Leprosy

OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING (C.G)

1. TOPIC-LEPROSY
PRESENTEDBY
OMVERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OFNURSING

2. INTRODUCTION
Leprosy, also known as Hansen's disease, is a chronic
infectious disease caused by Mycobacterium leprae. The
disease mainly affects the skin, the peripheral nerves, mucosal
surfaces of the upper respiratory tract and the eyes. Leprosy is
known to occur at all ages ranging from early infancy to very
old age.
Causes: Mycobacteriumleprae
Parent disease:Infection
DEFINITION:
ACCORDING TO BRUNNER ANDSUDDHART:“Leprosy
is an infectious disease that has been known since biblical
times. It is characterized by disfiguring skin sores, nerve
damage, and progressive debilitation“.
ACCORDING TOLEWIS:“Leprosy is a chronic bacterial
infection with Mycobacterium leprae. It primarily affects the
skin, mucous membranes (e.g. nose), peripheral nervous
system (nerve function), eyes andtestes.”
ACCCORDING TOLUCKMANN:“Leprosyisaninfectious
diseasecharacterizedbydisfiguringskinlesions,peripheral
nervedamage,andprogressivedebilitation.”
ACCORDING TO PHILLIPPIS:“ Leprosy is a chronic
infection caused by the Mycobacterium lepraebacteria. It can
affect the skin and the nerves of the hands and feet, as well as
the eyes and the lining of the nose. In some cases, leprosy can
also affect other organs, such as the kidneys and testicles in
men.”

3. TYPES:
Depending on clinical features, leprosy is classified
as:
Indeterminate leprosy(IL)
Tuberculoid leprosy(TT)
Borderline tuberculoid leprosy(BT)
Borderline borderline leprosy(BB)
Borderline lepromatous leprosy(BL)
Lepromatous leprosy(LL)
1.Indeterminateleprosy
refers to a very early form of leprosy that consists of a single
skin lesion with slightly diminished sensation to touch. It will
usually progress to one of the major types ofleprosy.
Includes Diseases: Tuberculoid leprosy; Lepromatousleprosy
Leprosytype Features
2.Tuberculoid
leprosy
Can be either one large red patch with well-defined raised
borders or a large hypopigmented asymmetricalspot
Lesions become dry andhairless
Loss of sensation may occur at site of somelesions
Tender, thickened nerves with subsequent loss of function
arecommon
Spontaneous resolution may occur in a few years or it may
progress to borderline or rarely lepromatoustypes
3.Borderline
tuberculoid
leprosy
Similar to tuberculoid type except that lesions are smaller
and morenumerous
Disease may stay in this stage or convert back to
tuberculoid form, orprogress

4. 4.Borderline
borderline
Numerous, red, irregularly shapedplaques
Sensory loss ismoderate
Disease may stay in this stage, improve orworsen
5.Borderline
lepromatous
leprosy
Numerous lesions of all kinds, plaques, macules, papules
and nodules. Lesions looking like inverted saucers are
common
Hair growth and sensation are usually not impaired over the
lesions
6.Lepromatous
leprosy
Early nerve involvement may gounnoticed
Numerous lesions of all kinds, plaques, macules, papules
andnodules
Early symptoms include nasal stuffiness, discharge and
bleeding, and swelling of the legs andankles
Left untreated, the following problems mayoccur:
Skin thickens over forehead (leonine facies), eyebrows
and eyelashes are lost, nose becomes misshapen or
collapses, ear lobes thicken, upper incisor teeth fallout
Eye involvement causing photophobia (light
sensitivity), glaucoma andblindness
Skin on legs thickens and forms ulcers when nodules
breakdown
Testicles shrivel causing sterility and enlarged breasts
(males)
Internal organ infection causing enlarged liver and
lymphnodes
Voice becomes hoarse due to involvement of the
larynx
Slow scarring of peripheral nerves resulting in nerve
thickening and sensory loss. Fingers and toes become
deformed due to painless repeatedtrauma.

