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What Is Leprosy?
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.
Case Study
on
LEPROSY
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