Commonly Asked Questions in Leprosy
Que. 1. How will you diagnose leprosy?
Ans. 1. Diagnosis of leprosy is based on the presence of at least one of three cardinal signs –
a) Definite loss of sensation in a pale (hypo pigmented) or reddish skin patch
b) Thickened or enlarged peripheral nerve with loss of sensation &/or weakness of muscles supplied by the nerve
c) Presence of acid-fast bacilli in a slit skin smear.
Que. 2. What do you mean by Leprosy?
Ans. 2. A chronic infectious disease caused by mycobacterium leprae. Disease mainly affects peripheral nerves but may involve skin, muscles, eyes, bones, testes and internal organs.
Que. 3. What are the types of Leprosy?
Ans. 3. Two types –
1) Pauci bacillary (PB) leprosy
2) Multi bacillary (MB) leprosy
Que. 4. When was the National Program on leprosy launched in India?
Ans. 4. 1955.
Que. 5. When was National Leprosy Control Program (NLCP) changed to the National Leprosy Eradication Program (NLEP)?
Ans. 5. 1983.
Que. 6. When was Multi Drug Therapy (MDT) introduced in NLEP in India?
Ans. 6. 1983.
Que. 7. When was elimination of leprosy as a public health problem achieved in the country?
Ans. 7. December 2005.
Que. 8. What do you mean by elimination of leprosy as a public health problem?
Ans. 8. Prevalence of leprosy less than 1 case per 10,000 population.
Que. 9. Who is the source of infection in leprosy?
Ans. 9. Untreated leprosy case.
Que. 10. How is leprosy transmitted?
Ans. 10. Transmitted to susceptible individual through droplet infections mainly through respiratory route.
Que. 11. What is the range and average incubation period of leprosy?
Ans. 11. Range of Incubation period – few weeks to 20 years
Average incubation period – 5-7 years.
Que. 12. Which are the socioeconomic factors associated with leprosy?
Ans. 12. Factors associated are –
1) Poverty
2) Overcrowding
3) Poor housing
Que. 13. When will you exclude leprosy on the basis of skin lesions?
Ans. 13. Followings will be excluded on the basis of skin lesions –
1) Present since birth
2) Depigmented skin lesions
3) Lesions having itching
4) Removable scaly/flakes present except in resolving reversal reaction.
5) Show any seasonal variation
Que. 14. In Leprosy, when will you say that nerves are involved?
Ans. 14. If any of the following is present –
1) Thickening of nerve trunk
2) Pain & tenderness in the course of nerve
3) Swelling (abscess) in the course of nerve
4) Impairment of nerve function
Que. 15. What factor does determine the success of management of leprosy?
Ans. 15. Preserving the function of nerve. If nerve already affected, then to prevent further deterioration.
Que. 16. When will you say in leprosy that nerve paralysis is incomplete?
Ans. 16. If –
1) Sensations are still felt in some areas of skin supplied by the affected nerve.
2) Loss of sensation is partial, affecting only certain types of sensation (Dissociated Anaesthesia)
3) Some of the muscles supplied by the affected nerve are not completely paralyzed.
Que. 17. How are peripheral nerves involved in leprosy?
Ans. 17. Either due to invasion by M. leprae or as part of the lepra reaction.
Que. 18. What is silent neuropathy?
Ans. 18. Sometimes involvement of nerve results in loss of sensation and weakness of muscles without any preceding pain or tenderness.
Que. 19. Which are the commonly affected peripheral nerve trunks in leprosy?
Ans. 19. Commonly affected peripheral nerve trunks are as follows –
1) Ulnar nerve – most commonly affected nerves.
2) Lateral popliteal nerve
3) Posterior tibial nerve
4) Trigeminal nerve
5) Median nerve
6) Facial nerve
7) Radial nerve
Que. 20. What are the clinical manifestations of involvement of ulnar nerve?
Ans. 20. Adduction of little finger, clawing of little & ring fingers.
Que. 21. Which nerve involvement does result in foot drop?
Ans. 21. Lateral popliteal nerve.
Que. 22. Which nerve involvement does result in clawing of toes?
Ans. 22. Posterior tibial nerve.
Que. 23. Which nerve involvement does result in wrist drop?
Ans. 23. Radial Nerve.
Que. 24. What are the clinical manifestations of involvement of facial nerve?
Ans. 24. Inability to close eyelid completely.
Que. 25. What are the clinical manifestations of involvement of median nerve?
Ans. 25. Clawing of thumb, ring finger & middle finger.
Que. 26. Why do lepra reaction occur in leprosy?
