Page 79 - LECTURE NOTES

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.

73