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1. LEPROSY
Manasseh Mvula

2. Definition
 Leprosy (Hansen’s disease) is a chronic
infectious disease caused by the acid-fast,
rod-shaped bacillus Mycobacterium leprae
 The disease mainly affects the skin, the
peripheral nerves, mucosal surfaces of the
upper respiratory tract and the eyes
 Can occur at all ages ranging from early
infancy to very old age

3. Properties of M. leprae
 Acid fast rod-shaped bacillus
 Grow very slowly taking up to 20 years to
develop signs of the infection
 Obligate intracellular pathogen – lacks
several genes needed for independent
survival
 Incubation period: 6 months - 40 years or
longer (4 years for tuberculoid leprosy (TT)
and 10 years for lepromatous leprosy (LL).

4. Prevalence
 Race
 occurs in all races
 Leprosy is endemic in Asia, Africa, the Pacific
basin
 Sex
 Leprosy is generally more common in males than
in females, with a male-to-female ratio of 2:1.
 Age
 can occur at any age, though very rare in infants

5. Transmission
 The exact mechanism of transmission of
leprosy is not known
 The principle means of transmission is by
aerosol spread from infected nasal
secretions to exposed nasal and oral
mucosa
 It is believed that leprosy is transmitted by
Prolonged, and close contact with
someone with untreated leprosy over
many months

6. Classification
 Classified into 2:
Tuberculoid
Lepromatous

7. Tuberculoid Leprosy
 Skin lesions are single or few
 Sharply demarcated
 Anesthetic or hyperesthetic and
bilaterally symmetrical
 Peripheral nerve involvement tends
to be severe

8. Lepromatous Leprosy
 Nodules, papules, macules
 Diffused infiltration are bilaterally
symmetrical and usually numerous
and extensive
 Involvement of the nasal mucosa may
lead to crusting, obstructed breathing
and epistaxis
 Ocular involvement leads to iritis and
keratitis

9. Cont’d
 Another classification (WHO)
depends on the number of
lesions and bacterial index (BI)
Paucibacillary
Multibacillary

10. Ridley-Jopling Classification
 Tuberculoid leprosy
 Borderline Tuberculoid
 Borderline
 Borderline Lepromatous
 Lepromatous Leprae

11. Paucibacillary
 Has fewer than 5 lesions
 No bacilli on smear testing
 Has two other classes
Indeterminate Leprosy (IL)
Tuberculoid Leprosy (TT)

12. Cont’d
 Indeterminate Leprosy (IL)
 This early form causes one to a few
hypopigmentated or sometimes erythematous
macules
 Sensory loss is unusual
 Tuberculoid Leprosy (TT)
 Skin lesions are few
 One erythematous large plaque is usually
present, with well-defined borders that are
elevated and that slope down into an atrophic
center

13. Multibacillary
 Has Five or more lesions with or
without bacilli
 Classes include:
Borderline
Lepromatous

14. Cont’d
 Borderline Tuberculoid leprosy (BT)
 Lesions in this form are similar to those in the
tuberculoid form, but they are smaller and
more numerous.
 Borderline borderline leprosy (BB)
 Cutaneous lesions consist of numerous, red,
irregularly shaped plaques that are less well
defined than those in the tuberculoid type.

15. Cont’d
 Borderline lepromatous leprosy (BL)
 Lesions are numerous and consist of
macules, papules, plaques, and nodules
 Lepromatous Leprosy (LL)
 Early cutaneous lesions consist mainly of
pale macules
 Late infiltrations are present with numerous
bacilli Macular lesions are small, diffuse, and
symmetric

16. Pathophysiology
 In general, leprosy affects the skin,
peripheral nerves, and eyes
 Systemic symptoms may occur
 Specific symptoms vary with the
severity of the disease

17. Cont’d
 Leprosy can manifest in different
forms, depending on the host
response to the organism
 Individuals who mount cellular
immune response to M. leprae have
the tuberculoid form of the disease
that usually involves the skin and
peripheral nerves

18. Cont’d
 Individuals with minimal cellular immune
response have the lepromatous form of
the disease, which is characterized by
extensive skin involvement
 The strength of the host’s immune system
influences the clinical form of the disease

19. Cont’d
 A strong cell-mediated immunity and a weak
humoral response results in mild forms of
disease, with a few well-defined nerves involved
and lower bacterial loads
 A strong humoral response but relatively absent
cell-mediated immunity results in LL, with
widespread lesions, extensive skin and nerve
involvement, and high bacterial loads
 The organism grows best at 27-30°C; therefore,
skin lesions tend to develop in the cooler areas
of the body, with sparing of the groin, axilla, and

20. Signs and Symptoms
 Prodromal: Pts have a history of
numbness first, sometimes years before
the skin lesions appear
 Patient cannot sense extremes of hot or
cold
 The next sensation lost is light touch, then
pain, and finally deep pressure.
 These losses are especially apparent in the
hands and feet; therefore, the chief complaint
may be a burn or ulcer in an anesthetic
extremity

21. 21
Signs and Symptoms
 Tuberculoid leprosy
Asymetrical
Localised circular hypopigmented
patches.
Hypoasthetic (sensation will be
reduced or no sensation)
Thickening of peripheral nerves.e.g
alna nerve

22. 22
Signs and Symptoms
 Lepromatous leprosy
 Insideous onset
 Has wide spread symetrical
hypopigmented patches.
 Mucosal thickening and becomes
yellow discolouration, particulary the
nasal mucosal.
 Conjuctivitis which may progress to
blindness.
 Autoamputation (digits; fingers fall
off)
 Colapse of the nasal bridge inwards

