Hansen’s disease (Leprosy) -A Literature Review

 

Usha B S*

Associate Professor, Siddaganga Institute of Nursing Science and Research Center, Tumkur, Karnataka, India.

 

ABSTRACT:

Mycobacterium leprae, an acid-fast, rod-shaped bacillus, causes leprosy, an infectious disease. The condition mostly affects the skin, peripheral nerves, upper respiratory tract mucosa, and eyes. Leprosy is treatable, and early treatment can help prevent disability.

·       Leprosy can be cured with multidrug therapy (MDT).

·       During close and regular contact with untreated individuals, leprosy is likely transferred by droplets from the nose and mouth.

·       Early detection and treatment with multidrug therapy (MDT) are essential for eradicating the disease as a public health issue.

·       Leprosy can cause permanent damage to the skin, nerves, limbs, and eyes if left untreated.

·       According to official figures from 159 countries across six WHO regions, there were 208 619 new leprosy cases worldwide in 2018.

The prevalence rate corresponds to 0.2/10 000 based on 184 212 cases at the end of 2018¹.

 

 

 

INTRODUCTION:

Leprosy is a contagious disease that lasts for a long time. Because this disease is spread by social factors, it is commonly referred to as a "social disease." M. leprae grows slowly, and the disease takes an average of 5 years to develop. Symptoms might appear in as little as a year, but they can also take as long as 20 years or even more. The condition mostly affects the skin, peripheral nerves, upper respiratory tract mucosa, and eyes.

 

Definition:

Leprosy (Hansen’s disease) Is Chronic Infections Disease Caused by Mycobacterium Leprae. This Disease Affects Mainly the Peripheral Nerves. It Also Affects the Skin, Muscles, Eyes, Bones and Internal Organs.

 

Causative organism:

Mycobacterium leprae"or Leprae bacilli"is the bacteria that causes leprosy.

 

Signs and symptoms of leprosy:

Headache, Malaise, Chilliness, Mental depression, Numbness of body.

 

Main diagnostic signs:

·       Skin blemishes or hypopigmented areas in leprosy-affected areas

·       total or partial loss of sensation (pain, touch, and temperature) is common.

·       Nerves thicken and hair begins to fall out.

·       Tumors on the face and ears' skin,

·       Finger amputation,

·       Toes with claws,

·       Sweating cessation or hair loss over the skin lesion².

 

Modes of Transmission:

·       Contact transmission:

Lepra bacilli are spread by intimate contact with families and people who have been affected with leprosy. Indirect contact with soil fomites is also a possibility.

·       Droplet infection:

Droplet infection is a common cause of leprosy and is spread through coughing and sneezing.

·       Other methods of transmission

It includes breast milk (from mother to child), insect (vector) bites (fleas and bed bugs, for example), and tattoo needles.

 

Incubation period: 3-5 years³

Classification:  leprosy is classified as follows-

A.  Madri classification:

1.     Indetermediate Leprosy (IL)

2.     Tuberculoid  Leprosy (TL)

3.     Borderline Lepromatous (BL)

4.     Lepromatous Leprosy (LL)

 

B.  Indian classification of leprosy:

The Indian classification (1981) is classified by Indian leprosy association (Hind Kusht Nivaran Sangh).It is a clinico-bacterial classification:

·       Intermediate leprosy is defined by the presence of one or two indistinct hypopigmented macules and normal but occasionally reduced feeling. Bacteriologically, the lesions are negative.

·       Tuberculoid Leprosy: One or two well-defined lesions, which may be flat or elevated, hypopigmented or erythematous, are present. Peripheral nerve enlargement.

·       Borderline Leprosy: Four or more lesions that are flat or elevated, well-defined or ill-defined, hypopigmented or erythematous, and have sensory impairment or loss. There is a wide range of bacteriological positive.

·       Lepromatous Leprosy: The presence of widespread infiltration or a symmetrical distribution of flat or elevated, poorly defined shining, smooth lesions all over the body. Eyebrows and eyelashes are missing. These have been found to be bacteriologically positive.

·       Pure neurotic Leprosy: It involves nerve endings but do not have any skin lesions.

 

Diagnostic tests:

1      Complete physical examination of the patient and case history.

2      Laboratory test of secretions of nose, throat and skin of the patient.

3      Histamine test.

4      Serum examination.

5      Biopsy examination

 

Complications:

1.     Partial or complete deformity or handicap

2.     Loss of manpower or national loss.

3.     Social and mental tension etc⁴.

 

Role of Community Health Nurse in Leprosy control:

Community nurse plays a major role in the control of leprosy. The following elements are considered as a minimum requirement for all leprosy control programmes.

 

1.     Medical measures:

Estimation of problem, Early case detection, Multidrug therapy, Surveillance, Immunoprophylaixs., Chemoprophylaxis, Deformities, Rehabilitation., Health education, Others.

