregnancy can be treated safely and successfully by combined
drug therapy.3 Pregnancy is a trigger factor for reaction. Up to 20% of
children born to mothers with leprosy may develop leprosy by puberty.
Increased awareness and health education, as well as long term surveillance
of ‘cured’ leprosy patients, are essential to break a potentially
vicious cycle of leprosy and pregnancy.1 |
REFERENCES
1. Duncan ME. An historical and clinical review of the interaction
of leprosy and pregnancy : a cycle to be broken.
Soc Sci Med 1993; 37 (4) : 457-72.
2. Lyde CB. Pregnancy in patients with Hansen disease. Arch
3.. Dermatol 1997; 133 (5) : 623-7.
3. Neuer A, Spang E, Stitcht-Groh V. Initial manifestation of tuberculoid
leprosy in pregnancy. Guidelines for diagnosis and therapy. Geburtshilfe
Frauenheilkd 1996; 56 (3) : 156-60.
1. Duncan ME. An historical and clinical review of the interaction
of leprosy and pregnancy : a cycle to be broken.
Soc Sci Med 1993; 37 (4) : 457-72.
2. Lyde CB. Pregnancy in patients with Hansen disease. Arch
3.. Dermatol 1997; 133 (5) : 623-7.
3. Neuer A, Spang E, Stitcht-Groh V. Initial manifestation of tuberculoid
leprosy in pregnancy. Guidelines for diagnosis and therapy. Geburtshilfe
Frauenheilkd 1996; 56 (3) : 156-60. |
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MASSAGE
TREATMENT FOR BACK PAIN
Evidence for symptomatic relief is encoruaging but not compelling
Swedish massage is a touch therapy that uses a range of techniques
to manipulate the soft tissues of the body : effleurage (slow
rhythmic stroking), kneading (circular compression), petrissage
(forceful skin rolling, friction (penetrating pressure from
the .ngertips with circular or transverse movement), tapotement
(percussive movements), vibration (trembling movement of both
hands). In most English speaking countries, massage is seen
as an alternative or complementary treatment.
Most massage therapists are convinced that massage treatment
is free of risk. This is not true. Too much force can cause
fractures of osteoporotic bones; and even rupture of the liver
and damage to nerves have been associated with massage. These
events are rarities and massage is relatively safe, provided
that well trained therapists observe the contraindications.
BMJ, 2003; 326 : 562.
TREATMENT OF ANCA ASSOCIATED VASCULITIS
The rate of relapse was similar among patients receiving maintenance
immunosuppressive treatment with azathioprine and among those
receiving maintenance treatment with cyclophosphamide.
Early substitution of azathioprine for cyclophosphamide can
reduce the rate of toxic effects associated with long-term cyclophosphamide
treatment of autoantibodies to neutrophil cytoplasmic antigens
(ANCA)-Associated vasculitis.
N Engl J Med, 2003; 349 : 36. |
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