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TOPIC- LEPROSY
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING
INTRODUCTION
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.
Causes: Mycobacterium leprae
Parent disease: Infection
DEFINITION :
ACCORDING TO BRUNNER AND SUDDHART : “ Leprosy
is an infectious disease that has been known since biblical
times. It is characterized by disfiguring skin sores, nerve
damage, and progressive debilitation “.
ACCORDING TO LEWIS : “Leprosy is a chronic bacterial
infection with Mycobacterium leprae. It primarily affects the
skin, mucous membranes (e.g. nose), peripheral nervous
system (nerve function), eyes and testes.”
ACCCORDING TO LUCKMANN : “ Leprosy is an infectious
disease characterized by disfiguring skin lesions, peripheral
nerve damage, and progressive debilitation.”
ACCORDING TO PHILLIPPIS : “ Leprosy is a chronic
infection caused by the Mycobacterium lepraebacteria. It can
affect the skin and the nerves of the hands and feet, as well as
the eyes and the lining of the nose. In some cases, leprosy can
also affect other organs, such as the kidneys and testicles in
men.”
TYPES :
Depending on clinical features, leprosy is classified
as:
 Indeterminate leprosy (IL)
 Tuberculoid leprosy (TT)
 Borderline tuberculoid leprosy (BT)
 Borderline borderline leprosy (BB)
 Borderline lepromatous leprosy (BL)
 Lepromatous leprosy (LL)
1. Indeterminate leprosy
refers to a very early form of leprosy that consists of a single
skin lesion with slightly diminished sensation to touch. It will
usually progress to one of the major types of leprosy.
 Includes Diseases: Tuberculoid leprosy; Lepromatous leprosy
Leprosy type Features
2. Tuberculoid
leprosy
 Can be either one large red patch with well-defined raised
borders or a large hypopigmented asymmetrical spot
 Lesions become dry and hairless
 Loss of sensation may occur at site of some lesions
 Tender, thickened nerves with subsequent loss of function
are common
 Spontaneous resolution may occur in a few years or it may
progress to borderline or rarely lepromatous types
3. Borderline
tuberculoid
leprosy
 Similar to tuberculoid type except that lesions are smaller
and more numerous
 Disease may stay in this stage or convert back to
tuberculoid form, or progress
4. Borderline
borderline
 Numerous, red, irregularly shaped plaques
 Sensory loss is moderate
 Disease may stay in this stage, improve or worsen
5. Borderline
lepromatous
leprosy
 Numerous lesions of all kinds, plaques, macules, papules
and nodules. Lesions looking like inverted saucers are
common
 Hair growth and sensation are usually not impaired over the
lesions
6.Lepromatous
leprosy
 Early nerve involvement may go unnoticed
 Numerous lesions of all kinds, plaques, macules, papules
and nodules
 Early symptoms include nasal stuffiness, discharge and
bleeding, and swelling of the legs and ankles
 Left untreated, the following problems may occur:
 Skin thickens over forehead (leonine facies), eyebrows
and eyelashes are lost, nose becomes misshapen or
collapses, ear lobes thicken, upper incisor teeth fall out
 Eye involvement causing photophobia (light
sensitivity), glaucoma and blindness
 Skin on legs thickens and forms ulcers when nodules
break down
 Testicles shrivel causing sterility and enlarged breasts
(males)
 Internal organ infection causing enlarged liver and
lymph nodes
 Voice becomes hoarse due to involvement of the
larynx
 Slow scarring of peripheral nerves resulting in nerve
thickening and sensory loss. Fingers and toes become
deformed due to painless repeated trauma.
ETIOLOGY:
 Mycobacterium leprae: Mycobacterium leprae grow slowly and mainly affect the
skin, nerves, and mucous membranes. Children are more susceptible than adults
to contracting the disease.
 Person to Person: Most scientists believe that leprosy spreads from person to
person through infected respiratory droplets. While this is one mode of leprosy
transmission. People who are at the greatest risk of leprosy transmission are:
o Parents of someone with leprosy
o Children of someone with leprosy
o Brothers or sisters of someone with leprosy.
 The extent of exposure
 Genetics
 Environmental conditions
PATHOPHYSIOLOGY :
It is thought to be passed from person to person through
nasal droplets and secretions. Casual contact (eg, simply
touching someone with the disease) and short-term
contact does not seem to spread the disease
transmission is by aerosol spread from infected nasal
secretions to exposed nasal and oral mucosa
The incubation period for leprosy is 6 months to 40 years
or longer
It affects the superficial peripheral nerves, skin, mucous
membranes of the upper respiratory tract, anterior
chamber of the eyes, and the testes
Tissue damage depends on the degree to which cell-
mediated immunity is expressed, the type and extent of
bacillary spread and multiplication, the appearance of
tissue-damaging immunologic complications (ie, lepra
reactions)
Result of nerve damage.
CLINICAL MANIFESTATION:
 Hands and feet - Leprosy bacteria attack the nerves in the handsand
feet and cause them to become numb.A person may get cuts or burns on
the numb parts and not know it, leading to infections which cause permanent
damage. Fingers and toes may be lost to infection. Serious infections in the
feet may require amputation. Paralysis may cause the fingers and toes to
curl up permanently.
 Eyes - Leprosy bacteria attack the nerves around the eyes, causing the
loss of blinking reflex (which protects the eye from injury and moistens the
surface). The eyes become dry and infected, and blindness may result.
Because of numbness of the eye, the person cannot feel debris in or
scratches on the eye.
 Face - Damage to the internal lining of the nose causes scarring and
eventual collapse of the nose.
 Skin Stiffness
 Skin lesions that are lighter than your normal skin color
o Lesions have decreased sensation to touch, heat, or pain
o Lesions do not heal after several weeks to months
 Numbness or absent sensation in the hands, arms, feet, and legs
 Severe pain in feet and hands.
 Muscle weakness.
 Skin dryness and stiffness.
 Loss of toes and fingers.
