LEPROSY

HANSEN’S DISEASE/HANSENOSIS

PRESENTED BY: MASULA, JESSEL B.

LEARNING OBJECTIVES:
 To identify the definition of leprosy
 To know the epidemiology, causes and signs and
symptoms on how the disease develop and spread.
 To gain knowledge about nursing management and
prevention on how we protect ourselves.
WHAT IS LEPROSY?
Leprosy is a chronic systemic infection characterized by progressive
cutaneous lesions. It causes severe, disfiguring skin sores and nerve
damage in the arms, legs, and skin areas around the body.

It caused by a mycobacterium (Mycobacterium leprae) affecting especially

the skin and peripheral nerves and characterized by the formation of
nodules or macules that enlarge and spread accompanied by loss of
sensation with eventual paralysis, wasting of muscle, and production of
deformities
— called also Hansen's disease
However, leprosy is actually not that contagious. You can catch it only if
you come into close and repeated contact with nose
and mouth droplets from someone with untreated leprosy. Children are
more likely to get leprosy than adults.

The disease has been around since ancient times, often surrounded by
terrifying, negative stigmas and tales of leprosy patients being
shunned as outcasts. Outbreaks of leprosy have affected, and panicked,
people on every continent. The oldest civilizations of China, Egypt, and
India feared leprosy was an incurable, mutilating, and contagious
disease.
WHO IS GERHARD ARMAUER HANSEN?

 Gerhard Henrik Armauer Hansen (29 July

1841 – 12 February 1912) was a Norwegian 
physician, remembered for his identification of
the bacterium Mycobacterium leprae in 1873 as
the causative agent of leprosy.

 In 1873, he announced the discovery of

Mycobacterium leprae in the tissues of all
sufferers, although he did not identify them as
bacteria, and received little support. The
discovery was made with a "new and better"
microscope.
 MYCOBACTERIUM LEPRAE

 acid-fast bacillus that attacks

cutaneous tissues and peripheral
nerves, producing skin lesions,
anesthesia, infection and deformities.

 was discovered by G. H. Armauer

Hansen in Norway in 1873, making it
the first bacterium to be identified as
causing disease in humans.
 also known as Hansen’s bacillus
spirilly, mostly found in warm
tropical countries, is a bacterium 
M. leprae is an aerobic bacillus that causes leprosy (Hansen's
(rod-shaped) surrounded by the disease). 
characteristic waxy coating unique
to mycobacteria. In size and shape,
it closely resembles Mycobacterium
tuberculosis.
EPIDEMIOLOGY
In 2016, leprosy cases for Philippines was 1,721. Though Philippines
leprosy cases fluctuated substantially in recent years, it tended to
decrease through 2007 - 2016 period ending at 1,721 in 2016.

Reported cases of leprosy in Region 7 or Central Visayas, which cover

Cebu, Bohol, Negros and Bicol.

Mortality in leprosy is often not considered important since the

disease is rarely an immediate cause of death. However, leprosy
patients are exposed to increase mortality risks due to its indirect
effects. ... In that population, leprosy was found to contribute to
about 1% of all deaths.
FUN FACTS!
According to the Bible, Naaman was a commander of the army of
Syria. He was a good commander and was held in favor because of
victory that God brought him. Yet Naaman was a leper. Naaman's wife
had a servant girl from Israel who said that a prophet there would be
able to heal him.

Several Greek writers, including Galen (2nd–3rd century CE), described

a disease that may have been leprosy, though the Greeks did not
apply to this disease the term lepra (“scaly”), from which the modern
term leprosy is derived; instead, they referred to it as elephantiasis
græcorum. In a similar vein, the “leprosy” referred to in the Bible
— both the tzaraath of the Hebrew Bible and the lepra of the Greek
New Testament—is not described in a clinically recognizable manner
and probably was any of a number of severe chronic skin diseases.
ETIOLOGIC AGENT/CAUSITIVE AGENT:
Mycobacterium Leprae

INCUBATION PERIOD: 5 ½ MONTHS TO 8 YEARS.

