Have you ever noticed the appearance of leprosy patients in old movies? They are usually represented wearing filthy clothes indicating a low socioeconomic status. Apart from that, they are portrayed with multiple wounds over the body with deformed limbs and faces.
Due to late diagnosis and lack of treatment options, patients often present with late stages of the disease with high morbidity in the older days. However, with recent advances in antimicrobial therapy for leprosy and better awareness and availability of medications, the morbidity of the disease has been minimized to a great extent!
The origin of the term leprosy was from the Latin word lepra, which means scaly. People once considered a disease as the curse of God. Olden time’s leprosy patients were treated as sinners. Leprosy patients were treated in leprosy colonies, isolated from society. In fact, the cover image of this article shows a part of one such leprosy colony on the island of Spinalonga, Greece. There was a time when these diseased people were asked to carry a bell to identify their presence. They used arsenic, creosote, and mercury to treat leprosy. How ridiculous, isn’t it?
Leprosy is a granulomatous bacterial disease caused by Mycobacterium leprae and Mycobacterium lepromatosis.
In 1873 G H Armauer Hansen discovered Mycobacterium leprae. As an honor to the scientist, leprosy is also called Hansen’s disease (HD).
The exact mechanism of transmission is still hidden. Even though classically we explain the transmission by,
It is a skin disease. So by appearance itself, it is easy to guess the disease clinically.
These are the clinical features of a leprosy patient. Other than this, you may also hear something like, in leprosy persons, the body parts will fall off. It’s nothing but another misconception about leprosy.
Other than these clinical symptoms, leprosy patients also show deformities. It can also be considered as a symptom of leprosy.
Face: Mask face, leonine facies, sagging face, lagophthalmos, loss of eyebrows (superciliary madarosis) and eyelashes (ciliary madarosis), corneal ulcers, and opacities, perforated nose, depressed nose, ear deformities, e.g., nodules on the ear and elongated lobules.
Hands: Claw hand, wrist-drop, ulcers, absorption of digits, thumb-web contracture, hollowing of the interosseous spaces, and swollen hand.
Feet: Plantar ulcers, foot-drop, inversion of the foot, clawing of the toes, absorption of the toes, collapsed foot, swollen foot, and callosities.
Based on the appearance of the skin lesions, leprosy is classified into three.
For easy assessment, and treatment leprosy is broadly classified into two.
We can only guess by seeing the lesions that it can be leprosy. But the skin lesions may also mimic psoriasis, syphilis lesions. To confirm whether it is leprosy or not, we will do certain lab investigations.
Bacteriological Examination: We will collect skin smears, nasal smears/ swabs, and nasal scrapings. And by the acid fasting method, we will try to detect the presence of acid-fast bacilli (M. Leprae).
Foot Pad Culture: This is done to distinguish between M. leprae and other acid-fast bacilli. We will inoculate the collected samples and see the colony formation of bacteria.
Histamine Test: For detecting early-stage peripheral nerve damage.
Immunological Tests:
These are done to distinguish immunological effects towards lepra infection:
Early detection and treatment are important to prevent the progression of the disease. We will use antileprotic drugs for the treatment of leprosy. It can be used individually or in a combined form. To prevent the development of antibiotic-resistant bacteria and to prevent the adverse effect, multi-drug therapy is more preferred over individual use of drugs.
For multibacillary leprosy we use,
For treating paucibacillary, we can use,
Rehabilitation is also an integral part of leprosy control.
To prevent and control the disease, health programs (The National Leprosy Eradication Programme) play an important role. BCG vaccination at birth is effective in preventing leprosy. Chemoprophylaxis with dapsone reduces the incidence of tuberculoid leprosy.
Reference:
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