LEPROSY

 Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast,

rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa
of the upper respiratory tract, and the eyes. Leprosy is curable and treatment in the early
stages can prevent disability.
 Leprosy is an age-old disease, described in the literature of ancient civilizations.
Throughout history, people afflicted have often been ostracized by their communities
and families.

CAUSE OF LEPROSY

 Leprosy is caused by a slow-growing type of bacteria called Mycobacterium leprae (M.

leprae). Leprosy is also known as Hansen's disease, after the scientist who discovered M.
leprae in 1873.
 The agent that causes Hansen’s disease is an acid-fast rod-shaped
bacillus Mycobacterium leprae. The organism multiplies very slowly (dividing
approximately once every 13 days) and is an obligate intracellular pathogen that lacks
several genes needed for independent survival, thus it has never been grown in
bacteriologic media. However, it has been grown in mouse foot pads by injecting ground
tissue from lepromatous nodules or nasal scrapings from leprosy patients into the foot
pad of the animal

MODE OF TRANSMISSION

 It is not known exactly how Hansen’s disease spreads between people.

 Scientists currently think it may happen when a person with Hansen’s disease coughs or
sneezes, and a healthy person breathes in the droplets containing the bacteria. Prolonged,
close contact with someone with untreated leprosy over many months is needed to catch
the disease.
 You cannot get leprosy from a casual contact with a person who has Hansen’s disease
like:
 Shaking hands or hugging
 Sitting next to each other on the bus
 Sitting together at a meal
 Hansen’s disease is also not passed on from a mother to her unborn baby during
pregnancy and it is also not spread through sexual contact.
 Due to the slow-growing nature of the bacteria and the long time it takes to develop signs
of the disease, it is often very difficult to find the source of infection.

SIGN AND SYMPTOMS

 It usually takes about 3 to 5 years for symptoms to appear after coming into contact with
the bacteria that causes leprosy. Some people do not develop symptoms until 20 years
later. The time between contact with the bacteria and the appearance of symptoms is
called the incubation period. Leprosy's long incubation period makes it very difficult for
doctors to determine when and where a person with leprosy got infected.

Skin symptoms such as:

 A large, discolored lesion on the chest of a person with Hansen’s disease.

 Discolored patches of skin, usually flat, that may be numb and look faded (lighter than
the skin around)
 Growths (nodules) on the skin
 Thick, stiff or dry skin
 Painless ulcers on the soles of feet
 Painless swelling or lumps on the face or earlobes
 Loss of eyebrows or eyelashes
 Symptoms caused by damage to the nerves are:
Numbness of affected areas of the skin

 Muscle weakness or paralysis (especially in the hands and feet)

 Enlarged nerves (especially those around the elbow and knee and in the sides of the neck)
 Eye problems that may lead to blindness (when facial nerves are affected)

Symptoms caused by the disease in the mucous membranes are:

 A stuffy nose
 Nosebleeds

FORM OF LEPROSY

 Tuberculoid. A mild, less severe form of leprosy. People with this type have only one or
a few patches of flat, pale-colored skin (paucibacillary leprosy). The affected area of skin
may feel numb because of nerve damage underneath. Tuberculoid leprosy is less
contagious than other forms.
 Lepromatous. A more severe form of the disease. It brings widespread skin bumps and
rashes (multibacillary leprosy), numbness, and muscle weakness. The nose, kidneys, and
male reproductive organs may also be affected. It is more contagious than tuberculoid
leprosy.
 Borderline. People with this type of leprosy have symptoms of both the tuberculoid and
lepromatous forms.

