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Leprosy

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LEPROSY / HANSEN’S DISEASE
Reported by: Sheryl A. Ramos

TOP LEPROSY FACTS 1. Leprosy is a bacterial disease of the skin and nerves 2. Leprosy is completely curable 3. Leprosy can cause permanent disabilities if left untreated 4. Leprosy causes anesthesia, meaning people are unable to feel pain in the affected areas 5. Leprosy treatment is free of charge but many people are unaware that it is available 6. The nine banded armadillo can transfer leprosy to humans 7. The last Sunday in Janurary marks World Leprosy Day

WHAT IS LEPROSY? Leprosy is an infectious disease that causes severe, disfiguring skin sores and nerve damage in the arms and legs. The disease has been around since ancient times, often surrounded by terrifying, negative stigmas and tales of leprosy patients being shunned as outcasts. However, leprosy is actually not that contagious. You can catch it only if you come into close and repeated contact with nose and mouth droplets from someone with untreated leprosy.

In 1873, Dr. Gerhard Henrik Armauer Hansen of Norway was the first person to identify the germ that causes leprosy under a microscope. Hence, the disease named after him.

ETIOLOGIC AGENT Mycobacterium leprae
INCUBATION PERIOD Ranges from five-and-a-half months to eight years
MODE OF TRANSMISSION * The disease can be transmitted through respiratory droplets * Inoculation through the skin break and mucous membranes may also be a mode of transmission

FORMS OF LEPROSY 1. Tuberculoid (paucibacillary leprosy)
Is a mild and less severe form of leprosy. People with this type have only one or a few patches of flat, pale-colored skin. The affected area of skin may feel numb because of nerve damage underneath. Tuberculoid leprosy is less contagious than other forms. 2. Lepromatous (multibacillary leprosy)
Is a more severe form of the disease. It has widespread skin bumps and rashes, numbness, and muscle weakness. The nose, kidneys, and male reproductive organs may also be affected. It is more contagious than tuberculoid leprosy. 3. Borderline (dimorphous leprosy) is a combination of both tuberculoid lepromatous.

SIGNS AND SYMPTOMS Early Signs: * Change in skin color either reddish or white * Loss of sensation (Anesthesia) * Loss of sweating and hair growth * Thickened and painful nerves * Muscle weakness or paralysis of extremities * Pain and redness of the eyes * Nasal obstruction or bleeding * Ulcers that do not heal
Late Signs * Madarosis * Lagopthalmos * Contractures * Chronic ulcers * Sinking of the nosebridge * Gynecomastia

PATHOGNMONIC SIGN Lionine Facies
HOW IS LEPROSY DIAGNOSED? 1. Biopsy 2. Slit Skin Smear 3. Lepromin Test
- a research tool that helps classify the different types of leprosy.
People who don't have leprosy will have little or no skin reaction to the antigen. Patients with a particular type of leprosy called lepromatous leprosy will also have no skin reaction to the antigen. A positive skin reaction may be seen in patients with specific forms of leprosy, such as tuberculoid and borderline tuberculoid leprosy. Patients with lepromatous leprosy will not have a positive skin reaction.

TREATMENT * Sulfone therapy * Rehabilitations, recreational and occupational therapy * Multiple drug therapy (MDT) * PAUCIBACILLARY/TUBERCULOID/NON-INFECTIOUS
Rifampicin once a month & Dapsone once a day for 6 months * MULTIBACILLARY/LEPROMATOUS & BORDERLINE/INFECTIOUS
Rifampicin once a month, Dapsone & Clofazomine once a day for 12 months

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. 3. Diet should be full, wholesome and nutritious. 4. Special attention should be given to personal hygiene. 5. Terminal disinfection should be carried out.

COMMON NURSING DIAGNOSIS * Impaired skin integrity * Social isolation * Ineffective coping * Knowledge deficit * Anxiety * Impaired body image

PREVENTION * Report all cases and suspects of leprosy. * Newborn infants should be separated from leprous mothers. * BCG vaccine may be protective if given during the first 6 months of life. * Health education should be given, with particular focus on the mode of transmission.

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