Leprosy

Symptoms Of Leprosy

This is a very slowly progressing disease, and it may take as many as 5 years on average for the symptoms to appear after the infection. You may be suffering from leprosy if you have the following symptoms:

Skin changes

• Patchy discoloration of the skin.

• Skin lesions which are typically flat, pale (hypopigmented) or reddish (erythematous) spots in the skin 

• Skin lesions with slightly decreased sensitivity to touch or pain.

• Skin becomes thick, dry, and hard.

• Hair loss in the affected area

• Extra growth of nodules on the skin.

• Growth of lumps on the face or earlobes that are painless.

• Ulcer formation on the soles of feet that may be painless.

• Thinning of eyebrows and eyelashes. Sometimes loss of eyebrows.

• Change in the shape of the nose.

Neurological symptoms

• Loss of sensation in the affected spots of the skin.

• Diminished sensation or feeling in the affected areas (anesthesia) 

• Burning and tingling sensations (paresthesias).

• Non-healing ulcers on the soles of the feet.

• Muscle weakness and atrophy of the small muscles of the hands or feet, leading to paralysis or crippling.

• Loss of sensation in toes and fingers.

• Painful, tender, and enlarged nerves.

• Vision changes.

Causes Of Leprosy

Leprosy is a chronic infectious disease caused by bacteria called Mycobacterium Leprae complex, which comprises M. leprae and M. lepromatosis. Leprosy is also called Hansen's disease, named after the scientist who discovered M. leprae in 1873.

Lab tests show that M. leprae grow optimally at temperatures ranging from 27 to 33 C. This explains its predilection for cooler regions of the body like skin, nerves close to the surface of skin, eyes and thin tissue lining the nose. It divides very slowly and takes years to reach a number sufficient to show any signs of infection. 

The mode of transmission is not entirely understood. It is thought that disease transmission happens when a person actively suffering from the disease sneezes or coughs and releases the bacteria into the atmosphere and a healthy person breathes in the droplets. However, it is not easily transmissible or highly contagious. Prolonged close contact with a person actively suffering from this disease is essential for disease transmission. 

Majority of people have a natural immunity to the disease and will not develop any symptoms even if they are exposed to it. Only about 5 percent of all people are susceptible to the disease. 

Types Of Leprosy

In order to make the diagnosis simple and ensure prompt and quick treatment of leprosy, WHO (World Health Organization) has classified it into 2 types - multibacillary leprosy and paucibacillary leprosy.

1. Paucibacillary leprosy is when a person has around 1 to 5 skin lesions and no bacteria are detected in the skin samples. It is the least contagious form and can be further classified into tuberculoid (T.T.) and borderline tuberculoid (B.T.)

2. Multibacillary leprosy is when a person has more than 5 skin lesions and bacteria are detected in the skin smear, or both. It is the most contagious form and can be further classified into borderline (B.B), borderline lepromatous (B.L.) and lepromatous (L.L.).

Note: In tuberculoid leprosy (TT), the infection is localized and the patients are resistant to the bacillus whereas in lepromatous leprosy (LL) the infection is disseminated and the patients  are extremely sensitive to the bacillus. The other borderline forms (BT, BB, BL) fall in between the two ends of the spectrum (TT and LL).

Risk Factors Of Leprosy

Overall, the risk of getting leprosy for any adult around the world is very low. That’s because more than 95% of all people have natural immunity to the disease. However, the following risk factors are associated with the disease:

• Close contact: Prolonged direct contact with an active leprosy patient considerably increases the chances of contracting the disease.

• Living in endemic areas: Living in areas where leprosy is endemic (parts of India, China, Japan, Nepal, Egypt, and other areas) increases the risk of contracting the disease.

• Age: Older people are more prone to risk of contracting leprosy. Higher risk has also been seen in ages between 5 to 15 and continued risk after 30.

• Genetic factor:  Genetic defects in the immune system may cause certain people to be more likely to become infected (region q25 on chromosome 6). 

• Exposure to certain animals: People who handle certain animals known to carry the bacteria like nine-banded armadillos, african chimpanzee, sooty mangabey, and cynomolgus macaque, are at risk of getting the bacteria from the animals, especially if they do not wear gloves while doing so.

• Immunosuppression: Leprosy typically occurs when immunity is suppressed like after solid organ transplantation, chemotherapy, HIV infection, or after administering agents for rheumatologic symptoms.

Diagnosis Of Leprosy

Usually, detailed observation and physical examination of the skin lesions are performed by the doctor, and the following supporting tests are used to confirm the diagnosis of leprosy:

Skin biopsy

A tiny piece of skin from the affected area is taken and studied under a microscope to check for the presence of leprosy-causing bacteria.

Skin slit smear 

This test is used for multibacillary leprosy only. A small slit is made using a sharp blade over the skin of the forehead, earlobe, or lesions. Then a smear is made by scraping the exposed skin onto a glass slide and examining for bacteria under a microscope.

Lepromin test

In this test, a small number of inactive leprosy bacteria are injected into the skin, and the patient's immune response is studied. This test determines the type of leprosy rather than diagnosing the condition.

DNA PCR test

This is a very specific molecular test that checks for the presence of leprosy bacteria DNA in the blood sample and can establish the diagnosis with certainty.

The following tests might also be performed to help determine if any other organ systems have been affected by leprosy:

• CBC test

• Liver function tests

• Creatinine test

• Nerve biopsy 

• Nerve conduction velocity test 

Prevention Of Leprosy

Leprosy can be transmitted only via prolonged and close contact with an active infected case. It is possible to prevent the transmission of leprosy by reducing close contact with the infected person. However, it is essential to note that leprosy cannot spread by a mere handshake, and discrimination against leprosy patients is strongly discouraged.

