Leprosy: Meaning, Types, Causes & Symptoms

Leprosy is an infectious illness that causes severe, disfiguring skin sores and nerve damage in the arms, legs, and other body parts. Leprosy has existed from the beginning of time. People have been impacted by outbreaks in every continent. However, leprosy, commonly known as Hanson's disease, is not a very contagious illness. You can only get it if you come into close and repeated contact with a leprosy-infected person's nose and mouth droplets. Leprosy is more common in children than in adults. 

Keyterms: Illness, Skin, Skin sore, Nerves, Arms, Legs, Microorganisms, Limbs, Eyes, WHO, Mycobacterium leprae, Mycobacterium lepromatosis

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What is Leprosy

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• Commonly known as Hansen's disease(HD), which is a chronic illness caused by the microorganisms Mycobacterium leprae and Mycobacterium lepromatosis.
• Leprosy is a granulomatous illness of the peripheral nerves and upper respiratory tract mucosa named after physician Gerhard Armauer Hansen. The most obvious outward symptom is skin lesions. 
• Leprosy can develop if left untreated, causing irreversible damage to the skin, nerves, limbs, and eyes.
• According to the World Health Organization, around 208,000 individuals worldwide are infected with leprosy, the majority of whom live in Africa and Asia. Every year, about 100 persons in the United States are diagnosed with leprosy, primarily in the South, California, Hawaii, and other US territories.

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Causative Agents of Leprosy

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• Leprosy is caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. 
• M. lepromatosis is a relatively new mycobacterium that was discovered in 2008 in a fatal case of diffuse lepromatous leprosy. 
• M. leprae is an intracellular, acid-fast bacteria that is aerobic and rod-shaped, with a waxy cell membrane coating typical of Mycobacterium species. 
• M. leprae and M. lepromatosis are obligate pathogens that are unculturable in the laboratory due to significant loss of genes required for independent development, a feature that makes it difficult to identify the organism under a strict interpretation of Koch's postulates. 
• Alternative causation has been established through the use of non-culture-based methods such as molecular genetics.

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Routes of Infection

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Leprae is generally transmitted via respiratory droplets from one person to another. Leprosy can also be transferred to people through contact with armadillos, according to studies. After treatment, leprosy is not known to be sexually transferred or particularly contagious. 95% of people possess innate immunity, and patients can no longer be contagious after only two weeks of treatment. Jacinto Convit was nominated for the Nobel Prize in Medicine in 1988 for creating a leprosy vaccination that combined tuberculosis (TB) immunizations with Mycobacterium Leprae. There are now many synthetic pharmaceuticals that are effective against leprosy, giving doctors a wider choice of treatment options.

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Types of Leprosy

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Leprosy is mainly classified into six types based on the severity of symptoms, such as Intermediate, Tuberculoid, Borderline Tuberculoid, Mid-borderline, Borderline, and Lepromatous leprosy.

Intermediate Leprosy

It is the most basic kind of leprosy. Patients in this stage have flat lesions that may heal on their own without spreading if they have a strong immune system.

Tuberculoid Leprosy or paucibacillary leprosy

It is a form of leprosy that is milder and less dangerous. Because of nerve damage, people with this condition exhibit patches of flat, pale-colored skin with no feeling in the afflicted region. This kind is less contagious than others. This infection can either cure on its own or develop to a more serious stage.

Borderline tuberculoid Leprosy

The symptoms are similar to tuberculoid, but the infections are smaller and more numerous at this stage, and they can continue and return to tuberculoid or any other advanced type.

Mid-borderline Leprosy

This stage's signs and symptoms are quite similar to those of borderline tuberculoid leprosy. This comprises reddish plaques with numbness that may retreat or develop to a different stage.

Borderline Leprosy

Leprosy associated with the cutaneous skin exhibits multiple wounds or scars, including flat bumps or flat, raised plaques that may not regress but continue.

Lepromatous Leprosy or multibacillary leprosy

It's a more severe form of the disease, with many lesions infected with microorganisms. There are lumps, numbness, muscular weakness, and rashes in the afflicted area. Other signs and symptoms include limb weakness, hair loss, and damage to other bodily systems such as the kidneys, nose, and male reproductive system. It is more contagious than tuberculosis, which never goes away.