5. ETIOLOGY:
Mycobacterium leprae: Mycobacterium leprae grow slowly and mainly affectthe
skin, nerves, and mucous membranes. Children are more susceptible than adults
to contracting thedisease.
Person to Person: Most scientists believe that leprosy spreads from personto
person through infected respiratory droplets. While this is one mode of leprosy
transmission. People who are at the greatest risk of leprosy transmissionare:
oParents of someone withleprosy
oChildren of someone withleprosy
oBrothers or sisters of someone withleprosy.
The extent ofexposure
Genetics
Environmental conditions

6. PATHOPHYSIOLOGY:
It is thought to be passed from person to person through
nasal droplets and secretions. Casual contact (eg, simply
touching someone with the disease) and short-term
contact does not seem to spread thedisease
transmission is by aerosol spread from infected nasal
secretions to exposed nasal and oralmucosa
The incubation period for leprosy is 6 months to 40 years
orlonger
It affects the superficial peripheral nerves, skin, mucous
membranes of the upper respiratory tract, anterior
chamber of the eyes, and thetestes
Tissue damage depends on the degree to which cell-
mediated immunity is expressed, the type and extentof
bacillary spread and multiplication, the appearance of
tissue-damaging immunologic complications (ie, lepra
reactions)
Result of nervedamage.

7. CLINICALMANIFESTATION:
Hands and feet-Leprosy bacteria attack the nerves in the handsand
feet and cause them to become numb. A person may get cuts or burns on
the numb parts and not know it, leading to infections which cause permanent
damage. Fingers and toes may be lost to infection. Serious infections in the
feet may require amputation. Paralysis may cause the fingers and toes to
curl uppermanently.
Eyes-Leprosy bacteria attack the nerves around the eyes, causingthe
loss of blinking reflex (which protects the eye from injury and moistens the
surface). The eyes become dry and infected, and blindness mayresult.
Because of numbness of the eye, the person cannot feel debris inor
scratches on the eye.
Face-Damage to the internal lining of the nose causes scarringand
eventual collapse of thenose.
SkinStiffness
Skin lesions that are lighter than your normal skincolor
oLesions have decreased sensation to touch, heat, orpain
oLesions do not heal after several weeks tomonths
Numbness or absent sensation in the hands, arms, feet, andlegs
Severe pain in feet andhands.
Muscleweakness.
Skin dryness andstiffness.
Loss of toes andfingers.
Eye problems which can lead toblindness.
Leprosy patients are not sensitive to light and touch in the affectedareas.
Skin rash (symmetrical) is noticed in people suffering from Lepromatous
leprosy. These rashes are commonly found on the wrists, face, elbows,
face, buttocks andknees.
Thinning of the eyelashes and eyebrows, bloody nose, nasalstuffiness,
collapsing of the nose and problems in the testes are other common
symptoms noticed in a person suffering from thedisease.
Skin lumps and bumps that can bedisfiguring.
If untreated, there can be progressive and permanent damage to the
skin, nerves, limbs andeyes.

9. DIAGNOSTICEVALUATION:
Assessment of HealthStatus
Lepromin skintest
The lepromin skin test is used to determine what type of leprosy a person has. This
testindicates
host resistance to M leprae. It results do not confirm thediagnosis,
but they are useful in determining the type ofleprosy.
To perform this
test, bacillary suspension is injected into the forearm. When the reaction is
assessed at 48 hours, it is called the Fernandez reaction and indicates delayed
hypersensitivity to antigens of M leprae or mycobacterium thatcross
react. When the reaction is read at 3-4 weeks it is called the Mitsuda reaction and
indicates that the immune systemis
capable of mounting an efficient cell-mediatedresponse.
BIOPSY
A biopsy describes the procedure that is used to obtain a very smallpiece
of the target tissue. For some tissues, like the lining of the cheek, cells
can be obtained just by scrapping the tissuesurface.
Sputum stain formycobacteria:
Sputum stain for mycobacteria is a test to check for a type of
bacteria that cause tuberculosis and other kinds ofinfection.

10. Skin lesionbiopsy
A skin lesion biopsy is the removal of a piece of skin to diagnose or rule out an
illness.
Nervebiopsy
A nerve biopsy is the removal of a small piece of anerve
forexamination.
Sensorytesting
Tactile and temperature sensations should be tested. . A wisp of cotton
can be used totest
for anesthesia of thelesions.
Polymerase chain reaction (PCR)analysis
PCR can beused
to detect and identify M leprae. The technique is used most often when
acid-fast bacilli are detected but clinical or histopathologic features are
atypical.