There is no commercially available vaccine available to prevent leprosy. However, the BCG vaccine which is used to prevent TB, provides some protection against leprosy but is not often used for that purpose.

Certain animals like  nine-banded armadillos, African chimpanzee, sooty mangabey, and cynomolgus macaque can rarely transfer M. leprae to humans. It is advisable not to handle such animals in the wild. 

If someone is extensively exposed to the bacteria, they may be started on prophylactic medicines to prevent the occurrence of the disease. Using Rifampicin reduces the development of paucibacillary leprosy by almost 50%.

Specialist To Visit

If you observe lesions on your skin and feel a loss of sensation in those parts or suffer from any other characteristic features of leprosy, you can consult the following specialists -

• Dermatologist

• Infectious disease specialist

• Internal medicine specialist

• Neurologist

Some patients might need to consult a general surgeon for rehabilitation and repair.

Treatment Of Leprosy

As leprosy is a bacterial disease, it is treated with a combination of antibiotics for a period of 6 months or 12 months depending upon the type of leprosy and can be extended as per individual case. As per the WHO guidelines, a 3-drug regimen of rifampicin, dapsone and clofazimine is recommended for all patients, with a treatment duration of 6 months for paucibacillary leprosy(PB) and 12 months for multibacillary leprosy (MB). This therapy helps to prevent the development of antibiotic resistance by the bacteria, which may further increase the course of treatment. The condition can be cured if the treatment is followed and completed as recommended by the doctor.

Antibiotics used to treat leprosy act by killing the bacteria, and hence, can cure the disease and prevent it from getting worse. However, it does not reverse the nerve damage or any physical deformation that has occurred prior to the diagnosis of the condition. Hence, it is extremely important to diagnose the condition at the earliest to prevent permanent nerve damage. 

1. Antibiotics

Depending on the type and severity of leprosy( PB and MB) a combination of the following drugs is given for 6 or 12 months:

• Clofazimine 

• Rifampicin 

• Dapsone

2. Nerve tonics (neurotonics)

Nerve tonics can help ease symptoms caused by nerve damage. However, the damage to the nerve is permanent.

3. Treatment of resistant cases

In cases which are resistant to one or two of above first line drugs, treatment can be extended to 24 months and following other drugs can be included in the multi drug therapy:

• • Clarithromycin

  • Minocycline

  • Ofloxacin

  • Moxifloxacin

  • Levofloxacin

Home Care For Leprosy

The aim of leprosy care at home is to minimize the occurrence of serious complications of the disease. You can do the following things at home:

• Protect your eyes from dust, harsh sunlight, and dryness. Clean your eyes gently with a clean cloth every day. Look in the mirror to check for the appearance of any changes in the eyes.

• Protect your hands and feet from injuries, and check for any undetected injuries every day. If there is a loss of sensation in the hands or feet, take extra care to prevent burns and injuries.

• Clean your hands and feet daily with lukewarm water. Soak hands/feet in lukewarm water and scrape away the hardened skin. Apply an emollient cream to your hands and feet to prevent dryness.

• Perform finger and toe exercises daily to prevent stiffness and loss of mobility of the digits.

Complications Of Leprosy

The complications of leprosy depend on how quickly the condition is diagnosed and effectively treated. Very few complications occur if physicians treat the disease early enough, but the following is a list of complications that can occur when diagnosis and treatment is either delayed or started late in the disease process:

• Wounds and ulceration in the hands or feet

• Permanent damage to the nerves of extremities

• Progressive deformities in the fingers, toes and nose

• Chronic nasal congestion, nosebleeds, and collapse of the nasal septum

• Glaucoma which is an eye condition that damages the optic nerve

• Uveitis or inflammation of eye

• Blindness

• Erectile dysfunction

• Infertility

• Kidney failure

Alternative Therapies Of Leprosy

Ayurveda

Leprosy is known as Kustha Roga in Ayurveda. There are several treatments in Ayurveda for leprosy, which include medicines for oral consumption, such as the compounds of Triphala, Khadira, Guduchi, Pippali, etc., or paste for topical application made from sulfur, mustard oil, turmeric, etc.

Physiotherapy

Physiotherapy exercises help maintain the function and mobility of the affected digits. It also helps prevent deformities, such as claw hand. It can also help improve the function of an already deformed hand.

Living With Leprosy

Leprosy patients need to be extra careful when taking care of their health as they are at an increased risk of getting injuries or burns due to reduced sensations. This necessitates special care for the extremities. Patients must be careful to wear gloves while holding hot utensils or other hot objects, and prompt medical care is essential even for minor cuts and injuries. Early treatment is the key to a successful outcome in leprosy.

Patients suffering from leprosy often have to battle social stigma and discrimination due to the misconceptions still prevalent about the disease. Due to this stigma most people do not seek medical help when the symptoms start to appear, which in turn delays the diagnosis as well as the treatment and increases the risk of disabilities.

Moreover, girls and women with leprosy have to face added social as well as gender discrimination which further affects the diagnosis and treatment. In some cases, this stigma can also interfere with the day-to-day life of the patient. Hence, it is very important to give due importance to mental health. Do not be apprehensive to consult a counselor or therapist. Sometimes sharing your feelings can help you deal with them better. It might be good to talk to someone who is going through exactly the same feelings as yours. Join a support group or you can also interact online, if you prefer to interact with people from the comfort of your own home.