Leprosy

Overview

Leprosy, alternatively known as Hansen’s Disease, is a chronic bacterial infection caused by Mycobacterium leprae. The disease may affect the skin, mucous membranes, or nerves. Initially triggered symptoms include pale or off-coloured skin patches, tingling or a feeling of numbness, muscle weakness, etc.

If left untreated, the later stages may lead to severe symptoms like high degrees of numbness, discolouration, or even deformity. Apart from experiencing physical disfigurement and the mental stress of going through a condition like leprosy, affected people are also faced with social stigmatisation.

What is Leprosy?

Leprosy is an anciently existing disease, known to cause nerve damage and disfigured sores. It is a chronic condition where the Mycobacterium leprae causes a bacterial infection, directly affecting the nerves, eyes, skin or mucous membranes. It can be spread via contact with an infected person, specifically, through mediums like respiratory droplets.

Leprosy, at an early stage, can be cured with the help of antibiotics (multidrug therapy) and professional care. However, if left untreated, it can lead to disability and disfigurement. Even with treatment options available, leprosy continues to be a huge public health concern with several cases being reported globally, especially from Africa and Asia.

Types of Leprosy

Not only have types of leprosy been categorised, but also the types of such types have been established. There are three different classifications of leprosy popularly recognised.
A. Based on a Person’s Immune Response: Firstly, here is a list of leprosy types based on a person’s immune response:

Tuberculoid Hansen’s Disease

In this type, the affected person's immune response is considered to be sufficient. The lesions are limited and the condition is only mildly contagious.

Lepromatous Hansen’s Disease

Here, the affected person's immune response is rather poor. The lesions are more in number and the condition is highly contagious.

Borderline Hansen’s Disease

This condition features characteristics of both the above-mentioned types, tuberculoid and lepromatous Hansen's disease.

B. Based on the Areas of the Skin Affected: The next categorisation is based on the areas of the skin affected, a classified by WHO:

Paucibacillary

Under this type, the affected individuals have, at most, five or fewer lesions and absolutely no bacteria detected in the tested skin samples.

Multibacillary

In this category, the affected person has more than five lesions and tested skin samples portray the presence of infection-causing bacteria.

C. Based on Severity of Symptoms: Finally, there’s a classification of five types of leprosy based on how severe the symptoms are. This is mainly used in clinical studies and is referred to as the Ridley-Jopling System:

Tuberculoid Hansen’s Disease

This type is recognised by a few flat lesions; some large and numb ones. There is also nerve involvement to a certain degree. While it can heal on its own, it can also get worse and progress to a dangerous state.

Borderline Tuberculoid Hansen’s Disease

In this type, the lesions are similar to tuberculoid Hansen's disease but are more widespread. It is also associated with more nerve involvement. This condition may persist, worsen or go back to the tuberculoid stage.

Mid-borderline Hansen’s Disease

This type manifests symptoms like reddish plaques, a moderate level of numbness and swollen lymph nodes. A higher amount of nerve involvement was available.

Borderline Lepromatous Hansen’s Disease

In this category, the affected person has many types of lesions including flat ones, raised bumps, plaques, and nodules. The individual experiences intense numbness in the affected areas.

Lepromatous Hansen’s Disease

This type is characterised by several lesions containing bacteria. Other symptoms include hair loss, severe degrees of nerve involvement with the peripheral nerve expanding, weakness in limbs, disfigurement, etc. This condition does not regress under any circumstance.

Symptoms of Leprosy

Leprosy primarily affects the eyes, insides of the nose, skin and peripheral nerves, ones outside the spinal cord and brain region. Some commonly recorded symptoms of leprosy include pale and flat, disfigured skin sores, bumps and lumps which do not heal even after several months.

Other associated symptoms include stiffening, drying or thickening skin, nasal congestion, skin growths, nosebleeds, and swelling or lumpy areas on the face and ears. As leprosy causes damage to the nerves, some resulting symptoms may be muscle weakness and loss of feeling in affected areas.

If the condition gets worse, symptoms shall get worse as well. Blindness, deformities on hands, nose or feet, general pain, redness, a burning sensation, thinning out of eyebrows/lashes, soles the feet, paralysis of hands/feet, short toes/fingers, etc. are other tell-tale signs of the Hansen disease’s later stage.

Causes of Leprosy

Coming in contact with the infection-spreading bacteria called Mycobacterium leprae, can cause Leprosy. Mycobacterium leprae only grows in living hosts, like in certain types of armadillos. So, specific types of armadillos can carry the disease-causing bacteria and spread it to humans. While most people have natural immunity towards the bacteria - people who don’t, are the ones that are truly vulnerable to leprosy.

One can develop leprosy by closely encountering an already infected person. The bacteria is transferred from one person to another via airborne channels, the droplets of infected cough and sneeze being examples of such mediums. However, the bacteria cannot be spread via simply hugging, holding hands or even through sexual contact.

Leprosy Diagnosis and Tests

Upon experiencing symptoms, one must visit a healthcare professional so they can start the treatment regimen at once. If the respective healthcare professional suspects that one may have Leprosy, a skin biopsy shall be conducted. A small sample of the issue will be collected and sent to the laboratory for testing.

Leprosy Management and Treatment

Leprosy can be treated through MDT, which is an abbreviation for multidrug therapy. This includes a combination of various antibiotics, prescribed for 6 - 12 months. Doctors typically prescribe three different antibiotics at once to the suffering individual so that their body does not build up resistance against a singular medicine.

Dapsone, clofazimine and rifampin are commonly prescribed antibiotics known to fight the Leprosy bacteria. However, there is no medication to cure nerve damage that may have resulted as a complication. Doctors often prescribe certain types of steroids to deal with the nerve pain.

Preventive Measures for Leprosy

As leprosy can be spread via airborne mediums, it is recommended that a healthy individual maintains the same degree of distance from an infected person, as a preventive measure. Early diagnosis and treatment can assure recovery, thus, it is recommended. In case an individual comes in contact with an infected person living within the same household, they must actively get examined and tested for the disease for, at least, the following five years, post-contact.

Myths and Facts Related to Leprosy

Here are some myths associated with leprosy and subsequently, the relevant factual alternatives:

Myth 1: Leprosy Doesn’t Exist Anymore
Fact: Leprosy is a disease that has been in existence for quite some time now. It still very much exists and around 200,000 people across Asian, African and South American countries are diagnosed per year.

Myth 2: Only Poor People Get Leprosy
Fact: Leprosy is not limited to poor people, and can happen to anybody with a weakened immune system. While it is true that the disease is more likely to spread in poorer areas, due to their limited resources to keep up proper sanitation - it ultimately depends upon the person’s immune system.

Myth 3: Leprosy Can Cause the Body Parts to Fall Off
Fact: Body parts will not fall off due to leprosy. However, later stages of the condition can cause disfigurations of the body. With the presence of untreated wounds, high degrees of inflammation can lead to amputation.