 Eye problems which can lead to blindness.
 Leprosy patients are not sensitive to light and touch in the affected areas.
 Skin rash (symmetrical) is noticed in people suffering from Lepromatous
leprosy. These rashes are commonly found on the wrists, face, elbows,
face, buttocks and knees.
 Thinning of the eyelashes and eyebrows, bloody nose, nasal stuffiness,
collapsing of the nose and problems in the testes are other common
symptoms noticed in a person suffering from the disease.
 Skin lumps and bumps that can be disfiguring.
 If untreated, there can be progressive and permanent damage to the
skin, nerves, limbs and eyes.
DIAGNOSTIC EVALUATION :
 Assessment of Health Status
 Lepromin skin test
The lepromin skin test is used to determine what type of leprosy a person has. This
test indicates
host resistance to M leprae. It results do not confirm the diagnosis,
but they are useful in determining the type of leprosy.
To perform this
test, bacillary suspension is injected into the forearm. When the reaction is
assessed at 48 hours, it is called the Fernandez reaction and indicates delayed
hypersensitivity to antigens of M leprae or mycobacterium that cross
react. When the reaction is read at 3-4 weeks it is called the Mitsuda reaction and
indicates that the immune system is
capable of mounting an efficient cell-mediated response.
BIOPSY
A biopsy describes the procedure that is used to obtain a very small piece
of the target tissue. For some tissues, like the lining of the cheek, cells
can be obtained just by scrapping the tissue surface.
 Sputum stain for mycobacteria:
 Sputum stain for mycobacteria is a test to check for a type of
bacteria that cause tuberculosis and other kinds of infection.
 Skin lesion biopsy
A skin lesion biopsy is the removal of a piece of skin to diagnose or rule out an
illness.
 Nerve biopsy
A nerve biopsy is the removal of a small piece of a nerve
for examination.
Sensory testing
Tactile and temperature sensations should be tested. . A wisp of cotton
can be used to test
for anesthesia of the lesions.
Polymerase chain reaction (PCR) analysis
PCR can be used
to detect and identify M leprae. The technique is used most often when
acid-fast bacilli are detected but clinical or histopathologic features are
atypical.
TREATMENT :
MDT:- Multidrug therapy (MDT) is the cornerstone of the leprosy
elimination strategy as it cures patients, reduces the reservoir of infection
and thereby interrupts its transmission. MDT also prevents disabilities
through early cure.
For purposes of treatment, leprosy is divided into two
types :
a) Pauci-bacillary(PB) leprosy : 1-5 skin lesions – Regimen of
two drugs – Rifampicin and Dapsone for 6 months;
b) Multi-bacillary(MB) leprosy : >5 skin lesions – Regimen of
three drugs – Rifampicin,Clofazimine and Dapsone for 12 months;
(1) Antimicrobials
(a) Dapsone
(Avlosulfon) - Acts by blocking folic acid synthesis. Dapsone half-life is 1-
2 days28-29. During dapsone therapy of lepromatous leprosy, ENL, often
develops. Now used as part of a multidrug regimen to treat leprosy.
Plasma concentrations ranges from 0.4-1.2microgram/ml, after 24hrs of
oral ingestion of its dose (100mg)30.
(b) Rifampin
(Rifadin, Rimactane)- Bactericidal for M leprae. Inhibits DNA-dependent
RNA polymerase, interfering with bacterial RNA synthesis. Usually given
with dapsone to reduce the emergence of resistance strains of leprae31.
Macrocyclic ring has an important bearing on
the binding to RNA polymerase, while the aromatic nucleus plays a large
part in
determining penetration into the bacteria32.
(c) Clofazimine (Lamprene)- It inhibits mycobacterial growth by binding
to GC-rich mycobacterial DNA33.Weakly bactericidal against M
leprae. Eosinophilic enteritis has been described as an adverse reaction
to the drug34-38.
(2) Corticosteroids
These medications can be used to treat leprosy reactions when a risk of
neurological deficits exists or when lesions occur in cosmetically
important places. They can also be used to treat ENL.
(a) Prednisone (Deltasone )- Maydecrease inflammation by
reversing increased capillary permeability andsuppressing PMN activity.
Stabilizes lysosomal membranes and also suppresses lymphocytes and
antibody production.
(3) Immunomodulators
These agents are used to modify the immune system response to
diverse stimuli.
Thalidomide
(Thalomid) – Immunomodulatory agent that may suppress excessive
production of tumor necrosis factor-alpha (TNF-alpha) and down-
regulates selected cell-surface adhesion molecules involved in leukocyte
migration. Can be used to treat recurrent or refractory ENL.
Leprosy Control :
The main objectives of a leprosy control program
are:
 1-To interrupt transmission of the infection, reducing the incidence
of the disease so that it no longer
 constitute a public health problem.
 2-To find new cases that are symptomatic or before symptoms
develop.
 3-To follow up all known cases and ascertain that they receive
proper medical care and take regular
 treatment.
 4-To prevent the development of associated deformities
 5-To educate the patient, his family, the health professional, and
the public.
SURGICAL MANAGEMENT :
Surgery may sometimes be used to drain abscesses to restore nerve function, reconstruct
collapsed nose, or to improve function or appearance of affected areas.
Patient education is paramount. Leprosy can be cured but it is essential to take the full
course of medication. It is no longer infectious once treatment has begun. Patients should be
instructed how to deal with existing nerve damage for example protecting numb feet from
injury. Physical, social and psychological rehabilitation is a necessary for those in whom
neglected disease has caused havoc.
IN PATIENT : In my patient no surgery is performed . only medical management is given.
NURSING MANAGEMENT:
 Avoiding physical contact with untreated people
 People who are in immediate contact with the leprosy patient
should be tested for leprosy.
 Annual examinations should also be conducted on these people
for a period of five years following their last contact with an
infectious patient
 Reconstructive surgery is aimed at preventing and correcting
deformities.