11. TREATMENT :
MDT:-Multidrugtherapy(MDT)isthecornerstoneoftheleprosy
eliminationstrategyasitcurespatients,reducesthereservoirofinfection
andtherebyinterruptsitstransmission.MDTalsopreventsdisabilities
throughearlycure.
For purposes of treatment, leprosy is divided intotwo
types:
a)Pauci-bacillary(PB) leprosy : 1-5 skin lesions –Regimenof
two drugs –Rifampicin and Dapsone for 6months;
b)Multi-bacillary(MB) leprosy : >5 skin lesions –Regimenof
three drugs –Rifampicin,Clofazimine and Dapsone for 12months;
(1)Antimicrobials
(a)Dapsone
(Avlosulfon) -Acts by blocking folic acid synthesis. Dapsone half-life is 1-
2 days
28-29
. During dapsone therapy of lepromatous leprosy, ENL, often
develops. Now used as part of a multidrug regimen to treatleprosy.
Plasma concentrations ranges from 0.4-1.2microgram/ml, after 24hrs of
oral ingestion of its dose(100mg)
30
.
(b)Rifampin
(Rifadin, Rimactane)-Bactericidal for M leprae. Inhibits DNA-dependent
RNA polymerase, interfering with bacterial RNA synthesis. Usually given
with dapsone to reduce the emergence of resistance strains ofleprae
31
.
Macrocyclic ring has an important bearingon
the binding to RNA polymerase, while the aromatic nucleus plays a large
partin
determining penetration into thebacteria
32
.
(c) Clofazimine (Lamprene)-It inhibits mycobacterial growth by binding
to GC-rich mycobacterial DNA
33
.Weakly bactericidal againstM
leprae. Eosinophilic enteritis has been described as an adversereaction
to the drug
34-38
.
(2)Corticosteroids
These medications can be used to treat leprosy reactions when a risk of
neurological deficits exists or when lesions occur in cosmetically
important places. They can also be used to treatENL.

12. (a) Prednisone(Deltasone)-Maydecrease inflammation by
reversingincreasedcapillarypermeabilityandsuppressingPMNactivity.
Stabilizeslysosomalmembranesandalsosuppresseslymphocytesand
antibodyproduction.
(3)Immunomodulators
These agents are used to modify the immune system response to
diversestimuli.
Thalidomide
(Thalomid) –Immunomodulatory agent that may suppress excessive
production of tumor necrosis factor-alpha (TNF-alpha) and down-
regulates selected cell-surface adhesion molecules involved in leukocyte
migration. Can be used to treat recurrent or refractoryENL.
LeprosyControl:
The main objectives of a leprosy controlprogram
are:
1-To interrupt transmission of the infection, reducing the incidence
of the disease so that it nolonger
constitute a public healthproblem.
2-To find new cases that are symptomatic or before symptoms
develop.
3-To follow up all known cases and ascertain that theyreceive
proper medical care and takeregular
treatment.
4-To prevent the development of associateddeformities
5-To educate the patient, his family, the health professional, and
thepublic.
SURGICALMANAGEMENT :
Surgery may sometimes be used to drain abscesses to restore nerve function, reconstruct
collapsed nose, or to improve function or appearance of affectedareas.
Patient education is paramount. Leprosy can be cured but it is essential to take the full
course of medication. It is no longer infectious once treatment has begun. Patients should be
instructed how to deal with existing nerve damage for example protecting numb feet from
injury. Physical, social and psychological rehabilitation is a necessary for those in whom
neglected disease has causedhavoc.

13. IN PATIENT : In my patient no surgery is performed . only medical management isgiven.
NURSINGMANAGEMENT :
Avoiding physical contact with untreatedpeople
People who are in immediate contact with the leprosy patient
should be tested forleprosy.
Annual examinations should also be conducted on thesepeople
for a period of five years following their last contact with an
infectiouspatient
Reconstructive surgery is aimed at preventing andcorrecting
deformities.
Comprehensive care involves teaching patients to care for
themselves.
Physiotherapy exercises are taught to the patients to maintaina
range of movement in finger joints and prevent the deformities
fromworsening.
Monitor in During the course of treatment, the body may reactto
the dead bacteria with pain and swelling in the skin andnerves.
This is treated withpain
medication, prednisone orthalidomide (under specialconditions).
Leprosy can be cured but it is essential to take the full course of
medication.
Patients should be instructed how to deal with existingnerve
damage for example protecting numb feet frominjury.
Physical, social and psychological rehabilitation is a necessary for
those in whom neglected disease.