Ans. 26. It occurs due to sudden alteration in the immunological status of host against the living or dead bacilli.
Que. 27. What are the types of lepra reaction?
Ans. 27. Two types –
1) Type 1 reaction (Reversal reaction)
2) Type 2 reaction (Erythema nodosum leprosum)
Que. 28. What is the effect of pregnancy on leprosy?
Ans. 28. Subclinical disease may become overt and established and may get worsened due to depression of cell mediated immunity.
Que. 29. When is world leprosy day celebrated?
Ans. 29. 30th January every year.
Que. 30. What is the theme of world leprosy day 2022?
Ans. 30. United for dignity.
Que. 31. What are the main objectives under NLEP?
Ans. 31. The main objectives of NLEP are as follows –
1) Elimination of leprosy
2) Early case detection without deformity
3) Strengthen Disability Prevention & Medical Rehabilitation (DPMR) of person affected by leprosy
4) Reduction in the level of stigma associated with leprosy.
Que. 32. Which are the important NLEP strategies?
Ans. 32. Important NLEP strategies are –
1) Strengthening of integration of leprosy services through general health care system
2) Early detection & complete treatment of new leprosy cases.
3) Conducting household contact surveys for early detection of hidden cases like FLC, ACD & RS
4) Involvement of ASHAs in the detection, follow up & completion of treatment of leprosy cases in time.
5) Strengthening of Disability Prevention & Medical Rehabilitation (DPMR) services
6) IEC & IPC activities in the community to improve self-reporting to PHC & reduction in stigma
7) Intensive monitoring & supervision at all levels.
Que. 33. Which are the program contents in Leprosy?
Ans. 33. The program contents are –
1) Case detection & management
2) DPMR
3) IEC including BCC
4) Capacity building
5) Program Management
6) PPP activities.
Que. 34. What do you mean by ABSULS & FLC?
Ans. 34. ABSULS – ASHA based surveillance for leprosy suspects.
FLC – Focused Leprosy Campaign
Que. 35. Where is the Central leprosy training & research institute (CLTRI) located?
Ans. 35. Chengalpattu (Tamil Nadu).
Que. 36. When was DPMR introduced under NLEP?
Ans. 36. 2006.
Que. 37. When was the upgraded simplified information system (USIS) introduced in NLEP?
Ans. 37. 2014.
Que. 38. What is the name of online reporting system under NLEP?
Ans. 38. NIKUSTH.
Que. 39. What are the responsibilities of ASHA/AWW under NLEP?
Ans. 39. Responsibilities of ASHA/AWW under NLEP are –
1) Suspect identification & referral to PHC
2) Timely completion of treatment
3) Counselling & IEC
4) Contact screening
5) Support for active case detection campaign
Que. 40. What are the responsibilities of Medical Officer (MO) under NLEP?
Ans. 40. Responsibilities of MO under NLEP are as follows –
1) Planning of NLEP activities
2) Case confirmation, treatment, Lepra reaction management & referral of complications
3) On job training to PHC staff
4) Supervision & monitoring
5) Review of activities & feedback to District Nucleus team.
Que. 41. When was Sparsh Leprosy Awareness Campaign (SLAC) launched in India?
Ans. 41. 2017.
Que. 42. What are the objectives of SLAC?
Ans. 42. Increasing the awareness, addressing high level of stigma & discrimination.
Que. 43. What do you mean by three pronged strategy in leprosy program?
Ans. 43. Three pronged strategy includes –
1) LCDC – 14 days active case detection in high endemic districts
2) FLC – for non-endemic districts
3) Special plan for hard to reach areas.
Que. 44. When was Sparsh Leprosy Elimination Campaign (SLEC) launched?
Ans. 44. 2018-19.
Que. 45. What is the vision of NLEP?
Ans. 45. Leprosy free India.
Que. 46. What is the current Grade II disability % among new cases at national level?
Ans. 46. 2.4% (NLEP 2019-20 data).
Que. 47. What is the figure of current grade II disability cases per million population at national level?
Ans. 47. 1.96 (NLEP 2019-20 data)
Que. 48. What are the doses of MDT?
Ans. 48. Rifampicin – 10 mg/kg body weight, monthly once
Dapsone – 2 mg/Kg body weight, daily
Clofazimine – 1mg/Kg body weight & 6 mg/Kg body weight, monthly dose.
Que. 49. What are the indications of Multi Drug Therapy (MDT)?
Ans. 49. The indications of MDT are as follows –
1) Persons with signs of leprosy who have never received treatment before (New Case)
2) Relapse
3) Re-entered for treatment
4) Referred cases
5) Re classified cases.
