WELCOME

By- Bhavesh kumar

B.Sc (N) 2nd year
LEPROSY
 INTRODUCTION
• Leprosy also known as HANSEN’s disease.
Leprosy is an infectious disease caused by
the acid- fast, rod-shaped bacteria
mycobacterium leprae, which was
discovered in 1873 by G.A. Hansen. It is
clinically characterised by hypopigmented
patches,partial or total loss of sensation
presence of thickened nerves and the
presence of acid-fast bacilli in skin
smears.
 DEFINITION
• Leprosy is a chronic disabling disease
caused by mycobacterium leprae. The
disease affects mainly the peripheral
nerves. It also affects the
skin,muscles, eye, bones, testes and
internal organ.
 CLASSIFICATION
• The indian classification which is the
official classification of the Hind Kusht
Nivaran Sangh is as below:
(a) Indeterminate type
(b) Tuberculoid type
(c) Lepromatus type
(d) Pure neuritic type
Cont…
• Cases have been further classified as:
(a) Multibacillary leprosy- this covers the
lepromatous leprosy and the borderline
cases, that is all infectious cases.
(b) Paucibacillary leprosy – This covers the
categories described as indeterminate,
tuberculoid and the pure neuritic types
of leprosy.
 MAGNITUDE OF THE
PROBLEM
• WORLD-Leprosy is a major health and
socioeconomic problem because of long duration
of the disease.
• It has been estimated that there were about 0.2
million cases of leprosy in the world during the
year 2005 and global prevalence rate of leprosy
was below 1 case per 10,000 population. At the
end of 2006, leprosy was a public health problem
only in 6 countries most of the cases occur in
Asia, Africa and latin america.
Cont…..
• INDIA- leprosy is widely prevalent in India. The goal of
elimination of leprosy at the national level (i.e. prevalence
rate of less than 1 case per 10,000 population) has been
achieved in the month of December 2005 when prevalence
rate was 0.95 per 10,000 population.
• In the month of march 2006 it has further dropped down to
0.84 per 10,000 population with 0.95 Lack cases on record.
• In the march 2006, 26 states have achieved the status of
leprosy elimination and 9 states are with Prevalence rate of
1-2 case per 10,000 population. These states are Bihar,
Chhattisgarh, Jarkhand, Orrisa, UP, West Bengal,
Chandigarh, and Delhi.
leprosy control programme

• The government of India launched the national

leprosy control program in the year 1955 in close
collaboration with state government to control the
spread of the disease and modern treatment
facilities to leprosy patient. The program is
implemented through the establishment of leprosy
control units, survey education and treatment
centers, Urban leprosy centers, temporary
Hospitalization wards and reconstructive surgery
units, by the state governments.
Cont….
• At the central level the leprosy cell of the Director general
of health services is responsible for planning, supervision
and monitoring of the programe. The cell is under the
control of an assistant director general, who advice the
government on all anti –leprosy activities in the country. He
is under the overall supervision of the director general of
health services and ministry of health and family welfare.