 Comprehensive care involves teaching patients to care for
themselves.
 Physiotherapy exercises are taught to the patients to maintain a
range of movement in finger joints and prevent the deformities
from worsening.
 Monitor in During the course of treatment, the body may react to
the dead bacteria with pain and swelling in the skin and nerves.
This is treated with pain
medication, prednisone orthalidomide (under special conditions).
 Leprosy can be cured but it is essential to take the full course of
medication.
 Patients should be instructed how to deal with existing nerve
damage for example protecting numb feet from injury.
 Physical, social and psychological rehabilitation is a necessary for
those in whom neglected disease .
NURSING CARE PLAN :
Pre operative nursing care plan -
ASSESSMENT NURSING
DIAGNOSIS
NURSING
GOAL
PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE
DATA:patient
complain that
he was having
pain in the
whole body.
Objective
Data: on
observation
that he was
having excess
pain showing
by his facial
expression.
Acutepain
related to
nerve
damage
To
reduce
the pain
Assess the level
of pain
-to provide
comfortable
position to the
patient.
-application of
cold packs to the
affected region.
-Diversional
therapy is
provided.
-local
application of
medicationas
-pain level is
assessed .
-comfortable
position isgiven.
-cold
application is
given
-to changethe
mood .
-medication is
given.
-to determine
the condition.
-to provide
comfort.
To reduce the
pain .
-to changethe
mood of the
patient.
-for the
treatment
After nursing
intervention
the patient
feel good
and the pain
is reduced.
ordered. regimen.
Subjective Activity Promotin -assess patient -patient general -. determinethe After the
Data : patient intolerance g general condition. condition is condition of the intervention
complain that related to adequate - To provide rest assessed. patient patient is
he is not doing fatigue , nutrition and comfort. -comfort and -for provide feel better .
any work, and altered and - to plan a rest provided. comfort.
numbnessin nutrition activity. progressive -activity -to increase the
hand and feet. status and activity schedule. schedule is activity tolerance
Objective Data numbness -To instruct the planned. muscle strength.
i observe that in hand patient to take -patient is -to meet
the patient is and feet. liquid diets. instructed for nutritional
weak and -to administer activity. require.
unable to do drug. -drug is -to reduce
work administered. fatigue.
ASSESSMENT NURSING NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS GOAL
Subjective
Data : patient
complain that
he is
uncomfortable
and not talk to
any one.
Objective Data
: on
observation I
found that he
is anxiousand
uncomfort .
Anxiety
and fear
related to
disease
and its
treatment.
To
reduce
the
anxiety
and fear
of the
patient.
-to assess the
patientgeneral
condition .
-to provide
continuity care .-
to allow and
encouragethe
patient to ask
question and
clear thedoubt.
- to encourage
the patient to
talk and express
feeling
-general
conditionis
assessed .
-care is provided.
-patient is
encourage d to
ask question.
-patient is
encouraged to
talk.
-determine the
patient
condition.
-for patient
security.
-to reduce the
fear and anxiety.
-to reduce the
fear andprovide
comfort.
After the
nursing
intervention the
patient feel
good.
Subjective
Data - patient
complain that
he is felling
hot and
uncomfortable
, irritation in
the anal
region, and
pain..
Objective
Data – On
observation by
touching his
hand he is
having fever.
Risk for
infection
related to
bacterial
invasion
and leison .
To
reduce
the risk
of
infection
and
provide
comfort.
-to assess the
general
condition of the
patient.
-to give
comfortable
position.
-to monitorthe
vitals.
- to changethe
dressing.
-patient general
condition
assessed.
-comfortable
position isgiven.
-Vital is
monitored
-dressing is
changed.
To know the
condition of the
patient.
For comfort and
relief.
-to knowthe
vitals.
- To reduce the
risk of infection
and maintain the
sterility.
After
intervention the
patients fever is
decreased and
fell comfort.
-to promote the
cool and comfort
environment.
- cool and
comfortable
environment
provided.
-to divert the
mind.
-maintain
personal
hygiene.
- personal
hygiene
maintained.
-To prevent from
complication.
-To administer
the antipyretic
as per order.
-antipyretic
administered as
per order.
-To relief from
fever.
ASSESSMENT NURSING NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS GOAL
.SUBJECTIVE
DATA –
Patient
relative
complain that
the patientis
not eating
food properly.
Alteration
in nutrition
less then
body
requiremen
t related to
anorexia,
nausea .
To
provide
proper
diet
requirem
ent to the
patient
-assess the
general
condition of the
patient.
-take vitals of
the patient.
-patient general
condition is
assessed.
-vital of the
patient taken.
-I/V fluid are
administered.
-important of
balanced diet is
explained.
-encouraged
patient for fluid
intake.
-instructed about
the frequent diet
.
to know the
general
condition of the
patient.
-to know the any
other problems.
-to maintain the
nutritional need
of the patients.
-to increase the
knowledge of
the patient.
-to maintainthe
fluid and
electrolyte
imbalance.
-t produce
energy that help
the patient to
feel energetic.
After
intervention the
patient feel
comfort and
take food
properly.
OBJECTIVE
DATA- On
observation
the patientis
weal and
refused the
food.
-administerI/V
fluids as
ordered.
Explain the
importance of
the balance diet.
-encouragefor
fluid intake.
-to instructabout
the frequent
diet.
SUBJECTIVE
DATA- Patient
complain that
the patient is
Not take
sleep.
OBJECTIVE
DATA- On
observation
that the
patient is
sleeplessness.
Sleeplessn
ess related
to leprosy
and
weakness.
To
provide
adequate
sleep to
patient.
-assess thelevel
ofsleeplessness.
talk to the
patient
-divert themind
of the patient.
-avoid nap
during the day
hours.
-encourage
patient for read
some books.
- patient general
condition is
assessed and
talked.
-mind of the
patient is
Diverted.
-naping is
avoided in the
day time.
-patient is read
the book or
magazine.
-to know the
condition of the
patient and to
know thereason
-To feel comfort.