Que. 50. What do you mean by Relapse case under NLEP?
Ans. 50. Re-occurrence of the disease at any time after the completion of full course of treatment.
Que. 51. What do you mean by Re-classified case under NLEP?
Ans. 51. Persons with PB leprosy, reclassified to MB leprosy & need full course of MB treatment.
Que. 52. Which drugs constitute MDT for MB leprosy?
Ans. 52. Rifampicin, Dapsone & Clofazimine.
Que. 53. Which drugs constitute MDT for PB leprosy?
Ans. 53. Rifampicin & Dapsone.
Que. 54. What is the duration of treatment with MDT for MB leprosy?
Ans. 54. Completion of 12 monthly blister calendar packs in 18 consecutive months.
Que. 55. What is the duration of treatment with MDT for PB leprosy?
Ans. 55. Completion of 6 monthly blister calendar packs in 9 months.
Que. 56. What are the side effects of Dapsone?
Ans. 56. Side effects of Dapsone are –
1) Anaemia (sometimes haemolytic)
2) Abdominal Symptoms
3) Exfoliate dermatitis
4) Hepatitis
5) Nephritis
Que. 57. What are the side effects of Rifampicin?
Ans. 57. Side effects of rifampicin are as follows –
1) Red discoloration of body fluids
2) Flu like illness
3) Abdominal Symptoms
4) Hepatitis
5) Allergy
Que. 58. What are the adverse effects of Clofazimine?
Ans. 58. Adverse effects of Clofazimine are as follows –
1) Brownish red discoloration of skin, urine & body fluids
2) Acute abdominal Symptoms
3) Ichthyosis
4) Conjunctival dryness
Que. 59. If a patient is suffering from Jaundice, will you start MDT?
Ans. 59. No. Will wait till Jaundice subsides.
Que. 60. If a patient has allergy to sulpha drugs, will you continue MDT?
Ans. 60. No. Stop Dapsone. Go for alternative regimen.
Que. 61. If a person is suffering from anaemia, will you start MDT?
Ans. 61. Yes. Start MDT along with treatment for anaemia.
Que. 62. What is the ASHAs incentive for leprosy case detection?
Ans. 62. Rs. 250/- per case.
Que. 63. What is the ASHAs incentive for PB case treatment completion?
Ans. 63. Rs. 400/- per case.
Que. 64. What is the ASHAS incentive for MB case treatment completion?
Ans. 64. Rs. 600/- per case.
Que. 65. In Reconstructive Surgery (RCS) of disabled leprosy case what fund is allocated by Government of India (GoI) per case?
Ans. 65. Rs. 8000/- per RCS case.
Que. 66. Name three pillars on which global leprosy strategy 2016-20 is based.
Ans. 66. Three pillars are as follows –
1) Strengthen government ownership coordination and partnership
2) Stop leprosy & its complications
3) Stop discrimination and promote inclusions.
Que. 67. What do you mean by the Leprosy free world?
Ans. 67. Refers to a situation wherein community is free of morbidity, disabilities& social consequences due to leprosy.
Que. 68. When was elimination of leprosy as a public health problem achieved at global level?
Ans. 68. In the year 2000.
Que. 69. What is the vision of Global Leprosy Strategy 2016-20?
Ans. 69. Leprosy free world.
Que. 70. What is the goal of Global Leprosy Strategy 2016-20?
Ans. 70. To further reduce the leprosy burden both locally and globally.
Que. 71. What are the main targets of Global Leprosy Strategy 2016-20?
Ans. 71. The main targets are as follows –
1) Zero grade 2 disability among paediatric leprosy patients
2) Reduction of new leprosy cases with G2 D to less than one case per million population
3) Zero countries with legislation allowing discrimination on basis of leprosy
Que. 72. What does detection of patients already with disabilities and the high proportion of MB cases indicate?
Ans. 72. Delay in detection in the community.
Que. 73. What are the advantages of MDT?
Ans. 73. The advantages of MDT are as follows –
1) Stops progression of disease, prevents further complications and reduces chances of relapse
2) Interrupts transmission of infection rapidly
3) Reduces the chances of development of resistance to drugs
4) Shortens the duration of treatment
5) Safe, minimal side effects and increased patient compliance
Que. 74. What do you mean by accompanied MDT (A-MDT)?
Ans. 74. When more than one (usually 3) BCPs at a time is given to the patient.
Que. 75. In which situations, will you give accompanied MDT?
Ans. 75. A-MDT, is given in following situations –
1) Underserved areas
2) Emergency situations
3) Migration
Que. 76. What are the WHO recommendation (2018) for treatment of drug resistant leprosy?
