LEPROSY

Prepared by: Siselle Fajardo BSN II-1

(Hansens Disease or Hansenosis)

Is a chronic systemic infection characterized by progressive cutaneous lesions

LEPROSY

Etiologic Agent:

Mycobacterium Leprae
Acid fast bacillus that attack cutaneous tissues and peripheral nerves

Mycobacterium leprae

Produces skin lesions, anesthesia, infection and deformities

NOT HIGHLY CONTAGIOUS and has LOW INFECTIVITY

Incubation Period
The incubation period of leprosy ranges from 5 and months to 8 years.

Mode of Transmission
Respiratory Droplets Inoculation through skin break and mucous membranes

Leprosy occurs in 3 distinct forms

Lepromatous Leprosy Tubercoloid Leprosy Borderline (Dimorphous) Leprosy

1. Lepromatous Leprosy
Most serious type and most infectious It causes damage to the respiratory tract, eyes, testes as well as the nerves and skin LEPROMIN TEST is NEGATIVE but skin lesion contains large amount of Hansens bacillus. Gradual thickening of skin with the development of a granulomatous condition.

Lesions frequently appear as macules and become nodular in character (leproma).

1. Lepromatous Leprosy
There is slow involvement of peripheral nerves with some degree of anesthesia and loss of sensation and gradual destruction of nerves There is atrophy of the skin and muscles and eventual melting or absorption of small bones, primarily those of hands and feet. Ulceration of mucus membrane of the nose. Because of melting or absorption of small bones, natural amputation may occur.

2. Tuberculoid Leprosy
Affects the peripheral nerves and sometimes the surrounding skin especially on the face, eyes and testes, as well the nerves and the skin. LEPROMIN TEST is POSITIVE, but the organism is rarely isolated from lesions. Macules are ELEVATED with clearing at the center, and are more clearly defined than in lepromatous form. Anesthesia is present, involvement of the peripheral nerves occurs more rapidly than in the lepromatous form.

3. Borderline (Dimorphous) Leprosy

Has the characteristic of both lepromatous and tuberculoid leprosy Skin lesions of this type are diffused and poorly defined.

PATHOLOGY

M. leprae

Peripheral nerves

Anesthesia, anhydrosis, dryness

Peripheral anethesia, muscle paralysis, atrophy

Motor nerve damage, weakness, pain

If M. leprae attacks large nerve trunk

CLINICAL MANIFESTATIONS
1. NEURAL INVOLVEMENT
The earliest manifestations of the disease in most cases are the result of nerve damage, as characterized by: a. Atrophy of the muscles of the hands in which extends to the thenar, hypothenar and the forearm of the muscles, resulting CLAWHAND. b. Nerves often involved are the ULNAR, MEDIAN, RADIAL, LATERAL, POPLITEAL and FACIAL. c. Paralysis and peripheral anesthesia can occur either independently or concurrently d. Secondary consequences of nerve involvement include malperforant, clawhand, and ocular complications incident to conreal insensitivity or paralysis of eyelids.

Old woman with Leprosy

CLINICAL MANIFESTATIONS
2. SKIN
Lepromatous and tuberculoid leprosy differ greatly in their cutaneous manifestations: a. In lepromatous leprosy, early lesions are multiple, symmetrical and erythematous, sometimes appearing as macules or papules with smooth surfaces b. Later, these lesions enlarge and form plaques or nodules on the earlobes, nose, eyebrows and forehead, giving the patient leonine apperance c. Eventually there is loss of eyebrowns and eyelashes. d. The loss of function of the sweat and sebaceous glands makes affected skin dry and hairless.

Leprosy; ulcerated foot

CLINICAL MANIFESTATIONS
2. SKIN
e. Tuberculoid leprosy maybe purely neural or may simultaneously affect the skin. f. Raised, large erythematous plaques appear on the skin with clearly defined boarders. As they grow, they become rough, hairless, and hypopigmented leaving an anesthetic scar.