-for better sleep.
-To increase
sleep pattern.
-for better sleep.
After
intervention
patient is Feel
comfort and
take sleep in
the night.
-maintain the
room dark at the
night.
-room is darked
at the night time.
-provide the
sleep.
- give
psychological
support to
patient.
-psychological
support is given.
- to reduce the
sleeplessness.
ASSESSMENT NURSING PALNNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
SUBJECTIVE
DATA-Patient
complain that
he is having
pain at the
surgical site.
Pain related
to surgical
incision.
To reduce
the pain and
provide
comfort.
-assess the level
of pain.
-provide
comfortable
position to the
patient.
-to know the
level of pain.
-to relief
from pain.
After
intervention
the patients
pain is
reduced.
OBJECTIVE
DATA – On
observation
that patient is
having pain
showing by
facial
expression.
SUBJECTIVE
DATA- Patient
complain for
itching in the
surgical site.
OBJECTIVE
DATA-On
observation
that the patient
is having
itching.
Risk for
infection
related to
unhygienic
condition
To reduce
the risk of
infection and
other
complication.
-divert the mind
of the patient .
-administer
analgesic as per
doctors order.
-maintain
personal hygiene.
-assess the
patient general
condition.
-monitor vitals
every 2 hours.
-maintain intake
and output chart.
-change the
dressing twice a
day.
-encourage to
maintain personal
hygiene.
-to provide
comfort to
the patient.
-to relief
from pain.
-reduce the
risk of
infection.
-to know the
condition of
patient.
-to know the
change in the
vitals which
shows any
infection.
-to prevent
from
complication.
After
intervention
the risk is
reduced.
-to prevent
from
infection.
-assess the level
of sleeplessness.
SUBJECTIVE
DATA- Patient
complain that
the patient is Sleeplessness
related to
surgery.
To provide
adequate
sleep to
patient.
-to know the
condition of
the patient.
-to know
After
intervention
patient is
ASSESSMENT NURSING PALNNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Not take sleep.
OBJECTIVE
DATA- On
observationthat
the patientis
sleeplessness.
-talk to thepatient
-divert the mind of
the patient.
-avoid nap during
the dayhours.
-encourage patient
for read some
books.
-maintain the room
dark at thenight.
The reason
-To feel
comfort.
-for better
sleep.
-To increase
sleeppattern.
Feel comfort.
-assess the levelof
discomfort.
-for better
sleep.
SUBJECTIVE
DATA- Patient
complain thathe
is feeling
discomfort.
OBJECTIVE
DATA- On
observationthat
patient is tired
and anxious .
Alteration in
comfort
related to
surgical
procedureand
hospital
environment.
To provide
comfort tothe
patient.
-check the vitals.
-provide
comfortable
position.
Encourage for rest
and sleep.
-use divertional
therapy.
To knowthe
patient
condition.
-to know the
variation inthe
vitals.
-to provide
comfort and
rest .
After
intervention
patient feel
comfort.
SUBJECTIVE
DATA- Patient
and relativewant
to know about
the discharge
treatment.
OBJECTIVE
DATA-On
observationthat
they are eagerto
know the
discharge
treatment.
Knowledge
deficitrelated
to discharge
treatment.
To givehealth
education and
discharge
planning.
-assess thepatient
and relatives
knowledge .
-explain the
disease,causes,
clinical
manifestationand
treatment.
-educatehowto
prevent from
complication.
To feel
comfort.
-to know the
level of
knowledge.
To increase
the
knowledge.
To reducethe
risk of
infection .
Afterteaching
the patients
knowledge is
increase.
To comfort.
HEALTH EDUCATION :
Points to emphasize to the patients are:
 -the necessity for regular treatment and surveillance
 -the good prognosis of Leprosy treated regularly
 -the possibility of reactions, their early signs and the necessity to
seek medical care for reactions.
 Louisiana Office of Public Health – Infectious Disease
Epidemiology Section- Infectious Disease Control Manual
 -In the case of existing disabilities, the patient should be taught to
cope with them. Special information
 to cover are: 1-Care of insensitive hands, 2-care of insensitive feet,
3-care of the eyes.
 Educate The Family: The family and close contacts of the case
have been exposed to the leprosy bacilli
 and should be examined regularly for early signs of leprosy. The
nurse should:
 -emphasize the purpose of these systematic examinations, explain
their frequency;
 -teach the contacts how to check for early signs of leprosy; change
in skin color, change in skin sensitivity,
 nodules in any part of the body, change in motor function;
 -stress the importance of the contact to have any suspect lesions
checked by a health person;
 -discuss the transmission of Leprosy, the immunity of the majority
of people, the incubation and any
 other relevant epidemiological information;
 -answer any questions the contact may have regarding leprosy.
 -assist the contact to adjust and accept the need of regular check
ups.
 The family plays an important role in the patient's care and
progress. They should be taught basic facts
 in the care and evolution of leprosy.
PREVENTION
The best way to prevent the spread of leprosy is the early diagnosis and treatment of
people who are infected. For household contacts, immediate and annual
examinations are recommended for at least five years after last contact with a
person who is infectious.Because leprosy is not very contagious, risk of spread is
low. Only the untreated lepromatous form is contagious, but even then the infection
is not easily spread. Once treatment has begun, leprosy cannot be spread. Avoiding
contact with bodily fluids from and the rash on infected people is the best prevention.
The BCG vaccine, used to prevent TB, provides some protection against leprosy but
is not often used. The best way to prevent leprosy is to avoid contact with body fluids
and the rashes of people who have leprosy.
REHABILITATION : Rehabilitation is part and parcel of effective leprosy
control. Preventing deformities by early detection and prompt treatment is one of the
essential steps in Rehabilitation Secondly for those patients who are having
deformities either special accessories or corrective surgical procedures have to be
undertaken. Social and vocational Rehabilitation are integral components for the
leprosy patients to lead a life of dignity. While we plan the rehabilitation, we have to
give specific attention to the social and economic
aspects. It is now increasingly realized that the economic reinstatement of a leprosy
patient will hasten the process of his social rehabilitation and acceptance in the
community.