 Single lesion paucibacillary (SLPB): One lesion

 Paucibacillary (PB): Two to five lesions
 Multibacillary (MB): Six or more lesions

COMPLICATIONS

 Without treatment, leprosy can permanently damage your skin, nerves, arms, legs, feet,
and eyes.
 Blindness or glaucoma
 Iritis
 Hair loss
 Infertility
 Disfiguration of the face (including permanent swelling, bumps, and lumps)
 Erectile dysfunction and infertility in men
 Kidney failure
 Muscle weakness that leads to claw-like hands or a not being able to flex your feet
 Permanent damage to the inside of your nose, which can lead to nosebleeds and a chronic
stuffy nose
 Permanent damage to the nerves outside your brain and spinal cord, including those in
the arms, legs, and feet
 Nerve damage can lead to a dangerous loss of feeling. If you have leprosy-related nerve
damage, you may not feel pain when you get cuts, burns, or other injuries on your hands,
legs, or feet.

LABORATORY DIAGNOSTICS

 Hansen’s disease is diagnosed based on clinical presentation and the diagnosis is

confirmed by skin or nerve biopsy and acid-fast staining

Skin and nerve biopsy

 Biopsies are needed to definitively confirm a diagnosis of Hansen’s disease and to

classify the disease, and slit skin smear may also be helpful in diagnosing those with
mutlibacillary disease.
 tissue biopsy of various affected sites may reveal typical histopathologic changes that
show large numbers of foam cells.

Acid fast staining

  The Ziehl-Neelson method using 5% sulphuric acid as decolorizing agent is used. The
presence of acid-fast bacilli confirms the diagnosis of Hansen’s disease.
 This acid-fast-stained photomicrograph of a tissue sample extracted from a patient with
leprosy shows a chronic inflammatory lesion known as a granuloma, within which
numerous red-colored M. leprae bacteria are visible.

TREATMENT

 Hansen’s disease is treated with multidrug therapy (MDT) using a combination of

antibiotics depending on the form of the disease:
 Paucibacillary form – 2 antibiotics are used at the same time, daily dapsone and
rifampicin once per month
 Multibacillary form – daily clofazimine is added to rifampicin and dapsone.
 Treatment usually lasts between one to two years. The illness can be cured if treatment is
completed as prescribed.
What is Hansen’s Disease?

Hansen’s disease (also known as leprosy) is an infection caused by bacteria

called Mycobacterium leprae. These bacteria grow very slowly and it may take up to 20 years to
develop signs of the infection.

The disease can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa). The bacteria
attack the nerves, which can become swollen under the skin. This can cause the affected areas to
lose the ability to sense touch and pain, which can lead to injuries, like cuts and burns. Usually,
the affected skin changes color and either becomes:

 lighter or darker, often dry or flaky, with loss of feeling, or

 reddish due to inflammation of the skin.

If left untreated, the nerve damage can result in paralysis of hands and feet. In very advanced
cases, the person may have multiple injuries due to lack of sensation, and eventually the body
may reabsorb the affected digits over time, resulting in the apparent loss of toes and
fingers. Corneal ulcers and blindness can also occur if facial nerves are affected. Other signs of
advanced Hansen’s disease may include loss of eyebrows and saddle-nose deformity resulting
from damage to the nasal septum.

Information for Healthcare Professionals

Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae and usually

affects the skin and peripheral nerves, but can have a wide range of possible clinical
manifestations.

Etiologic Agent

The agent that causes Hansen’s disease is an acid fast rod-shaped bacillus Mycobacterium
leprae. The organism multiplies very slowly (dividing approximately once every 13 days) and is
an obligate intracellular pathogen that lacks several genes needed for independent survival, thus
it has never been grown in bacteriologic media. However, it has been grown in mouse foot pads
by injecting ground tissue from lepromatous nodules or nasal scrapings from leprosy patients
into the foot pad of the animal

Transmission

How do people get Hansen’s disease?

It is not known exactly how Hansen’s disease spreads between people. Scientists currently think
it may happen when a person with Hansen’s disease coughs or sneezes, and a healthy person
breathes in the droplets containing the bacteria. Prolonged, close contact with someone with
untreated leprosy over many months is needed to catch the disease.

You cannot get leprosy from a casual contact with a person who has Hansen’s disease like:

 Shaking hands or hugging

 Sitting next to each other on the bus
 Sitting together at a meal
Hansen’s disease is also not passed on from a mother to her unborn baby during pregnancy and it
is also not spread through sexual contact.

