Introduction

What Is Leprosy?

Leprosy (Hansen’s Disease), is a chronic infectious disease that primarily affects

the peripheral nerves, skin, upper respiratory tract, eyes, and nasal mucosa. The
disease is caused by a bacillus (rod-shaped) bacterium known as Mycobacterium
leprae (M. leprae).

The Bacterium: Mycobacterium leprae

Mycobacterium leprae, discovered by G.A. Hansen in Norway in 1873, is a slow
growing, intracellular pathogen, incapable of living outside its host. The organism
has never been grown in a laboratory, making it more difficult to study than other
bacteria; at this point it can only be grown in animals. Armadillos and
immunocompromised mice are the only two sources for growing the bacteria for
research purposes.
Another factor complicating studies of leprosy is that M. leprae multiplies slowly,
with an average doubling time of 12-14 days, and only in a select group of animals.

The Disease

The mode of transmission of leprosy is still unclear and has been assumed to be
via the respiratory system mainly through nasal droplets; broken skin also remains
a possibility. The primary tissues that are affected by M. leprae are the superficial
sites of the skin and peripheral nerves because the bacteria survive best at low
temperatures.
Leprosy has been described by Ridley and Joplin as a continuous spectrum of
disease. The course of human leprosy depends on the immunity of infected
persons. Some people in a family may have the infection, but other close family
members will not develop it, depending on their personal ability to fight off the
bacteria.
Leprosy usually affects the skin, peripheral nerves and upper airways but has a
wide range of clinical manifestations. Clinical forms of leprosy represent a
spectrum reflecting the cellular immune response to M. leprae. Patients with good
T-cell immunity (Th1 type) exhibit tuberculoid (TT) leprosy which is also known as
pauci-bacillary leprosy, a milder form of the disease, characterized by skin
discoloration . Those with poor T-cell immunity typically exhibit lepromatous (LL)
leprosy or multi-bacillary leprosy which is associated with symmetric skin lesions,
nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa
resulting in congestion and nose bleeds. In between these forms of leprosy are the
borderline tuberculoid (BT), borderline-borderline (BB) and borderline lepromatous
(BL) forms.
LL leprosy is also characterized by large numbers of organisms in the skin, many
skin lesions with slight hypopigmentation, and less sensory loss in the lesions.
While individuals with LL have high titer antibodies to M. leprae, they also have an
impaired cellular immune response to the bacillus. Changes in immunity of the
host as well as treatment can result in worsening of the clinical course of the
disease.
All forms of leprosy may cause some degree of peripheral neurological damage
(nerve damage in the arms and legs) which causes sensory loss in the skin as well
as muscle weakness. People with long-term leprosy may lose the use of their
hands or feet due to repeated traumatic injury resulting from lack of sensation. If
left untreated, it can cause progressive and permanent damage to the skin,
nerves, eyes and limbs.

Two major types of leprosy:

Paucibacillary leprosy encompasses indeterminate, tuberculoid, and

borderline tuberculoid leprosy. It is characterized by one or more hypopigmented
skin macules and anaesthetic patches, where skin sensations are lost because of
damaged peripheral nerves that have been attacked by the human host's immune
cells.
Multibacillary leprosy includes midborderline, borderline lepromatous, and
lepromatous leprosy. It is associated with symmetric skin lesions, nodules,
plaques, thickened dermis, and frequent involvement of the nasal mucosa
resulting in nasal congestion and epistaxis (nose bleeds) but typically detectable
nerve damage is late.

WHO Ridley-Jopling MeSH Description

It is characterized by one or more
tuberculoid hypopigmented skin macules and
("TT"), anaesthetic patches, where skin sensations
Paucibacill Tuberculoi
borderline are lost because of damaged peripheral
ary d
tuberculoid nerves that have been attacked by the
("BT") human host's immune cells.

Borderline leprosy is of intermediate

severity and is the most common form. Skin
lesions resemble tuberculoid leprosy but are
more numerous and irregular; large patches
may affect a whole limb, and peripheral
midborderline
Multibacilla nerve involvement with weakness and loss
or borderline Borderline
ry of sensation is common. This type is
("BB")
unstable and may become more like
lepromatous leprosy or may undergo a
reversal reaction, becoming more like the
tuberculoid form.