COMPLICATION:
 Feet: Plantar ulcers with secondary infection are a major
cause of morbidity, making walking painful.
 Nose: Damage to the nasal mucosa can result in chronic
nasal congestion and nosebleeds and, if untreated, erosion
and collapse of the nasal septum.
 Eyes: Iritis may lead to glaucoma, and corneal insensitivity
may lead to scarring and blindness.
 Cosmetic Disfigurement
 Muscle Weakness
 Nerve Damage in the Extremities
 Sensory Loss in the Skin
 Long-term leprosy may lose the use of hands or feet due
to repeated injury resulting from lack of sensation.
Leprosy
Leprosy

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Leprosy

  • 1. TOPIC- LEPROSY PRESENTED BY OM VERMA ASSISTANT PROFESSOR RELIANCE INSTITUTE OF NURSING
  • 2. INTRODUCTION 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. Causes: Mycobacterium leprae Parent disease: Infection DEFINITION : ACCORDING TO BRUNNER AND SUDDHART : “ Leprosy is an infectious disease that has been known since biblical times. It is characterized by disfiguring skin sores, nerve damage, and progressive debilitation “. ACCORDING TO LEWIS : “Leprosy is a chronic bacterial infection with Mycobacterium leprae. It primarily affects the skin, mucous membranes (e.g. nose), peripheral nervous system (nerve function), eyes and testes.” ACCCORDING TO LUCKMANN : “ Leprosy is an infectious disease characterized by disfiguring skin lesions, peripheral nerve damage, and progressive debilitation.” ACCORDING TO PHILLIPPIS : “ Leprosy is a chronic infection caused by the Mycobacterium lepraebacteria. It can affect the skin and the nerves of the hands and feet, as well as the eyes and the lining of the nose. In some cases, leprosy can also affect other organs, such as the kidneys and testicles in men.”
  • 3. TYPES : Depending on clinical features, leprosy is classified as:  Indeterminate leprosy (IL)  Tuberculoid leprosy (TT)  Borderline tuberculoid leprosy (BT)  Borderline borderline leprosy (BB)  Borderline lepromatous leprosy (BL)  Lepromatous leprosy (LL) 1. Indeterminate leprosy refers to a very early form of leprosy that consists of a single skin lesion with slightly diminished sensation to touch. It will usually progress to one of the major types of leprosy.  Includes Diseases: Tuberculoid leprosy; Lepromatous leprosy Leprosy type Features 2. Tuberculoid leprosy  Can be either one large red patch with well-defined raised borders or a large hypopigmented asymmetrical spot  Lesions become dry and hairless  Loss of sensation may occur at site of some lesions  Tender, thickened nerves with subsequent loss of function are common  Spontaneous resolution may occur in a few years or it may progress to borderline or rarely lepromatous types 3. Borderline tuberculoid leprosy  Similar to tuberculoid type except that lesions are smaller and more numerous  Disease may stay in this stage or convert back to tuberculoid form, or progress
  • 4. 4. Borderline borderline  Numerous, red, irregularly shaped plaques  Sensory loss is moderate  Disease may stay in this stage, improve or worsen 5. Borderline lepromatous leprosy  Numerous lesions of all kinds, plaques, macules, papules and nodules. Lesions looking like inverted saucers are common  Hair growth and sensation are usually not impaired over the lesions 6.Lepromatous leprosy  Early nerve involvement may go unnoticed  Numerous lesions of all kinds, plaques, macules, papules and nodules  Early symptoms include nasal stuffiness, discharge and bleeding, and swelling of the legs and ankles  Left untreated, the following problems may occur:  Skin thickens over forehead (leonine facies), eyebrows and eyelashes are lost, nose becomes misshapen or collapses, ear lobes thicken, upper incisor teeth fall out  Eye involvement causing photophobia (light sensitivity), glaucoma and blindness  Skin on legs thickens and forms ulcers when nodules break down  Testicles shrivel causing sterility and enlarged breasts (males)  Internal organ infection causing enlarged liver and lymph nodes  Voice becomes hoarse due to involvement of the larynx  Slow scarring of peripheral nerves resulting in nerve thickening and sensory loss. Fingers and toes become deformed due to painless repeated trauma.
  • 5. ETIOLOGY:  Mycobacterium leprae: Mycobacterium leprae grow slowly and mainly affect the skin, nerves, and mucous membranes. Children are more susceptible than adults to contracting the disease.  Person to Person: Most scientists believe that leprosy spreads from person to person through infected respiratory droplets. While this is one mode of leprosy transmission. People who are at the greatest risk of leprosy transmission are: o Parents of someone with leprosy o Children of someone with leprosy o Brothers or sisters of someone with leprosy.  The extent of exposure  Genetics  Environmental conditions
  • 6. PATHOPHYSIOLOGY : It is thought to be passed from person to person through nasal droplets and secretions. Casual contact (eg, simply touching someone with the disease) and short-term contact does not seem to spread the disease transmission is by aerosol spread from infected nasal secretions to exposed nasal and oral mucosa The incubation period for leprosy is 6 months to 40 years or longer It affects the superficial peripheral nerves, skin, mucous membranes of the upper respiratory tract, anterior chamber of the eyes, and the testes Tissue damage depends on the degree to which cell- mediated immunity is expressed, the type and extent of bacillary spread and multiplication, the appearance of tissue-damaging immunologic complications (ie, lepra reactions) Result of nerve damage.
