LEPROSY: IT’S CURABLE

There is a belief that Leprosy is hereditary, and incurable. These misconceptions about Leprosy cause aversion towards these patients. People take it as a social stigma. They postpone the treatmen...

There is a belief that Leprosy is hereditary, and incurable. These misconceptions about Leprosy cause aversion towards these patients. People take it as a social stigma. They postpone the treatment for the sake of their families. They impose confinement on themselves. When the disease progresses they leave their homes or they are compelled to leave.
Leprosy is caused by Mycobacterium leprae bacillus. The mode of transmission is still unknown. Air borne {droplet} dissemination of the bacteria is the source of infection. Skin to skin infection, or transfer by fleas, bedbugs or mosquito, gastrointestinal mode of entry rarely can be there. The organism survives for two to seven days outside the human body. The incubation period can be 9 months to 20 years that means when a bacillus enters in to a human body, it takes 9 months to 20 years to show the sign and symptoms. The disease can occur in both men and women. The low socio-economic status is a predisposing factor. In India 95% people are immune to leprosy. All the patients of the disease are not infectious. The undetected and relapsed cases are source of infection.

Important Signs
Skin lesion – a light or copper coloured hypo pigmented, erythematous patch with loss of sensation.
Thickened nerves at the site of predilection. Thickening of the skin, especially the face and ears. The ulnar nerve, the tibial nerve, lateral popliteal nerve, the radial cutaneous nerve at the wrist, facial and greater auricular nerves, gets involved and thickened.
Loss of feeling and weakness in the fingers and toes. Pain in the nerves.

Diagnosis
 New case – is a person having definite loss of sensation and has not received a course of MDT.
 Old case – who has all the signs and symptoms and has received a full course of MDT.   
 Previous medical history. Patches appear slowly. The person has numbness, tingling or a burning feeling in their hands and feet. Unusual sensations in the hands or feet. They have problems in lifting the things. Loosing strength in the hands or feet. Presence of acid fast bacilli in the skin smear examination. The skin is dry to touch nodules or lumps can be present on the skin. Nerve damage. Eyes can have normal vision or reduced vision [lagophthamos] can exist.
 A resolution was passed in 1991 to eradicate leprosy by 2000 AD. In 1993 the World Bank too supported the MDT program phase-1. The program was modified time to time. In 2005, the prevalence rate was 0.95/10,000 and government declared achievement of elimination target. National Rural Mission and National Leprosy Eradication Program are taking the responsibility of the patients.

Treatment
Regular treatment of the cases by providing multi drug therapy [ MDT ].
The treatment is simple. The drugs should be given for a maximum recommended dose. The treatment should not be discontinued during episodes of reaction. The dosage of the medicine should not be altered. Sometimes there can be drug rashes, anemia, intestinal disturbances, nausea, vomiting, diarrhea and psychosis. Doctor will prescribe the treatment for these problems. Competent care is needed. In certain circumstances hospitalization is necessary. If the treatment is started earlier there will be no complications. The trouble starts when the patients delay the treatment. That time the disease has already progressed. To treat the complications, the help of orthopedic surgeon and ophthalmic surgeon can be taken. Good diet is essential.   
The best time to go for treatment is immediately after the disease appears. This way the disease will not spread to friends or other relatives. Deformity can be prevented. The complete cure is possible.

Delay
Because they feel ashamed. They are afraid people will reject them. They do not know the early signs and symptoms. They think there is no cure for leprosy. No advice from their family or friends. Social stigma is attached to the disease.

Disability prevention and medical rehabilitation
Government of India has approved a program with following objectives
Leprosy patients should be managed well and prevent the disability.
No disability should be worsened.
The suitable cases should be taken for reconstructive surgeries.
Prevention
Maintain your personal hygiene. Wash, soak and oil wash the hands and feet every night. Soak them in warm water for ten to fifteen minutes. Remove any dead skin with a stone or fingers. Do not use any blade or razor. Use Vaseline or any oil for massage. Do not walk bare-foot. Press with your thumb on six places on your feet – under the thumb, on the sole, below the fingers and below the heel to check the sensation. Inspect your feet regularly. Use right kind of shoes. Treat immediately any ulcer of the feet. Walk with short steps and slowly, this will prevent your feet from hard work. Take care of your eyes. Wash them carefully, protect your eyes from dust. Close the eyelids thrice daily. Remove with a clean piece of cotton cloth if there is any dust particle in the eye.  Avoid bright sunlight. Prevention from flies is important as they spread eye diseases. In case of any eye problem, consult opthalmologist. If you visit the patient, take precautions. Hand washing is important. If you are having any cuts, do proper dressing. Use of gloves and masks are important.

Zubeda Akhtar is Deputy Nursing Superintendent, SKIMS, Soura.

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