How is leprosy diagnosed. What are the symptoms of Hansen’s disease. How is leprosy treated. What complications can arise from untreated leprosy. Why is early diagnosis crucial for leprosy patients.

The Fundamentals of Leprosy: An Overview of Hansen’s Disease

Leprosy, also known as Hansen’s disease, is a chronic infectious condition caused by the bacterium Mycobacterium leprae. This slow-growing bacterium primarily affects the skin, peripheral nerves, eyes, and nasal lining. Despite its ancient reputation as a highly contagious and cursed affliction, modern medicine has demystified leprosy and proven it to be far less transmissible than once believed.

The term “leprosy” carries a heavy historical burden, often associated with social stigma and isolation. However, it’s crucial to understand that the biblical concept of leprosy (tzaraat) differs from the medical condition we know today. The misuse of the term “leper” as a synonym for outcast is considered offensive to those affected by the disease.

Historical Misconceptions vs. Modern Understanding

For centuries, leprosy was shrouded in mystery and fear. People believed it to be highly contagious and a divine punishment for sins. This led to the cruel isolation of those affected. Today, we know that while leprosy is indeed contagious, it’s not as easily transmitted as once thought. This knowledge has transformed the approach to treatment and patient care.

Recognizing the Signs: Symptoms of Leprosy

One of the challenges in diagnosing leprosy early is its long incubation period. Symptoms may not appear for at least a year after infection, with most cases developing signs only 5-7 years later. This delayed onset can make it difficult to pinpoint the exact moment of infection.

Common Symptoms of Leprosy

• Skin patches that appear lighter or darker than surrounding skin
• Reddish skin patches
• Loss of feeling in affected skin areas
• Numbness in hands, arms, feet, and legs
• Muscle weakness

It’s important to note that these symptoms can vary in severity and combination depending on the type of leprosy and the stage of the disease.

Diagnostic Procedures: Confirming Leprosy

Accurate diagnosis of leprosy is crucial for proper treatment and prevention of complications. Healthcare providers use a combination of clinical examination and laboratory tests to confirm the presence of M. leprae.

Key Diagnostic Steps

1. Physical examination: Doctors look for characteristic skin patches and test for loss of sensation.
2. Skin biopsy: A small sample of skin is taken to examine under a microscope for the presence of bacteria.
3. Nerve biopsy: In some cases, a small piece of nerve tissue may be examined.
4. Additional tests: To rule out other skin conditions that may present similar symptoms.

Can leprosy be diagnosed through blood tests? While blood tests can provide supportive information, they are not the primary means of diagnosis. The gold standard for leprosy diagnosis remains the identification of acid-fast bacilli in skin smears or biopsy specimens.

Treatment Strategies: Combating Leprosy Effectively

The good news is that leprosy is curable with timely and appropriate treatment. The World Health Organization (WHO) recommends a multidrug therapy (MDT) approach to treat leprosy effectively and prevent drug resistance.

Multidrug Therapy for Leprosy

The standard treatment regimen typically includes a combination of the following antibiotics:

• Dapsone
• Rifampicin
• Clofazimine (added for certain types of leprosy)

How long does leprosy treatment last? The duration of treatment usually ranges from one to two years, depending on the type and severity of the infection. It’s crucial for patients to complete the full course of antibiotics as prescribed to ensure complete eradication of the bacteria.

Important Considerations During Treatment

Patients undergoing leprosy treatment should be aware of the following:

• Report any new numbness or loss of feeling to their healthcare provider
• Take extra precautions to prevent injuries due to loss of sensation
• Continue treatment until the doctor confirms it’s complete
• Inform the doctor of any skin patches becoming red and painful, nerve pain or swelling, or fever development

Complications of Untreated Leprosy: The Importance of Early Intervention

If left untreated, leprosy can lead to severe complications affecting various parts of the body. These complications underscore the critical importance of early diagnosis and treatment.

