Leprosy or Hansen's disease (HD) is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis.Named after physician Gerhard Armauer Hansen, leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external sign. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs and eyes. Contrary to folklore, leprosy does not cause body parts to fall off, although they can become numb or diseased as a result of secondary infections; these occur as a result of the body's defences being compromised by the primary disease. Secondary infections, in turn, can result in tissue loss causing fingers and toes to become shortened and deformed, as cartilage is absorbed into the body.
Signs and symptoms of Leprosy
Skin lesions are the primary external sign. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs, and eyes.
How to Diagnosis Leprosy
Diagnosis in the U.S. is often delayed because healthcare providers are unaware of leprosy and its symptoms. Early diagnosis and treatment prevents nerve involvement, the hallmark of leprosy, and the disability it causes. There are many kinds of leprosy but there are common symptoms. These include runny nose, dry scalp, eye problems, skin lesions, and muscle weakness.
Risk factors of Leprosy
At highest risk are those living in endemic areas with poor conditions such as inadequate bedding, contaminated water, and insufficient diet, or other diseases that compromise immune function. However, though hard evidence is limited, and fringe publications have made passionate claims to the contrary, professional studies show little evidence that HIV is an important factor in increasing the risk of leprosy infection. It is presumed that this might be because of differences between the modes of immunity involved. However, it is plain that the two infections and their signs and progressions need not be fully independent, so the matter should be regarded with reserve. For example, a Medscape clinical presentation reports that HIV infection neither is a risk factor for acquisition nor for increased virulence of leprosy, but that latent cases of leprosy may emerge after starting HAART. Lewis, F. S. et al. ; Dermatologic Manifestations of Leprosy Clinical Presentation
Prevention of Leprosy
In a recent trial, a single dose of rifampicin reduced the rate at which contacts acquired leprosy in the two years after contact by 57%; 265 treatments with rifampicin prevented one case of leprosy in this period. A non-randomized study found that rifampicin reduced the number of new cases of leprosy by 75% after three years.
BCG offers a variable amount of protection against leprosy as well as against tuberculosis.
Efforts to overcome persistent obstacles to the elimination of the disease include improving detection, educating patients and the population about its cause, and fighting social taboos about a disease that has caused its patients throughout history to be considered "unclean" or "cursed by God" as outcasts. Leprosy is not a hereditary disease. Where taboos are strong, patients may be forced to hide their condition (and avoid seeking treatment) to avoid discrimination. The lack of awareness about Hansen's disease can lead people to believe (falsely) that the disease is highly contagious and incurable.
The ALERT hospital and research facility in Ethiopia provides training to medical personnel from around the world in the treatment of leprosy, as well as treating many local patients. Surgical techniques, such as for the restoration of control of movement of thumbs, have been developed.
Treatments for Leprosy
Enough synthetic pharmaceuticals that are effective against leprosy have by now been identified, and support a flexible choice of treatments. The WHO Study Group's report on the Chemotherapy of Leprosy in 1993 recommended two types of standard MDT regimen be adopted. The first was a 24-month treatment for multibacillary (MB or lepromatous) cases using rifampicin, clofazimine, and dapsone. The second was a six-month treatment for paucibacillary (PB or tuberculoid) cases, using rifampicin and dapsone. At the First International Conference on the Elimination of Leprosy as a Public Health Problem, held in Hanoi the next year, the global strategy was endorsed and funds provided to WHO for the procurement and supply of MDT to all endemic countries.