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 Leprosy is a chronic systemic infection characte rized by progressive cutaneous lesions. Myc obacterium leprae is an acid-fast bacillus that attacks cutaneous tissues and peripheral nerves, producing skin lesions, anesthesia, infection and deformities

Vanessa Leprosy

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Leprosy is a chronic systemic infection

characterized by progressive cutaneous lesions.

Mycobacterium leprae is an acid-fast bacillus

that attacks cutaneous tissues and peripheral

nerves, producing skin lesions, anesthesia,

infection and deformities

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  a. Early signs and symptoms

• change in skin color-either reddish or white

• loss of sensation on the skin lesion 

• decrease/ loss of sweating and hair growth

over the lesion• thickened and or painful nerves 

• muscle weakness or paralysis of extremities 

• pain and redness of the eyes 

• nasal obstruction or bleeding 

• ulcers that do not heal 

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b. late sign and symptoms• loss of eyebrow- madarosis

• inability to close eyelids- lagophalmos

• clawing of fingers and toes 

• contractures 

• enlargement of the breast in males or

gynecomastia

• chronic ulcer 

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  the incubation period of leprosy ranges

from five- and –a half month to eight years

1. the disease can be transmitted throughrespiratory droplets.

2. inoculation through the skin break and

mucous membranes may also be a mode oftransmission.

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  1. Lepromatous leprosy(multibacillary)

a. this is the most serious type and isconsidered to be the most infectious.

b. It causes damage to the respiratory tract,

eyes and testes, as well as the nerves and theskin.

c. Lepromin test is negative but the skin lesion

contains large amount of Hensen`s bacillus.d. There is gradual thickening of the skin with

the development of a granulomatous condition.

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e. the lesions frequently appear as macules

become nodular in character (leproma)

f. there is slow involvement of the peripheralnerves , with some degree of anesthesia and

loss of sensation and gradual destruction ofthe nerve

g. there is atrophy of the skin and muscles andeventual melting or absorption of small bones,primarily those of the hands and feet

h. there is ulceration of the mucousmembrane of the nose

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  i. because of the melting or absorption ofsmall bones and ulceration, natural

amputation may occur.

2. Tuberculoid leprosy

a. It affects the peripheral nerve and

sometimes the surrounding skin,, especiallyon the face, eyes and testes, as well as thenerves and the skin.

b. Lepromin test is positive, but the organismis rarely isolated from the lesions.

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c. Macules are elevated, with clearing at thecenter , and are more clearly defined than in

the lepromatous form.

d. Anesthesia is present, and involvement ofthe peripheral nerve occurs more rapidly than

in the lepromatous form.

3. Borderline (dimorphous) leprosy has thecharacteristics of both lepromatous and

tuberculoid leprosy.

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1 M.leprae attacks the peripheral nerves,especially the ulnar, radial, posterior-popliteal,

anterior-tibial and facial nerves.

2 When the bacilli damage the skin`s fine nerve,they cause anaesthesia,anhidrosis and dryness.

3 If they attack a large nerve trunk, motor nerve

damage ,weakness and pain occur , followed byperipheral anesthesia,muscle paralysis and

atrophy.

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 1. Neural involvement

the earliest manifestation of the disease in mostcases are the result of nerve damage, ascharacterized by;

a. Atrophy of the muscles of the hands which

extends to the thenar, the hypothenar, and theforearm muscles , resulting in clawhand.

b. Nerves often involved are the ulnar, median,radial, lateral popliteal and facial

c. Paralysis and peripheral anesthesia can accur eitherindependently or concurrently

d. Secondary consequences of nerve involvementinclude

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Skin

Lepromatous and tuberculoid leprosy differ greatly intheir cutaneous manifestation:

a. In lepromatous disease, early lesions are multiple,symmetrical and earythematous , sometimesapprearing as macules or papules with smoothsurfaces.

b. Later, these lesions enlarge and form plaques ornodules on the earlobes , nose , eyebrows andforehead, giving the patient a leonine appearance.

3. Eye

a. The conjunctiva, sclera, cornea and iris are affected,sparing the retina and optic nerve.

b. Photophobia, conjunctivitis and iridocyelitisfrequently occur.

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 4. Upper respiratory tract

> the nose, mouth pharynx ,larynx , trachea and

esophagus are often involved in lepromatousleprosy.

>Epistaxis ,ulceration of the uvula and tonsils,septal perforation and nasal collapse are also

present.

5.Visceral leprosy

Apart from the skin and nerve, the heaviest

concentration, of lesions is in the organsrepresenting the reticuloendothelial system, thelymph system and the liver.

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1 Identification of the sign and symptoms

2 Tissue biopsy3 Tissue smear

4 Blood tests show increased RBC and ESR, decreasedserum calcium, albumin and cholesterol levels.

1 Sulfone therapy

2 Rehabilitation, recreational and occupation therapy

3 Multiple drug therapy (MDT)

a. The drug used in MDT are combinition of rifampicin,clofazimine and dapsone for multibacillary leprosy, andrifampicin and dapsone for the pausibacillary type.

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  b. Among these, rifampicin is the most importantanti-leprosy drug and is therefore included in the

treatment of both types of leprosy.c. For multibacillary leprosy, rifampicin 600 mg isgiven once a month ;dapsone 100 mg daily; andclofazimine 50mg daily for a 12 month duration.

d For paucibacillary leprosy,give rifampicin600mg once a month, dapsone once daily;duration of treatment is 6 months.

g Clofazimine causes brownish black

discoloration and dryness of the skin.h MB and PB patient should have fixed-durationtreatment, which means;

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• for MB patient –after taking 12 monthlydoses of MDT, the person is considered cured

and should be removed from the register;

• for PB patient- after taking 6 monthlydoses of MDT, the person is considered cured

and should be discharge.

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 1 If the patient is admitted to the hospital ,

isolation and medical asepsis should be carriedout.

2 Moral support and encouragement are

necessary.3 Diet should be full, wholesome and nutritious.

4 Special attention should be given to personal

hygiene.5 Terminal disinfection should be carried out.

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  1 Impaired skin integrity

2 Social isolation

3 Ineffective coping

4 Knowledge deficit5 Anxiety

6 Impaired body image

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1 Report all cases and suspect of leprosy.

2 Newborn infant should be separated

from leprous mother.3 BCG vaccine may be protective if given

during the first 6 months of life.

4 Health education should be given, withparticular focus on the mode of transmission.