leprosy management of leprosy nursing students

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1. Content Introduction Background Causative agent Background Epidemiology Transmission Incubation Period Clinical features Types Diagnosis Treatment Preventive Measures WHO Response Strategic Pillars Set by WHO to Eliminate Leprosy Myths and misconceptions

2. What is leprosy? Leprosy is a chronic infectious disease, also known as Hansen's disease , caused by a type of bacteria, Mycobacterium leprae . The disease predominantly affects the skin and peripheral nerves. Left untreated, the disease may cause progressive and permanent disabilities. The bacteria are transmitted via droplets from the nose and mouth during close and frequent contact with untreated cases .

3. background Hansen’s disease is named after a Norwegian scientist,   Gerhard- Henrik Armauer Hansen , who discovered  leprae   in 1873

4. Causative agent Mycobacterium   leprae Acid fast, rod shaped bacillus Stain with Ziehl Neelsen carbol fuchsin . C annot be grown in bacteriological media or cell cultures. Present intra and extracellular, forming characteristic clumps called Globi .

5. Background Leprosy has afflicted humanity, left behind a terrifying image in history and human memory of mutilation, rejection and exclusion from society. Lots of people have suffered its chronic course of incurable disfigurement and physical disability. By  G.A. Hansen in 1873. First bacterium to be identified as causing disease in man.

6. Cont. Many countries in Asia, Africa and Latin America with a significant number of cases. About 1 – 2 million people disabled due to past and present leprosy who need to be cared for by the community.

7. Epidemiology Leprosy is a neglected tropical disease (NTD) which still occurs in more than 120 countries, with more than 2,00,000 new cases reported every year. The reduction in the number of new cases has been gradual, both globally and in the WHO regions.

8. Cont. As per data of 2019, Brazil, India and Indonesia reported more than 10 000 new cases, while 13 other countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines, Somalia, South Sudan, Sri Lanka and the United Republic of Tanzania) each reported 1000–10 000 new cases. 45 countries reported 0 cases and 99 reported fewer than 1000 new cases.

9. Transmission It’s unclear how Leprosy (Hansen’s disease) transmits from person to person. Leprosy is likely transmitted via droplets, from the nose and mouth, during close and frequent contact with untreated cases Scientists believe it occurs when a person with leprosy (Hansen’s disease)  coughs or sneezes   and a healthy individual breaths in the  droplets containing pathogen .

10. Cont. It takes  months of close contact  with an untreated leprosy patient to contract the illness. Hansen’s disease cannot be conveyed from a mother to her unborn child during  pregnancy , nor can it be transmitted through sexual contact. Identifying the source of infection can be difficult due to the bacteria’s slow growth rate and the time it takes for symptoms to manifest.

11. Incubation Period The incubation period of leprosy is 5 years on an average. However, symptoms may appear within 1 years or as long as 20 years or more as well.

12. Clinical features The disease manifests commonly through skin lesion and peripheral nerve involvement. Leprosy is diagnosed by finding at least one of the following cardinal signs: D efinite loss of sensation in a pale ( hypopigmented ) or reddish skin patch. Thickened or enlarged peripheral nerve , with loss of sensation and/or weakness of the muscles supplied by that nerve. Microscopic detection of bacilli in a slit-skin smear.

13. Discolored patches of skin that are usually flat, numb, and fading (lighter than the skin around) Skin growths (nodules) Thick, stiff, or dry skin Painless ulcers on the soles of the Feet. Swelling or lumps on the cheeks or earlobes that aren’t painful Loss of brows or eyelashes Numbness in the affected parts of the skin (especially in the hands and feet) Enlarged nerves (particularly those around the elbow and knee, as well as those on the sides of the neck) Blinding eye problems (when facial nerves are affected ) .

14. Types The quantity and type of skin lesions determine the severity of leprosy. The type of leprosy determines the symptoms and treatment. The various types of leprosy are :

15. 1. Tuberculoid Leprosy that is milder and less severe. This variety has only one or a few flat, pale-colored patches on its skin ( paucibacillary leprosy) Because of nerve injury beneath the skin, the affected area may feel numb. Tuberculoid is less contagious than other types of leprosy.

16. 2. Lepromatous An advanced stage of the disease It causes extensive skin lumps and rashes, numbness, and muscle weakness ( multibacillary leprosy) The nose, kidneys, and male reproductive systems may also be affected. It is more infectious than tuberculosis.