Ans. 76. Two of the following 2nd line drugs : Clarithromycin, minocycline or a quinolone (Ofloxacin, Levofloxacin or moxifloxacin), plus Clofazimine daily for 6 months, followed by Clofazimine plus one of the 2nd line drugs daily for an additional 18 months.
Que. 77. What is the WHO recommendation (2018) for chemoprophylaxis of contacts of leprosy?
Ans. 77. Single dose of Rifampicin (SDR) may be used for contacts of leprosy patients (adults & children aged 2 years & above) after excluding leprosy and TB disease, & in the absence of other contraindications.
Que. 78. Whether type 1 lepra reaction (reversal reaction) is antigen-antibody reaction?
Ans. 78. Type 2 Lepra reaction (ENL) is an antigen-antibody reaction while type 1 lepra reaction (Reversal Reaction) is delayed hypersensitivity reaction.
Que. 79. Which are the signs of reversal reaction?
Ans. 79. Consider severe reversal reaction, if any of the following is present –
1) Loss of nerve function i.e. loss of sensation or muscle weakness
2) Pain or tenderness in one or more nerves
3) Silent neuritis
4) Marked swelling and redness in skin patches. A red, swollen patch on the face, or overlying another major nerve trunk
5) A skin lesion anywhere that remains ulcerated
6) Marked oedema of the hands, feet or face.
Que. 80. Which are the signs of a severe ENL reaction?
Ans. 80. Consider severe ENL reaction, if any of the following is present –
1) Pain or tenderness in one or more nerves, with or without loss of nerve functions
2) Ulceration of ENL nodule
3) Pain or / & redness of the eyes, with or without loss of visual acquity
4) Painful swelling in the testis or of the fingers
5) Marked arthritis or lymphadenitis
Que. 81. What is the treatment of ENL reaction?
Ans. 81. The treatment of ENL reaction includes –
1) Prednisolone
2) Bed rest
3) Rest to the affected nerves by splint & analgesics
Que. 82. What is the prednisolone regimen for the treatment of ENL reaction?
Ans. 82. Start prednisolone tablet (dose at 1mg/KBW/day), given in single morning dose after breakfast. After the reaction is controlled, prednisolone is tapered by 10 mg fortnightly till the dose of 20 mg /day. Thereafter prednisolone is tapered by 5mg fortnightly till withdrawal.
Que. 83. What is the regimen of Clofazimine in the treatment of ENL reaction?
Ans. 83. One capsule (100 mg) TDS for 4 or more weeks then one capsule (100 mg) BD for next 4-12 weeks followed by one capsule (100 mg) OD for next 4-12 weeks or more.
Que. 84. If prednisolone is contraindicated, what is the drug used for treatment of lepra reaction?
Ans. 84. Thalidomide.
Que. 85. What is the regimen of thalidomide for treatment of lepra reaction?
Ans. 85. Started as 200 mg BD or 100 mg QID then gradually tapered off. Maintenance dose of 50-100 mg daily may be required for prolonged period in some cases.
Que. 86. How will you define relapse in NLEP?
Ans. 86. It is defined as the re-occurrence of the disease at any time after the completion of a full course of treatment.
Que. 87. What are the features of Relapse?
Ans. 87. The features of relapse are as follows –
1) Appearance of new skin lesions
2) In MB leprosy, BI of 2 or more on skin smear examination
3) Time since completion of treatment is usually more than 3 days
4) No associated pain, tenderness & swelling
5) General condition is not affected
Que. 88. Which are the important nerves of face & neck that gets commonly affected in leprosy?
Ans. 88. The commonly involved nerves of face & neck are –
1) Facial Nerve
2) Trigeminal Nerve
3) Greater auricular nerve
4) Supra-orbital nerve
5) Supra trochlear nerve
Que. 89. Which are the important nerves of upper limb that gets commonly affected in the leprosy?
Ans. 89. The commonly involved nerves of upper limb are as follows –
1) Ulnar nerve
2) Median nerve
3) Radial nerve
Que. 90. Which are the important nerves of lower limb that gets commonly affected in leprosy?
Ans. 90. The commonly involved nerves in lower limb are –
1) Lateral popliteal nerve
2) Posterior tibial nerve
Que. 91. How will you grade muscle strength in the assessment of motor function of nerve (VMT)?
Ans. 91. The grading of VMT is as follows –
1) S (Strong) – Able to perform movement against full resistance
2) W (Weak) – Able to perform movement but not against full resistance
3) P (Paralysed) – Not able to perform the movement at all
Que. 92. How will you calculate EHF score?
