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  1. 1. Leprosy Presented by: Dave Jay S. Manriquez RN.
  2. 2. • Leprosy is a chronic infectious disease and communicable disease • Non hereditary • caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus • The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes, apart from some other structures. • Leprosy has afflicted humanity since time immemorial. • It once affected every continent and it has left behind a terrifying image in history and human memory - of mutilation, rejection and exclusion from society. EARLY SIGNS & SYMPTOMS = change in skin color = decrease/loss of sweating & hair growth = eye pain & redness = ulcers that do not heal LATE SIGNS/SYMPTOMS • Madarosis • Lagopthalmos • Clawing of fingers & toes • Contractures • Sinking of nosebridge • Gynecomastia Diagnosis of Leprosy • Diagnosis of leprosy is most commonly based on the clinical signs and symptoms. • These are easy to observe and elicit by any health worker after a short period of training. • In practice, most often persons with such complaints report on their own to the health centre. • Only in rare instances is there a need to use laboratory and other investigations to confirm a diagnosis of leprosy. • In an endemic country or area, an individual should be regarded as having leprosy if he or she shows ONE of the following cardinal signs: • skin lesion consistent with leprosy and with definite sensory loss, with or without thickened nerves • positive skin smears
  3. 3. • The skin lesion can be single or multiple, usually less pigmented than the surrounding normal skin. Sometimes the lesion is reddish or copper-coloured. A variety of skin lesions may be seen but macules (flat), papules (raised), or nodules are common. • Sensory loss is a typical feature of leprosy. The skin lesion may show loss of sensation to pin pick and/or light touch. Thickened nerves, mainly peripheral nerve trunks constitute another feature of leprosy. • A thickened nerve is often accompanied by other signs as a result of damage to the nerve. These may be loss of sensation in the skin and weakness of muscles supplied by the affected nerve. • In the absence of these signs, nerve thickening by itself, without sensory loss and/or muscle weakness is often not a reliable sign of leprosy. • Positive skin smears: In a small proportion of cases, rod-shaped, red-stained leprosy bacilli, which are diagnostic of the disease, may be seen in the smears taken from the affected skin when examined under a microscope after appropriate staining. • A person presenting with skin lesions or with symptoms suggestive of nerve damage, in whom the cardinal signs are absent or doubtful should be called a `suspect case' in the absence of any immediately obvious alternate diagnosis. WHO CLASSIFICATION OF LEPROSY Basis of Multidrug Therapy (MDT) • PAUCIBACILLARY = non-infectious type = 6-9 months MDT = Rifampin & Dapsone • MULTIBACILLARY (Lepromatous and Borderline) = infectious type = 24-30 months treatment = Rifampicin, Clofazimine, Dapsone Classification of leprosy • Leprosy can be classified on the basis of clinical manifestations and skin smear results. In the classification based on skin smears, patients showing negative smears at all sites are grouped as paucibacillary leprosy (PB), while those showing positive smears at any site are grouped as having multibacillary leprosy (MB).
  4. 4. • PREVENTION = avoidance of prolonged skin-skin contact = BCG vaccination • MANAGEMENT/TREATMENT = Multi-drug therapy = RA 4073 Domiciliary Home Treatment Transmission of leprosy • Leprosy is known to occur at all ages ranging from early infancy to very old age. The youngest age reported for occurrence of leprosy is three weeks in Martinique (Montestruc & Berdonneau, 1954). • The youngest case seen by the author was in an infant of two-and-a-half months, where the diagnosis of leprosy was confirmed by histopathology. Occurrence of leprosy, presumably for the first time, is not uncommon even after the age of seventy. Method of transmission of leprosy • The exact mechanism of transmission of leprosy is not known. At least until recently, the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. • More recently the possibility of transmission by the respiratory route is gaining ground. There are also other possibilities such as transmission through insects which cannot be completely ruled out. • It occurs in large numbers in the lesions of lepromatous leprosy, chiefly in masses within the lepra cells, often grouped together like bundles of cigars or arranged in a palisade. • It occurs in large numbers in the lesions of lepromatous leprosy, chiefly in masses within the lepra cells, often grouped together like bundles of cigars or arranged in a palisade. • Treatments are aimed to eliminate the microorganism that causes leprosy and to reduce the symptoms. Common treatments include: • Dapsone • Rifampin • Clofazimine • Ethionamide • Aspirin
  5. 5. • Prednisone • Thalidomide
  6. 6. • Prednisone • Thalidomide