MODE OF TRANSMISSION:
1. The disease can be transmitted through respiratory
droplets.
2. Inoculation through the skin break and mucous
membranes may also be a mode of transmission.
 Leprosy occurs in three distinct forms:

1. Lepromatous leprosy (multibacillary)

a. This is the most serious type and is considered
to be the most infectious.
b. It causes damage to respiratory tract, eyes and
testes, as well as the nerves and the skin.
c. Lepromin test is negative but the skin lesion
contains large amounts of Hansen’s bacillus.
d. There is gradual thickening of the skin with
the development of a granulomatous condition.
e. The lesions frequently appear as macules and
become nodular in character (leproma).
f. There is slow involvement of the peripheral
nerves, with some degree of anesthesia and
loss of sensation and gradual destruction of
the nerves.
g. There is atrophy of the skin and muscles and eventual melting or
absorption of small bones, primarily those of the hands and
feet.
h. There is ulceration of the mucous membrane of the nose.
i. Because of the melting or absorption of small bones and
ulcerations, natural amputation may occur.
2. Tuberculoid leprosy
a. It affects the peripheral nerves and sometimes the surrounding skin,
especially on the face, eyes and testes, as well as the nerves and the
skin.
b. Lepromin test is positive, but the organism is rarely isolated from the
lesions.
c. Macules are elevated, with clearing at the center, and are more clearly
defined than in the lepromatous form.
d. Anesthesia is present, and involvement of the peripheral nerves occurs
more rapidly than in the lepromatous form.
3. Borderline (dimorphous) leprosy

Has the characteristics of both lepromatous and tuberculoid

leprosy. Skin lesions of this type of leprosy are diffused and poorly
defined.

Borderline lepromatous leprosy Borderline tuberculoid leprosy

 PATHOPHYSIOLOGY
M. Leprae enters the body (skin,
nose, etc.)
ATTACKS!
Peripheral nerves

Bind to Schwann cells of axon

(Principal target of bacteria)

Demyelination of nerve

Loss of axonal conductance

Deformity (loss of pain, temperature, touch,

sensation)
PATHOLOGY
1. M. Leprae attacks the peripheral nerves, especially the ulnar,
radial, posterior-popliteal, anterior-tibial and facial nerves.
2. When the bacilli damage the skin’s fine nerves, they cause
anesthesia, anhidrosis and dryness.
3. If they attack a large nerve trunk, motor nerve damage,
weakness and pain occur, followed by peripheral anesthesia,
muscle paralysis and atrophy.
CLINICAL
MANIFESTATION
Neural Involvement
The earliest manifestations of the disease is most cases are the result of
nerve damage, as characterized by:
a. Atrophy of the muscles of hands which extends to the thenar, the
hypothernar, and the forearm muscles, resulting in clawhand.
b. Nerves often involved are the ulnar, median, radial, lateral popliteal
and facial.
c. Paralysis and peripheral anesthesia can occur either independently
or concurrently.
d. Secondary consequences of nerve involvement include
malperforant, clawhand and ocular complications incident to
corneal insensitvity or paralysis of the eyelids.
Skin
Lepromatous and tuberculoid leprosy differ greatly in their
cutaneous manifestations:
a. In lepromatous disease, early lesions are multiple, symmetrical and
erythematous, sometimes appearing as macules or papules with
smooth surfaces.
b. Later, these lesions enlarge and form plaques or nodules on the
earlobes, nose, eyebrows and forehead, giving the patient a leonine
appearance.
c. Eventually, there is the loss of eyebrows and eyelashes.
d. The loss of function of the sweat and sebaceous glands makes
affected skin appear dry and hairless.
e. Tuberculoid leprosy may be purely neural or may simultaneously
affected the skin.
f. Raised, large erythematous plaques appear on the skin with clearly
defined boarders. As they grow, they become rough, hairless and
hypopigmented, leaving an anesthetic scar.
Eye
a. Specific ocular manifestations are found only in lepromatous
and boderline leprosy.
b. The conjunctiva, sclera, cornea and iris are affected, sparing the
retina and optic nerve.
c. Photophobia, conjunctivitis and irisdocyelitis frequently occur.
Opacity of the cornea, insensitivity and ulceration can lead to
blindness.
Upper Respiratory Tract
a. The nose, mouth, pharynx, larynx, trachea and esophagus are
often involved in lepromatous leprosy.
b. Epistaxis, ulceration of the uvula and tonsils, septal perforation
and nasal collapse are also present.
Visceral leprosy

Apart from the skin and nerves, the heaviest concentration of

lesions is in the organs representing the reticuloendothelial
system, the lymph system and the liver.