14. NURSINGCAREPLAN:
Pre operative nursing care plan-
ASSESSMENT NURSING
DIAGNOSIS
NURSING
GOAL
PLANNING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE
DATA:patient
complainthat
hewashaving
pain in the
whole body.
Objective
Data: on
observation
that he was
havingexcess
pain showing
by his facial
expression.
Acutepain
related to
nerve
damage
To
reduce
thepain
Assess thelevel
ofpain
-to provide
comfortable
position tothe
patient.
-application of
cold packs tothe
affectedregion.
-Diversional
therapy is
provided.
-local
application of
medicationas
-pain levelis
assessed.
-comfortable
position isgiven.
-cold
applicationis
given
-to changethe
mood.
-medicationis
given.
-to determine
thecondition.
-toprovide
comfort.
To reducethe
pain.
-to changethe
mood of the
patient.
-for the
treatment
Afternursing
intervention
the patient
feel good
and the pain
isreduced.

15. ordered. regimen.
Subjective Activity Promotin-assesspatient-patientgeneral-. determinetheAfterthe
Data:patientintoleranceg generalcondition.conditionis condition of theintervention
complainthatrelatedtoadequate-To providerestassessed. patient patientis
he is notdoingfatigue, nutritionandcomfort. -comfortand -forprovide feel better.
any work,andaltered and -to plana restprovided. comfort.
numbnessinnutritionactivity.progressive -activity -to increasethe
hand andfeet.statusand activityschedule.scheduleis activitytolerance
ObjectiveDatanumbness -To instructthe planned. musclestrength.
i observethatinhand patient totake -patientis -tomeet
the patientisandfeet. liquiddiets. instructedfor nutritional
weakand -toadminister activity. require.
unable todo drug. -drug is -toreduce
work administered.fatigue.

16. ASSESSMENTNURSING NURSINGPLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSISGOAL
Subjective
Data :patient
complain that
he is
uncomfortable
and not talk to
any one.
ObjectiveData
:on
observation I
found that he
is anxiousand
uncomfort.
Anxiety
and fear
related to
disease
and its
treatment.
To
reduce
the
anxiety
andfear
of the
patient.
-to assessthe
patientgeneral
condition.
-to provide
continuity care.-
to allow and
encourage the
patient to ask
question and
clear thedoubt.
-to encourage
the patient to
talk andexpress
feeling
-general
conditionis
assessed.
-care isprovided.
-patient is
encourage dto
ask question.
-patient is
encouragedto
talk.
-determinethe
patient
condition.
-forpatient
security.
-to reduce the
fear andanxiety.
-to reduce the
fear andprovide
comfort.
After the
nursing
interventionthe
patient feel
good.
Subjective
Data -patient
complain that
he is felling
hot and
uncomfortable
, irritationin
the anal
region, and
pain..
Objective
Data –On
observationby
touching his
hand he is
havingfever.
Risk for
infection
related to
bacterial
invasion
and leison.
To
reduce
the risk
of
infection
and
provide
comfort.
-to assessthe
general
condition ofthe
patient.
-to give
comfortable
position.
-to monitorthe
vitals.
-to changethe
dressing.
-patientgeneral
condition
assessed.
-comfortable
position isgiven.
-Vital is
monitored
-dressingis
changed.
To know the
condition ofthe
patient.
For comfortand
relief.
-to knowthe
vitals.
-To reduce the
risk of infection
and maintainthe
sterility.
After
intervention the
patients feveris
decreased and
fellcomfort.
-to promote the
cool andcomfort
environment.
-cool and
comfortable
environment
provided.
-to divertthe
mind.
-maintain
personal
hygiene.
-personal
hygiene
maintained.
-To preventfrom
complication.
-Toadminister
theantipyretic
as perorder.
-antipyretic
administeredas
per order.
-To relieffrom
fever.

