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Leprosy - Types, Symptoms, Causes, and Treatment

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Leprosy - Types, Symptoms, Causes, and Treatment

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Leprosy is an infectious disease caused by a slow-growing bacteria called Mycobacterium leprae.

Medically reviewed by

Dr. Nidhin Varghese

Published At July 25, 2022
Reviewed AtJanuary 8, 2024

What Is Leprosy?

Leprosy, also called Hansen's disease, is an infectious disease that causes severe, disfiguring skin sores and nerve damage in the arms, legs, and skin areas around the body. Leprosy is caused by close contact with nose and mouth droplets from an infected person. Leprosy has been discovered in animals in different locations across the world. On the American continent, armadillos are naturally infected with the bacteria that cause leprosy. Leprosy can spread from these infected armadillos to humans. The United Kingdom's red squirrel population is also known to carry leprosy, but there are no instances of transmission from these squirrels to humans.

How Many Cases of Leprosy per Year?

It is estimated that about 250,000 new cases of leprosy are diagnosed worldwide every year. The condition is most common in India, Brazil, and other areas with warm climates. Children have a higher risk of getting leprosy than adults.

What Causes Leprosy and How It Is Spread?

The disease leprosy is caused by a slow-growing bacteria called Mycobacterium leprae (M. leprae). It may happen when a person has leprosy, coughs, or sneezes, and a healthy person gets infected through the droplets containing the bacteria. The infection can spread through long-term contact with an infected person.

Leprosy is not caused by the following:

  • Shaking hands or hugging.

  • Sitting next to each other.

  • Eating meals.

  • Mother to her unborn baby during pregnancy.

  • Sexual contact.

What Does Leprosy Look Like?

Leprosy mainly affects the skin, nerves, and mucous membranes (the soft, moist areas inside the body's openings). It usually takes three to five years for symptoms to appear after contact with the leprosy bacillus.

The disease may cause skin symptoms such as:

  • A large, discolored lesion on a person's chest with leprosy.

  • Skin patches that are discolored, flat, numb, and faded.

  • Skin growths.

  • Thick and dry skin.

  • Painless ulcers on the soles of feet.

  • Painless swelling.

  • Lumps on the face or earlobes.

  • Loss of eyebrows or eyelashes.

Leprosy also causes nerve damage; symptoms may include:

  • Numbness in the affected areas of skin.

  • Enlarged nerves.

  • Muscle weakness or paralysis.

  • Eye problems that may lead to blindness.

  • Enlarged nerves below the skin.

Symptoms when leprosy affects the mucous membranes:

  • Stuffy nose.

  • Nose bleeding.

What Are the Types of Leprosy?

The number and type of skin sores classify leprosy.

  • Tuberculoid Leprosy: It is a less severe and mild form of leprosy. Tuberculoid leprosy is less infectious than other types. People with this type of leprosy have only one or a few flat and pale skin (paucibacillary leprosy). The affected skin area gets numb because of nerve damage below the skin.

  • Lepromatous Leprosy: It is more severe and causes bumps and rashes (multibacillary leprosy), numbness, and muscle weakness. It affects the nose, kidneys, and male reproductive organs.

  • Borderline Leprosy: People with this form of leprosy have tuberculoid and lepromatous leprosy symptoms.

The World Health Organization (WHO) Classification:

  • Single Lesion Paucibacillary (SLPB): There is only one skin lesion.

  • Paucibacillary (PB): There are two to five lesions. There is generally a loss of sensation in these areas.

  • Multibacillary (MB): Six or more lesions. Multibacillary leprosy usually involves many cutaneous lesions, including damage and lumps under the skin (nodules). In addition, the moist tissues lining the body openings, such as the eyelids and the inside of the nose and mouth (mucous membranes), can also be affected, leading to vision loss, destruction of nasal tissue, or impaired speech.

How Is Leprosy Diagnosed?

In the case of a skin sore that might be leprosy, the healthcare provider removes a small sample and sends it to a lab for examination (a skin biopsy). The health care provider may also do a skin smear test. In the case of paucibacillary leprosy, no bacteria will be in the test results. A lepromin skin test is done to see which type of leprosy someone has. In this test, the provider injects a small amount of inactive leprosy-causing bacteria under the skin of the forearm. Then, the provider checks the spot where the person got the shot three days later and then again 28 days later to see if there is any reaction. People who respond to this test may have tuberculoid or borderline tuberculoid leprosy, while those who do not respond may have leprosy or lepromatous leprosy.

How Is Leprosy Cured?

