Leprosy learing causing and effwct

1. Tropical and Communicable Diseases
Leporsy
25-03-2023

2. Objectives
By the end of session the students will be able to:
Define Leprosy
Explain epidemiological triad.
Describe signs and symptoms of Leprosy
Discuss nursing care with essential nursing diagnosis.
Identify the possible complications of Leprosy
Explain the prevention and control of Leprosy.
Learning material (Video clips and articles).

3. Leporsy
• Hansen's disease (also known as leprosy) is a chronic infection caused by
slow-growing bacteria called acid-fast bacilli Mycobacterium leprae or the
closely related organism Mycobacterium lepromatosis.
• Mycobacterium leprae was the only known cause of leprosy until 2008, when
a second species, Mycobacterium lepromatosis was identified in Mexico.
Together, these two organisms are called Mycobacterium leprae complex.
• It can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa). With
early diagnosis and treatment, the disease can be cured.

4. Conti…
• Mycobacterium leprae grow slowly (doubling in 2 weeks). The usual
incubation period ranges from 6 months to 10years. Once infection
develops, distribution can occur.
• The diagnosis of leprosy is based on the presence of at least one of three
cardinal signs: definite loss of sensation in a pale or reddish skin patch, a
thickened or enlarged nerve with loss of sensation and weakness of the
muscles supplied by that nerve, and the presence of acid-fast bacilli in
a skin smear

5. Why is Hansen disease called leprosy?
The microorganism was discovered by Dr. Gerhard Armauer Hansen in
1874, a Norwegian physician who was searching for the unknown
bacteria in the skin nodes of lepers, so the illness was called “Hansen's
disease”

6. Epidemiological triad.
• The triad consists of an external agent, a susceptible host, and an
environment that brings the host and agent together.
• The traditional epidemiologic triad model holds that infectious
diseases result from the interaction of agent, host, and
environment.
• Humans are the main natural reservoir for Mycobacterium
leprae. Armadillos are the only confirmed source other than
humans, although other animal and environmental sources may exist.

7. Conti…
• Leprosy is thought to be spread by passage from person to person
through nasal droplets and secretions. Casual contact (eg, simply
touching someone with the infection) and short-term contact does not seem
to spread it.
• About half of people with leprosy probably contracted it through close,
long-term contact with an infected person. Even after contact with the
bacteria, most people do not develop leprosy; health care workers often
work for many years with people who have leprosy without contracting it.

8. Classification of leprosy
Classification by type and number of skin areas affected:
Paucibacillary: ≤ 5 skin lesions with no bacteria detected on samples from
those areas. Multibacillary: ≥ 6 skin lesions, bacteria detected on samples from
skin lesions.
Classification by cellular response and clinical findings:
Tuberculoid (People with tuberculoid leprosy typically have a few skin lesions
(paucibacillary), and the disease is milder, less common, and less contagious)

9. Conti…
Lepromatous and Borderline
• People with lepromatous (multiple skin lesions that are smaller than
those observed in tuberculoid leprosy) or borderline leprosy typically
have poor cell-mediated immunity to Mycobacterium leprae and have
more severe, systemic infection with widespread bacterial infiltration of
skin, nerves, and other organs (eg, nose, testes, kidneys). They have more
skin lesions (multibacillary), and the disease is more contagious.

10. Signs and symptoms of Leprosy
• Symptoms of leprosy usually do not begin until > 1 year after infection
(average 5 to 7 years). Once symptoms begin, they progress slowly.
• Leprosy affects mainly the skin, nerves and mucous membranes (the
soft, moist areas just inside the body’s openings).
• Nerve involvement causes numbness and weakness in areas controlled
by the affected nerves.

11. The disease can cause skin symptoms such as;
• Discolored patches of skin, usually flat, that may be
numb and look faded (lighter than the skin around)
• Growths (nodules) on the skin
• Thick, rigid or dry skin
• Painless ulcers on the soles of feet
• Painless swelling or lumps on the face or earlobes
• Loss of eyebrows or eyelashes
A large, discolored
lesion on the chest
of a person with
Hansen’s disease.