Potential Complications

• Nerve damage leading to paralysis and deformity of hands and feet
• Loss of sensation resulting in unnoticed injuries
• Reabsorption of digits, causing apparent loss of fingers and toes
• Corneal ulcers and potential blindness due to facial nerve damage
• Loss of eyebrows
• Saddle-nose deformity from nasal septum damage

Why is early diagnosis crucial in leprosy? Early detection and treatment can prevent the progression of the disease and the development of these severe complications. While antibiotics can cure the infection, they cannot reverse nerve damage or physical deformities that have already occurred.

Specialized Care: Treatment Centers for Leprosy

In the United States, individuals diagnosed with Hansen’s disease have access to specialized treatment facilities. The National Hansen’s Disease Program operates several federally supported outpatient clinics throughout the country and Puerto Rico.

Benefits of Specialized Leprosy Treatment Centers

• Expertise in managing complex cases
• Access to the latest treatment protocols
• Comprehensive care addressing both medical and social aspects of the disease
• Support for patients and families in managing the condition

These specialized centers play a crucial role in not only treating the disease but also in educating patients, healthcare providers, and the public about leprosy.

Breaking the Stigma: Modern Perspectives on Leprosy

Despite significant advancements in understanding and treating leprosy, social stigma remains a challenge for many affected individuals. Education and awareness are key to breaking down these barriers and ensuring that people with leprosy receive the support and care they need.

Dispelling Common Myths

• Myth: Leprosy is highly contagious
• Fact: It’s actually difficult to contract leprosy, requiring prolonged close contact with untreated individuals
• Myth: Leprosy always leads to severe disfigurement
• Fact: Early diagnosis and treatment can prevent most complications
• Myth: People with leprosy need to be isolated
• Fact: Modern treatment allows patients to live normal lives without risk to others

How can society support individuals affected by leprosy? By promoting education, challenging stereotypes, and ensuring equal access to healthcare and social services, we can create a more inclusive environment for those affected by Hansen’s disease.

Research and Future Prospects: Advancing Leprosy Care

Ongoing research into leprosy continues to improve our understanding of the disease and enhance treatment options. Scientists are exploring new diagnostic tools, more effective drug combinations, and potential vaccines.

Current Areas of Research

• Development of rapid diagnostic tests
• Investigation of new antibiotic regimens to shorten treatment duration
• Studies on the transmission of M. leprae
• Exploration of genetic factors influencing susceptibility to leprosy

What are the prospects for a leprosy vaccine? While there is currently no vaccine specifically for leprosy, the BCG vaccine (used for tuberculosis) offers some protection. Researchers are working on developing more targeted vaccines that could prevent leprosy infection or reduce its severity.

As our knowledge of leprosy continues to grow, so does our ability to combat this ancient disease. With continued research, improved treatments, and efforts to reduce stigma, we move closer to a world where leprosy no longer poses a significant threat to public health.

Understanding leprosy – its symptoms, diagnosis, and treatment – is crucial not only for those affected by the disease but for society as a whole. By dispelling myths and promoting accurate information, we can ensure that individuals with Hansen’s disease receive timely, effective care and support. As we look to the future, ongoing research and public health initiatives offer hope for further advancements in leprosy prevention and treatment, potentially leading to its eventual elimination as a public health concern.

Diagnosis and Treatment | Hansen’s Disease (Leprosy)

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.

To confirm the diagnosis, your doctor will take a sample of your skin or nerve (through a skin or nerve biopsy) to look for the bacteria under the microscope and may also do tests to rule out other skin diseases.

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.

If you are treated for Hansen’s disease, it’s important to:

• Tell your doctor if you experience numbness or a loss of feeling in certain parts of the body or in patches on the skin. This may be caused by nerve damage from the infection. If you have numbness and loss of feeling, take extra care to prevent injuries that may occur, like burns and cuts.
• Take the antibiotics until your doctor says your treatment is complete. If you stop earlier, the bacteria may start growing again and you may get sick again.
• Tell your doctor if the affected skin patches become red and painful, nerves become painful or swollen, or you develop a fever as these may be complications of Hansen’s disease that may require more intensive treatment with medicines that can reduce inflammation.

