LEPROSY

Criteria Diagnostic from WHO:

In an endemic area, diagnostic of leprosy if having one of the following cardinal sign:
- Skin lesion consistent with leprosy and with definite sensory loss, with or without
thickened nerves.
- Positive skin smears
A person presenting with skin lesions or with symptoms suggestive of nerve damage, in
whom cardinal sign are absent or doubtful should be called a suspect case, advised to return
to the centre if signs persist for more than 6 months or if at anytime worsening, may also be
sent for more facilities for diagnosis.

Anamnesis / History Taking:

•Skin lesion that may be faded/discoloured
•Growths on the skin
•Thick, stiff, or dry skin
•Sensory loss, pain, numbness, tingling sensation
•Muscle weakness or paralysis (especially in the hands and feet)
•Eye problems that may lead to blindness
•Ulcers on the soles of feet or on hands
•Deformity of hands or feet
•Source of infection
•History of treatment

Physical Examination
•Gait
•Face: stuffy nose, nosebleeds, eye problems, eyebrows lost
•Skin: faded / discoloured lesion, dry skin, nodul
•Extremity: deformity, contracture, ulcers, muscle atrophy, digital amputee
•Nerve thickening.
Peripheral nerves affected in leprosy:
1. Supra orbital n.
2. Facial n.
 3. Great auricular n.
4. Supraclavicular n. (rare)
5. Radial n.
6. Ulnar n.
7. Radial cutaneus n.
8. Median n.
9. Femoral cutaneous n. (rare)
10. Common peroneal n.
11. Superficial peroneal n.
12. Sural n.
13. Posterior tibial n.
•Signs of neuritis: nerve pain, local oedema, rapid loss of function
•Motor weakness
•Sensory deficits
•Hand functions

Problem List:
Medical
Surgical: if any deformity, contracture can be corrected
Rehabilitation:
R1. Mobilisation: is there any gait/ambulation disturbance?
R2. ADL: is there any hand function disturbance related to ADL?
R3. Communication:
R4. Psychological: is there any signs of depression, loss of confidence?
R5. Social economy: is there any social economy problems related to health facility?
R6. Vocational: Is there problem with patient’s vocational?
R7. Others: Stiffness of joints, contracture, deformity, sensory deficits, motor weakness,
otonom disturbance (dry skin)

IDH Classification:
Impairment: Contracture, claw hand, drop hand, ape hand, drop foot, digital amputee, sensory
deficits, ulcers, skin lesion, stuffy nose, nerve thickening.
Disability: can not walk for long distance, buttoning, unbuttoning (dressing)
Handicap: can not climb stair, can not shake hand

Goals:
Short term:
Pain management (neuropathic), strengthening limb muscles, maintenance ROM, treat the
infection, sensory re-education.
Long term:
Increase quality of life, prevent deformity, return to function as before

Planning:
Diagnostic: BTA (acid fast staining), serology test for Leprosy (ELISA), consult to
Dermatology Department
Therapy:
Modality: TENS, Electrical stimulation
Thera Ex: ROM exercise, gentle stretching, strengthening exercise of extremity muscles,
sensory re-education
OP: AFO
Monitoring: clinical, ROM, MMT, sensory
Education: exercise at home, routinely control (take medication), finding and suggesting the
source of infection to get medication and treatment too.

Prognosis:
Ad Vitam: life, Ad sanam: recover, Ad functionam: depends on the stage of the disease when
first diagnosed and treated.