Leprosy

Definition
• Leprosy, also known as Hansen's disease, is a chronic
infectious disease caused by Mycobacterium leprae.
The disease mainly affects the skin, the peripheral
nerves, mucosal surfaces of the upper respiratory tract
and the eyes. Leprosy is known to occur at all ages
ranging from early infancy to very old age.
• It is a chronic infectious bacterial disease that destroys
peripheral nerves, resulting in loss of sensation and
progressive tissue degeneration.
Incubation period
• An average of about three to five years.
MODE OF TRANSMISSION
1. Transmission by inhalation
• Droplet infection (most common)
2. Transmission by contact
• Skin to skin contact with infectious cases
• Contact with soil or fomites
3. Other Routes
• Insect Vectors e.g. Mosquito, Bedbugs
Types
Types
Other types
• Early and indeterminate leprosy
• Tuberculoid leprosy
• Borderline tuberculoid leprosy
• Borderline leprosy
• Borderline lepromatous leprosy
• Lepromatous leprosy
• Histoid leprosy
• Diffuse leprosy of lucio and latapi
Causes of leprosy
• Leprosy is caused by a slow growing type of
bacteria called Mycobacterium leprae (M.
Leprae) Leprosy is also known as Hansen’s
disease.
Clinical features
1. Damage to the skin and peripheral nervous: skin lesions
and deformities, most often affecting the cooler places on
the body (eyes, nose, earlobes, hands, feet, and testicles)
2. Skin lesions are lighter than normal skin color.
3. The skin lesions and deformities can be very disfiguring.
4. Lesions have decreased sensation to touch, heat, or pain
and do not heal after several weeks to months.
5. Thickened peripheral nerves: ulnar nerve behind the medial
epicondyle and humerus can be palpated as a cord like
structure.
6. Muscle weakness.
Investigation
1. Clinical examination
• Interrogation
• Physical examination
2. Bacteriological examination
• Smear (scrapings from lesions, nasal mucosa, nerve
biopsy, etc)
3. Routine test
• CBC, LFT, Creatinine test
4. Other test
• Lepromin test
• PCR (Polymerase chain reaction)
Pathophysiology
M.Laprae enters the body (skin, nose, etc)
Attack
Peripheral nerves

Bind to schwann cells of axon

Demyelination of nerve

Loss of axonal conductance

Deformity (loss of pain, temperature, touch, sensation)

Pathophysiology
M.Laprae enters the body (skin, nose, etc)
Attack
Peripheral nerves

Bind to schwann cells of axon

Good CMI response Bad CMI response

Paucibacillary leprosy Multi bacillary leprosy
No skin/nerve lesions appear in addition to skin & nerve, eye
Medical Management
Multidrug therapy:
 Multi-bacillary leprosy:
1. Rifampicin- 600 mg, once monthly, given under supervision
2. Dapsone- 100 mg daily self-administered
3. Clofazimine – 300 mg once monthly, and 50 mg daily self
administered
Duration of treatment: The end pint of combined treatment should
be for at least 2 years and continued, where possible up to smear
test negative.
 Paucibacillary leprosy:
1. Rifampicin – 600 mg once a month for 6 months
2. Dapsone- 100 mg daily for 6 months
Nursing Management
Assessment
History:
• Recently visitation of any endemic area where the cases may
present
• Any contact with positive patient
Physical examination:
• Interrogation
• Check investigation
• Vital signs
Nursing Management
Diagnosis
• Impaired skin integrity related to presence of lesion
• Deficit of knowledge related to disease progress
• Decreased muscle strength related to infection
• Negative self-image related to isolation
• Impaired physical mobility related to loss of sensation
and vision problems
Nursing Management
Intervention
1. Establish therapeutic nurse Clint relationship: promotes
trust allowing client to feel free to communicate his
problems
2. Provide accurate information about leprosy to the clients:
to increase the level of knowledge and at the same time
correct misconception about the disease
3. Educate the client about the importance of taking the
prescribed medicine- to increase adherence to medications
thus managing the disease and problems
4. Encourage the client to avoid sneezing or coughing in front or
people or in the public
5. Provide positive reinforcement when client losses hope
Prevention
• Isolation of bacteriologically positive cases in
endemic areas.
• Avoid close physical contact with untreated
patient
• Keep away from the animal which are suspected
to the bacteria
• Use of mask and gloves while handling the
patient
• Vaccination- BCG vaccine (at birth, intramuscular,
0.05ml)