Leprosy Case Sheet
Name :
Age :
Sex :
Education :
Occupation :
Address :
Residence :
Nearest health facility :
Family details :
Name Age Sex Qualification Relation to HOH Occupation Income Health
status
Family tree:
Family type:
Total family income:
Per capita income:
Socioeconomic scale:
Education
Occupation
Income
Total score
Socioeconomic status:
Chief complaints:
History of presenting illness:
H/O Hypopigmented patches
Side
Size
Number
Duration
H/O sensory disturbance over the skin patch
h/o muscle weakness-inability to extension or usage of hands
h/o pain along the nerves
h/o muscle wasting
h/o ulcers and blisters - serous discharge from ulcer
h/o nodules over skin
h/o clawing of hands and foot
h/o joint pain
h/o loss of eyebrows
h/o pain in and around eyes
h/o redness of eye
h/o photophobia
h/o epistaxis
h/o nasal stuffiness
h/o slipping of foot wear
h/o swelling of hands and feet
h/o gynecomastia
h/o fever
Past history:
h/o similar complaints in past
h/o diabetes
h/o hypertension/epilepsy
h/o allergy/ asthma
h/o previous surgery
Treatment history:
h/o antileprosy treatment
h/o treatment for any chronic illness
Contact history:
h/o contact with known leprosy patient
Family history:
h/o contact with hansen’s patient
Personal history :
Diet
Bladder and bowel habit
Sleep pattern
Appetite
H/ao Alcohol/smoking/drug abuse
Nutritional history:
24hrs method
Time Food Quantity Calorie Protein (g)
(Kcal)
Morning
Afternoon
Evening
Dinner
Calorie intake protein intake
● Actual _________ __________
Recommended _________ __________
Deficit by _________ __________
Vegetables intake:
Fruits intake:
Salt intake:
Cooking oil:
Fried food and outside food intake:
Fasting practice:
Environmental history:
Housing:
Rent/Own house
Pucca/Kutcha house
[Link] living room
[Link] doors
[Link] windows
[Link] people
Overcrowding
Adequate ventilation
Adequate lighting
Cross ventilation
Kitchen:
Separate kitchen
Fuel/firewood used
Smoking outlet
Water:
Drinking water supply
Habit of boiling
Sanitation:
Separate toilet
Septic tank
Open air defecation
Solid waste:
Collection method
Collection day interval
Disposal method
Water waste:
Collection
Street drainage
Animals/pet
Mosquito breeding sites present or not
Surrounding area clean or not
General Examination:
Patient conscious,oriented to time place person
Moderately build and nourished
No pallor
No icterus
No cyanosis
No clubbing
No general lymphadenopathy
No bilateral pedal edema
VITALS:
BP PR RR
Anthropometry:
Height:
Weight:
BMI:
Head to foot examination:
Face : Nodule
Eyebrows:Diffuse loss of eyebrow(Madarosis)
Tears:
Nose:nasal depression,naso labial fold,saddle nose
Skin:Scaly dry
Chest:Gyanacomastia,Nodules
Hands:No clawing of hands & muscle wasting
No nodules
Thickening of nerves
Legs :No ulcer on foot and toes
Multiple nodules and hypo pigmented plaque over legs
Systematic examination:
CVS: S1S2 heard,no murmur
RS : Normal vesicular breathe sounds
CNS: No focal neural deficit
ABDOMEN: Soft,non tender,no organomegaly
Local Examination:
Inspection:No ulcers
Palpation:Thickening of nerves,nodules present or not
[Link] of skin patch:
Number
Color
Sensory deficit
Infiltration
Raised or swollen
[Link] Examination:
Thickenin Tendernes
Nerves g s
Left Right Left Rig
ht
Ulnar nerve
Median nerve
Radial nerve
Lateral
popliteal nerve
Posterior tibial
nerve
Facial nerve
[Link] of nerve function:(Voluntary muscle test)
Score as S-Strong
W-weak
P-paralysed
Nerve Test Right Left
Facial nerve Eyelid closure
test
Ulnar nerve Little finger out
test
Median nerve Thumb up test
Radial nerve Wrist up
Lateral popliteal Footup
nerve
Posterior tibial Dorsiflex toes
nerve against extension
[Link] test:
Present/absent bilateral/Unilateral
Hands:
Fine touch
Crude touch
Feet:
Fine touch
Crude touch
Eye corneal sensation
[Link] of disability:
EHF Score
Right Left
Hand
Feet
Eyes
Total grade:
Clinicosocial diagnosis:
Name,age,sex,rural/urban,family type,socioeconomic status is dignosed to
have leprosy type and grade,nutrition status
Any problems identified:
Management:
Investigation:
Slit skin smear test
CBC,LFT,RFT
Treatment:
[Link] 100mg daily
[Link] 600mg once a month
[Link] 50mg daily,300mg once a month × 12 months
Advice:
To patient:
Inspect feet regularly for any unknown injury
Wash feet regularly
Wear MCR slippers
Take drugs regularly
Awareness about importance of drug intake and lepra reaction
Take green leafy vegetables and fruits easily available
Government schemes and rehabilitation
To Family:
Symptom to family member-Reach hospital
Provide social and psychological support
Personal hygiene
Promote separate bedding
Wash clothes frequently and separately
To community:
Symptoms to community-Reach hospital
Donot stigmatize the condition
Social and psychological support to family
Prevention:
Comprehensive management:
Prevention level Primary(specific Secondary Tertiary
to protection and (Early diagnosis (Rehabilitation)
health and treatment)
promotion)
Individual Avoid contact Quick approach Regular intake
with leprosy to hospital if of antileprosy
patient there is any drugs
symptoms
Family Chemoprophylax Social and moral
is support
Community Awareness Identification of Rehabilitation
reservoirs
Programme:
NLEP
NMHP