2.     Social support.

3.     Program management.

4.     Evaluation.

 

As a community health nurse, she has to explain regarding 3 aspects of medical management, they are: About treatment, Maintenance of hygiene’s, Loss of sensation includes – care of hands, feet, care of shoes, etc.

 

Treatment:

Dapsone has an important drug for the treatment of Leprosy; Govt. of India has recommended the drugs as-

 

1. Paucibacillary patients:

Dapsone -100mg daily - 6months

Rifampicin - 600mg once a month

After the completion of 6 months dapsone may be continued according to the condition of the patient observation is necessary for at least two years after the treatment.

 

2. Multibacillary patients:

Dapsone 100mg daily - for initial 2 weeks.

Rifampicin 600 mg daily - for initial 2 weeks.

 

After that the treatment given 2 years.

Dapsone 100mg daily.

Rifampacin 600mg once a month

Clofazamine 50mg daily.

 

Daily treatment diagnostic test and follow up should be continued up to 5 years.

 

Duration of treatment:

1.     Paucibacillary leprosy : for 6 months

2.     Multibacillary leprosy: for 12 months

3.     Educate the people regarding multidrug therapy.

4.     Educate the importance of regular treatment.

5.     Educate how to take medicine, storage of medicines, side effects of medicines etc.

6.     Explain about the duration of treatment⁵.

 

Hygiene:

Dirt brings disease (or) sickness, and persons who have dirty habits are more prone to contract leprosy than those who have clean habits.

 

Body hygiene:

i        It is critical to wash your hands with soap on a daily basis.

ii      Wash your body parts on a daily basis.

iii    Take extra care of hands (or feet) that cannot feel sensation.

 

Clothing hygiene:

Dirty garments are a breeding ground for fleas, lice, and other parasites, causing irritation and allowing germs to enter.

 

Maintenance of houses hygiene:

·       Sweep the house and corners every day and dispose of the dirt appropriately.

·       Allow air to circulate by opening the windows.

·       Maintain a clean latrine.

 

Compound upkeep is essential (Around house) :

·       Maintain good hygiene by keeping the grass mowed.

·       Do not throw garbage from the kitchen into the compound; instead, place it in the dust bin.

 

Loss of sensation:

Skin care:

·       Wash your feet and hands every night after work, preferably with soap.

·       Soak the hands (or feet) for at least 20 minutes in water.

·       Remove any dead skin with a stone (or) finger after soaking, but do not use a razor blade.

·       Use cooking oil (or) Vaseline to oil the skin; do not use butter. It is necessary to soak the skin first, then rub in the oil.

 

Care of feet:

·       After washing your feet, inspect them and push with your thumb on the six points designated with a 'x' on the thumb, and so on.

·       If the area is red (or) uncomfortable to the touch (or) swollen. These are red flags.

·       We can avoid it if we don't walk.

·       Take a break from work and rest your foot at home.

·       If you need a bandage, don't walk to the clinic.

·       The most basic treatment is rest

·       Wear the proper shoes to protect your feet if you have lost feeling in them.

·       Take little steps when walking. It will not put such a strain on the feet.

·       Avoid walking on rough ground.

 

 Care of eyes:

·       In the early stages of eyelid weakening, everyday exercises such as beeping the eyelids 20 times three times a day can help.

·       If you have no sensation in your eyes, check them every day. Check your eye with a minor to see if there are any dust particles. If this is the case, remove them with a clean piece of cloth.

·       Cover your eyes with a clean cloth (or) a bed sheet at night. This will prevent dust from falling from the roof of the home into our eyes, which we are unable to detect.

·       If your eyes are dry, wash your hands and put some clean oil in them; dry eyes are dangerous.

·       If there is direct sunshine, wear an eye shade (or) a white brine cap.

·       To keep flies away from your eyes, wash them thoroughly every day. Flies spread eye disease⁶.

 

REFERENCES:

1.      https://www.who.int/news-room/fact-sheets/detail/leprosy

2.      K.K.Gulani.A Textbook of Community Health Nursing for GNM.Vol.1,Second Edition, Kumar Publishing House, New Delhi. 189-195.

3.      Kamala. G.Community Health Nursing-I.1^st edition, Florence Publishers, Hydrabad..416-425.

4.       Papri Das. Textbook of Community Health Nursing. 1^st edition, Paras Medical Publisher, New Delhi. 206-209.

5.      Shivaleela S Sarawad, Veerabhadrappa G Mendagudli. Hansen’s disease (Leprosy) – A Review. Int. J. Nur. Edu. and Research. 2021; 9(2):242-244. doi: 10.5958/2454-2660.2021.00058.2

6.      Veerabhadrappa G M. The Short Textbook of Community Health Nursing.1^st Edition, Jaypee Brothers Medical Publishers, New Delhi. page no.184-189.

 

Received on 16.03.2022         Modified on 18.04.2022

Accepted on 10.05.2022       ©A&V Publications All right reserved