23. 23
Investigations
 History
 Physical examination
 Lepromin test
 +ve in tuberculoid
 -ve in lepromatous
 Skin smear for AAFB
 +ve lepromatous
 -ve in tuberculoid
 Biopsy of skin lesions
 Caseating lesions in tuberculoid

24. 24
Treatment
 Medical
 Dapsone 250mg twice weekly or daily
 Rifampicin 600mg
 Steroid- prednisolone
 Supportive
 Orthopaedic treatment for deformities.
 Psychological treatment

25. 25
NURSING CARE OF A PATIENT WITH
LEPROSY
 Admission
 Patients are admitted to a
hospital called leprosarium in
the initial phase
To stabilise on treatment
For monitoring of side effects of
drugs
For constructive surgery if

26. 26
NURSING CARE OF A PATIENT WITH
LEPROSY
 Psychological care
 Patient will be worried about self-
esteem and that they will be treated
as an outcast.
 Involve the family members, educate
them on the disease and their attitude
which will affect the patient on self
image.
 Allow patient to get involved in family
affairs.

27. Cont’d
 Family should not isolate patient.
 Explain that when the patient is on treatment,
there is no possibility of contracting infection.
 Patient needs to be kept busy.
 They can be taught simple skills e.g gardening,
cooking, sewing, making mats.
 These measures prevent boredom and lessens
emotional problems.
 It also gives an art which they can use to earn
an income.

28. 28
NURSING CARE OF A PATIENT WITH
LEPROSY
 Nutrition
 Build and maintain the nutritional
status of the patient to help build
patient’s resistance to the
disease.
 Patient requires a high nutritious
diet with iron and vitamin
supplements for tissue repair as
well as for maintenance of normal
haemoglobin levels.

29. 29
NURSING CARE OF A PATIENT WITH
LEPROSY
 Observations
 Routine vital sign check
 Keep on monitoring the degree of loss
of sensation.
 Observe for drug reaction, e.g skin
reaction like rashes, psychosis etc.
 Protect the patient from injury i.e
burns, broken bottles because patient
wont feel any pain when hurt.

30. 30
NURSING CARE OF A PATIENT WITH
LEPROSY
 I.E.C
 Teach the patient about this
condition in simple terms.
 Teach them about the importance
of drug administration to achieve
effectiveness and control
progress of disease.
 Teach them on food and personal
hygiene.

31. 31
NURSING CARE OF A PATIENT WITH
LEPROSY
 Tell patient that the affected parts
like the legs, hands should be
kept dry and clean all the time to
prevent infection.
 Teach them to wear protective
foot wear to prevent injury.
 Teach them on the importance of
plastic surgery in order to correct
deformity.

32. 32
REHABILITATION IN LEPROSY
 Measures to regain usefulness of
an individual and also making the
patient psychologically
dependence are done.
 There are 3 types of
rehabilitation:
Physical
Occupational
emotional

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REHABILITATION IN LEPROSY
 Physical rehabilitation
 Prevention
 Help patient to get over physical
disabilities of leprosy e.g physical
deformities and blindness.
 To prevent disability there is need for
early diagnosis, early treatment and
the need to recognise early reactions
of nails and eyes and treat them
promptly.

34. 34
REHABILITATION IN LEPROSY
 Management of disability
 Control the ulcerations
 Avoid destruction of extremities
 Teach patient on the care of
anaesthetised part.
 Make him be aware of the
abnormality; he should have
protective foot wear.

35. 35
REHABILITATION IN LEPROSY
 Restrict the use of the anaesthetised part.
 Advise patient to protect the hands by using
gloves.
 Dead and coloured tissues can be removed
in the hospital.
 Skin grafting should be done on ulcerations,
reserving paralysed muscles and those not
in use to prevent atrophy.

36. 36
REHABILITATION IN LEPROSY
 Physiotherapy
 Aims
 To prevent contractures
 To retain full range of motion
 To prevent muscular atrophy
 To prevent overstretching of paralysed
muscles
 To assist in gaining normal muscle power

37. 37
REHABILITATION IN LEPROSY
 Implementation
 Do passive exercises
 Massage
 Electrical stimulation
 splinting of immobile parts

38. 38
REHABILITATION IN LEPROSY
 Reconstructive surgery
 Indications
 Functional purposes
 Entropion inversion of eyelid so that they rub against
the eyeball.
 Facial nerve palsy
 Hand paralysis
 Foot drop
 Amputation
 Claw toes

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REHABILITATION IN LEPROSY
 Cosmetic reasons
 Replacement of eyebrows
 Nasal collapse
 Sagging face or earlobes
 Gynaecomastia
 Prosthetic reasons
 Artificial leg or amputation

40. 40
REHABILITATION IN LEPROSY
 Emotional (social & physical) rehabilitation
 Socially patient is fearful, anxious and feels
rejected and he/she might think that he/she
can transmit infection to the family.
 Reasure patient
 Talk to the family and community on the
importance of accepting the patient.
 Explain on the condition and how they will
protect the patient.

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REHABILITATION IN LEPROSY
 Occupational (vocational ) rehabilitation
 This varies according to peoples’ attitudes,
opportunities and the availability of farm land.
 Control of Leprosy
 Early diagnosis and treatment of infectious
cases.
 Out patient care should be within reach

42. 42
CONTROL OF LEPROSY
 Case finding and surveys
 IEC to infected cases and community
 Immunisation for those at risk i.e babies
in infected families.
 Children below 10 years with infected
parents are put on prophylactic treatment.

43. THE END