CLINICAL MANIFESTATIONS
3. EYES
a. Specific ocular manifestations are found only in the lepromatous and borderline leprosy. b. The conjunctiva, sclera, and cornea and iris are affected, sparing the retina and optic nerve. c. Photophobia, conjunctivitis, and iridocyelitis, frequently occur. Opacity of the cornea, insensitivity and ulceration can lead to blindness.

CLINICAL MANIFESTATIONS
4. UPPER RESPIRATORY TRACT
a. The nose, mouth, pharynx, larynx , trachea and esophagus are often involved in lepromatous leprosy.

b. Epistaxis, ulceration of the uvula and tonsils, septal perforation and nasal collapse are also present.

CLINICAL MANIFESTATIONS
5. VISCERAL LEPROSY
Apart from the skin and nerves, the heaviest concentration of lesions is in the organs representing the reticuloendothelial system, the lymph system and the liver.

Testicular damage occurs in almost moderately advanced cases of lepromatous leprosy.

DIAGNOSTIC PROCEDURES
1. Identification of the signs and symptoms 2. Tissue Biopsy 3. Tissue Smear 4. Blood tests: Increased RBC and ESR; and decreased serum calcium, albumin and cholesterol levels.

MODALITIES OF TREATMENT
1. Sulfone therapy 2. Rehabilitation, recreational and occupational therapy 3. Multiple Drug Therapy (MDT)
a. DRUGS USED: refampicin, clofazimine, and dapsone for MULTIBACILLARY LEPROSY, and rifampicine and dapsone for pausibacillary type. b. Among these, RIFAMPICINE is the most important antileprosy drug and is therefore included in the treatment of both types of leprosy. c. Treatment of leprosy with only one anti-leprosy drug will always result in the development of drug resistance.

MODALITIES OF TREATMENT
d. Treatment of leprosy with dapsone or any anti-leprosy drug used as monotherapy should be considered as an unethical practice. e. For multibacillary leprosy, rifampicin 600 mg is given ONCE a month; dapsone 100 mg daily; and clofazimine 50 mg daily for 12-month duration. f. For paucibacillary leprosy, give rifampicin 600 mg once a month; dapsone once daily; duration of treatment is 6 months.

MODALITIES OF TREATMENT
g. Clofazimine causes brownish black discoloration and dryness of the skin. However, this disappears within a few months after stopping treatment. This should be explained to patients starting the MDT regimen for MB Leprosy. h. MB and PB patients should have fixed-duration treatment which means:
For MB patients after taking 12 monthly doses of MDT, the person is considered cured and should be removed from the register; For PB patients after taking 6 monthly doses of MDT, the person is considered cured and should be discharged.

NURSING MANAGEMENT
1. If the patient is admitted to the hospital, isolation and medical asepsis should be carried out. 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.

COMMON NURSING DIAGNOSIS

1. Impaired Skin Integrity 2. Social Isolation 3. Ineffective coping 4. Knowledge deficit 5. Anxiety 6. Impaired body image

PREVENTION
1. Report all cases and suspects of leprosy. 2. Newborn infants should be separated from leprous mothers. 3. BCG vaccine may be protective if given during the first 6 months of life. 4. Health education should be given with particular focus on the mode of transmission.l

A: Tuberculoid Leprosy B. Lepromatous Leprosy

Skin involvment of Leprosy. A 23-year old man infected with leprosy.

Lepromatous Leprosy of Hands

Lepromatous Leprosy

Additional Info!!!

Lucio Leprosy
Type 3 lepra reaction or the Lucio reaction/phenomenon (erythema necroticans) only occurs in patients with Lucio leprosy, a variety of lepromatous leprosy diffuse lepromatous leprosy [the skin of the whole body becomes diffusely thickened, rendering it stiff and smooth as in scleroderma and it is the purest form of lepromatous leprosy]. It is due to infarction consequent upon deep cutaneousvasculitis centred upon M. Leprae in vascular endothelial cells, and causing the appearance of irregularly shaped erythematous patches which become dark and heal, or form bullae and necrose, leaving deep painful ulcers that are slow to heal (large polygonal sloughing ulcerations, usually on the legs).

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