Leprosy

What is Leprosy?

This is a disease that is chronic and caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. It is also referred to as Hansen’s disease or HD after the physician, Gerhard Hansen, who discovered the disease. It is believed that these bacteria are the first to be identified as causing disease in humans.

This disease is common in many countries around the world and in tropical, temperate as well as subtropical climates. It is estimated that 100 cases each year are diagnosed in the United States. Although the number of cases in countries worldwide continues to drop, there are areas of prevalence that are high in Brazil, India, Nepal, some areas of Africa as well as the western Pacific.

Leprosy Symptoms

The early symptoms and signs of leprosy are very elusive and slowly occur over years. The symptoms are comparable to those that might happen with tetanus, leptospirosis as well as syphilis. Some of the first symptoms experienced include:

• Numbness
• Loss of temperature sensation – not able to sense hot or cold

As this disease progresses, the sense of touch, then pain and then deep pressure are diminished or lost. Then the disease will develop the following symptoms or signs:

• Skin lesions – flat and pale areas
• Painless ulcers
• Eyes become dry with reduced blinking
• Larger ulcerations eventually develop
• Loss of digits
• Disfigurement of the face

The long-term symptoms continue on the following areas:

• Face
• Hands
• Feet
• Knees

The literature on leprosy describes several forms established on the individual’s immune reaction to M. Leprae. An immune response that is good can create the tuberculoid type of this disease, having restricted lesions of the skin as well as some unequal nerve participation. There are some individuals who may have features of both types. There are presently two (2) classification systems in the literature and they include:

• Ridley-Jopling system
• WHO system – World Health Organization

Ridley Jopling System

Ridley-Jopling system comprises six (6) types, according to the increased severity of the symptoms. They include:

Indeterminate leprosy

A limited number of hypopigmented lesions; may heal naturally, perseveres or progresses to other types

Tuberculoid leprosy

A limited number of hypopigmented lesions, several are large and some have lost pain sensation; some neural association where nerves turn out to be enlarged; natural resolution in a few years, perseveres or progresses to other types

Borderline-tuberculoid leprosy

The lesions resembling tuberculoid leprosy only smaller but numerous with less enlargement of nerves; this type may persevere, relapse to tuberculoid leprosy, or progress to other types

Mid-borderline leprosy

Numerous reddish plaque that are distributed asymmetrically, moderately loss of pain sensation, with regional swollen lymph nodes; this form might persist, relapse to another type or progress

Borderline-lepromatous leprosy

Numerous lesions that are flat, raised bumps, plaques as well as nodules, at times with or without loss of pain sensation; the form might persist, relapse or progress to lepromatous leprosy

Lepromatous leprosy

Beginning lesions are flat, pale areas that are symmetric as well as diffused; later numerous M. leprae organisms can be found. The following also occurs:

• Hair loss
• No eyebrow or eyelashes
• Loss of pain sensation in many areas
• Limb weakness
• Tissue death because of lack of blood to area
• Skin nodules
• Many areas of disfigurement including face
• Does not relapse to less severe form

WHO system

The Ridley-Jopling system is normally used worldwide in the assessment of individuals in medical studies. Yet, the WHO cataloging system is widely used having only two (2) forms of this disease. The WHO classifications of 2009 are only based on the total of lesions as follows:

Paucibacillary leprosy

Lesions of the skin with no M. leprae seen in a skin smear

Multibacillary leprosy

Lesions of the skin with M. leprae seen in skin smear

Leprosy Causes

As previously mentioned, leprosy is caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Medical researchers believe that M. leprae is spread person to person by secretions or droplets from the nasal passage. It is believed that droplets which are infected reach other individuals’ nasal passages and that the infection begins in the nasal passages. There are other researchers who support the theory that the droplets that are infected can infect other individuals by infecting any breaks of the skin. M. leprae cannot infect intact skin. There are also rare cases where individuals get leprosy from some animal species. Routes of transmission are still under investigation. Some genetic studies have shown that there are genes – approximately seven (7) – linked to a vulnerability to leprosy; some investigators conclude that this vulnerability to leprosy might be to some extent hereditary.

Most cases of leprosy are diagnosed by clinical finding – in other words what the patches of skin look like, the loss of sensation, as well as the thickened peripheral nerves. Some clinical tests can be performed such as skin biopsies or skin smears that under a microscope will show the bacilli that indicate multibacillary leprosy or no bacteria which leads to a diagnosis of paucibacillary leprosy.

Other tests also can be done but most of these need to be done in specialized labs which are scarce in the areas where leprosy is prevalent. Other tests that might be done in order to determine involvement of other organ systems include:

• CBC test
• Liver function tests
• Creatinine test
• Nerve biopsy

Leprosy Treatment

Most of the cases of leprosy are treated with antibiotics prescribed by a physician. The antibiotics, doses and interval of therapy are grounded on what type or grouping of the disease. Normally, paucibacillary leprosy is treated with two (2) antibiotics together:

• Dapsone
• Rifampicin

Multibacillary leprosy is treated with three (3) antibiotics together:

• Dapsone
• Rifampicin
• Clofazimine

Normally the antibiotics are taken for at least six (6) to twelve (12) months or in some cases longer.

Antibiotics treatment for paucibacillary leprosy has very slight or no lingering effects on the individual. Multibacillary leprosy can usually be kept from progressing, and living M. leprae can be basically eradicated from the individual by antibiotics, but normally any damage done before treatment being given is not reversible.

Recently, the WHO advocated treatment of individuals with only one (1) lesion with single-dose rifampicin, minocycline or ofloxacin and this has proven affective. Research with other antibiotics is ongoing.

There is an application for surgery in leprosy treatment after medical therapy with antibiotics is completed and skin smears show negative or no active bacilli and then only in advanced cases. Surgery is customized for each individual with a goal to try for cosmetic enhancements and when possible, to reinstate function to the limbs as well as some neural purposes that had been lost to this disease.

Leprosy Contagious

The prevention of contact with any droplets from nasal or other sections from individuals with untreated M. leprae infection is currently the best way to avoid this disease. Early treatment of individuals with the current antibiotics will stop them from further spreading the disease.

Leprosy Pictures