LEPROSY

Leprosy is an ancient disease and is a leading cause of permanent physical

disability among the communicable diseases. It is a chronic mildly communicable
disease that mainly affects the skin, the peripheral nerves, the eyes and mucosa of
the upper respiratory tract.

Leprosy or Hansen’s disease is one infectious disease whose prospects for control
and eradication appear to be bright. A century ago, the disease was thought to be
incurable, and victims suffered not just deformities but great stigma that made
them virtual social outcasts. Now, the WHO reports that not only is the disease
curable but it can actually be eliminated worldwide as a public health problem. The
total number of people in the world who have been cured of leprosy has topped 10
million as of mid-1998. The global prevalence has been reduced by more than 70
percent and one to two million deformities have been prevented. These successes
were made possible by Multi-Drug Therapy (MDT) – a combination of three drugs:
rifampicin, clofazimine and dapsone – which accordind to WHO had been provided
to all known cases of the disease by the end of 1997. MDT continues to be highly
effective in curing leprosy completely with very low relapse rates of around 0.3 per
1000 cases per year. More importantly, no resistance to all three drugs together
has been detected anywhere in the world in Mycobacterium leprae, the bacillus that
causes the disease.

The WHO’s current recommended strategy is for endemic countries to embark on

intensive leprosy elimination campaign aimed at bringing to light the large numbers
of still “hidden” cases which must be detected and put on MDT treatment.
Education of the public on the facts of leprosy is an important component of this
campaign in order to dispel unfounded fears, superstitions, myths and social stigma
which make patients hide instead of presenting themselves for treatment.

LEPROSY CONTROL PROGRAM (DOH)

Leprosy has been a public health problem in the Philippines for several decades.
The disease is unequally distributed throughout the country. In 1987, in the
provinces of Ilocos Norte and Ilocos Sur, Abra, Sulu, Palawan, Cebu, La Union,
Pangasinan and Metro Manila, the prevalence rate is lower than 0.40/ 1000
population. The National Prevalence Rate as of 1998 was 0.65/1000.

The nationwide implementation of Multi-Drug Therapy (MDT) since 1998 has

resulted in the decrease in the prevalence rate of leprosy. The prevalence rate of
the disease declined from 7.2/10000 population in 1986 to 1.2/10000 population in
1997. Since then, the treatment of leprosy has shifted from institutional care to
that of home treatment.

Signs and Symptoms

a) Early S/S
• 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 S/S
• Loss of eyebrows – madarosis
• Inability to close eyelids – lagophthalmos
• Clawing of fingers and toes
• Contractures
• Sinking of the nosebridge
• Enlargement of the breasts in males or gynecomastia
• Chronic Ulcers

Infectious Agent
Mycobacterium leprae, an acid fast, rod-shaped bacillus which can be detected be
Slit Skin Smear (SSS)

Method of Transmission
• Airborne – inhalation of droplet/spray from coughing and sneezing of
untreated leprosy patient
• Prolonged skin-to-skin contact

Diagnosis of leprosy is currently based on clinical signs and symptoms especially if

there is history of contact with person with Leprosy (PWL). Only in rare instances is
there a need to use laboratory and other investigations to confirm a diagnosis.

Slit Skin Smear (SSS) examination is an optional procedure. It is done only when
clinical diagnosis is doubtful. The main objective is to prevent misclassification and
wrong treatment. A ready referral facility must be recognized in the conduct of SSS
procedures.

Susceptibility
Children especially twelve years and below are more susceptible.

Prevention
• Avoidance of prolonged skin-to-skin contact especially with a lepromatous
case
• Children should avoid close contact with active, untreated leprosy case
• BCG vaccination
• Good personal Hygiene
• Adequate Nutrition
• Health Education

Management/ Treatment
• Ambulatory chemotherapy through use of Multi-drug therapy
• Domiciliary treatment as embodied in R.A. 4073 which advocates home
treatment
WHO classification of Leprosy which is the basis of the modern management or
Mult-Drug Therapy:
Paucibacillary (tuberculoid and indeterminate)
Non-infectious types
Duration of treatment: 6-9 months
Multibacillary (lepromatous and borderline)
Infectious types
Duration of treatment: 24-30 months

Multi-Drug Therapy (MDT) is the use of 2 or more drugs for the treatment of leprosy.
It is proven effective cure for leprosy and renders patients non-infectious a week
after starting treatment. Further, MDT makes home treatment of leprosy patients
possible.