Ans. 92. EHF score is the sum of individual disability grades. EHF score i.e. the sum of all individual disability grades for both eyes, two hands & two feet (0-12) is recorded at each visit.
Que. 93. Why operations for lagophthalmos are usually considered a high priority?
Ans. 93. Because of possibility of secondary damage to the eye leading to blindness.
Que. 94. What is the goal of DPMR services in NLEP?
Ans. 94. To reduce disability burden due to leprosy.
Que. 95. What are the objectives of DPMR services in NLEP?
Ans. 95. The objectives of DPMR services are –
1) To prevent disability in new cases
2) To prevent new disability or worsening of the disability in under treatment cases and in the cases who have completed the treatment
Que. 96. Which logistics & supplies should be present at primary care level institutions?
Ans. 96. These are –
1) MDT
2) Prednisolone
3) MCR footwear
4) Dressing materials
5) Treatment protocol, learning material & flash cards
6) Recording & Reporting format
7) Referral slips
Que. 97. What are the basic principles of ulcer management?
Ans. 97. The basic principles are –
1) Rest
2) Good wound environment
3) Hygiene
4) Protection from injuries & infections
Que. 98. What are the common causes of ulcer in leprosy?
Ans. 98. The common causes of ulcer in leprosy are –
1) Sudden injury
2) Repetitive pressure, friction or shear forces
3) Burns
4) Secondary infection of macerated skin
5) Rarely rat bite
Que. 99. Which standard foot wear is recommended in leprosy patients to prevent plantar ulcer?
Ans. 99. Micro-cellular Rubber (MCR) footwear.
Que. 100. What is the main objective of monitoring?
Ans. 100. To identify & resolve operational problems as soon as they emerge.
Que. 101. What does increased proportion of leprosy affected children in the population indicate?
Ans. 101. Presence of active transmission of the leprosy in the community.
Que. 102. On decline of leprosy burden, which group is more affected?
Ans. 102. Old age group.
Que. 103. Which is the only way to reduce the burden of leprosy in the community?
Ans. 103. To reduce the source of infection through the MDT.
Que. 104. Why leprosy disease is associated with stigma?
Ans. 104. As leprosy causes disabilities and deformities.
Que. 105. Which body’s unit is affected by Mycobacterium Leprae?
Ans. 105. Nerve Schwann cell.
Que. 106. In which type of leprosy, good cell mediated immunity (CMI) is the characteristic feature?
Ans. 106. Pauci-bacillary (PB) leprosy.
Que. 107. In which type of leprosy, routine slit skin smears are positive?
Ans. 107. Multi-bacillary (MB) leprosy.
Que. 108. Once nerves are destroyed in leprosy, what will happen next?
Ans. 108. Destroyed nerves do not regenerate & are replaced by fibrous tissues.
Que. 109. What do you mean by pure neurotic leprosy?
Ans. 109. When there is only nerve involvement in leprosy without any evidence of skin involvement.
Que. 110. When may lepra reaction occur in leprosy patients?
Ans. 110. Can occur at any time. Patient may present with lepra reaction, may occur during the treatment phase and after treatment.
Que. 111. Which type of lepra reaction is a delayed hypersensitivity reaction?
Ans. 111. Type 1 Lepra reaction.
Que. 112. Which type of lepra reaction occur in MB leprosy?
Ans. 112. Type 2 lepra reaction.
Que. 113. Whether BCG vaccination can also protect from leprosy?
Ans. 113. Yes up to some extent.
Que. 114. When will you give adult BCPs of MDT to leprosy affected children?
Ans. 114. For children 10-14 years with body weight more than 35 kg.
Que. 115. Currently, which test is recommended to diagnose latent leprosy infection?
Ans. 115. No test is recommended in NLEP.
Que. 116. Whether you will stop MDT if a patient develops lepra reaction during treatment?
Ans. 116. Do not stop MDT.
Que. 117. Which treatment will you provide to a relapsed leprosy case?
Ans. 117. MDT.
Que. 118. Which footwear you will provide to leprosy cases to prevent plantar ulcer?
Ans. 118. MCR footwear.
Que. 119. When will you replace self-care kit contents provided to leprosy patients?
Ans. 119. Once a month as it is sufficient for 30 applications.
Suggested Further Readings –
1) K. Park; Park’s textbook of Preventive & Social Medicine, 26th edition, 2021
2) R. Bhalwar; textbook of Public health & Community Medicine, AFMC-WHO, 1st edition, 2009
3) Mahajan & Gupta; Textbook of Preventive & Social Medicine; 4th edition
4) AH Suryakantha; Community Medicine with Recent Advances, 3rd Edition.