Treatment of leprosy in special cases

Certain clinical situations require special consideration during the management of leprosy, including co-infection with tuberculosis and the occurrence of leprosy reactions.

Leprosy with tuberculosis co-infection management

Patients diagnosed with both tuberculosis and leprosy should receive standard anti-tuberculosis treatment in addition to multidrug therapy (MDT) for leprosy.

During tuberculosis treatment:

• Rifampicin should be administered at the dosage recommended for tuberculosis treatment.

• After completion of the intensive phase of anti-tuberculosis therapy, the patient should continue receiving the monthly rifampicin dose as part of the leprosy multidrug therapy regimen.

Leprosy reactions

Leprosy reactions are immune-mediated complications that may occur before, during, or after multidrug therapy.

The two main types of leprosy reactions are:

• Type I (reverse) reaction.

• Type II reaction, also known as erythema nodosum leprosum (ENL).

For detailed diagnosis and management of leprosy reactions, refer to the Manual for the Management of Tuberculosis and Leprosy in Tanzania.

Treatment of leprosy reactions

Treatment depends on the severity of the reaction.

• Mild reactions may be managed with anti-inflammatory medicines.

• Moderate to severe reactions are usually treated with corticosteroids, most commonly prednisolone, administered for a prolonged period with appropriate clinical monitoring.

Important note

Healthcare workers who suspect a leprosy reaction should promptly communicate with the District TB and Leprosy Coordinator (DTLC) and the Regional TB and Leprosy Coordinator (RTLC) for further evaluation and management.