In view of recent advances in the treatment of leprosy, the following are the
standard mode of treatment for leprosy cases:

For Paucibacillary (PB) Leprosy Cases:

All paucibacillary leprosy cases shall be treated with the PB regimen as
follows:

Dosage: PB adult
Monthly Treatment: Day 1
Rifampicin 600 mg
Dapsone 100 mg
Daily Treatment: Days 2-28
Dapsone 100 mg
Duration of treatment: 6 blister packs to be taken monthly within a maximum
period of 9 months

Dosage: PB Child (10-14 years)

Monthly Treatment: Day 1
Rifampicin 450 mg
Dapsone 50 mg
Daily Treatment: Days 2-28
Dapsone 50 mg
Duration of treatment: 6 blister packs to be taken monthly within a maximum
period of 9 months

• Adjust dose appropriately for children less than 10 years. For example,
Rifampicin 300 mg and Dapsone 25 mg.

• Patients with single skin lesion and a negative slit skin smear may be treated
with a single dose of the ROM regimen as follows:

Dosage: Single dose ROM

Adult: Child:
Rifampicin 600 mg 300 mg
Ofloxacin 400 mg 200 mg
Minocycline 100 mg 50 mg
For MB Leprosy Cases:
All multibacillary leprosy cases shall be treated with the MB regimen as
follows:

Dosage: MB Adult
Monthhly Treatment: Day 1
Rifampicin 600 mg
Clofazimine 300 mg
Dapsone 100 mg
Daily Treatment: Days 2-28
Clofazimine 50 mg
Dapsone 100 mg
Duration of treatment: 12 blister packs to be taken monthly within a maximum
period of 18 months

Dosage: MB Child (10- 14 years)

Monthly treatment: Day 1
Rifampicin 450 mg
Clofazimine 150 mg
Dapsone 50 mg
Daily Treatment: Days 2-28
Clofazimine 50 mg every other day
Dapsone 50 mg
Duration of treatment: 12 blister packs to be taken monthly within a maximum
period of 18 months

• Adjust dose appropriately for children less than 10 years. For example,
Rifampicin 300 mg Dapsone 25 mg and Clofazimine 100 mg once a month
and 50 mg twice a week.
• Should the patient fail to complete treatment within the prescribed duration,
the said patient should continue treatment until he/she has consumed 24 MB
blister packs.

Completion of Treatment
All patients who have complied with the above mentioned treatment protocol
are considered cured and no longer regarded as a case of leprosy, even if some
sequelae of leprosy remain.

Responsibilities of the Nurse

Prevention
• Health education of patients, families and the community on the nature of
the disease, symptomatology and its transmission. Children who are more
susceptible to the disease should not be exposed to untreated lepromatous
cases.
• Advocates healthful living through proper nutrition, adequate rest, sleep and
good personal hygiene.
• BCG vaccination especially of infants and children.
Management and Treatment
The shift from institutional to domiciliary care of Hansenites placed a greater
responsibility on public health workers especially the public health nurse.
• Promotes healthful living by teaching the value of good personal hygiene,
proper nutrition, adequate rest and sleep.
• Helps patient/ family understand and accept the problems brought about by
the illness and assess their capacities to deal with them.
• Provides and arranges for provision of nursing care of patients at home.
• Prevents secondary injury by teaching leprosy patients/family to protect
cases from burns and rough/sharp objects. Use of pads and wooden handles
of utensils are advised to protect hands and special shoes with padded soles
should be worn to protect the feet. Any injury to hands, feet and eyes should
be treated early to prevent deformities.
• Guides and supports patients/ family throughout the treatment phase by
giving them information on the importance of sustained therapy, correct
dosage, effects of drugs and the need for medical checkup from time to time.
• Gives mental and emotional support by encouraging self-confidence and self-
reliance on the part of the patient/family and by maintaining an
understanding and objective attitude.
• Refers patient to other health and allied workers as the physician, dentist,
social worker, physiotherapist, mental hygienist, occupational therapist as
needed.