Leprosy

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1. LESSON PLAN ON LEPROSY SUBMITTED BY MANU MEHTA ROLL NO – 16 BASIC B.SC NURSING 2 nd YEAR

2. OBJECTIVES At the end of the class student will be able to Define leprosy Its type Cause and risk factor Sign and symptoms Pathophysiology Transmission Prevention Diagnosis Management Complication Summary and Bibliography

3. INTRODUCTION Leprosy (Hanson’s disease) is a chronic infection caused by the bacteria Mycobacterium Laprae or Mycobacterium Lapromatosis . Symptoms that develop include granulomas of the nerves, respiratory tract, skin and eyes. This may result in lack of ability to feel pain and thus loss of parts of extrimities due to repeated injury.

4. DEFINITION Leprosy is a chronic infectious and communicable disease caused by Mycobacterium laprae . Its principal lesion occur in the cooler tissues of body; Skin , superficial nerves , nose and larynx , pharynx ,etc.

5. INCIDENCE Worldwide , two to three million people are estimated to be permanently disable because of leprosy. India has the greatest number of cases , with brazil second and indonesia third. Children are more susceptible then adult. A family history of leprosy probably means highest susceptibility to infection .

6. TYPES Lapromatous leprosy: Generalized form of disease and is found in individuals with low degree of resistance. Skin lesion appear as yellow or brown infiltrated nodules that effect the mucus membranes of the eyes, nose, and throat . Tuberculoid leprosy: This is a localized form of disease and is found in patients with high degree or resistance. Skin lesions appear as light red or purplish spots.

7. Conti…… Borderline type : In this type of leprosy the lesions produced possess characteristics of both lapromatus and tuberculoid lesions . Indeterminate type : In this type of leprosy the lesions produced often resemble maculo – anesthetic patches which are neither characteristics of lepromatous nor tuberculoid type .

8. Cause and risk factor Cause : 1) Microbactrium laprae 2) Genetics : several genes have been associated with a susceptibility to leprosy . Risk factors : 1)Living in areas with polluted water and poor diet. 2) Immunocompromised people . 3) Travel to an area that has experienced a leprosy attack. 4) People who handle certain animal that are known to carry the bacteria ( african chimpanzee , armadillos ) are at high risk . 5) Those who live in the areas where leprosy is endemic.

9. SIGN AND SYMPTOMS Numbness and loss of touch, pain, temperature sensation . Granulomas of the nerves ,respiratory tract ,skin and eyes Painless ulcer Skin lesions Loss of digits Facial disfigurement

10. PATHOPHYSIOLOGY M.Laprae enters the body( skin,nose,etc ) attack Peripheral nerves Bind to schwann cells of axon Demyelination of nerve

11. Loss of axonal conductance Deformity(loss of pain, temperature,touch,sensation )

12. TRANSMISSION Droplet infection : leprosy is believed to transmit through nasal discharge . Contect infection : studies indicate that leprosy is transmitted through direct skin contact. Vector –born infection. Trough placenta and milk .

13. PREVENTION Isolation of bacteriologically positive cases in endemic areas . Avoid close physical contact with untreated patient. Keep away from the animal which are suspe cted to the bacteria . Use of mask and gloves while handling the patient . vaccination – BCG vaccine (at birth, intramuscular, 0.o5 ml )

14. DIAGNOSIS Clinical examination Interrogation Physical examination Bacteriological examination Smear (scrapings from lesions , nasal mucosa, nerve biopsy , etc ) Routine test CBC , LFT , Creatinine test Other test Lepromin test PCR

15. complication Partial or complete deformity / handicap . Complete isolation from the society . Social and mental tension. Sensory loss . Paralysis. Muscle weakness . Progressive disfigurment ( eyebrow lost , disfigurement of the toes , fingers and nose ) Loss of manpower / national loss.

16. MANAGEMENT MEDICAL MANAGEMENT : Multidrug therapy : rifampicin , dapsone , clofazimine , ethionamide , quinolones , minocycline , etc are used . Corticosteroids : these are used to treat nerve damage associated with leprosy Aspirin and thalidomide are used to control inflammation.

17. Conti… Surgical management: Neural surgery Nerve grafting Amputation Cosmetics surgery : nasal reconstruction Removal of excess skin Replacement of eyebrows

18. Conti… Nursing care Detect the disease in the initial stage and keep watch over other susceptible patients . Take care of localized wound . Rehabilitation of cured persons . Provide health education. Provide shelter and social support, moral support. Provide follow- up service .

19. SUMMARY Leprosy is a chronic infection caused by M. laprae . Immunosupress people are at high risk of infection . The sign and symptoms of these disease are numbness and loss of senstion and the sign are painless ulcer, skin lesions, eye damage , etc. leprosy is transmitted by droplet infection and direct contact with untreated people .It is diagnosed by bacteriological examination , lepromin test , PCR, etc .

20. CONCLUSION From this lesson plan we are know about leprosy its type, cause and risk factors , sign and symptoms , pathophysiology, its transmission , prevention, diagnosis, complication, and its management.

21. BIBLIOGRAPHY PARK K : textbook of preventive and social medicine , 22 nd edition published by M/S Banarsidas Bhanot , Jabalpur,2013, page no – 287-299 SWANKAR KESHEV : community health nursing , 3 rd edition published by N.R. brother , indore , 2011 page no – 539 – 541 ANANTHANARAYAN et al : textbook of microbiology , 8 th edition , published by universities press, Hydrabad , 2009 , page no – 364 – 370 .

22. Conti…. BEESON et al : textbook of medicine , 12 th edition , published by W. B. saunders company , Philadelphia and London , 1968, page no – 296- 300. en.wikipedia.org/wiki/leprosy.com

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