In my previous article, I have told full information about the history of Leprosy, the origin of Leprosy, full details about medicines used in the treatment of Leprosy, the Role of rifampicin in Leprosy, about NLEP programs, full form of PEP, FLC, etc, and milestones of Leprosy.
In my previous articles, I have told about the history of Leprosy, the origin of Leprosy. In my previous article, I have full discous about stigma in Leprosy, I have told about world Leprosy day, told about the current situation of Leprosy in India, told about history and role of Refempicin in Leprosy and other Medicines which is used for the treatment of Leprosy, detail about NLEP programs and Milestones of NLEP,
In this article, I will tell you about the signs and symptoms of Leprosy, the Incubation period of Leprosy the definition of leprosy, the causes of Leprosy, what causes Leprosy. In this article, I also tell you how to palpate and to examine the involved nerves in Leprosy. in this article I will tell you that how many nerves are involved in Leprosy.
Note: Leprosy is not a contagious disease it is completely curable with MDT (Multidrug therapy).
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Definition of leprosy (Hansens disease)| what is Leprosy:
Hansen’s disease (also called leprosy) could be a chronic communicable disease caused by slow-growing microorganisms termed Mycobacterium leprae (M.leprae) an impervious, rod-shaped true bacteria. infectious disease chiefly affects the skin, peripheral nerves, eyes, and lining of the nose (nasal mucosa). The condition can be cured with early detection and treatment. Leprosy is treatable, and early treatment can help prevent disability.
The incubation period of leprosy:
The symptoms of the disease occurs generally after a long period of getting the infection.
On average, the incubation period of leprosy is 5 years but symptoms may occur within 1 year. It can also take as long as 20 years or even more to occur, as M.leprae multiplies very slowly.
Classification of Leprosy:
Up to five hypopigmented anesthetic patches or involvement of one nerve.
MORE THAN FIVE hypopigmented anesthetic patches on skin, nodules, or involvement of 2or more nerves.
it is a typical MB leprosy case. in this type patient’s nose becomes depressed(termed as saddle nose deformity), their face looks Mongolian, oily, loses of eyebrows(as shown below in the figure.) this type of patient is highly infectious.
Causes of leprosy:
LOW IMMUNE SYSTEM IS THE MAIN REASON TO A PERSON INFECTED WITH M.LAPRAE because due to low immunity bacteria can survive in the human body and damage the body.
Mode of infection|How does leprosy spread:
An untreated leprosy-affected person can only be the source of the transmission of bacteria.
When an untreated leprosy-affected person coughs or sneezes then M.leprae comes out with his droplets and enters in healthy person through the respiratory system. If this person has low immunity then the bacteria migrate to the skin and there they start multiplying and damaging the skin and in a later stage may cause permanent disability (if not treated early).
Signs and symptoms of Leprosy (Hansens disease):
(what are the sign and symptoms of leprosy?)
What are the cardinal signs of leprosy?
There are 3 cardinal signs of Leprosy:
1. Patch with definite loss of sensation
2. tenderness of nerve.
3. presence of mycobacterium laprae in a skin smear test.
Note: If there is a presence of Mycobacterium laprae in skin smear and there is no evidence of physical signs like Anaesthetic patch and Tenderness of nerve even then we will start the treatment. We won’t wait for physical signs to appear.
Leprosy affected person can be shown following signs and symptoms:
- Hypopigmented patch with definite loss of sensation: When bacteria enter the skin then the bacteria start eating pigment cells to service, as a result, the hypopigmented patch develops. after eating pigment cells of that area they start eating sensory nerves of that area resulting in sensory loss of that area.
- painful nerves: When bacteria ate the sensory nerves and if a person is not treated yet then the bacteria migrate to motor nerves and starts eating the Shawn cells of nerves resulting in the tenderness of nerve (painful nerves).
- In a later stage, bacteria damage the nerve resulting in weakness of the affected part. if not treated then the bacteria completely damage the nerves and then resulting incomplete paralysis of the affected part.
- Nodules in ear lobes
- Swelling and lumps in the face
- Painful wounds or burns in the hand and feet.
Examination and diagnosis | Physical examination of Leprosy:
Skin examination in Leprosy Patient :
TESTING THE SENSATION OVER SKIN:
Put a ballpoint pen(with a plastic body) without a cap and touch the affected part of the skin and ask the patient to count on each touch. if the patient can’t count the touch area, it is to confirm that part is anesthetic and the patient is leprotic.
- Don’t use any instruments like a pin, because this may injure the patient as the patient may have no sensation to that part, and if he has no sensation to that part patient may get ulcerated.
- When testing for sensation touches the skin lightly with the pen. don’t stroke.
