Management protocols for Leprosy in Uganda

Cardinal Signs (≥1 required for diagnosis)

1. Hypopigmented patch(es) with definite loss of sensation. 2. Thickened or enlarged peripheral nerve(s) with loss of sensation and/or muscle weakness. 3. Positive slit-skin smear for Acid Fast Bacilli (AFB) — done at referral centres.

Classification — Paucibacillary (PB)

1–5 skin lesions. Negative slit-skin smear. Treatment duration: 6 months.

Classification — Multibacillary (MB)

>5 skin lesions OR positive slit-skin smear. Treatment duration: 12 months.

Disability Grading — Hands/Feet

Grade 0: No sensation problem, no visible deformity or damage. Grade 1: Sensation problem, no visible deformity. Grade 2: Visible deformity or damage.

Disability Grading — Eyes

Grade 0: No eye problem due to leprosy. Grade 1: Eye problem present but vision not severely affected (≥6/60). Grade 2: Severe visual impairment (<6/60), lagophthalmos, iridocyclitis, corneal opacities.

Early diagnosis and effective treatment to break transmission.

Screening of contacts of known leprosy patients.

Single-dose rifampicin prophylaxis for contacts: adults/≥15 years: 600 mg; 10–14 years: 450 mg; children 6–9 years: weight-based dose.

MDT — Adult PB Leprosy (6 months)

Rifampicin 600 mg once monthly (supervised). Dapsone 100 mg daily (self-administered). Duration: 6 months.

MDT — Adult MB Leprosy (12 months)

Rifampicin 600 mg once monthly (supervised). Clofazimine 300 mg once monthly + 50 mg daily. Dapsone 100 mg daily. Duration: 12 months.

MDT — Children 10–14 years PB (6 months)

Rifampicin 450 mg once monthly. Dapsone 50 mg daily.

MDT — Children 10–14 years MB (12 months)

Rifampicin 450 mg once monthly. Clofazimine 150 mg once monthly + 50 mg daily. Dapsone 50 mg daily.

MDT — Children <10 years or <40 kg PB (6 months)

Rifampicin 10 mg/kg once monthly. Dapsone 2 mg/kg daily.

MDT — Children <10 years or <40 kg MB (12 months)

Rifampicin 10 mg/kg once monthly. Clofazimine 6 mg/kg once monthly + 1 mg/kg daily. Dapsone 2 mg/kg daily.

Severe Leprae Reactions (Type 1 Reversal Reaction & Type 2 ENL)

Prednisolone 40 mg once daily in the morning. PB: treat for 12 weeks, reduce dose by 10–5 mg every 2 weeks. MB: treat for 24 weeks, reduce by 10–5 mg every 3 weeks.

Notes

Do NOT use dapsone in patients co-infected with HIV and on cotrimoxazole. Health workers must directly observe monthly doses. Residual signs after treatment completion do NOT indicate need to restart treatment. Rehabilitation and physiotherapy for all patients.