Leprosy (Hansen's Disease) Pictures, Symptoms, Treatment: What is Leprosy?

Leprosy, also called Hansen's disease, is a chronic infectious disease that primarily affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract, and the eyes. Leprosy can lead to progressive permanent damage of these structures, and the resulting devastating disfigurement and disability has led to the historical social stigma and isolation (leper colonies) of those affected by the disease.

Historically speaking, leprosy has existed since at least 4000 BC, and the disease was present and described in the ancient civilizations of China, India, and Egypt. The first known written reference to the disease is from the Bible, and some references exists from Egyptian papyrus dates from about the same period, 1550 BC. It is believed that leprosy was brought to Europe by the Romans and the Crusaders and that later the Europeans brought it to the Americas. For centuries, leprosy remained a poorly understood disease characterized by human suffering and social isolation. In 1873, G.A. Hansen discovered the bacterial cause of this infectious disease. The first medication breakthrough occurred in the 1940s with the development of the drug dapsone, and later it was discovered that the bacteria which caused leprosy was more effectively killed by using multiple medications.

Leprosy is a curable disease with the use of multidrug therapy (MDT). In 1991, the World Health Assembly passed a resolution to eliminate leprosy as a public-health problem by the year 2000. The elimination of leprosy was defined as a prevalence rate of less than one case per 10,000 population. With assistance from the World Health Organization (WHO), MDT has been distributed free to all patients with leprosy since 1995. Though leprosy is still endemic in a few developing countries, there has been a dramatic worldwide decrease in the prevalence of the disease due to this successful public-health initiative. Over the past 20 years, more than 14 million leprosy patients have been cured, and the prevalence rate of the disease has decreased by 90%. In the United States, 150 new cases were reported in 2008 (the most recent data available), with most cases occurring in Texas, California, New York, Louisiana, Hawaii, and Massachusetts.

What is Leprosy?

Leprosy is a disease caused by the bacterium Mycobacterium leprae. Leprosy is often also referred to as Hansen's disease, after the discoverer of the bacterium. While in ancient history, the term leprosy has been used to denote a wide range of afflictions that cause boils, sores, or other skin diseases, in modern usage it refers exclusively to Hansen's disease as caused by Mycobacterium leprae. While the exact mode of transmission for leprosy is unknown, most people believe the bacterium passes through moisture exuded from the body.

There are two prevalent myths about leprosy, both of which are totally false. The first is that leprosy is incurable. In truth, leprosy is treatable by using a regimen of drugs. The first real treatments for leprosy, using a drug called dapsone, were established in the 1940s. The World Health Organization (WHO) provides this Multi Drug Therapy (MDT) to any country in need as part of their ongoing efforts to eliminate leprosy as a world health problem.

The second myth is that leprosy is extremely contagious. In actuality, most people are naturally immune to the disease, and for those that are not, transmission is still unlikely. It is estimated that more than 90% of the world's population possesses total immunity to leprosy. For those that are susceptible, close contact with infected persons, particularly those exhibiting strong signs of the disease, is recommended against. In no way, however, is transmission anywhere near as easy as most people believe -- in the popular mindset, simple contact with a leper virtually guarantees becoming infected oneself, a scenario that is highly unlikely, if not outright impossible.

Since the World Health Organization has made a determined effort to eliminate the threat of leprosy worldwide, incidence of the disease has been drastically reduced. Between 2003 and 2004 there was a reduction of more than 20% in new cases, down to just over 400,000 worldwide. Of the remaining cases of leprosy, the majority are found in Africa, Latin America, and Asia, with nearly 90% of all leprosy cases found in Nepal, Brazil, Madagascar, Mozambique, and Tanzania. India has proven a strong model for what education and disbursement of drugs can do to eliminate leprosy, with the number of cases in that country reduced greatly over just a few years.

One of the most difficult challenges for groups like the World Health Organization to overcome in their fight against leprosy is the deeply entrenched social stigma associated with the disease. In many cultures, leprosy is viewed as a divine punishment, and those afflicted are often ostracized from society as a whole. Leper colonies and asylums have existed in many countries for many hundreds of years as places for a group to ship off their lepers to and let them die of the disease in exile. While leper colonies primarily exist in developing nations such as the Philippines and India, in recent years the Japanese government has come under intense criticism for their own colonies.

In general, the global outlook on leprosy seems to be very favorable, with the World Health Organization's "Final Push" program making significant inroads, even in countries once thought to be virtually beyond assistance. If things continue as they are, leprosy may go the way of smallpox and polio, becoming nothing more than a historical artifact.

What Is the Cause of Leprosy?

The cause of leprosy can be one of two bacteria, Mycobacterium leprae, and Mycobacterium lepromatosis. Both bacteria come from the same family as tuberculosis, and some cases of leprosy may be classified as tuberculin infections, depending on the symptoms. Infection is believed to be transmitted through the inhalation of respiratory secretions, such as mucous or saliva. In some cases, the bacteria can also be transmitted from animals to humans, most notably from armadillos.