Nerve examination in Leprosy Patients | Assessment of Leprosy Patient :
Commonly affected nerves in leprosy | Most Common Nerves Involved :
- Facial nerve
- Radial nerve
- Ulnar nerve
- Median nerve
- Lateral poplitial nerve (Common peroneal nerve)
- Posterior tibial nerve
Involvement of peripheral nerves, as demonstrated by definite thickening with a loss of sensation with or without weakness of the corresponding muscles of the hands, feet, or eyes.
Examination of nerves in all the patients is very important for diagnosis, and prevention of deformity.
Palpation of nerves:
- The patient and examiner should be properly positioned.
- Locate the nerve correctly.
- Observe the patient’s face while you palpating the nerve to elicit tenderness. If the patient pulls the hand back or starts shrinking the face, then it confirms the involvement of the nerve.
- Palpate the nerve with the pulp of fingers not the tips of fingers.
- Always palpate the nerve across the course of the nerve.
SITE: Within the groove higher than and behind the medial appendage of the elbow.
- Position of the patient: each the patient and examiner facing one another.
- To examine the arm bone nerve(for example- if examine right ULNER nerve.)ask the patient to flex the elbow slightly and hold the patient’s right carpus together with your paw.
- With the correct hand fell the medial epicondyle and pass behind the elbow and feel the ULNER nerve within the groove.
- Gently touch the nerve with a pulp of 2fingers (index and middle)and feel across the nerve, and perpetually observation facial expressions for the sign of tenderness.
Median nerve palpation:
SITE: The median nerve runs parallel to the palmaris longus on the ring finger.
- Position of the patient: both the patient and examiner facing each other.
- To examine ask the patient to bend their wrist against the pressure.
- palpate the median nerve parallel to the palmaris longus, and
- constantly watching facial expressions for the sign of tenderness.
Radial nerve palpation:
SITE: The redial nerve passes diagonally into the redial groove.
- Position of the patient: both the patient and examiner facing each other.
- To examine ask the patient to fold the arm and move around
- palpate the redial nerve at the point of entry of the deltoid muscle, and constantly watching facial expressions for the sign of tenderness.
Lateral popliteal nerve | Common peroneal nerve Palpation:
SITE: Back of knee behind the leg bone.
- Position of the patient: patient standing with knees slightly flexed (not absolutely flexed) and examiner squatting.
- Identify the head of the fibula on the lateral side of the knee within the line with the lower finish of the patella.
- Pass backward and feel the nerve simply behind the fibular head.
- Gently feel the nerve with a pulp of 2fingers (index and middle)and feel across the nerve, and perpetually observance facial expressions for the sign of tenderness.
Posterior tebial nerve palpation:
SITE: Bellow and behind the medial malleolus.
- Position of the patient: to rest the ankle joint on the thigh.
- Identify the medial malleolus, find the nerve just under, and behind the medial malleolus (approximately at the center between medial malleolus and heel)
- Gently touch the nerve with a pulp of 2fingers (index and middle)and feel across the nerve, and perpetually observance facial expressions for the sign of tenderness.
Sensory test (S.T.):
The method of sensory test over the skin supplied by the nerve is the same as for testing a patch.
Nerve distribution areas:
Ulnar nerve distribution area:
Area of nerve supply: The little finger and ring finger and middle part of the palm.
TEST: Check the tip of the ring finger and the little finger with the tip of the ball pen.
Median nerve distribution area:
Area of nerve supply: Thumb, index finger, middle finger, and three-quarters of the palm.
TEST: Check the tip of the thumb, index finger, and middle finger with the tip of the ball pen.
Radial nerve distribution area:
Area of nerve supply: Top of thumb and back of the hand.
TEST: Testing the back of the hand with the tip of a ball pen.
Lateral popliteal nerve |Common peroneal nerve distribution area:
Area of nerve supply: Outward & posterior part of the foot.
TEST: Examine the top part of the great toe with the tip of a ball pen.
Posterior tibial nerve distribution area:
Area of nerve supply: Full area of the sole.
TEST: Test with the tip of a ball pen near the toes and heels.
Facial nerve distribution area:
Area of nerve supply: Cornea of the eye(supplied by the trigeminal nerve).
TEST: Examine the cornea with the end of a cotton swab.
FAQs for Sign and Symtoms of Leprosy:
What is the incubation period of leprosy?
The incubation period of Leprosy is 2 to 20 Years.
What is the mode of infection of Leprosy?
The mode of infection of Leprosy is droplet infection.
How many nerves are Commonly affected in Leprosy?
6 nerves are commonly affected in Leprosy.
When MDT launches
MDT launched by WHO in 1982
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