Testicular damage occurs in almost all moderately advanced

cases of lepromatous leprosy.
STIGMA OF LEPROSY
The fear of leprosy leads to the stigma and discrimination and is due to
lack of understanding and knowledge about leprosy - which increases
misconceptions about the disease’s transmission and treatment. The fact
that most of those with untreated leprosy end up with severe deformities
and disfigurements has contributed to the stigma.
Some studies have concluded that stigma affects many aspects of the
lives of people affected by leprosy including “mobility, interpersonal
relationships, marriage, employment, leisure activities, and attendance
at social and religious functions.
Leprosy has always been linked with stigma. For many people stigma is
synonymous with leprosy. This is due to:
leprosy often causing severe disfigurement and disability
lack of knowledge about the disease.
The key messages that can overcome stigma are:
•leprosy is curable
•drug treatment is available free of charge
•there is no need to discriminate against people affected by leprosy.

If the misconceptions about leprosy are not changed, it will be

difficult to eliminate leprosy as a public health problem.
Diagnostic Procedures

1. Identification of the signs and symptoms

2. Tissue biopsy
3. Tissue smear
4. Lepromin test – is used to determine the type of leprosy a person
has contracted. It involves the injection of standardized extract of the
inactivated “leprosy bacillus” under the skin. It is not recommended as
a primary mode of diagnosis.
5. Blood vessels show increased RBC and ESR; and decreased serum
calcium, albumin and cholesterol levels.
MODALITIES OF
TREATMENT
1. Sulfone therapy
2. Rehabilitation, recreational and occupational therapy
3. Multiple drug therapy (MDT)

a. The drugs used in MDT are combinations of rifampicin,

clofamizine and dapsone for multibacillary leprosy, and
rifampicin and dapsone for the pausibacillary type.
b. Among these, rifampicin is the most important anti-leprosy drug
and is therefore included in the treatment of both types of leprosy.
c. Treatment of leprosy with only one anti-leprosy drug will always
result in the development of drug resistance.
d. Treatment of leprosy with dapsone or any anti-leprosy drug used
as monotherapy should be considered as an unethical practice.
e. For multibacillary leprosy, rifampicin 600 mg is given once a
month; dapsone 100 mg daily; and clofazimine 50 mg daily for
12-month duration.
f. For paucibacillary leprosy, give rifampicin 600 mg once a month;
dapsone once daily; duration of treatment is 6 months.
g. Clofazimine causes brownish black discoloration and dryness of
the skin. However, this disappears within a few months after
stopping treatment. This should be explained to patients starting the
MDT regimen for MB leprosy.
h. MB and PB patients should have fixed-duration treatment, which
means:
• for MB patients – after taking 12 monthly doses of MDT,
the person is considered cured and should be removed
from the register;
• for PB patients – after taking 6 monthly doses of MDT, the
person is considered cured and should be discharged.
NURSING MANAGEMENT
1. If the patient is admitted to the hospital, isolation and medical
asepsis should be carried out.
2. Moral support and encouragement are necessary.
3. Diet should be full, wholesome and nutritious.
4. Special attention should be given to personal hygiene.
5. Terminal disinfection should be carried out.
COMMON NURSING DIAGNOSES
1. Impaired skin integrity
2. Social isolation
3. Ineffective coping
4. Knowledge deficit
5. Anxiety
6. Impaired body image
PREVENTION
1. Report all cases and suspects of leprosy.
2. Newborn infants should be separated from leprous mothers.
3. BCG vaccine may be protective if given during first 6 months
of life.
4. Secondary prevention by tracing contacts, making an early
diagnosis, and treating infection early.
5. Health education should be given, with particular focus on
the mode of transmission.
THANK YOU! 