While the bacteria is the only known cause of leprosy, several risk factors may increase the chance of infection. High instances of the disease are linked to extreme levels of poverty and the resulting lack of adequate sanitation or clean drinking water. It also tends to be disproportionately found in tropical or sub-tropical climates, though it can occur elsewhere. The most important risk factor for leprosy may be the presence of certain genes, which are known to be susceptible to the disease. According to some experts, less than 10% of the world's population may possess these genes, meaning that most people will be fully immune to the disease.

What Are the Symptoms of Leprosy?

The symptoms of leprosy can vary depending on whether the patient is suffering from tuberculoid or lepromatous leprosy. Both types of leprosy are generally caused by the bacteria Mycobacterium leprae, though tuberculoid leprosy is often considered a less serious form of the disease. Both forms leprosy can develop serious complications if left untreated, and can lead to permanent disability. Initial symptoms of leprosy generally include a skin rash, which may or may not be widespread; pain and weakness in the extremities; and dryness and stiffening of the skin. More serious complications, including loss of toes and fingers, blindness, nerve damage and infertility, can occur as the disease progresses.

Antibiotics can now be administered to treat Hansen's disease, the disease long known as leprosy. Some sources believe that leprosy remains a serious public health problem, and that there may be as many as two million people in the world today suffering from the long-term consequences of leprosy complications. Early treatment is generally recommended, since treatment often can't reverse the damage leprosy does to the body.

Early symptoms of leprosy generally include a rash on the skin. Lepromatous leprosy typically causes the most widespread rash, which can appear on the ears, face, wrists, elbows, buttocks, and knees. The rash may be bumpy or smooth, pale, or distinctive. In cases of tuberculoid leprosy, the rash is generally smaller and lighter and appears in only a few patches on the torso, hands and feet. Many patients experience reduced touch sensation in the area of a leprosy rash.

As the disease progresses, the symptoms of leprosy can become severe. Symptoms of advancing tuberculoid leprosy often include extreme pain, and weakness in the feet and hands. Skin may begin to feel dry and stiff. Digits can fall off. Nerve damage can occur, often in the nerves surrounding the knee and elbow joints. Tuberculoid leprosy can damage the tissue of the eyes, eventually leading to vision loss and blindness.

Lepromatous leprosy is often considered more serious than tuberculoid leprosy. As the disease advances, eyelashes and eyebrows may begin to fall out. The skin of the face may become thicker. Lepromatous leprosy often has devastating effects on facial structures. It can cause nasal congestion and bleeding, leading to eventual loss of the nose itself.

Later symptoms of lepromatous leprosy can damage the reproductive tract. In men, symptoms of leprosy can include gynecomastia, or the growth of breasts, and the development of scar tissue in the testes. Infertility can result. Lymph nodes in the armpits and groin may become swollen.

With prompt treatment, many of the more serious symptoms of leprosy can be prevented. Nerve damage, blindness, infertility, and loss of extremities generally can't be reversed, but treatment with antibiotics can stop the course of the disease to prevent further debilitation.

What Is the Treatment For Leprosy?

Leprosy treatment seeks to minimize or prevent damage to the systems it affects, including skin, eyes, respiratory system, and peripheral nerves. Multidrug therapy (MDT) is recommended by the World Health Organization (WHO) as an effective leprosy treatment, supplemented by other supportive care if needed. The disease is curable if the leprosy medication regimen is followed adequately.

The first choice for leprosy treatment is drugs, especially antibiotics to kill the bacterium. Medications most often used are dapsone, rifampicin, and clofazimine. They may be combined to enhance the bacteria-killing effects and prevent resistance of the organism, and are generally safe. Oral corticosteroids and thalidomide help reduce inflammation and immune response. WHO provides MDT therapy free of charge for leprosy patients worldwide, a great help to those with little or no income.

Education is a large part of leprosy treatment. Patients are taught self-care similar to individuals with diabetic neuropathy, involving careful inspection of extremities and protecting numb areas from injuries. In areas where the disease is a cause of ostracism and fear of contamination, education can help bring sufferers forward for treatment, and community-based rehabilitation helps reintegrate them into society. Psychological counseling can help patients deal with the social stigma of the condition and its mental effects.

If leprosy is left untreated for very long, deformities and loss of function can occur. Patients have the option of reconstructive surgery to restore function, appearance, and sensation in damaged areas, unless leprosy treatment has been neglected and the disease has advanced. Physical rehabilitation and prosthetics to replace extremities lost to the disease are options for those unable to have surgery.

Patients who fail to stick to the MDT regimen risk permanent disability if there is nerve involvement. MDT therapy halts the infectious process, keeping the spread of the disease in check. As with any antibiotic treatment, patients must take the entire course of medication, or they may contribute to antibiotic resistance of Mycobacterium leprae. In many jurisdictions, leprosy is a reportable disease, meaning cases must be documented with the local health department.

Ocular damage is common in untreated leprosy, and it is the third leading cause of blindness in the world. This makes early diagnosis of the disease crucial in preventing complications that can cause significant disability. If the full course of medication is followed, leprosy treatment is likely to result in a good outcome for the patient.

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