Symptoms o Painless skin patch accompanied by loss of sensation but not itchiness (Loss of sensation is a feature of tuberculoid leprosy, unlike lepromatous leprosy, in which sensation is preserved.) Chronic insensate patch is seen in the mage below.

o o o

Chronic insensate patch due to leprosy infection. Ho Chi Minh City, Vietnam. (Courtesy of D. Scott Smith, MD) Loss of sensation or paresthesias where the affected peripheral nerves are distributed Wasting and muscle weakness Foot drop or clawed hands (may result from neuritic pain and rapid peripheral


nerve damage; as seen in the image below) Characteristic clawed hand deformity caused by ulnar involvement in leprosy. Daloa, Ivory Coast. (Courtesy of D. Scott Smith, MD) Ulcerations on hands or feet (ulcer at the metatarsal head is seen in the image

below) Chronic nonhealing ulcer at the metatarsal head resulting from loss of sensation in the feet. Karigiri, Tamil Nadu, India. (Courtesy of Tara Ramachandra) o Lagophthalmos, iridocyclitis, corneal ulceration, and/or secondary cataract due to nerve damage and direct bacillary skin or eye invasion[7] Symptoms in reactions o Type 1 (reversal) - Sudden onset of skin redness and new lesions o Type 2 (erythema nodosum leprosum [ENL]; as seen in the image below) - Many skin nodules, fever, redness of eyes, muscle pain, and joint pain

 As the disease progresses. or serpiginous. as predilection is toward cooler zones. Redwood City.Common peroneal nerve  Neck . Physical The cardinal signs of leprosy include hypoesthesia. . Exposure: The incubation period of leprosy is long.Superficial radial cutaneous and median nerves  Popliteal fossa . ranging from a few months to 20-50 years.Ulnar nerve  Wrist . The subtype of leprosy often determines the degree of skin involvement.   Patient with erythema nodosum leprosum type 2 reaction several weeks after initiation of drug therapy.Great auricular nerve Physical findings in specific leprosy subtypes include the following: o Tuberculoid leprosy  The initial lesion is often a sharply demarcated hypopigmented macule that is ovoid. lesions tend to destroy the normal skin organs such as sweat glands and hair follicles. Scott Smith. skin lesions. The mean incubation time is estimated to be 10 years for lepromatous leprosy and 4 years for tuberculoid leprosy. MD) Travel: Leprosy should be considered in anyone who has lived in the tropics or who has traveled for prolonged periods to endemic areas. The lesions may be somewhat elevated with a dry scaly center and erythematous borders. and axilla are not normally involved because of the temperature differential in these zones. Because of immunologic reasons. circular. The perineum. (Courtesy of D. California.   Physical examination should include the following: o Evaluation of skin lesions o Careful sensory and motor examination o Palpation of peripheral nerves for pain or enlargement. only around 5-10% of the population is estimated to be susceptible to infection.  Common lesion sites include the buttocks. The organism's slow dividing time (once every 2 wk) contributes to the challenge of epidemiologically linking exposures to the development of disease. and extensor surfaces of limbs. This photograph was taken after tendon release. and peripheral neuropathy. with particular attention paid to the following locations:  Elbows . face. scalp. The first physical signs of leprosy are usually cutaneous.

loss of eyebrows and eyelashes. . or papules. Ho Chi Minh City. Common areas of involvement include the face. those in lepromatous leprosy have poorly defined borders and raised and indurated centers. MD)  The leonine facies associated with leprosy develop as the disease progresses. MD) Unlike lesions in tuberculoid leprosy. ears. The patient may experience severe neuropathic pain. As in all forms of leprosy. plaques. elbows. Multiple flat hypopigmented lesions are seen in the image below. and cutaneous nerves are sometimes enlarged. and typical hand impairments. indicative of ulnar neuropathy. Keratitis. California. Scott Smith. although visibly thickened and highly infected. Involvement of the eye may include keratitis. United States. lepromatous lesions are worst on cooler parts of the body.  Nerve involvement in lepromatous leprosy is not as severe as in tuberculoid leprosy.    Multiple flat hypopigmented lesions on shoulder and neck. Peripheral nerves are often involved and thickened asymmetrically. Hoarseness. Note ulceration of hypothenar area of hand. o Man with advanced deformities caused by unmanaged leprosy.  Axillary and inguinal adenopathy may develop. and nasal collapse secondary to septa perforation may occur in advanced cases of disease. since nerves. in addition to scarring of the testes and subsequent gynecomastia and sterility. (Courtesy of D. (Courtesy of D. Nerve involvement can also lead to trauma and muscle atrophy. which can include macules. or iridocyclitis as seen in the image below. Scott Smith. buttocks. Lepromatous leprosy  This form is characterized by extensive bilaterally symmetric cutaneous involvement. still function reasonably well in early stages of the disease. glaucoma. wrists. and the facial skin becomes thickened and corrugated. loss of eyebrow.o Superficial nerves that lead from the lesions tend to enlarge and are sometimes palpable. and knees. suggestive of multibacillary leprosy. nodules. Vietnam. Borderline tuberculoid leprosy: The lesions are few or moderate and asymmetric with almost complete anesthesia. thickened skin. Redwood City.

