Introduction
It is a chronic, mild infectious disease of man that affects
the peripheral nervous system, the skin and certain other tissues of the body
causing discoloration and lumps on the skin. In severe cases, leprosy causes
disfigurement and deformities.
Causative Agent:
Mycobacterium leprae
Incubation period:
2-5 years
Mode of transmission
- Direct
contact with untreated lepromatous patient’s discharges from the nose.
- Through fomites
of an infected person.
Pathophysiology
M. Leprae invades via the nasal mucosa and haematogenously
spread to skin and nerves. They invade peripheral nerves where the temperature
is lower than core body temperature.
The organism produces anaesthesia along distribution of its
cutaneous innervations. Then paralysis and deformity follow sensory loss.
Types of Leprosy
1. W.H.O classification
- Paucibacillary leprosy(PBL)
- Slit smear
negative.
- Person with
this kind of leprosy has less than 5 patches/skin lesions.
- Multibacillary
leprosy (MBL)
- Slit smear
positive.
- Person with
this kind of leprosy has more than 5 patches/skin lesions.
2.
Madrid
classification.- Indeterminate
leprosy
- Often goes
unrecognized.
- Lesion is
usually poorly defined.
- Disease
usually regresses with spontaneous healing of the lesion.
- Tuberculoid skin
lesions
- Lesions arc
large and well defined.
- Single or
few in number.
- It is
usually benign.
- Lepromatous lesions
- Numerous
lesions with poorly defined margins.
- Muscle
weakness and paralysis.
- Lesions are
limited to the cooler portion, of the body e.g. testis, skin, URT etc.
- Dimorphous (Borderline)
- This is
between the two major forms which are tuberculiod and lepromatous.
- Clinical
features represents a combination of the two principal types.
- This
depends upon whether treatment is received or not.
Clinical features
- Definite
loss of sensation in a skin patch (cardinal sign).
- Evidence of
peripheral nerve involvement (cardinal sign).
- Positive
slit skin smear (cardinal sign).
- Numbness.
- Nasal
obstruction with epistaxis.
- Painless
would on a hand or foot.
- Large ear
lobes (bat ears).
- Orchitis.
- Hoarse voice.
Diagnosis; is
based on the cardinal signs.
Medical treatment
- It is a long term treatment with the drugs. Dapsone and Rifampicin
with or without clofazimine are used.
- Alternative
drugs are Ethionamide or protionamide.
- Isolation of
patient in leprosarium is no longer necessary because within 72hrs of starting
chemotherapy, they are non-infectious.
- The treatment last for 6 months in paucibacillary skin
lesion and then 12 months for multibacillary lesions.
Nursing Management
- General
nursing care of patients with infectious disease.
- Give
psychological care.
- Physical
care.
- Patient
& relative education.
Prevention
- Prophylaxis
with Dapsone.
- Immunization
with BCG.
- Treat infected
persons.
- Health
education.
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