Leprosy is curable. Treatment depends on the type of leprosy someone has. Leprosy medication usually includes antibiotics. Doctors recommend long-term treatment, usually for six months to a year. Severe forms of leprosy may need to take antibiotics longer than the other forms.

  • Leprosy medication includes multidrug therapy (MDT), the most common leprosy treatment that combines antibiotics.

  • Anti-inflammatory drugs are taken to control nerve pain and damage related to leprosy. These drugs include steroids like Prednisone.

  • Leprosy medication also includes Thalidomide. It suppresses the immune system and helps treat skin nodules. Thalidomide is never taken in pregnancy as it is known to cause severe, life-threatening congenital disabilities.

What Is Armadillo Leprosy?

In the southern United States, armadillos carry the bacteria that causes leprosy. There are many chances for the occurrence of armadillo leprosy. However, the risk of armadillo leprosy is low, and there are fewer chances for people to get infected. If the people decide to have the meat, it should be undercooked. Through cooking, the armadillo, which carries the bacteria, will destroy the bacteria.

What Are the Complications of Leprosy?

Leprosy can permanently damage the skin, nerves, arms, legs, feet, and eyes if left untreated.

The complications of Leprosy may include

  • Blindness or glaucoma.

  • Iritis.

  • Hair loss.

  • Infertility.

  • Face disfiguration.

  • Erectile dysfunction.

  • Kidney failure.

  • Muscle weakness that leads to claw-like hands.

  • Nosebleeds and a chronic stuffy nose due to permanent damage to the nose.

  • Permanent nerve damage outside the brain and spinal cord leads to loss of feeling.

How Is Leprosy Prevented?

The most effective way to avoid leprosy is to prevent contact with droplets from the nasal and other secretions from people with untreated leprosy. The WHO recommends the prevention of leprosy through a single dose of Rifampicin for eligible familial and social contacts.

What Are the Risk Factors Associated With Leprosy?

The most common risk of leprosy is getting in contact with someone who is already infected with leprosy. Compared to the normal population, people who have encountered the infected person have a five to eight times higher risk of leprosy. Certain conditions can increase the risk of leprosy, such as malnutrition, genetic mutations, or other illnesses. Some genetic factors are seen to develop leprosy in a person. Certain genetic conditions can cause tuberculosis or lepromatous leprosy.

Conclusion

Leprosy is an infection caused by a slow-growing bacteria called Mycobacterium leprae. It can affect the nerves, skin, eyes, and nasal mucosa. Leprosy was once considered a highly contagious and devastating disease, but now it does not spread easily, and treatment is very effective. However, leprosy can permanently damage the skin, nerves, arms, legs, feet, and eyes if left untreated. However, with early diagnosis and treatment, it is possible to cure the disease completely. People affected by leprosy can have a normal lifestyle during and post-treatment.

Frequently Asked Questions

1.

How Long Does It Take for Leprosy Symptoms to Appear?

It usually takes about three to five years for symptoms to appear after coming into contact with the bacteria, Mycobacterium leprae that causes leprosy. However, some people may not develop symptoms until 20 years later. The time between contact with the bacteria and the appearance of symptoms is known as the incubation period.

2.

How Does Leprosy Damage the Body?

Leprosy can affect the nerves, skin, eyes, and mucous membranes. The bacteria attack the nerves, which become swollen under the skin, causing the affected areas to lose the ability to sense touch, heat, and pain. Most people with leprosy have areas of skin lesions and problems with nerve function called peripheral neuropathy. If left untreated, leprosy can permanently damage the skin, nerves, arms, legs, feet, and eyes resulting in blindness or glaucoma, iritis, hair loss, infertility, face disfiguration, erectile dysfunction, kidney failure, and muscle weakness.

3.

How Is Leprosy Detected?

A lepromin skin test is performed to see which type of leprosy someone has. In this test, the healthcare provider injects a small amount of inactive leprosy-causing bacteria under the skin of the forearm. Then the provider checks the spot where the person got the shot three days later and then again 28 days later to check if there is any reaction. People who respond to this test may have tuberculoid or borderline tuberculoid leprosy, while those who do not respond, have leprosy or lepromatous leprosy.

4.

What Does Leprosy Do to the Skin?

Leprosy causes skin manifestations such as discolored lesions on the chest, skin patches, skin growths, thick and dry skin, painless ulcers on the soles of feet, painless swelling, lumps on the face or earlobes, and loss of eyebrows or eyelashes.

5.

How Is Leprosy Prevented?

The best way to avoid leprosy is to prevent contact with droplets from the nasal and other secretions from people with untreated leprosy. Treatment of people with antibiotics also helps stop the spreading of the disease from one to another. The WHO recommends the prevention of leprosy through a single dose of rifampicin for eligible familial and social contacts.