17. ASSESSMENTNURSINGNURSINGPLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSISGOAL
.SUBJECTIVE
DATA –
Patient
relative
complainthat
the patientis
not eating
foodproperly.
Alteration
in nutrition
less then
body
requiremen
t related to
anorexia,
nausea.
To
provide
proper
diet
requirem
enttothe
patient
-assess the
general
condition ofthe
patient.
-take vitalsof
thepatient.
-patientgeneral
condition is
assessed.
-vital of the
patienttaken.
-I/V fluid are
administered.
-important of
balanced dietis
explained.
-encouraged
patient forfluid
intake.
-instructedabout
the frequentdiet
.
to know the
general
condition ofthe
patient.
-to know theany
otherproblems.
-tomaintainthe
nutritionalneed
ofthepatients.
-to increasethe
knowledge of
thepatient.
-to maintainthe
fluid and
electrolyte
imbalance.
-t produce
energy thathelp
the patient to
feelenergetic.
After
interventionthe
patient feel
comfort and
take food
properly.
OBJECTIVE
DATA-On
observation
the patientis
weal and
refused the
food.
-administerI/V
fluids as
ordered.
Explain the
importance of
the balancediet.
-encouragefor
fluidintake.
-to instructabout
the frequent
diet.
SUBJECTIVE
DATA-Patient
complain that
the patient is
Not take
sleep.
OBJECTIVE
DATA-On
observation
that the
patientis
sleeplessness.
Sleeplessn
essrelated
to leprosy
and
weakness.
To
provide
adequate
sleep to
patient.
-assess thelevel
ofsleeplessness.
talk to the
patient
-divert themind
of thepatient.
-avoid nap
during theday
hours.
-encourage
patient forread
somebooks.
-patientgeneral
condition is
assessed and
talked.
-mind ofthe
patient is
Diverted.
-naping is
avoided inthe
daytime.
-patient isread
the book or
magazine.
-to know the
condition of the
patient and to
know thereason
-To feelcomfort.
-for bettersleep.
-To increase
sleeppattern.
-for bettersleep.
After
intervention
patient isFeel
comfort and
take sleep in
thenight.
-maintain the
room dark atthe
night.
-room is darked
at the nighttime.
-providethe
sleep.
-give
psychological
support to
patient.
-psychological
support isgiven.
-to reduce the
sleeplessness.

18. ASSESSMENT NURSING PALNNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
SUBJECTIVE
DATA-Patient
complain that
he is having
pain at the
surgicalsite.
Painrelated
tosurgical
incision.
To reduce
the painand
provide
comfort.
-assess thelevel
ofpain.
-provide
comfortable
position tothe
patient.
-to knowthe
level ofpain.
-to relief
frompain.
After
intervention
thepatients
painis
reduced.
OBJECTIVE
DATA –On
observation
that patient is
having pain
showing by
facial
expression.
SUBJECTIVE
DATA-Patient
complain for
itching in the
surgicalsite.
OBJECTIVE
DATA-On
observation
that thepatient
ishaving
itching.
Risk for
infection
related to
unhygienic
condition
To reduce
the risk of
infection and
other
complication.
-divert themind
of the patient.
-administer
analgesic asper
doctorsorder.
-maintain
personalhygiene.
-assess the
patient general
condition.
-monitorvitals
every 2hours.
-maintain intake
and outputchart.
-change the
dressing twicea
day.
-encourage to
maintainpersonal
hygiene.
-toprovide
comfortto
thepatient.
-torelief
frompain.
-reducethe
risk of
infection.
-toknowthe
conditionof
patient.
-to know the
change inthe
vitals which
shows any
infection.
-to prevent
from
complication.
After
intervention
the risk is
reduced.
-toprevent
from
infection.
-assess thelevel
ofsleeplessness.
SUBJECTIVE
DATA-Patient
complain that
the patientis
Sleeplessness
related to
surgery.
Toprovide
adequate
sleep to
patient.
-toknowthe
conditionof
thepatient.
-toknow
After
intervention
patientis

