Is an ancient disease that causes permanent physical disability among

communicable disease. Leprosy has been a public health problem in the

Philippines for several decades. In 1989 Multi Drug Therapy (MDT) was
implemented nationwide.

Also known as Hansen's disease. Mycobacterium leprae (rod shaped bacteria) are
part of the family Mycobacteriaceae, which is the same family as the bacteria that
cause tuberculosis (Mycobacterium tuberculosis).
Causative Organism:
Mycobacterium leprae or leprosy bacilli
Mycobacterium leprae -- the bacteria responsible for
leprosy -- grow slowly and mainly affect the skin, nerves,
and mucous membranes. The bacteria are likely transmitted
from person to person in respiratory droplets. Transmission
from animals to humans is extremely rare.

Even in severe cases, Mycobacterium leprae destruction is limited to the:

 Skin
 Peripheral nerves
 Front portion of the eyes
 Upper respiratory passages
 Testes
 Hands
 Feet
Two nerves that Mycobacterium leprae seem to prefer are the ulnar nerve by the
elbow and the peroneal nerve by the head of the fibula. In people with lepromatous
leprosy, Mycobacterium leprae seem to prefer the liver, spleen, and bone marrow.

Mode of Transmission:
1. Airborne: inhalation of droplet/spray from coughing and sneezing of untreated
leprosy patient.
2. Prolonged skin-to-skin contact
Susceptibility: 12 y.o. and below
 Children should avoid close contact with active, untreated leprsosy case
 BCG Vaccination
 Good personal hygiene, Adequate Nutrition
  Health Education
Signs and Symptoms:
Early:
 Change in skin color
 Loss of sensation of skin lesion
 Decrease/loss of hair/sweat
 Thickened/painful nerves
 Muscle weakness/paralysis of extremities
 Pain and redness of eyes
 Nasal obstruction or bleeding
 Ulcers that do not heal
Late:
 (madarosis) – loss of eyebrows
 (lagopthalmos) – inability to close eyelids
 clawing of fingers and toes
 contractures
 sinking of nosebridge
 gynecomastia – enlargement of the breast
 choronic ulcers

WHO Classification of Leprosy based on Modern Management or Multi-Drug Therapy

1. Paucibacillary (tuberculiod and indeterminate)

 milder and characterized by one or more hypopigmented skin macules
 non-infectious
 Treatment duration: 6-9 month
2. Multibacillary (Leperamatous and borderline)
 associated with symmetric skin lesions, nodules, plaques, thickened dermis,
and frequent involvement of the nasal mucosa resulting in nasal congestion
& epistaxis
 Infectious
 Treatment duration: 24-30 months
Diagnostic Exam: Slit Skin Smear or SSS

Treatment: MDT- Multi Drug Therapy

1. Rifampicin
 2. Dapsone
3. Lamprene – cause darkening of patient’s skin

Multi Drug Therapy:

1. Paucibacillary Tx:

Drug Adult Child

(10 – 14yrs)

Supervised Dose Rifampicin 600 mg 450 mg

(1 month)
Dapsone 100 mg 50 mg

Home Tx (Daily) Dapsone 100 mg 50 mg

* Duration of Tx: 6-9 months

If patient have single lesion with negative slit skin smear:

Tx: Single dose of Rifampicin 600 mg 300 mg

ROM regimen:
Oflaxacin 400 mg 200 mg

Minocycline 100 mg 50 mg

2. Multibacillary Tx:

Drug Adult Child

Supervised Dose (1 Rifampicin 600 mg 450 mg

month)
Clofazimine 300 mg 150 mg

Dapsone 100 mg 50 mg

Home Tx (Daily) Clofazimine 50 ng 50 mg q other day

 Dapsone 100 mg 50 mg

* Duration of Tx: 24-30 months if patient failed to complete the 18 months treatment

Surveillance: MB – 5 years

PB – 3 years

Nursing Responsibilities for Leprosy:

1. Prevention:

 Health Education, IEC

 Advocate healthful living through proper nutrition, adequate rest, sleep and
personal hygiene
 BCG immunization

2. Case finding

 Early recognition of s/s of Leprosy

 Epidemiological investigation
 Contact tracing
 Health inspection of school children

3. Management and treatment

 Promote healthful living

 Help patient and family accept illness and treatment
 Provide mental and emotional support
 Referral of cases for management

4. Rehabilitation

 Help create a congenial atmosphere essential to progressive environment

 Skill or occupational therapy
 Referral to agencies for occupational or social rehab

Strategies are case-finding, treatment, advocacy, rehabilitation, manpower

development and evaluation.
Is treatment expensive?
Treatment costs nothing. Since 1995, the WHO has supplied MDT FREE to all
patients in the world, initially with funding provided by the The Nippon
Foundation, and subsequently through MDT donated by Novartis and the Novartis
Foundation for Sustainable Development.

Is there any reason to isolate people with leprosy?

No, today, there is no medical or social justification for isolating people with
leprosy. People can continue their normal way of life while receiving treatment.
Any attempt to isolate people with leprosy stigmatizes them and reinforces age-old
prejudices about the disease.

Where is the treatment available?

Leprosy can be diagnosed and treated at the nearest health center or health post as
leprosy services have been integrated with general health services.

Why does leprosy lead to deformity?

If untreated, leprosy causes nerve damage and other complications. Patients lose
feeling and other complications. Patients lose feeling in their hands and feet, and
muscles become paralyzed because the nerves supplying them have been impaired.
As a result, people with the disease are susceptible to injuries that can result in
festering wounds or ulcers. These are secondary infections due to other organisms
and are not caused by the leprosy germ.

Will leprosy eventually disappear?

Leprosy has a long incubation period of between 5 and 20 years. It is likely that a
fair number of new cases will be diagnosed in the next few years but that over time
the incidence of the disease will grow less and less.

Can a person with deformities be cured of leprosy?

Leprosy can be cured at any stage. To be cured of leprosy means to have no
leprosy-causing bacteria remaining in the body. However, if leprosy is detected
and treated only after permanent nerve damage has occurred, there will be residual
disabilities and deformities. Disability is preventable and timely diagnosis and
prompt treatment. Residual disabilities and deformities are not a source of leprosy
infection.