Managing Hansen’s disease in a 20-years young girl: A case report

Suganya1*, Sowmiya2, Jaya Menon3, Lucy Grace4

1Infection Control Nurse, Kauvery Hospital, Tennur, Trichy

2Staff Nurse, Kauvery Hospital, Tennur, Trichy

3Nursing Superintendent, Kauvery Hospital, Tennur, Trichy

4Nurse Educator, Kauvery Hospital, Tennur, Trichy

Correspondence: Jaya Menon@kauveryhospital.com

Background

Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by the bacterium Mycobacterium Leprae. It primarily affects the skin, peripheral nerves, upper respiratory tract, and eyes. Leprosy has been known since ancient times, but with modern medicine, it is now treatable and preventable, though stigma and social issues still persist in some areas.

Leprosy risk factors include close contact with infected people, weak immune systems, living in crowded conditions, and genetic factors. People in tropical regions, with poor healthcare access or stigma, are also at higher risk.

The global incidence of Leprosy (Hansen’s disease) has significantly decreased over the past several decades due to effective multidrug therapy (MDT), which has been available since the 1980s. However, leprosy remains a public health concern in certain regions of the world.

As of recent data (2023), the estimated global incidence of leprosy is about 200,000 to 250,000 new cases per year, although the actual number may be higher due to underreporting, especially in regions with limited healthcare access. India accounts for around 60% of global leprosy cases. The incidence rate is about 0.7 to 1.0 cases per 10,000 populations, though some states have higher rates.

As of the most recent data, leprosy is still spreading in certain regions of the world, especially in areas with high levels of poverty, inadequate healthcare access, and poor sanitation. In this, we highlight that young girls are among those affected by Hansen’s Disease.

Clinical Presentation

A 20 years’ young girl was admitted with c/o ulcer over right foot and lateral aspect of 5th toe for 10 days. H/o pain and swelling present, associated with pus discharge. H/o occasional chills. Normal bowel and bladder habits. No H/o trauma. No known co-morbidities.

Past History: The Right great toe had already been amputated earlier for a similar illness

No relevant family history

On examination patient was conscious & oriented, afebrile, PR: 86/min, BP: 120/70 mm hg, SpO2: 96% in room air, CVS: S1 S2, RS: NVBS, P/A: Soft.

Local examination

  1. Ulcer with discharge present
  2. Wet gangrene of right 5th toe present
  3. Warmth and tenderness present
  4. Foot pulses – Normal
  5. Left foot trophic ulcer.

Patient was started on empirical antibiotics Inj. Piperacillin and tazobactam 4.5g IV 1-1-1, Clindamycin (Dalacin) 600mg IV 1-1-1

Lab Report

  1. WBC-16100 Cells/Cumm
  2. INR-1.01 Seconds
  3. Pre-Operative Pus C&S report (17.07.2024): Escherichia coli

Surgery notes

1. Amputation of 5th toe done on 18.07.2024 under nerve block

  • Perioperative period: No complications
  • Parts painted and draped
  • 5th toe amputation performed
  • Tissues debrided.
  • Specimen sent for C/S – Bone / Tissue
  • Wound washed
  • Hemostasis ensured.
  • Dressing applied. Tissue C&S report (18.07.2024): Staphylococcus aureus

2. Left Sural Nerve Biopsy done on 23.07.2024 under local anesthesia

  • Perioperative period: No complications.
  • Under all aseptic precautions, local infiltrated and linear incision made.
  • Short saphenous vein retracted and nerve identified.
  • 4-5cm of sural nerve excised for biopsy

Histopathology: Report on both tissues:

  • Tissue: Many Mycobacterium Leprae seen
  • Sural Nerve: “Hanse’s Neuritis, LL Spectrum”

3. Nerve Conduction Study (24.07.2024)

NCS of all limbs shows generalized sensorimotor axonal neuropathy.

Wound reviewed – healthy granulation tissue present and stitch line healthy.

Condition at Discharge
General Condition was good, Afebrile, Vitals were stable
PR: 96/min, BP: 100/60 mm Hg, SpO2: 97% in room air.
Dressing intact, No soakage.

Advice on discharge

Alternate day dressing with Primapore with Hydroheal AM ointment

S. NoDrugDoseFrequencyDuration
1Cap. Augmentin375mg1-1-17 days
2Tab. Trigabantin100mg1-0-1until review

She received MDT, which included three drugs: Dapsone, Rifampicin and Clofazimine.

She has shown significant improvement, and the wound has healed effectively.

Fig (1): The toe amputation is in the healing stage.

Conclusion

Leprosy is a treatable disease, yet its historical and social stigma continues to affect millions of people worldwide. While global efforts, such as the introduction of multidrug therapy (MDT), have significantly reduced its incidence, leprosy remains a challenge in certain regions. Continued progress in early detection, improving healthcare access, and reducing stigma will be crucial to ensuring that leprosy is fully eradicated in the coming decades. With ongoing efforts, we are closer than ever to the goal of a leprosy-free world.

Ms. Suganya
Infection Control Nurse

Ms. Sowmiya
Staff Nurse

Ms. Jaya Menon
Nursing Superintendent

Ms. Lucy Grace
Nurse Educator

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