19. ASSESSMENT NURSING PALNNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Not takesleep.
OBJECTIVE
DATA-On
observationthat
the patient is
sleeplessness.
-talk to thepatient
-divert the mind of
thepatient.
-avoid napduring
the dayhours.
-encouragepatient
for readsome
books.
-maintain theroom
dark at thenight.
Thereason
-To feel
comfort.
-forbetter
sleep.
-To increase
sleeppattern.
Feelcomfort.
-assess the levelof
discomfort.
-forbetter
sleep.
SUBJECTIVE
DATA-Patient
complain thathe
is feeling
discomfort.
OBJECTIVE
DATA-On
observationthat
patient istired
and anxious.
Alteration in
comfort
related to
surgical
procedureand
hospital
environment.
To provide
comfort tothe
patient.
-check thevitals.
-provide
comfortable
position.
Encourage forrest
andsleep.
-usedivertional
therapy.
To knowthe
patient
condition.
-to know the
variation inthe
vitals.
-to provide
comfortand
rest.
After
intervention
patient feel
comfort.
SUBJECTIVE
DATA-Patient
and relativewant
to know about
the discharge
treatment.
OBJECTIVE
DATA-On
observationthat
they are eagerto
know the
discharge
treatment.
Knowledge
deficit related
to discharge
treatment.
To givehealth
education and
discharge
planning.
-assess thepatient
and relatives
knowledge.
-explain the
disease, causes,
clinical
manifestationand
treatment.
-educate howto
prevent from
complication.
To feel
comfort.
-to knowthe
level of
knowledge.
Toincrease
the
knowledge.
To reducethe
risk of
infection.
Afterteaching
the patients
knowledge is
increase.
Tocomfort.

20. HEALTHEDUCATION:
Points to emphasize to the patientsare:
-the necessity for regular treatment andsurveillance
-the good prognosis of Leprosy treatedregularly
-the possibility of reactions, their early signs and the necessity to
seek medical care forreactions.
Louisiana Office of Public Health –InfectiousDisease
Epidemiology Section-Infectious Disease ControlManual
-In the case of existing disabilities, the patient should be taught to
cope with them. Specialinformation
to cover are: 1-Care of insensitive hands, 2-care of insensitive feet,
3-care of theeyes.
Educate The Family: The family and close contacts of thecase
have been exposed to the leprosybacilli
and should be examined regularly for early signs of leprosy. The
nurseshould:
-emphasize the purpose of these systematic examinations,explain
theirfrequency;
-teach the contacts how to check for early signs of leprosy; change
in skin color, change in skinsensitivity,
nodules in any part of the body, change in motorfunction;
-stress the importance of the contact to have any suspect lesions
checked by a healthperson;
-discuss the transmission of Leprosy, the immunity of the majority
of people, the incubation andany
other relevant epidemiologicalinformation;
-answer any questions the contact may have regarding leprosy.
-assist the contact to adjust and accept the need of regular check
ups.
The family plays an important role in the patient's care and
progress. They should be taught basicfacts
in the care and evolution ofleprosy.

21. PREVENTION
The best way to prevent the spread of leprosy is the early diagnosis and treatment of
people who are infected. For household contacts, immediate and annual
examinations are recommended for at least five years after last contact with a
person who is infectious.Because leprosy is not very contagious, risk of spread is
low. Only the untreated lepromatous form is contagious, but even then the infection
is not easily spread. Once treatment has begun, leprosy cannot be spread. Avoiding
contact with bodily fluids from and the rash on infected people is the best prevention.
The BCG vaccine, used to prevent TB, provides some protection against leprosy but
is not often used. The best way to prevent leprosy is to avoid contact with body fluids
and the rashes of people who haveleprosy.
REHABILITATION : Rehabilitation is part and parcel of effectiveleprosy
control. Preventing deformities by early detection and prompt treatment is one of the
essential steps in Rehabilitation Secondly for those patients who are having
deformities either special accessories or corrective surgical procedures have to be
undertaken. Social and vocational Rehabilitation are integral components for the
leprosy patients to lead a life of dignity. While we plan the rehabilitation, we have to
give specific attention to the social and economic
aspects. It is now increasingly realized that the economic reinstatement of aleprosy
patient will hasten the process of his social rehabilitation and acceptance in the
community.
COMPLICATION:
Feet: Plantar ulcers with secondary infection are a major
cause of morbidity, making walkingpainful.
Nose: Damage to the nasal mucosa can result in chronic
nasal congestion and nosebleeds and, if untreated, erosion
and collapse of the nasalseptum.
Eyes: Iritis may lead to glaucoma, and corneal insensitivity
may lead to scarring andblindness.
Cosmetic Disfigurement
MuscleWeakness
Nerve Damage in theExtremities
Sensory Loss in theSkin
Long-term leprosy may lose the use of hands or feet due
to repeated injury resulting from lack ofsensation.