Leprosy is a chronic systemic infection characterized by progressive cutaneous lesions.

Mycobacterium leprae is an acid-fast bacillus that attacks cutaneous tissues and peripheral nerves, producing skin lesions, anesthesia, infection and deformities

a. Early signs and symptoms change in skin color-either reddish or white loss of sensation on the skin lesion decrease/ loss of sweating and hair growth over the lesion thickened and or painful nerves muscle weakness or paralysis of extremities pain and redness of the eyes nasal obstruction or bleeding ulcers that do not heal

b. late sign and symptoms loss of eyebrow- madarosis inability to close eyelids- lagophalmos clawing of fingers and toes contractures enlargement of the breast in males or gynecomastia chronic ulcer

the incubation period of leprosy ranges from five- and a half month to eight years

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.

1. Lepromatous leprosy(multibacillary) a. this is the most serious type and is considered to be the most infectious. b. It causes damage to the respiratory tract, eyes and testes, as well as the nerves and the skin. c. Lepromin test is negative but the skin lesion contains large amount of Hensen`s bacillus. d. There is gradual thickening of the skin with the development of a granulomatous condition.

e. the lesions frequently appear as macules 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 nerve 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 ulceration, natural amputation may occur. 2. Tuberculoid leprosy a. It affects the peripheral nerve 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 nerve occurs more rapidly than in the lepromatous form. 3. Borderline (dimorphous) leprosy has the characteristics of both lepromatous and tuberculoid leprosy.

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 nerve, they cause anaesthesia,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.

1. Neural involvement the earliest manifestation of the disease in most cases are the result of nerve damage, as characterized by; a. Atrophy of the muscles of the hands which extends to the thenar, the hypothenar, 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 accur either independently or concurrently d. Secondary consequences of nerve involvement include

Skin Lepromatous and tuberculoid leprosy differ greatly in their cutaneous manifestation: a. In lepromatous disease, early lesions are multiple, symmetrical and earythematous , sometimes apprearing 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. 3. Eye a. The conjunctiva, sclera, cornea and iris are affected, sparing the retina and optic nerve. b. Photophobia, conjunctivitis and iridocyelitis frequently occur.

4. Upper respiratory tract > the nose, mouth pharynx ,larynx , trachea and esophagus are often involved in lepromatous leprosy. >Epistaxis ,ulceration of the uvula and tonsils, septal perforation and nasal collapse are also present. 5.Visceral leprosy Apart from the skin and nerve, the heaviest concentration, of lesions is in the organs representing the reticuloendothelial system, the lymph system and the liver.

1 Identification of the sign and symptoms 2 Tissue biopsy 3 Tissue smear 4 Blood tests show increased RBC and ESR, decreased serum calcium, albumin and cholesterol levels.

1 Sulfone therapy 2 Rehabilitation, recreational and occupation therapy 3 Multiple drug therapy (MDT) a. The drug used in MDT are combinition of rifampicin, clofazimine 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. For multibacillary leprosy, rifampicin 600 mg is given once a month ;dapsone 100 mg daily; and clofazimine 50mg daily for a 12 month duration. d For paucibacillary leprosy,give rifampicin 600mg once a month, dapsone once daily; duration of treatment is 6 months. g Clofazimine causes brownish black discoloration and dryness of the skin. h MB and PB patient should have fixed-duration treatment, which means;

 for MB patient after taking 12 monthly doses of MDT, the person is considered cured and should be removed from the register; for PB patient- after taking 6 monthly doses of MDT, the person is considered cured and should be discharge.

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.

1 Impaired skin integrity 2 Social isolation 3 Ineffective coping 4 Knowledge deficit 5 Anxiety 6 Impaired body image

1 Report all cases and suspect of leprosy. 2 Newborn infant should be separated from leprous mother. 3 BCG vaccine may be protective if given during the first 6 months of life. 4 Health education should be given, with particular focus on the mode of transmission.