6.

Is It Possible to Cure Leprosy Completely?

Yes, leprosy is curable, and the treatment depends on the type of leprosy a person has. Multidrug therapy (MDT) is the most common treatment for leprosy that combines antibiotics. Anti-inflammatory drugs are also recommended for controlling nerve pain and damage related to leprosy. Thalidomide is also used to suppress the immune system and help treat skin nodules.

7.

Does Leprosy Spread by Touch?

No, leprosy does not spread by touching someone with the disease. Leprosy is not passed from person to person by shaking hands or hugging, sitting next to each other, eating meals together, mother to her unborn baby during pregnancy, and sexual contact. It happens when a person with leprosy coughs or sneezes, and a healthy person breathes in the droplets containing the bacteria.

8.

Is Leprosy a Virus or Bacteria?

Leprosy is a chronic infectious disease caused by a slow-growing bacterium called Mycobacterium leprae. It damages peripheral nerves and may affect the skin, eyes, nose, and muscles.

9.

What Are the Non-Human Sources of Leprosy?

Leprosy has been discovered in animals in different locations across the world. In the American continent, armadillos are naturally infected with the bacteria that cause leprosy. Leprosy can spread from these infected armadillos to humans. The United Kingdom's red squirrel population is also known to carry leprosy, but there are no instances of transmission from these squirrels to humans.

10.

What Was the Treatment for Leprosy in the Middle Ages?

Leprosy was considered highly contagious during the middle age period. The primary treatment was containment, which involved isolating the people affected with leprosy from healthy people. People with leprosy would wear bandages to cover their sores and carried a bell to warn people that they were coming. No cure was available until a Norwegian scientist, GH Armauer Hansen, isolated the Mycobacterium leprae in 1873. When treatments were introduced in the 20th century, they were painful to administer, or the germ quickly developed resistance. In 1970 the ‘multi-drug’ was created and later approved by the World Health Organization in 1981.

11.

Which Antibiotics Are Used to Cure Leprosy?

WHO recommended multidrug therapy (MDT) in 1981. The currently recommended MDT regimen consists of antibiotics such as Dapsone, Rifampicin, and Clofazimine. This treatment typically lasts six months for paucibacillary leprosy and 12 months for multibacillary cases. MDT cures people with leprosy by killing the pathogen.

12.

What Is the Standard Treatment for Leprosy?

Treatment for leprosy consists of a combination of antibiotics, including Dapsone, Rifampicin, and Clofazimine. This treatment is called multidrug therapy (MDT). This therapy effectively prevents the development of antibiotic resistance by the bacteria, which may occur due to the length of the treatment. The treatment usually lasts six months for paucibacillary leprosy and 12 months for multibacillary cases.

13.

Can Poor Hygiene Cause Leprosy?

Previous studies have shown that WASH factors, including water source, access to water, access to soap, handwashing practices, and open defecation, are associated with leprosy infection.

14.

Is Leprosy Contagious?

Leprosy is not very contagious. The primary route of transmission of leprosy is via droplets from the nose and mouth during close and frequent contact with an untreated individual with leprosy. The disease is usually acquired after long-term contact with an untreated individual affected by the disease.

15.

What Vaccines Prevent Leprosy?

The bacillus Calmette–Guerin (BCG) vaccine provides a protective effect against leprosy. BCG vaccination is used routinely in childhood in countries where leprosy is endemic and for the household contacts of diagnosed leprosy people.

16.

How Is Leprosy Different from Tuberculosis?

Tuberculosis and leprosy are major infectious diseases caused by related mycobacterial pathogens, Mycobacterium tuberculosis and M. leprae respectively. Although both the diseases are from the same mycobacterial ancestor, the target organs affected by them are different (skin and peripheral nerves in leprosy; lungs and extrapulmonary lesions in tuberculosis). So, the clinical symptoms of both conditions are strikingly different.

17.

What Is Borderline Leprosy?

Borderline leprosy is a skin condition characterized by annular, “punched out” or “swiss cheese” skin lesions with a clear inner border and unclear outer edges. This form of leprosy manifests in the skin as erythematous macules, papules, plaques, or nodules.

18.

Where Is Leprosy Most Commonly Found?

Leprosy can occur anywhere, but it is most common in warm, wet areas of the tropics and subtropics. The worldwide prevalence of leprosy is around 5.5 million, with 80 % of these cases in 5 countries- India, Indonesia, Myanmar, Brazil, and Nigeria.
Dr. Nidhin Varghese
Dr. Nidhin Varghese

Dermatology

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