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Symptoms of Leprosy

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Leprosy affects the skin initially, then the peripheral nerves, which are nerves located outside of the brain and spinal cord.

Although symptoms usually develop three to five years after coming into contact with the bacteria, in some cases symptoms appear after 20 years of infection.

The incubation period refers to the time between being exposed and the onset of symptoms. If this time interval extends, doctors will have a difficult time diagnosing the illness.

Following are some of the symptoms of leprosy:

• Numbness (among the first symptoms)
• Loss of temperature sensation (among the first symptoms)
• Touch sensation reduced (among the first symptoms)
• Pins and needles sensations (among the first symptoms)
• Pain (joints)
• Deep pressure sensations are decreased or lost
• Nerve injury
• Weight loss
• Blisters and/or rashes
• Ulcers, relatively painless
• Skin lesions of hypopigmented macules (flat, pale areas of skin that lost color)
• Eye damage (dryness, reduced blinking)
• Large ulcerations (later symptoms and signs)
• Hair loss (for example, loss of eyebrows)
• Loss of digits (later symptoms and signs)
• Facial disfigurement (for example, loss of nose) (later symptoms and signs)
• Erythema nodosum leprosum: tender skin nodules accompanied by other symptoms like fever, joint pain, neuritis, and edema

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Diagnosis of Leprosy

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If a patient develops a skin sore that may be leprosy, the doctor will take a tiny sample and send it to a lab for testing. A skin biopsy is a medical term for this procedure. A skin smear test may also be performed by the doctor. There will be no bacteria in the test findings if someone has paucibacillary leprosy. There will be if they have multibacillary leprosy.

A lepromin skin test may be required to determine the form of leprosy a person has. A tiny quantity of dormant leprosy-causing bacteria will be injected just beneath the skin of the forearm for this test. They'll inspect the site where the patient had the shot three days later, and then again 28 days later to see if the patient has reacted. They may have tuberculoid or borderline tuberculoid leprosy if they have a response. This test does not affect those who do not have leprosy or who have lepromatous leprosy.

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Treatment of Leprosy

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Leprosy is curable. The type of leprosy determines the treatment options. The infection is treated with antibiotics. Long-term therapy is generally recommended by doctors, ranging from 6 months to a year. If someone has severe leprosy, they may need to take antibiotics for a longer period. Antibiotics are unable to cure the nerve damage caused by leprosy.

• Multidrug therapy (MDT) is a common treatment for leprosy that combines antibiotics. That means taking two or more medications, often antibiotics:
• Paucibacillary leprosy: People need to take two antibiotics, such as dapsone each day and rifampicin once a month.
• Multibacillary leprosy: Need to take a daily dose of the antibiotic clofazimine in addition to the daily dapsone and monthly rifampicin. Also, people take multidrug therapy for 1-2 years and then get cured.

Someone may also take anti-inflammatory drugs to control nerve pain and damage related to leprosy. This could include steroids, like prednisone.

Doctors sometimes treat leprosy with thalidomide, a potent medication that suppresses the immune system. It helps treat leprosy skin nodules. Thalidomide is also known to cause severe, life-threatening birth defects. 

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Complications of Leprosy

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• Blindness.
• Kidney failure is a serious condition.
• Muscle weakening.
• Face disfigurement is a condition in which a person's face is disfigured
• Erectile dysfunction and infertility in males.
• The nerves in the brain are permanently damaged.
• The interior of the nose is permanently damaged, leading to nose bleeding.

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Things to Remember

• Leprosy is curable with multidrug therapy (MDT). Untreated, it can cause progressive and permanent damage to the skin, nerves, limbs, and eyes.
• Leprosy can develop if left untreated, causing irreversible damage to the skin, nerves, limbs, and eyes.
• M. leprae and M. Lepromatosis organisms are obligate organisms that cannot be cultured in a lab, making it nearly impossible to identify them using Koch's theory.
• The bacillus is likely transmitted via droplets, from the nose and mouth, during close and frequent contact with untreated cases.
• For the treatment and prevention of leprosy, there is currently a vaccine and a wide range of pharmacological alternatives.
• Pregnant mothers with leprosy can’t pass it to their unborn babies. It’s not transmitted by sexual contact either.

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Previous Year Questions

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