lepromatosis bacteria. or both clinical findings together often comprise the clinical diagnosis. Living near people with leprosy is associated with increased transmission. and cases of suspected zoonotic transmission have been reported. Indeterminate leprosy: Skin lesions are typically either hypopigmented or hyperpigmented macules or plaques. but cutaneous nerves are not. Peripheral nerves are often enlarged symmetrically. gram-positive bacillus is an obligate intracellular organism with a predilection for Schwann cells and macrophages. skin nodules. The route of transmission has not been definitively established. reduced blinking). Later. Leprosy is caused by an infection with Mycobacterium leprae or M. or a nerve biopsy may be done to help determine if other organ systems have been affected. Other tests such as CBC test. and they are asymmetrical and somewhat anesthetic. creatinine test. How is leprosy diagnosed? The majority of cases of leprosy are diagnosed by clinical findings. progressive disease that damages the skin and nervous system. Among household contacts. but cutaneous nerves are not. Leprosy is not spread by touch. but most of these are done by specialized labs and may help a clinician to place the patient in the more detailed Ridley-Jopling classification and are not routinely done (lepromin test. Other tests can be done. Skin smears or biopsy material that show acid-fast bacilli with the Ziehl-Neelsen stain or the Fite stain (biopsy) can diagnose multibacillary leprosy. phenolic glycolipid-1 test. and eye damage (dryness. large ulcerations. . The acid fast. skin lesions of hypopigmented macules (flat. loss of digits. Causes   M leprae is the causative agent associated with leprosy. Signs of leprosy are painless ulcers. Borderline lepromatous leprosy: Moderate to numerous slightly asymmetrical skin lesions appear with minor or no 10-fold in multibacillary and 2to 4-fold in paucibacillary forms. pale areas of skin). although human-to-human aerosol spread of nasal secretions is thought to be the most likely mode of transmission in most cases. Animal reservoirs do exist (armadillos. M leprae has not been successfully grown using artificial media. PCR. liver function tests.o o o Midborderline leprosy: The number of skin lesions is moderate. the relative risk for leprosy is increased 8. and facial disfigurement may develop. certain nonhuman primates). especially since most current cases are diagnosed in areas that have limited or no laboratory equipment available. thickened peripheral nerves. Patients may note that these lesions are anesthetic or paresthetic. or if bacteria are absent. diagnose paucibacillary leprosy. Hypopigmented patches of skin or reddish skin patches with loss of sensation. M leprae was discovered as the causative agent in 1873. Early symptoms begin in cooler areas of the body and include loss of sensation. which has been recognized as an infectious disease for the last 2 millennia. Leprosy (Hansen's Disease) At A Glance     Leprosy is a slowly developing. Peripheral nerves may be somewhat symmetrically enlarged. since the mycobacteria are incapable of crossing intact skin. lymphocyte migration inhibition test or LMIT).

    Leprosy (Hansen's disease) Last Reviewed: October 2011 What is leprosy? Leprosy is a chronic bacterial disease of the skin and nerves in the hands and feet and. Tissue damage is caused by the degree to which cell-mediated immunity is expressed.  Pathophysiology: The areas most commonly affected by leprosy are the superficial peripheral nerves. but household and prolonged close contact is important. The germs probably enter the body through the nose and possibly through broken skin. Lepromatous leprosy symptoms are a chronically stuffy nose and many skin lesions and nodules on both sides of the body. Leprosy is rarely transmitted from chimpanzees.   How soon after exposure do symptoms appear? It usually takes about four years for tuberculoid leprosy symptoms to appear and about eight years for lepromatous leprosy symptoms to appear. Leprosy is a rare disease in the United States. Antibiotics are used in the treatment of leprosy. the extent of bacillary spread and multiplication. lepra reactions). in some cases. Anyone can get leprosy. The germs get in the air through nasal discharge of untreated lepromatous patients. and nine-banded armadillos to humans by droplets or direct contact. mangabey monkeys. skin. and the development of nerve damage and its sequelae.     The infection is thought to be spread person to person by nasal secretions or droplets.  When and for how long is a person able to spread leprosy? .   What are the symptoms of leprosy? Tuberculoid leprosy symptoms are a few well-defined skin lesions that are numb. Susceptibility to getting leprosy may be due to certain human genes. M leprae is an obligate intracellular acid-fast bacillus with a unique ability to enter nerves.     Who gets leprosy? susceptible than adults. the lining of the nose. anterior chamber of the eyes. but children seem to be more How is leprosy spread? It is not clear how the leprosy germ is spread. mucous membranes of the upper respiratory tract. and testes. the appearance of tissue-damaging immunologic complications (ie. These areas tend to be cooler parts of the body.

What is the treatment for leprosy? Patients with leprosy should be treated by a doctor who has experience with the disease. immediate and annual examinations are recommended for at least five years after last contact with a person who is infectious.   How can leprosy be prevented? The best way to prevent the spread of leprosy is the early diagnosis and treatment of people who are infected. . For household contacts. a person will not infect others within a day of beginning treatment with multidrug therapy. Treatment is with multiple drugs for six months to two years.   In most cases.

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