Leprosy

Introduction

Leprosy, also known as Hansen's disease (HD), a chronic infectious disease caused by a Mycobacterium (Mycobacterium leprae) affecting especially the skin and marginal nerves. It is characterized by the formation of nodules or macules that enlarge and spread with loss of sensation and eventually paralysis, wasting of muscle, and production of deformities called also Hansen's disease. This infection is caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis . The disease is characterized by long incubation period generally 5-7 years and is classified as paucibacillary or mulitbacillary, depending on the bacillary load. It is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract, skin lesions are the primary external sign. If left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs and eyes.

Historical facts about Leprosy

The earliest records of a ‘leprosy like’ disease come from Egypt, dating as far back as 1400 BC. In China and India the first records appeared in the sixth century BC. In China, a disciple of Confucius named Pai-Nie suffered from a disease resembling lepromatous leprosy, which was known at that time as ’li’ or ‘lai’. In India, leprosy was first described in the Susruth Samhita and treatment with ‘chaulmoogra’ oil was known at that time. It is said that leprosy was referred to as Kusht in the Vedic writing, which is how the disease is known as even to this day in India, Nepal, Indonesia, Malaysia and many other countries in South East Asia. Clay statues of leprosy patients were also found in Mesopotamia dating as far as back as 400 BC.

Initially, leprosy patients were isolated and segregated. Communities were hostile to them and the patients were also self-conscious and afraid to mix with the community. Leprosoria to segregate the patients from the community were built in Europe in the middle ages. Several statutory acts and laws were also enacted during that time against them.

A drug “Chaulmoogra” oil was used for leprosy treatment until “Dapsone” was discovered with antileprosy effects during 1940s. It was in 1970s when multi drug therapy (MDT) consisting of Rifampicin, Clofazimine and Dapsone were identified as cure for leprosy which came into wide use from 1982 following the recommendations of WHO. Since then the services for leprosy patients gradually changed from institutional to outpatient care through health centres and field clinics. Gradually the infected and cured leprosy patients began to be accepted by the Community as a result of intensive health education and visibly successful results of MDT.

Symptom

The disease has following symptoms:

• Skin lesions that may be faded/discolored
• Growths on the skin
• Thick, stiff or dry skin
• Severe pain
• Numbness on affected areas of the skin
• Muscle weakness or paralysis (especially in the hands and feet)
• Eye problems that may lead to blindness
• Enlarged nerves (especially those around the elbow and knee)
• A stuffy nose
• Ulcers on the soles of feet

Causes

Mycobacterium leprae and Mycobacterium lepromatosis are the causative agents of leprosy. Mycobacterium can spread from person to person. This might happen when someone with the disease coughs or sneezes. This can release droplets into the air. It might also happen if somebody is exposed to other nasal fluids (also known as secretions) that might be contaminated with the bacteria.

Risk factors: Those living in endemic areas with poor conditions such as:

• Inadequate bedding
• Contaminated water
• Insufficient diet, or other diseases that compromise immune function

Diagnosis

How to suspect Leprosy?

• See the patient in good daylight
• See for presence of following signs/symptom:
• Patches over skin
• Pale or reddish color, small or big, single or multiple patch anywhere on body.
• There is no pain or itching over the patches
• Nodules on the skin
• Thickening and reddishness of skin or nodules on skin especially on Ear lobes, Face, Trunk, Arms & Legs
• Deformities and ulcers
• Weakness and deformity in hand, foot or eye.
• Ulcer on the sole of foot.
• Inability to close the eye completely.

Diagnosis of leprosy is most commonly based on the clinical signs and symptoms.

Lepromin test:

• Positive skin smears
• Skin lesion consistent with leprosy and with definite sensory loss, with or without thickened nerves

If one suspect leprosy, He/she should visit to the doctor for diagnosis and treatment.

Management

Self - care practices

• Soak the hands/feet for about ½ hour in water
• Apply cooking oil when hands/feet are wet.
• Protect hand against heat and friction.
• Use MCR footwear for anesthetic feet and work slowly with short step.
• Clean the wound with soap and water. Dress with clean cloth.
• Check eyes daily using mirror.

A number of leprostatic agents are available for treatment.

How to Group Leprosy cases for treatment?

• Pauci Bacillary (PB) – 1 to 5 skin patches
• Multi Bacillary (MB) – more than 5 skin patches

Multi drug therapy (MDT) as given by WHO.

1. Multibacillary (MB) leprosy For adults the standard regimen is:
• Rifampicin: 600 mg once a month
• Dapsone: 100 mg daily
• Clofazimine: 300 mg once a month and 50 mg daily
• Duration= 12 months.
2. Paucibacillary (PB) leprosy : For adults the standard regimen is:
• Rifampicin: 600 mg once a month
• Dapsone: 100 mg daily
• Duration= six months
3. Single Skin Lesion Paucibacillary leprosy : For adults the standard regimen is a single dose of:
• Rifampicin: 600 mg
• Ofloxacin: 400 mg
• Minocycline: 100 mg

Prevention

The BCG vaccine offers a variable amount of protection against leprosy in addition to tuberculosis. This vaccine appears to be about 25% effective with two doses working better than one. Development of a more effective vaccine is still going on.

Source: National Health Portal