It is associated with symmetric skin lesions,

borderline
nodules, plaques, thickened dermis, and
lepromatous
Multibacilla Lepromato frequent involvement of the nasal mucosa
("BL"), and
ry us resulting in nasal congestion and epistaxis
lepromatous
(nose bleeds) but typically detectable nerve
("LL")
damage is late.
Leprosy statistics
According to the World Health Organization, approximately 4,250 cases of
leprosy are registered in the Philippines.
Its island geography along with areas of high mountains and deep jungles
make case-finding difficult in remote regions of the Philippines. Nearly 80,000
people have been cured with MDT in the Philippines.
Latest update :- Leprosy Today
Today, the diagnosis and treatment of leprosy is easy and most endemic
countries are striving to fully integrate leprosy services into existing general health
services.
This is especially important for those under-served and marginalised communities
most at risk from leprosy, often the poorest of the poor.
Access to information, diagnosis and treatment with multidrug therapy (MDT)
remain key elements in the strategy to eliminate the disease as a public health
problem, defined as reaching a prevalence of less than 1 leprosy case per 10,000
population. MDT treatment has been made available by WHO free of charge to all
patients worldwide since 1995, and provides a simple yet highly effective cure for
all types of leprosy.
According to official reports received during 2008 from 118 countries and
territories, the global registered prevalence of leprosy at the beginning of 2008
stood at 212,802 cases, while the number of new cases detected during 2007 was
254,525 (excluding the small number of cases in Europe). The number of new
cases detected globally has fallen by 11,100 cases (a 4% decrease) during 2007
compared with 2006.
Most previously highly endemic countries have now reached elimination (defined
as a registered prevalence rate of <1 case/10 000 population). During 2007, both
the Democratic Republic of the Congo and Mozambique reached this important
stage. Those few countries that remain are very close to eliminating the disease.
However, pockets of high endemicity still remain in some areas of Angola, Brazil,
Central African Republic, Democratic Republic of Congo, India, Madagascar,
Mozambique, Nepal, and the United Republic of Tanzania. These countries remain
highly committed to eliminating the disease, and continue to intensify their leprosy
control activities.
Information campaigns about leprosy in high risk areas are crucial so that patients
and their families, who were historically ostracized from their communities, are
encouraged to come forward and receive treatment. The most effective way of
preventing disabilities in leprosy, as well as preventing further transmission of the
disease, lies in early diagnosis and treatment with MDT.
Conclusion
The number of new cases detected annually is declining gradually in many
countries. The majority of leprosy endemic countries are still detecting new cases
even though the numbers may be low. This reinforces the importance of the need
to sustain leprosy control activities to ensure that all new cases are properly
diagnosed and treated. Through such efforts the disease burden is expected to
continue to decline in all endemic countries. National programmes cannot afford to
be complacent. A bigger challenge lies ahead for these programmes – especially
those operating where there is low endemicity – in their endeavours to sustain
political commitment and maintain services, especially at peripheral levels, for
leprosy control activities. Maintaining expertise in leprosy control among health-
workers is challenging, especially in countries where the disease has become
relatively rare.
Brazil, Nepal and Timor-Leste have yet to eliminate leprosy. Efforts in these
countries will continue to be strengthened in order to help them achieve the
elimination goal in the next few years.
WHO will continue to provide technical support, especially in capacity
building, monitoring and evaluation, as well as in implementing key activities to
ensure that every new case of leprosy is properly diagnosed, treated and
ultimately cured by multidrug therapy. It is hoped that effective collaboration with
various partners will help mitigate the stigma and social discrimination borne by
people affected by leprosy and the negative outlook associated with the disease in
most communities will disappear.
 a

Case Study
on

LEPROSY
Submitted by:

Members (group 57):

Gutierrez, Theresa Isabel

Ilustrisimo, Alyssa R.
Juntilla, Jefferson
Lobingco, Floyd John
Maraon, Marie Ann G.
Nacario, Caren V.
Noel, Vivien Marie H.
Pilapil, Zarim C.
Reales, Queenie
Recio, Marie Angelie C.
Satinitigan, Jan Angeli
Sepra, Kathleen Mae

Submitted to:

Mrs. Marichie Yap

Clinical Instructor