Due to the slow-growing nature of the bacteria and the long time it takes to develop signs of the
disease, it is often very difficult to find the source of infection.

Signs and Symptoms

Symptoms mainly affect the skin, nerves, and mucous membranes (the soft, moist areas just
inside the body’s openings).

The disease can cause skin symptoms such as:

A large, discolored lesion on the chest of a person with Hansen’s disease.

 Discolored patches of skin, usually flat, that may be numb and look faded (lighter than
the skin around)
 Growths (nodules) on the skin
 Thick, stiff or dry skin
 Painless ulcers on the soles of feet
 Painless swelling or lumps on the face or earlobes
 Loss of eyebrows or eyelashes
Symptoms caused by damage to the nerves are:

 Numbness of affected areas of the skin

 Muscle weakness or paralysis (especially in the hands and feet)
 Enlarged nerves (especially those around the elbow and knee and in the sides of the neck)
 Eye problems that may lead to blindness (when facial nerves are affected)

Enlarged nerves below the skin and dark reddish skin patch overlying the nerves affected by the
bacteria on the chest of a patient with Hansen’s disease. This skin patch was numb when
touched.
Symptoms caused by the disease in the mucous membranes are:

 A stuffy nose
 Nosebleeds
Since Hansen’s disease affects the nerves, loss of feeling or sensation can occur. When loss of
sensation occurs, injuries such as burns may go unnoticed. Because you may not feel the pain
that can warn you of harm to your body, take extra caution to ensure the affected parts of your
body are not injured.

If left untreated, the signs of advanced leprosy can include:

 Paralysis and crippling of hands and feet

 Shortening of toes and fingers due to reabsorption
 Chronic non-healing ulcers on the bottoms of the feet
 Blindness
 Loss of eyebrows
 Nose disfigurement
Other complications that may sometimes occur are:

 Painful or tender nerves

 Redness and pain around the affected area
  Burning sensation in the skin

Diagnosis and Treatment

How is the disease diagnosed?

Hansen’s disease can be recognized by appearance of patches of skin that may look lighter or
darker than the normal skin. Sometimes the affected skin areas may be reddish. Loss of feeling in
these skin patches is common. You may not feel a light touch or a prick with a needle.

How is the disease treated?

Hansen’s disease is treated with a combination of antibiotics. Typically, 2 or 3 antibiotics are
used at the same time. These are dapsone with rifampicin, and clofazimine is added for some
types of the disease. This is called multidrug therapy. This strategy helps prevent the
development of antibiotic resistance by the bacteria, which may otherwise occur due to length of
the treatment.

Treatment usually lasts between one to two years. The illness can be cured if treatment is
completed as prescribed.

Treatment

Hansen’s disease is treated with multidrug therapy (MDT) using a combination of antibiotics
depending on the form of the disease:

 Paucibacillary form – 2 antibiotics are used at the same time, daily dapsone and
rifampicin once per month
 Multibacillary form – daily clofazimine is added to rifampicin and dapsone.
Treatment usually lasts between one to two years. The illness can be cured if treatment is
completed as prescribed.

Laboratory Diagnostics

Hansen’s disease is diagnosed based on clinical presentation and the diagnosis is confirmed by
skin or nerve biopsy and acid fast staining
Skin and nerve biopsy
Biopsies are needed to definitively confirm a diagnosis of Hansen’s disease and to classify the
disease, and slit skin smear may also be helpful in diagnosing those with mutlibacillary disease.

tissue biopsy of various affected sites may reveal typical histopathologic changes that show large
numbers of foam cells.
Acid fast staining
The Ziehl-Neelson method using 5% sulphuric acid as decolorizing agent is used. The presence
of acid-fast bacilli confirms the diagnosis of Hansen’s disease.

This acid-fast-stained photomicrograph of a tissue sample extracted from a patient with leprosy
shows a chronic inflammatory lesion known as a granuloma, within which numerous red-
colored M. leprae bacteria are visible.