Leprosy (Hansen’s disease) : Leprosy Reaction, Natural Treatment, Nurse
Management and Advice For Patient
Is a chronic mycobacterial infectious disease caused by myco bacterium
leprae that affect the skin and peripheral nerves? It causes nerve damage
(nerve function loss) characterized by muscle weakness and hypo pigmented
macula. In advanced cases papules, nodules and inflammation.
What is a leprosy reaction?
A leprosy reaction is manifested with inflammation of the skin lesion and
peripheral nerves. It occurs due to the immune system in the body attacking
the leprosy bacilli. The inflammation in the skin lesions causes redness
and edema, therefore the hypopigmented macular lesion become red and
raised. It causes discomfort and pain or may ulcerated in sever cases. If
this not treated early the inflammation in the peripheral nerves causes
tenderness/pain/ and enlargement of the nerves, which may lead nerve damage
with motor or sensory loss (muscle paralysis and loss of sensation of
extremities) The nerve damage, account, for the disability and stigma in
leprosy.
When do reactions occur?
A person with leprosy can have a reaction at almost any time. Before
treatment, during treatment and after treatment has been completed.
Classification of leprosy
For the choice of multi drug therapy bacillary (MDT) patients are
classified as Paucibacillary (PB) and Multi bacillary (MB). So, new patient
will be classified based on the numbers of skin lesions and result of skin
smear.
You need one of the three to diagnose leprosy. If you are in doubt wait and
recheck after few months
Paucibacillary
Patient with one to five leprosy skin lesions
Multi bacillary
- Patient with six or more skin lesions
- Patient with less than six skin lesions and have positive skin smear result
How to examine for leprosy reaction of skin
- Ask the person if there is any pain and swelling on the skin patches, the nerves have to be examined for swelling of nerves and tenderness
- Exam the patient for signs of inflammation on skin- Examine the hands and feet for signs of loss of sweating loss of sensation of palm and sole, ulcer and weakness of muscles
When to diagnose Leprosy?
• Hypopigmented macular lesion with loss of sensation.
• Enlarged, tender peripheral nerve with loss of sensation.
• Puncture skin smear for M/leprae
How to diagnosis leprosy
Leprosy lesion can be patch or nodules Diagnosis is based on the cardinal signs of leprosy. At least one of the following cardinal sign must be presnt
1. Anesthetic patch (hypo pigmented patch with loss of sensation)
2. Nerve enlargement and/or tenderness
3. AFB in slit skin smears examination (positive acid fast bacilli in slit skin smear examination) If in doubt give an appointment for 3-6 months
The two types of leprosy reaction
1. Type I or reversal reaction
2. Type II or erythema nodosum Leprosum (ENL)
Who is likely to get a type I of reaction (reversal reaction)?
Type1 reaction is caused by increased activity of the body is immune system in fighting the leprosy bacilli. It occur in people who have strong all mediated immunity Both paucibacillary and multibacillary get type 1 reaction and commonly seen within six months of starting treatment, but some of patients may show this reaction before starting treatment even before leprosy has been diagnosed.
What are the clinical features of type I reaction?
The most common clinical feature is inflammation in the skin patches with swelling, redness and warmth. The patches are not usually painful, but there may be some discomfort associated with swelling of the limbs or face may occur. The peripheral nerves become enlarged and tender. The nerve damage in type 1 reaction is usually severe. And cause disability and deformity.
Type II reactions (Erythema Nodsum Leprosum)
Occur in a patient with high bacillary load. When large numbers of leprosy bacilli are killed and gradually decompose. Proteins from the dead bacilli provoke humoral allergic reaction. Since these proteins/antigens are present in the blood stream, the reaction will involve the whole body causing generalized symptoms. Nerve damage in type II reaction is usually mild.
Who is likely to get a type II reaction?
Only multibacilli patient with positive slit skin smear get type 2 reactions
When do type II reactions occur?
The reactions occur most commonly during leprosy treatment and since it takes long time to clear the dead bacilli and remains for years after stopping the treatment.
What are the clinical features of type II reaction?
Type II reaction exhibits the typical sign of erythema nodsum, these are subcutaneous nodules which are painful as a result of inflammation. It can be few or many in number and occur on the face, trunk, and extremities The lesion appear in groups and subside spontaneously while new crops reappears. The peripheral nerves may be enlarged with or without functional loss.
Management and Nursing intervention
1. Identify the types of reaction
2. If both types of reaction are mild treat with acetyl- salicylic acid (ASA)of aspirin, adult dose is 600 mg up to six time per day with Anti acid or after meal
3. For sever reaction corticosteroids predinsolon is most commonly used.
Nursing intervention
♦ Rest is important during episode of reaction or inflammatory condition
♦ Splint can be applied to the limb to rest affected Muscle & nerves
♦ As recovery begins the nurse has to do passive exercise to help the range of movement and follow by active exercise to restore muscle strength
♦ Give health education to the patient about the medication and reducing the risk of damage to body parts
♦ If patient has loss of sensation in their feet, advise to wear proper footwear, with microcella rubber inside the shoes
♦ If the patient has wound, you should keep clean by using water and soap and cover them with clean dressing and advice rest
♦ Oil such as vegetable oil or Vaseline should be applied to keep the skin in good ondition and smooth
♦ Make sure the patient is getting the ordered medication properly.
♦ Avoid discrimination and stigmatization
♦ Give health education on the disease condition to the family including community
Thanks For Visiting ! Keep Your Healthy !
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