12. Symptoms caused by damage to the nerves are:
• Numbness of affected areas of the skin
• Muscle weakness or paralysis (especially in the hands and feet)
• Enlarged nerves (especially those around the elbow and knee and in the
sides of the neck)
• Eye problems that may lead to blindness (when facial nerves are affected)

13. Symptoms caused by the disease in the mucous membranes are:
• A stuffy nose (occurs when the tissues lining it become swollen)
• Nose bleeds
Since Hansen’s disease affects the nerves, loss of feeling or sensation can
occur. When loss of sensation occurs, injuries such as burns may go
unnoticed. Because you may not feel the pain that can warn you of harm
to your body, take extra caution to ensure the affected parts of your body
are not injured.

14. If left untreated, the signs of advanced leprosy can include:
• Paralysis and crippling (causing a person to become unable to walk or
move properly "crippling disease") of hands and feet
• Shortening of toes and fingers
• Chronic non-healing ulcers on the bottoms of the feet
• Blindness, Loss of eyebrows and Nose deformity

15. Possible complications of Leprosy
Complications that may sometimes occur are:
• Painful or tender nerves
• Redness and pain around the affected area
• Burning sensation in the skin

16. How is the disease diagnosed?
• Hansen’s disease can be recognized by appearance of patches of skin that
may look lighter or darker than the normal skin.
• Sometimes the affected skin areas may be reddish. Loss of feeling in these
skin patches is common. You may not feel a light touch or a prick with a
needle.
• To confirm the diagnosis, your doctor will take a sample of your skin or
nerve (through a skin or nerve biopsy) to look for the bacteria under the
microscope and may also do tests to rule out other skin diseases.

17. Prevention and control of Leprosy
Hansen’s disease is treated with multidrug therapy (MDT) using a
combination of antibiotics depending on the form of the disease:
Paucibacillary form – 2 antibiotics are used at the same time, daily
dapsone and rifampicin once per month
Multibacillary form – daily clofazimine is added to rifampicin and
dapsone.
Treatment usually lasts between one to two years. The illness can be
cured if treatment is completed as prescribed.

18. Leprosy, the risk of quickly spread is low. Only the untreated lepromatous form
is contagious, but even then, the infection is not easily spread. However,
household contacts (particularly children) of patients with leprosy should be
monitored for development of symptoms and signs of leprosy. Once treatment
has begun, leprosy cannot be spread.
• The best prevention is;
• Avoiding contact with bodily fluids from and the rash on infected people
• The bacille Calmette-Guérin (BCG) vaccine, used to prevent tuberculosis (TB),
provides some protection against leprosy but is not often used for that purpose

19. Nursing care
• Ensure adequate intake of fluid to maintain optimal skin hydration.
• Ensure proper rest and nutrition of the affected leprosy patient.
• Ensure proper treatment nursing of eye inflammation to preserve
vision.
• Ensure moisture of nasal mucosa with 0.9% saline.

20. Key Points
• Leprosy is a chronic infection usually caused by the acid-fast bacilli
Mycobacterium leprae. Leprosy is not very contagious in untreated patients and
not at all contagious once treatment starts.
• Leprosy affects mainly the skin and peripheral nerves.
• The most severe complications result from loss of the sense of touch, pain, and
temperature; muscle weakness that can result in deformities; and disfiguring
lesions of the skin and nasal mucosa.
• Inflammatory reactions called leprosy reactions can occur and require treatment
with corticosteroids. Diagnose based on biopsy; Mycobacterium leprae and
Mycobacterium lepromatosis cannot be grown in culture.
• Treatment depends on the form of leprosy but involves multidrug regimens
typically using dapsone, rifampin, and clofazimine for multibacillary and
dapsone and rifampin for paucibacillary.

21. Reference
• Britton WJ, Lockwood NJ. Leprosy. Source: Lancet. 2004;363:1209-1219.
• Hartzell JD, Zapor M, Peng S, Straight T. Leprosy: a case series and review. Source: South Med
J. 2004;97:1252-1256.
• Parkash O. Classification of leprosy into multibacillary and paucibacillary groups: an
analysis. FEMS Immunology & Medical Microbiology. 2009 Jan 1;55(1):1-5.
• Williams D, Hagino T, Sharma R, et al. Primary Multidrug-Resistant Leprosy, United States.
Source: Emerging Infectious Diseases. 2013;19(1):179-181. doi:10.3201/eid1901.120864.
• World Health Organization. Surveillance of drug resistance in leprosy: 2010. Source: Wkly
Epidemiol Rec. 2011;86:237–240.