17. 3. Borderline- Its symptoms are similar to both tuberculoid and lepromatous leprosy. Doctors may also use the following classification: Single lesion paucibacillary (SLPB) : One lesion Paucibacillary (PB ): Two to five lesions Multibacillary (MB):   Six or more lesions

18. diagnosis Diagnosis of leprosy is most commonly based on the clinical signs and symptoms. In an endemic country or area, an individual should be regarded as having leprosy if he or she shows ONE of the following cardinal signs: Skin lesion consistent with leprosy and with definite sensory loss, with or without thickened nerves. positive skin smears .

19. For patients  presenting the symptoms, a leprosy diagnosis is confirmed after analysis of tissues biopsied from infected sites. Typically , a stain for acid-fast bacteria is performed. Additional steps may include- C ulturing infected tissue to confirm other bacteria are not involved-M . leprae cannot be culture. U sing PCR amplification to verify the presence of DNA specific to M. leprae .

20. Treatment In 1995, the World Health Organization (WHO) devised a multidrug medication to treat all kinds of leprosy (Hansen’s disease). It’s available for free all over the world. Several antibiotics are also used to treat Hansen’s disease by destroying the bacterium that causes it. These antibiotics are dapsone ( Aczone ), rifampin ( Rifadin ), clofazimine ( Lamprene ), minocycline ( Minocin ), and ofloxacin ( Ocuflux )

21. Cont. Anti-inflammatory drug such as aspirin (Bayer), prednisone ( Rayos ), or thalidomide (Thalidomide) ( Thalomid ). The treatment will persist for months, with the possibility of lasting up to two years.

22. Preventive Measures Immunoprophylaxis Good coverage of BCG vaccine Chemoprophylaxis of chronic infectious diseases. Education and awareness among the people Avoiding long-term, close contact with an untreated person who has leprosy (Hansen’s disease) is also the greatest way to prevent it. However, in case if a person is affected with leprosy, early diagnosis and prompt treatment is the best way to prevent the spread of leprosy.

23. WHO Response WHO published ‘ WHO guidelines for the diagnosis, treatment, and prevention of leprosy 2018’ in, which recommended a three-drug regimen (rifampicin, dapsone , and clofazimine ) for both paucibacillary and multibacillary varieties of leprosy. In April 2021, WHO announced ‘Towards Zero Leprosy – Global Leprosy (Hansen’s disease) Strategy 2021-2030’ in line with NTD road plan 2030, following extensive consultations with countries, specialists in leprosy, partners, and people affected by leprosy.

24. Strategic Pillars Set by WHO to Eliminate Leprosy In all endemic nations, implement coordinated, country-owned zero leprosy roadmaps. Increase leprosy prevention while also incorporating active case detection.

25. Manage leprosy and its complications, as well as the risk of new disabilities. Defeat stigma and ensure that human rights are upheld For this strategic phase, the strategy comprises a set of core research priorities. To eradicate leprosy, global and national research investments are also required

26. WHO issued a technical guide on Leprosy/Hansen Disease treatment of responses/prevention of disabilities in 2020 to provide hands-on information to health workers on how to diagnose and manage Lepra reactions early In 2020, the World Health Organization published a technical guidance on Leprosy Hansen disease contact tracing and post-exposure prophylaxis. WHO has created e-learning modules to help professionals at all levels improve their knowledge and skills on issues ranging from suspected referrals and diagnosis through leprosy treatment and disability management.

27. Myths and misconceptions Myth : Hansen's disease is very contagious. Fact:  Hansen’s disease does not spread easily from person to person. You cannot get it through casual contact such as shaking hands, sitting next to, or talking to someone who has the disease. Resources- CDC Guidelines

28. Myth: There is no cure for Hansen's disease. Fact:  Hansen's disease is curable. People being treated for Hansen's disease can live a normal life among their family and friends and can continue to attend work or school. Myth: Hansen's disease makes your fingers and toes fall off. Fact:  Fingers and toes do not “fall off” due to Hansen's disease. The bacteria that cause the disease attacks the nerves of the fingers and toes, causing them to become numb. Burns and cuts on numb parts may go unnoticed, which may lead to permanent damage and reabsorption.

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