  • 7. CLINICAL MANIFESTATION:  Hands and feet - Leprosy bacteria attack the nerves in the handsand feet and cause them to become numb.A person may get cuts or burns on the numb parts and not know it, leading to infections which cause permanent damage. Fingers and toes may be lost to infection. Serious infections in the feet may require amputation. Paralysis may cause the fingers and toes to curl up permanently.  Eyes - Leprosy bacteria attack the nerves around the eyes, causing the loss of blinking reflex (which protects the eye from injury and moistens the surface). The eyes become dry and infected, and blindness may result. Because of numbness of the eye, the person cannot feel debris in or scratches on the eye.  Face - Damage to the internal lining of the nose causes scarring and eventual collapse of the nose.  Skin Stiffness  Skin lesions that are lighter than your normal skin color o Lesions have decreased sensation to touch, heat, or pain o Lesions do not heal after several weeks to months  Numbness or absent sensation in the hands, arms, feet, and legs  Severe pain in feet and hands.  Muscle weakness.  Skin dryness and stiffness.  Loss of toes and fingers.  Eye problems which can lead to blindness.  Leprosy patients are not sensitive to light and touch in the affected areas.  Skin rash (symmetrical) is noticed in people suffering from Lepromatous leprosy. These rashes are commonly found on the wrists, face, elbows, face, buttocks and knees.  Thinning of the eyelashes and eyebrows, bloody nose, nasal stuffiness, collapsing of the nose and problems in the testes are other common symptoms noticed in a person suffering from the disease.  Skin lumps and bumps that can be disfiguring.  If untreated, there can be progressive and permanent damage to the skin, nerves, limbs and eyes.
  • 8.
  • 9. DIAGNOSTIC EVALUATION :  Assessment of Health Status  Lepromin skin test The lepromin skin test is used to determine what type of leprosy a person has. This test indicates host resistance to M leprae. It results do not confirm the diagnosis, but they are useful in determining the type of leprosy. To perform this test, bacillary suspension is injected into the forearm. When the reaction is assessed at 48 hours, it is called the Fernandez reaction and indicates delayed hypersensitivity to antigens of M leprae or mycobacterium that cross react. When the reaction is read at 3-4 weeks it is called the Mitsuda reaction and indicates that the immune system is capable of mounting an efficient cell-mediated response. BIOPSY A biopsy describes the procedure that is used to obtain a very small piece of the target tissue. For some tissues, like the lining of the cheek, cells can be obtained just by scrapping the tissue surface.  Sputum stain for mycobacteria:  Sputum stain for mycobacteria is a test to check for a type of bacteria that cause tuberculosis and other kinds of infection.
  • 10.  Skin lesion biopsy A skin lesion biopsy is the removal of a piece of skin to diagnose or rule out an illness.  Nerve biopsy A nerve biopsy is the removal of a small piece of a nerve for examination. Sensory testing Tactile and temperature sensations should be tested. . A wisp of cotton can be used to test for anesthesia of the lesions. Polymerase chain reaction (PCR) analysis PCR can be used to detect and identify M leprae. The technique is used most often when acid-fast bacilli are detected but clinical or histopathologic features are atypical.
  • 11. TREATMENT : MDT:- Multidrug therapy (MDT) is the cornerstone of the leprosy elimination strategy as it cures patients, reduces the reservoir of infection and thereby interrupts its transmission. MDT also prevents disabilities through early cure. For purposes of treatment, leprosy is divided into two types : a) Pauci-bacillary(PB) leprosy : 1-5 skin lesions – Regimen of two drugs – Rifampicin and Dapsone for 6 months; b) Multi-bacillary(MB) leprosy : >5 skin lesions – Regimen of three drugs – Rifampicin,Clofazimine and Dapsone for 12 months; (1) Antimicrobials (a) Dapsone (Avlosulfon) - Acts by blocking folic acid synthesis. Dapsone half-life is 1- 2 days28-29. During dapsone therapy of lepromatous leprosy, ENL, often develops. Now used as part of a multidrug regimen to treat leprosy. Plasma concentrations ranges from 0.4-1.2microgram/ml, after 24hrs of oral ingestion of its dose (100mg)30. (b) Rifampin (Rifadin, Rimactane)- Bactericidal for M leprae. Inhibits DNA-dependent RNA polymerase, interfering with bacterial RNA synthesis. Usually given with dapsone to reduce the emergence of resistance strains of leprae31. Macrocyclic ring has an important bearing on the binding to RNA polymerase, while the aromatic nucleus plays a large part in determining penetration into the bacteria32. (c) Clofazimine (Lamprene)- It inhibits mycobacterial growth by binding to GC-rich mycobacterial DNA33.Weakly bactericidal against M leprae. Eosinophilic enteritis has been described as an adverse reaction to the drug34-38. (2) Corticosteroids These medications can be used to treat leprosy reactions when a risk of neurological deficits exists or when lesions occur in cosmetically important places. They can also be used to treat ENL.
  • 12. (a) Prednisone (Deltasone )- Maydecrease inflammation by reversing increased capillary permeability andsuppressing PMN activity. Stabilizes lysosomal membranes and also suppresses lymphocytes and antibody production. (3) Immunomodulators These agents are used to modify the immune system response to diverse stimuli. Thalidomide (Thalomid) – Immunomodulatory agent that may suppress excessive production of tumor necrosis factor-alpha (TNF-alpha) and down- regulates selected cell-surface adhesion molecules involved in leukocyte migration. Can be used to treat recurrent or refractory ENL. Leprosy Control : The main objectives of a leprosy control program are:  1-To interrupt transmission of the infection, reducing the incidence of the disease so that it no longer  constitute a public health problem.  2-To find new cases that are symptomatic or before symptoms develop.  3-To follow up all known cases and ascertain that they receive proper medical care and take regular  treatment.  4-To prevent the development of associated deformities  5-To educate the patient, his family, the health professional, and the public. SURGICAL MANAGEMENT : Surgery may sometimes be used to drain abscesses to restore nerve function, reconstruct collapsed nose, or to improve function or appearance of affected areas. Patient education is paramount. Leprosy can be cured but it is essential to take the full course of medication. It is no longer infectious once treatment has begun. Patients should be instructed how to deal with existing nerve damage for example protecting numb feet from injury. Physical, social and psychological rehabilitation is a necessary for those in whom neglected disease has caused havoc.
