5 - Leprosy

8/8/2019 5 - Leprosy

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8/8/2019 5 - Leprosy


Leprosy - is a chronic systemic infection

characterized by progressive cutaneouslesions.

Etiologic Agent:

Mycobacterium leprae is an acid-fast bacilli thatattack cutaneous tissue and peripheralnerves, skin lesions, anesthesia, infection

and deformities.

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Incubation per iod:

Five and a half months to eight years.

Mode of Tr ansmission:

1. Respiratory droplet.2. Inoculation through skin break and mucus

membrane.

8/8/2019 5 - Leprosy


THREE DISTINCT FORMS OF LEPROSY

1. Lepromatous leprosy - is found in

those patients with no or very little immune

resistance to the Micobacterium leprae organism.

2. Tuber culoid leprosy - appears on the

extreme left of the Immunological Spectrum as that

form of the disease which is most resistant.

3. Borderline leprosy - is a cutaneousskin condition with numerous skin lesions that are

red irregularly shaped plaques.

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Lepromatous (multibacillary) leprosy

a. Most serious and most infectious type.

b. Causes damage to the respiratory tract, eyes

and testes.

c. Lepromin test is negative but the skin lesioncontains large amount of Hansen·s bacillus.

d. Gradual thickening of the skin.

e. Lesions appear as macules (leproma).

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f. Slow involvement of peripheral nerves.g. Atrophy of skin and muscles and eventual melting of

small bones in the hands and feet.

h. Ulceration in the mucous membrane of the nose.

i. Amputation may occur.

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Tuberculoid leprosy

(A Paucibacilliary Type)

a. Affects the peripheral nerves and sometimes

surrounding the skin.

b. Lepromin test is positive, but the organism is rarely

isolated from the lesions.

c. Macules are elevated with clearing and more clearly

defined than in the lepromatous form.

d. Anesthesia is present.

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Borderline (Borderline (dimorphousdimorphous) )

leprosy leprosy - Both lepromatous and tuberculoid leprosy. Skin

lesions of this type of leprosy are diffused and poorly

defined.

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Pathology:

1. M. leprae attacks the peripheral nerves.

2. When bacilli damage the skin·s fine nerves, they cause

anesthesia, anhidrosis, and dryness.

3. If they attack a large nerve trunk, motor nerve damage,weakness, and pain occur, followed by peripheral

anesthesia, muscle paralysis, and atrophy.

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Clinical Manifestations:

1. Clawhand, footdrop and ocular manifestations such ascorneal insensitivity and ulceration, conjunctivitis,

photophobia, and blindness development.

2. Invades tissues in every organ of the body.

3. Early lesions are multiple, symmetrical anderythematous, sometimes macules or papules.

4. Later, lesions inlarge and form plagues on nodules on

the ear lobes, nose, eyebrows, and forehead.

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5. Loss of eyebrows and eyelashes.

6. Loss of function of sweat and sebaceous gland.

7. Epistaxis, ulceration of the ovula and tonsils,

septal perforation and nasal collapse.

8. Raised, large erythematous plagues appear on the

skin.

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Diagnostic Procedures:

1. Signs and symptoms.

2. Tissue biopsy.

3. Tissue smear.

4. Blood tests.

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Modalities of T reatment:

1. SulfoneTheraphy

2. Multiple Drug Theraphy (MDT)

3. Rehabilitation, recreational and occupational therapy.

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Nursing Management:

1. If the patient is admitted to the hospital, isolation and

medical asepsis should be carried out.

2. Moral support and encouragement are necessary.

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Prevention:

1. Report all cases and suspects of leprosy.

2. Newborn infants should be separated from leprous

mothers.

3. BCG vaccine may be protective if given during the first

6 months of life.

4. Health education should be give as to the mode of

transmission.

5 - Leprosy

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