• At the state level, the state leprosy officers are

responsible for organisation, supervision, guidance and
monitoring of all anti-leprosy activities. At the district
level, the district leprosy officer is responsible for the
implementation and supervision of the program.
LEPROSY ERADICTION
PROGRAME
In 1983, the national leprosy control
program was enhanced to national leprosy
eradication program on the
recommendation of working group on
leprosy. This was done because of
availability of highly effective treatment
for leprosy. The objective of eradication
program was to eliminate leprosy from the
country by the end of 20th century.
 EPIDEMIOLOGICAL
FACTOR
1. AGENT- The causative agent is
Mycobacterium Leprae. The organism is
now grown in the foot pads of Mice and
in the Armadillo.
2. HOST –(a) AGE- Infection can take
place at any age. In endemic areas, the
disease is usually acquired in childhood.
Cont….
• (b) SEX- More commonly seen in male than in
female.
• (c) RACE- All human races are susceptible.
• 3. ENVIROMENT- (Climate) - More
common in warm and humid climate.
• SOCIAL FACTOR- poverty, poor
environmental surroundings,
overcrowding, low personal hygiene, use
of common clothing and linen.
 MODE OF
TRANSMISSION
1. Contact transmission- Direct or indirect
contact between an infectious and
healthy person.
2. Droplet infection is very common
airborne disease play any part.
3. Other route –labra bacilli have been
found in human milk.
INCUBATION PERIOD- It is not exactly
known. Commonly between 2 to 5 year.
PATHOPHYSIOLOGY
 CLINICAL FEATURE
• EARLY SIGNS – 1. hypopigmented patches on
the skin
• 2. diffuse thickening of the skin with a shiny
appearance.
• 3. loss of sweating or loss of hair over the skin
lesion.
• 4. loss of sentation to pain, touch and
temperature in the hands and feet.
Cont….
• 5. Nodules in the skin especially of the nose, chin and ears.
• 6. Thikening of earlobes.
• LATER DEFORMITIES-(a) Depression of the
bridge of nose
• (b) wrinkling of the facial skin.
• (c) Loss of eye brows.
• (d) Stiffness of joint of fingers.
• (e) SHORTENING AND LOSS OF FINGER &TOE
• (f) Blindness
 DIAGNOSTIC TEST
1. Case history
2. Physical examination
3. Histamine test
4. Skin biopsy
5. Nasal smear
Cont….
• Histamine test- Intradermal Injection of 0.1ml of
histamine phosphate is injected intradermally
into hypopigmental patches or in areas of
anesthesia. in leprosy, flare response is lost.
• Nasal smears -These can be prepared from
early morning mucus material or an alternative is
to use an nasal mucosal scrapper. The smear is
immediately fixed by passing over a spirit lamp
and stained with ziehl-neelsen method, 5 percent
HCL is used for decolurisation.
 TREATMENT
• Patient with paucibacillary leprosy are
given Rifampicin 600 mg once a month and
dapson 100 mg daily for six months.
• For multibacillary leprosy, rifampicin 600
mg once a month, dapsone 100 mg daily,
clofazimine 300 mg once a month, and 50
mg clofazimine daily are given for one
year.
 NURSING
MANAGEMENT
NURSING DIAGNOSIS:

• Activity intolerance related to pain

• Self care deficit related to impaired vision.
• Disturbed body image related to change in
appearance.
• Acute pain related to injury to biological agents.
• Disturbed sleep pattern related to pain.
 NURSING
MANAGEMENT
• Nurse will support the patient to cope with
disease condition.
• Nurse provide education related to disease
condition and its prevention.
• Take care of localized wound.
• Nurse should provide psychological support to the
patient because appearance of the skin may
affect the patient self –esteem.
• As a nurse co-operate to doctor plans to
elimination the disease condition and rehabilited
to the patient daily activity.
 MEDICAL
MANAGEMENT
• 1981 – WHO proposes multidrug
therapy – combination of dapsone,
rifampicin and clofazimine.
 COMPLICATION
• Permanent damage to the nerves in the fingers,
toes, hands and feet.
• This may affect a person ability to feel pain and
temperature in these areas of the body.
• Muscle weakness.
• Deformities and even the loss of fingers and toes.
• Untreated leprosy can also cause swelling and skin
sores and lesion that are more severe.
• Leprosy can also damage the kidney, which can
lead to kidney failure.
 PREVENTION &
CONTROL
• The best way to prevent is to avoid contact with body fluids
and the rashes of people who have leprosy.
• CONTROL- (1) survey
• (2) early detection of cases
• (3) chemotherapy
• (4) selective isolation
• (5) prevention of contact
• (6) chemoprophylaxis
• (7) health education
 HEALTH EDUCATION
• The community health nurse should teach the family about the
nature of the disease the need for strict home isolation of the
patient and the need for the regular treatment of the patient.
• Instruction should be given about keeping the eating and drinking,
utensil of the patient separeted, so also the clothes towels and
other linen used by the patient keep seprated.
• Follow up of patient during and after completion of chemotherapy.
• Educate the client about her medicine to take regular medicine as
per doctor order.
• Ulcer or tissue damage can result, leading to skin infection and
disability.
• Proper footwear and injury prevention should be encouraged.
SUMMARY
THANK YOU