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Leprosy
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Overview
Leprosy is a chronic bacterial infection of the skin and superficial nerves. It may also involve the nose, eyes, throat and testicles. Leprosy is also known as Hansen's disease, Hanseniasis or HD.
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Causes
Leprosy is caused by the organism Mycobacterium leprae.
It is spread when an untreated infected person coughs or sneezes (but not by sexual contact or pregnancy). However, leprosy is not very contagious; approximately 95% of people have natural immunity to the disease. People with leprosy who are treated with medication do not need to be isolated from society.
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Epidemiology
Leprosy can affect people of all races all around the world. However, it is most common in warm, wet areas in the tropics and subtropics. Worldwide prevalence is reported to be around 5.5 million, with 80% of these cases found in 5 countries: India, Indonesia, Myanmar, Brazil and Nigeria.
Leprosy presents most often during two different periods of life, between the ages of 10 and 14 and in those aged 35-44 years old. It is rarely seen in infants.
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Prevention
Prevention consists of avoiding close physical contact with untreated people. People on long-term medication become noninfectious (they do not transmit the organism that causes the disease).
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Symptoms
Leprosy has traditionally been classified into two major types, tuberculoid and lepromatous. Patients with tuberculoid leprosy have limited disease and relatively few bacteria in the skin and nerves, while lepromatous patients have widespread disease and large numbers of bacteria.
(Details: open / close) Tuberculoid leprosy is characterized by a few flat or slightly raised skin lesions of various sizes that are typically pale or slightly red, dry, hairless, and numb to touch (anesthetic). Lepromatous leprosy is at the other end of the spectrum, with a much more generalized disease, diffuse involvement of the skin, thickening of many peripheral nerves, and at times involvement of other organs, such as eyes, nose, testicles, and bone.
There are also intermediate subtypes between these two extremes that are commonly known as borderline leprosy. The intermediate subtypes are borderline tuberculoid, midborderline, and borderline lepromatous leprosy. Borderline leprosy and the subtypes are characterized by more extensive disease than polar tuberculoid, with more numerous skin lesions and more nerve involvement, but not as widespread disease as in lepromatous leprosy.
Indeterminate leprosy refers to a very early form of leprosy that consists of a single skin lesion with slightly diminished sensation to touch. It will usually progress to one of the major types of leprosy. |
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Diagnosis
- Lepromin skin test can be used to distinguish lepromatous from tuberculoid leprosy, but is not used for diagnosis. The lepromin skin test is used to determine what type of leprosy a person has. It involves the injection of a standardized extract of inactivated leprosy-causing bacteria under the skin.
- Skin scraping examination for acid fast bacteria where a piece of skin is removed to diagnose or rule out the disease.
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Treatment
Management of leprosy is aimed at stopping infection and minimising potential physical deformities. Antibiotics used first-line to eliminate organisms include dapsone, rifampicin and clofazimine. Varying regimens are used depending on the type of leprosy and the severity of infection. This may be a combination of two or three antibiotics given over varying lengths of time (up to years). Other antibiotics include minocycline, ofloxacin and clarithromycin.
Oral corticosteroids and thalidomide are helpful in preventing nerve damage by reducing swelling. Long courses are necessary to decrease severity of deformities and disabilities.
Surgery may sometimes be used to drain abscesses to restore nerve function, reconstruct collapsed nose, or to improve function or appearance of affected areas.
Leprosy can be cured but it is essential to take the full course of medication. It is no longer infectious once treatment has begun.
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Illustrations
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Lepromatous Leprosy
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News
Leprosy Cases Increase in Indonesia
Tuesday, 13th February 2007
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Health Tip: Causes of Blindness
Thursday, 22nd February 2007
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Scientific Articles (a selection for patients)
Corticosteroids for treating nerve damage in leprosy
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Background: Leprosy causes nerve damage which can result in nerve function impairment and disability. Corticosteroids are commonly used for treating nerve damage, although the long-term effect is uncertain. Objectives: To assess the effects of corticosteroids on nerve damage in leprosy. Method: Relevant study groups were selected from a variety of databases. Trials of corticosteroids were performed for nerve damage in leprosy. Results: There was no significant difference in nerve function improvement between people treated with prednisolone or with placebo (drugs which do not have any pharmacological effect). Conclusions: Corticosteroids are used for treating acute nerve damage in leprosy but evidence shows no significant long-term effect. The above is a summarization of the following article:
Full reference of the article: Van Veen NHJ, Nicholls PG, Smith WCS, Richardus JH. "Corticosteroids for treating nerve damage in leprosy" Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005491. DOI: 10.1002/14651858.CD005491.pub2 |
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Scientific Articles (a selection for health professionals)
Corticosteroids for treating nerve damage in leprosy
Van Veen NHJ, Nicholls PG, Smith WCS, Richardus JH
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Toll-Like Receptor 2 (TLR2) Polymorphisms Are Associated with Reversal Reaction in Leprosy.
Bochud PY, Hawn TR, Siddiqui MR, Saunderson P, Britton S, Abraham I, Argaw AT, Janer M, Zhao LP, Kaplan G, Aderem A.
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