INTRODUCTION:

Leprosy Is A Chronic Communicable Disease. This Is Commonly Called As A ‘’Social Disease’’ Because This Disease Spreading From Social Factors. M. leprae multiplies slowly and the incubation period of the disease, on average, is 5 years. Symptoms may occur within 1 year but can also take as long as 20 years or even more to occur. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract, and the 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:

The causative organism of leprosy is Mycobacterium leprae’’or Leprae bacilli.

Signs and symptoms of leprosy:

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

Main diagnostic signs:

Marks or hypo-pigmented patches on skin, Total or partial loss of sensation (pain, touch and temperature) in leprosy affected parts, Nerves become thick and starting the hair falling, Tumors on the skin of face and ears, Loss of fingers, Claw toes, Loss of sweating or loss of hair over the skin lesion

Modes of Transmission:

· Contact transmission: Lepra bacilli transmitted by direct close contact with families, persons who have infected from leprosy. And indirect contact with soil fomites.

· Droplet infection: Droplet infection is very common for leprosy through coughing, sneezing.

· Other modes of transmission may include: through breast milk(mother to child), insect (vector) bite (fleas and bed bugs, etc.), tattooing needles.

Incubation period: 3-5 years

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:

1. Intermediate Leprosy:

It is the presence of one or two vague hypo pigmented macules and sensation normal but sometimes impaired. The lesions are bacteriologically negative.

2. Tuberculoid Leprosy:

It is the presence of one or two well-defined lesions, which may be flat or raised, hypo pigmented or erythematous. Enlarged peripheral nerve.

3. Borderline Leprosy:

Presence of four or more lesions which is characterized by flat or raised, well or ill-defined, hypo pigmented or erythematous and show sensory impairment or loss. The bacteriological positivity is varied.

4. Lepromatous Leprosy:

The presence of diffuse infiltration or numerous flat or raised, poorly defined shiny, smooth, symmetrically distributed lesions all over the body. Loss of eyebrows and eyelashes. These are bacteriologically positive.

5. 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 etc.

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 treatment.

Maintenance of hygiene:

Dirt brings disease, (or) sickness, people with dirty habits are more likely to catch leprosy than those with clean habits.

Maintenance of body hygiene:

· It is important to wash daily, with soap.

· Wash the parts of body, daily

· Take special care of hands (or) feet that cannot feel sensation.

Maintenance of clothes hygiene:

· Dirty clothes are good place for fleas, lice etc.

· These cause itching giving entry to germs.

Maintenance of houses hygiene:

· Everyday sweep the house and corners and dispose the dirt appropriately.

· Open the windows to for air ventilation.

· Keep latrine clean.

Maintenance of compound (Around house) Hygiene:

· Keep the grass cut.

· Do not through the rubbish from the kitchen into compound, dispose in dust bin.

Loss of sensation:

Care of skin:

· Wash the feet and hands every night after work use soap if possible.

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

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

· Oil the skin use either cooking oil (or) Vaseline, but do not use butter, it is essential to soak first, then rubs in oil.

Care of feet:

· Inspect your feet every night after washing then press with thumb on the 6 places marked with on ‘x’ on the thumb, etc.

· If you find red (or) painful on pressure (or) swollen. These are danger signs.

· We can prevent it by not walking.

· Rest the foot at home.

· Do not walk to the clinic to get a bandage.

· Rest is the basic treatment.

· Protect the feet that have lose feeling by wearing the right kind of shoes.

· Walk with the short steps. It will not give feet such hard work.

· Avoid walking on rough ground.

Care of eyes:

· In early stages of eyelid weakness, daily exercise can beep close the eyelids for 20 times, 3 times a day.

· If eyeballs have no sensation, inspect your eyes every day. Use a minor to see if there are pieces of dust in eye. If so remove them with clean peace of cotton.

· At night cover the eyes with clean cloth (or) bed sheet. This will prevent dust from dropping form roof of house into the eyes which we cannot feel.

· If eyes are dry, wash hands put clean oil into eye, eyes that are dry are in danger.

· If bright sunlight, wear an eye shade (or) hat with white brine.

· Wash your eyes carefully everyday to keep flies away from your eyes. Flies spread eye disease.

REFERENCES:

1. Papri Das. Textbook of community health nursing. 1^st edition, Paras Medical Publisher, New Delhi. 206-209.

2. Veerabhadrappa G Mendagudli. The Short textbook of Community Health Nursing.1^st edition, Jaypee brothers medical publishers, newdelhi.page no.184-189.

3. K.K.Gulani.A textbook of Community Health Nursing for GNM.Vol.1,second edition, kumar publishing house, New delhi. 189-195.

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

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

Received on 12.12.2020 Modified on 28.12.2020

Int. J. Nur. Edu. and Research. 2021; 9(2):242-244.

DOI: 10.5958/2454-2660.2021.00058.2