  • 13. IN PATIENT : In my patient no surgery is performed . only medical management is given. NURSING MANAGEMENT:  Avoiding physical contact with untreated people  People who are in immediate contact with the leprosy patient should be tested for leprosy.  Annual examinations should also be conducted on these people for a period of five years following their last contact with an infectious patient  Reconstructive surgery is aimed at preventing and correcting deformities.  Comprehensive care involves teaching patients to care for themselves.  Physiotherapy exercises are taught to the patients to maintain a range of movement in finger joints and prevent the deformities from worsening.  Monitor in During the course of treatment, the body may react to the dead bacteria with pain and swelling in the skin and nerves. This is treated with pain medication, prednisone orthalidomide (under special conditions).  Leprosy can be cured but it is essential to take the full course of medication.  Patients should be instructed how to deal with existing nerve damage for example protecting numb feet from injury.  Physical, social and psychological rehabilitation is a necessary for those in whom neglected disease .
  • 14. NURSING CARE PLAN : Pre operative nursing care plan - ASSESSMENT NURSING DIAGNOSIS NURSING GOAL PLANNING INTERVENTION RATIONALE EVALUATION SUBJECTIVE DATA:patient complain that he was having pain in the whole body. Objective Data: on observation that he was having excess pain showing by his facial expression. Acutepain related to nerve damage To reduce the pain Assess the level of pain -to provide comfortable position to the patient. -application of cold packs to the affected region. -Diversional therapy is provided. -local application of medicationas -pain level is assessed . -comfortable position isgiven. -cold application is given -to changethe mood . -medication is given. -to determine the condition. -to provide comfort. To reduce the pain . -to changethe mood of the patient. -for the treatment After nursing intervention the patient feel good and the pain is reduced.
  • 15. ordered. regimen. Subjective Activity Promotin -assess patient -patient general -. determinethe After the Data : patient intolerance g general condition. condition is condition of the intervention complain that related to adequate - To provide rest assessed. patient patient is he is not doing fatigue , nutrition and comfort. -comfort and -for provide feel better . any work, and altered and - to plan a rest provided. comfort. numbnessin nutrition activity. progressive -activity -to increase the hand and feet. status and activity schedule. schedule is activity tolerance Objective Data numbness -To instruct the planned. muscle strength. i observe that in hand patient to take -patient is -to meet the patient is and feet. liquid diets. instructed for nutritional weak and -to administer activity. require. unable to do drug. -drug is -to reduce work administered. fatigue.
  • 16. ASSESSMENT NURSING NURSING PLANNING INTERVENTION RATIONALE EVALUATION DIAGNOSIS GOAL Subjective Data : patient complain that he is uncomfortable and not talk to any one. Objective Data : on observation I found that he is anxiousand uncomfort . Anxiety and fear related to disease and its treatment. To reduce the anxiety and fear of the patient. -to assess the patientgeneral condition . -to provide continuity care .- to allow and encouragethe patient to ask question and clear thedoubt. - to encourage the patient to talk and express feeling -general conditionis assessed . -care is provided. -patient is encourage d to ask question. -patient is encouraged to talk. -determine the patient condition. -for patient security. -to reduce the fear and anxiety. -to reduce the fear andprovide comfort. After the nursing intervention the patient feel good. Subjective Data - patient complain that he is felling hot and uncomfortable , irritation in the anal region, and pain.. Objective Data – On observation by touching his hand he is having fever. Risk for infection related to bacterial invasion and leison . To reduce the risk of infection and provide comfort. -to assess the general condition of the patient. -to give comfortable position. -to monitorthe vitals. - to changethe dressing. -patient general condition assessed. -comfortable position isgiven. -Vital is monitored -dressing is changed. To know the condition of the patient. For comfort and relief. -to knowthe vitals. - To reduce the risk of infection and maintain the sterility. After intervention the patients fever is decreased and fell comfort. -to promote the cool and comfort environment. - cool and comfortable environment provided. -to divert the mind. -maintain personal hygiene. - personal hygiene maintained. -To prevent from complication. -To administer the antipyretic as per order. -antipyretic administered as per order. -To relief from fever.
  • 17. ASSESSMENT NURSING NURSING PLANNING INTERVENTION RATIONALE EVALUATION DIAGNOSIS GOAL .SUBJECTIVE DATA – Patient relative complain that the patientis not eating food properly. Alteration in nutrition less then body requiremen t related to anorexia, nausea . To provide proper diet requirem ent to the patient -assess the general condition of the patient. -take vitals of the patient. -patient general condition is assessed. -vital of the patient taken. -I/V fluid are administered. -important of balanced diet is explained. -encouraged patient for fluid intake. -instructed about the frequent diet . to know the general condition of the patient. -to know the any other problems. -to maintain the nutritional need of the patients. -to increase the knowledge of the patient. -to maintainthe fluid and electrolyte imbalance. -t produce energy that help the patient to feel energetic. After intervention the patient feel comfort and take food properly. OBJECTIVE DATA- On observation the patientis weal and refused the food. -administerI/V fluids as ordered. Explain the importance of the balance diet. -encouragefor fluid intake. -to instructabout the frequent diet. SUBJECTIVE DATA- Patient complain that the patient is Not take sleep. OBJECTIVE DATA- On observation that the patient is sleeplessness. Sleeplessn ess related to leprosy and weakness. To provide adequate sleep to patient. -assess thelevel ofsleeplessness. talk to the patient -divert themind of the patient. -avoid nap during the day hours. -encourage patient for read some books. - patient general condition is assessed and talked. -mind of the patient is Diverted. -naping is avoided in the day time. -patient is read the book or magazine. -to know the condition of the patient and to know thereason -To feel comfort. -for better sleep. -To increase sleep pattern. -for better sleep. After intervention patient is Feel comfort and take sleep in the night. -maintain the room dark at the night. -room is darked at the night time. -provide the sleep. - give psychological support to patient. -psychological support is given. - to reduce the sleeplessness.
