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About leprosy

Although leprosy is not easily transmissible, it is hard to shake off the stigma associated with the condition.

Leprosy has been eradicated in 116 out of 122 countries where it is endemic. The global prevalence of leprosy has been reduced by more than 90% since 1985, with more than 14.5 million people cured of the condition. However, there are pockets of the condition in Africa, Asia and South America.

A condition which has been documented since pre-biblical times, leprosy is caused by the bacteria, mycobacterium leprae. The exact mode of transmission is not known. Although it is a communicable disease, one can only get infected through prolonged close contact. It is believed that the methods of transmission are through skin-to-skin contact and droplets from the mouth and nose. Humans are the only known reservoir of infection, although an organism that is indistinguishable from mycobacterium leprae has been found in wild armadillos in the United States.

Leprosy affects both sexes, regardless of age. Its progress is slow and the average incubation period is between three and eight years. Symptoms can take as long as 20 years to appear. Patients can lead normal lives. If the disease is detected early and treated, it will not result in disabilities. If untreated, it may result in progressive damage to the skin, nerves, eyes and limbs.

Clinical features

Leprosy is described clinically as tuberculoid and lepromatous, with a large borderline group between the first two groups. It affects the skin and nerves, mainly. The affected skin has a patch or patches, with definite loss of sensation. They can appear anywhere and can be flat or raised, pale, red or copper-coloured. The patches cannot feel touch, heat or pain, and does not itch. Other signs include skin-coloured or reddish nodules or smooth, shiny, diffuse thickening of the skin without loss of sensation.

In general, leprosy should not be diagnosed without a definite loss of sensation. Leprosy is categorised into paucibacillary and multibacillary types, depending on the number of patches. There are one to five patches in the former, and more than five in the latter.

There may be ulcerations on the hands and feet, weakness and the wasting of muscles and a claw foot or a foot drop. The nerves may be enlarged, palpable or visible, especially those near the affected skin. The eyes and the testes may be involved, with infection and glaucoma in the former, and sterility and enlarged breasts (gynaecomastia) in the latter.

Diagnosis

Mycobacterium leprae is an acid fast, rod-like organism (bacilli). It cannot be cultured in a laboratory dish. However, it has been cultured using mice and the nine-banded armadillo. DNA technology has made it possible to clone genes of the bacteria.

Skin and nasal smears can be checked for acid fast bacilli by using stains. Skin biopsies are useful for the diagnosis and classification of leprosy. The biopsy findings vary depending on the type of leprosy. Granulomas are usual. The nerves may be visible or destroyed. The bacilli may be abundant, few or absent.

There may be different abnormalities detected in nerve conduction studies carried out when the nerves are affected. Nerve biopsies may reveal abnormalities. Sometimes, it is the only method of making a diagnosis.

Treatment

The World Health Organisation recommends a multi-drug therapy (MDT), comprising the use of dapsone, rifampicin and clofazimine. The drug regimen kills the bacteria and cures the patient. The MDT is very effective. Those with paucibacillary leprosy are usually cured within six months, while those with multibacillary leprosy are cured within 12 months. Patients are no longer infectious after completing the first dose of MDT. There is virtually no recurrence after treatment has been completed. It is safe to use MDT in pregnant women and patients with tuberculosis or HIV infection.

It is important for patients to understand that the full course of medication must be completed. If treatment is interrupted, it has to be started all over again. All patients under- going treatment can lead normal lives.

The drugs may cause the urine to be red and/or the skin may darken. This should not be of concern, as it will return to normal upon completion of treatment. However, immediate medical attention should be sought if there are any problems, e.g. fever, pain, muscle weak- ness, tiredness, swollen hands and feet, skin changes like nodules, and loss of sensation. These are not side effects of MDT but the body's response to leprosy.

Prevention

Leprosy sufferers who have loss of sensation in the hands and feet may injure themselves without noticing it. Subsequently, the wounds may get infected and deformities may result. Family members and those who have close contact with a leprosy sufferer have to be examined if they have a skin abnormality. The earlier a diagnosis is made, the sooner treatment can commence. This will prevent transmission of the condition, and also prevent complications and deformities from developing.

     
     

Understanding leprosy

About leprosy

Leprosy susceptibility - 7 genes identified

 

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