الفهرس 
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Abstract
Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune response in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world ($co.lltud et ai, 2006).
The fact that the organism cannot be grown in culture has hindered studies in vitro, and clinical trials are difficult in this sloWly progressive chronic infection, Over the past .5-10 years, however, there have been major advances in undel”5t:andling the biology of both M.lepnu and the host response to the organism and more than 11 million patients have been treated with multi-drug therapy (MDT) (WHO, 2002).
CUrrently, leprosy control is being integrated into general health care, whichoffers new challenges if leprosy patients areto be detected and their’ disease managed appropriately (Britton and Lockwood, 2004 ).
During the 19908 a bold,ambitious leprrosy elimination campaign was launched, after the adoption by the Wodd Health Assembly of the goal of ”elimination of leprosy asa public health problem by the year 2000” (WHO, 19.91).
Elimination was defined as a reduction in the prevalence of leprosy patients receiving antimicrobial therapy to less than I per 10 000 populations. The rational for this deftnition. lay in the recognition, that combination antibiotic therapy was highly effective
Introduction 4. Aim oj tile Worll
and the assumption. that once the pool of infectious patients was reduced, the disease would gradually disappear. However, there was no evidence that achievement of the arbitrarily chosen prevalence would reduce transmission of M.leprae (Lockwood, 2002).
MDT was developed ill response to the widespread emergence of dapsone resistance and” was based on effective combinations of antibiotics in experimental leprosy infection. l’vIDTcllres the infection, but immunological reactions may occur and neuropathy may lead to disability and deformity. It is importanttl’lat the manifestations of the conditions are recognized as early as possible SO that early nerve damage can be identified and treated rapidly (Walker and Loekwood, 2006).
In 1985, there were an estimated 12 million people with leprosy worldwide, a prevalence of 12 per 10 000. In 2002, WHO reported that there were 597 000 registered cases and 719 000 new cases detected during 2000, resulting in a global prevalence of registered leprosy patients of just below 1 per 10 000 {WHO, 20M}.
Fifteen endemic countrie-s still have a prevalence of more than l per 10 000, mainly in Asia, Africa and South America, but] 07 of the 122 countries endemic for leprosy in 1985 have reached the elimination. target. There is accncentration of 83% of the registered. cases in only six countries; India, Brazil, Burma, Indonesia, Madagascar and Nepal, with India accounting for 64% of all leprosy cases worldwide (Durrheim et aL, 1002)
As a result of tllis outstanding. public-health achievement, more than II million people with leprosy have been cured by MDT, many without any disability. The fall in the prevalence of leprosy
has not, however. been accompanied by a fall in the rate of detection of new cases. The observed fall in the prevalence could have been largely caused by shortening of the duration of treatment and the removal from the registers of cured or defaulted patients, rather ’than a reduction in the transmission of M. lep~ae infection (Britton and Lockwood; 2004).
The WHO in the year 2003 reported that the prevalence rate of leprosy ill Egypt was 0.3 per ’I000!), The number of the reported cases of leprosy was 525 in Dakahlia governorate during the period from 1986-1992 (Rezk et aL, 1993) and 349 in Kalyoubia governorate during the period from 1992-1995 (wassifet aL,. 1996).
Appropriate community health education, that leprosy is treatable before disability eccurs, is an important component of leprosy control to promote early presentation before the appearance of impairment of nerve function and disability, The development of tools to recognize infection with M. leprae before the disease manifests itself might help to target prophylactic approaches, Finally, continued political commitment to leprosy control is essential, because these measures will be required for decades before leprosy can be judged a disease of the past ( Britton and Lockwood ,2004).