  • 18. ASSESSMENT NURSING PALNNING INTERVENTION RATIONALE EVALUATION DIAGNOSIS SUBJECTIVE DATA-Patient complain that he is having pain at the surgical site. Pain related to surgical incision. To reduce the pain and provide comfort. -assess the level of pain. -provide comfortable position to the patient. -to know the level of pain. -to relief from pain. After intervention the patients pain is reduced. OBJECTIVE DATA – On observation that patient is having pain showing by facial expression. SUBJECTIVE DATA- Patient complain for itching in the surgical site. OBJECTIVE DATA-On observation that the patient is having itching. Risk for infection related to unhygienic condition To reduce the risk of infection and other complication. -divert the mind of the patient . -administer analgesic as per doctors order. -maintain personal hygiene. -assess the patient general condition. -monitor vitals every 2 hours. -maintain intake and output chart. -change the dressing twice a day. -encourage to maintain personal hygiene. -to provide comfort to the patient. -to relief from pain. -reduce the risk of infection. -to know the condition of patient. -to know the change in the vitals which shows any infection. -to prevent from complication. After intervention the risk is reduced. -to prevent from infection. -assess the level of sleeplessness. SUBJECTIVE DATA- Patient complain that the patient is Sleeplessness related to surgery. To provide adequate sleep to patient. -to know the condition of the patient. -to know After intervention patient is
  • 19. ASSESSMENT NURSING PALNNING INTERVENTION RATIONALE EVALUATION DIAGNOSIS Not take sleep. OBJECTIVE DATA- On observationthat the patientis sleeplessness. -talk to thepatient -divert the mind of the patient. -avoid nap during the dayhours. -encourage patient for read some books. -maintain the room dark at thenight. The reason -To feel comfort. -for better sleep. -To increase sleeppattern. Feel comfort. -assess the levelof discomfort. -for better sleep. SUBJECTIVE DATA- Patient complain thathe is feeling discomfort. OBJECTIVE DATA- On observationthat patient is tired and anxious . Alteration in comfort related to surgical procedureand hospital environment. To provide comfort tothe patient. -check the vitals. -provide comfortable position. Encourage for rest and sleep. -use divertional therapy. To knowthe patient condition. -to know the variation inthe vitals. -to provide comfort and rest . After intervention patient feel comfort. SUBJECTIVE DATA- Patient and relativewant to know about the discharge treatment. OBJECTIVE DATA-On observationthat they are eagerto know the discharge treatment. Knowledge deficitrelated to discharge treatment. To givehealth education and discharge planning. -assess thepatient and relatives knowledge . -explain the disease,causes, clinical manifestationand treatment. -educatehowto prevent from complication. To feel comfort. -to know the level of knowledge. To increase the knowledge. To reducethe risk of infection . Afterteaching the patients knowledge is increase. To comfort.
  • 20. HEALTH EDUCATION : Points to emphasize to the patients are:  -the necessity for regular treatment and surveillance  -the good prognosis of Leprosy treated regularly  -the possibility of reactions, their early signs and the necessity to seek medical care for reactions.  Louisiana Office of Public Health – Infectious Disease Epidemiology Section- Infectious Disease Control Manual  -In the case of existing disabilities, the patient should be taught to cope with them. Special information  to cover are: 1-Care of insensitive hands, 2-care of insensitive feet, 3-care of the eyes.  Educate The Family: The family and close contacts of the case have been exposed to the leprosy bacilli  and should be examined regularly for early signs of leprosy. The nurse should:  -emphasize the purpose of these systematic examinations, explain their frequency;  -teach the contacts how to check for early signs of leprosy; change in skin color, change in skin sensitivity,  nodules in any part of the body, change in motor function;  -stress the importance of the contact to have any suspect lesions checked by a health person;  -discuss the transmission of Leprosy, the immunity of the majority of people, the incubation and any  other relevant epidemiological information;  -answer any questions the contact may have regarding leprosy.  -assist the contact to adjust and accept the need of regular check ups.  The family plays an important role in the patient's care and progress. They should be taught basic facts  in the care and evolution of leprosy.
  • 21. PREVENTION The best way to prevent the spread of leprosy is the early diagnosis and treatment of people who are infected. For household contacts, immediate and annual examinations are recommended for at least five years after last contact with a person who is infectious.Because leprosy is not very contagious, risk of spread is low. Only the untreated lepromatous form is contagious, but even then the infection is not easily spread. Once treatment has begun, leprosy cannot be spread. Avoiding contact with bodily fluids from and the rash on infected people is the best prevention. The BCG vaccine, used to prevent TB, provides some protection against leprosy but is not often used. The best way to prevent leprosy is to avoid contact with body fluids and the rashes of people who have leprosy. REHABILITATION : Rehabilitation is part and parcel of effective leprosy control. Preventing deformities by early detection and prompt treatment is one of the essential steps in Rehabilitation Secondly for those patients who are having deformities either special accessories or corrective surgical procedures have to be undertaken. Social and vocational Rehabilitation are integral components for the leprosy patients to lead a life of dignity. While we plan the rehabilitation, we have to give specific attention to the social and economic aspects. It is now increasingly realized that the economic reinstatement of a leprosy patient will hasten the process of his social rehabilitation and acceptance in the community. COMPLICATION:  Feet: Plantar ulcers with secondary infection are a major cause of morbidity, making walking painful.  Nose: Damage to the nasal mucosa can result in chronic nasal congestion and nosebleeds and, if untreated, erosion and collapse of the nasal septum.  Eyes: Iritis may lead to glaucoma, and corneal insensitivity may lead to scarring and blindness.  Cosmetic Disfigurement  Muscle Weakness  Nerve Damage in the Extremities  Sensory Loss in the Skin  Long-term leprosy may lose the use of hands or feet due to repeated injury resulting from lack of sensation.