If left untreated, the nerve damage can result in paralysis and crippling 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 or blindness can also occur if facial nerves are affected, due to loss of sensation of the cornea (outside) of the eye. Other signs of advanced leprosy may include loss of eyebrows and saddle-nose deformity resulting from damage to the nasal septum.

Antibiotics used during the treatment will kill the bacteria that cause leprosy. But while the treatment can cure the disease and prevent it from getting worse, it does not reverse nerve damage or physical disfiguration that may have occurred before the diagnosis. Thus, it is very important that the disease be diagnosed as early as possible, before any permanent nerve damage occurs.

In the U.S., people with Hansen’s disease may be treated at special clinics run by the National Hansen’s Disease ProgramExternal. There are several federally supported outpatient clinicsExternal throughout the U.S. and Puerto Rico.

• National Hansen’s Disease ProgramExternal
• Information for Healthcare Professionals

What Is Leprosy? Symptoms, Causes, Diagnosis, Treatment, and Prevention

By Holly PevznerMedically Reviewed by Jane Yoon Scott, MD

Reviewed: January 19, 2023

Medically Reviewed

For centuries, leprosy was considered a highly contagious and dangerous disease that only struck — and deformed — those who were unlucky enough to be cursed. (1) In fact, biblical leprosy (tzaraat) not only refers to a skin condition, but also “the state of ritual impurity” and punishment for sins. The real meaning of leprosy was simply lost in translation somewhere along the way. (2) Even today, the term “leper” is widely used to mean an outcast, and that’s highly offensive to the hundreds of thousands of people affected by the disease today. (3)

Despite the lingering mystery and stigma, the medical community now understands that leprosy, also known as Hansen’s disease, is a chronic and progressive infectious disease caused by a slow-to-grow bacterium called Mycobacterium leprae (M. leprae). (3)

This bacterium invades the skin, eyes, nasal lining, and peripheral nerves (nerves outside the brain and spinal cord). (3) And while leprosy is, in fact, contagious, it’s not nearly as transmissible as was thought in ancient times, which means that isolating those infected is never warranted. (1,4)

Having light or dark spots on the back, arms, or legs is a common symptom of leprosy.Prawet Thadthiam/Shutterstock

Signs and Symptoms of Leprosy

Unfortunately, there are usually no immediate leprosy symptoms to clue you in that you’ve become infected by M. leprae. Instead, it can take at least a year to develop symptoms, with most people showing signs of leprosy only five to seven years after contracting the disease. (5)

In general, leprosy affects the skin (in the form of rashes, lesions, and bumps) and the peripheral nerves. Numbness on skin spots, loss of feeling in the hands and feet, and muscle weakness are all symptoms of peripheral nerve loss. Leprosy symptoms vary depending on how far the disease has progressed. In some of the worst cases, where leprosy hasn’t been treated in a timely manner, disfigurement and blindness can occur. (4) Some symptoms of leprosy include:

• Spots on the Skin These usually appear on the arms, legs, or back. They may be darker or lighter than normal skin, or slightly red. (3) They don’t burn or hurt, but they may become raised, and nodules may form. (1)
• Painless Swelling This occurs on the face and earlobes. (6)
• Eye Issues Light sensitivity can be an early symptom. (7) And if the disease has invaded facial nerves, the blinking reflex can be lost, which can lead to dry eyes, ulcers, and even blindness. (3)
• Hair Loss The skin spots may lose hair, and eyebrows or eyelashes may fall out. (3,6)
• Numbness and Tingling Skin spots feel numb, and a loss of sensation can occur, first in a finger or toe, then progressing to hands and feet. Tingling can occur, too. (7)
• Foot Ulcers Painless ulcers may appear on the soles of the feet. (6)
• Dry, Cracked Skin If leprosy has damaged the nerves in the skin, this can cause sweat and oil glands to stop functioning, leading to dry and cracked skin on the hands and feet. (1)
• Curled Fingers Over time, the small muscles in the hands can become paralyzed, and fingers and thumbs can curl. (3)
• Muscle Weakness This can be experienced in the hands and feet. (6)
• Injury to Extremities Loss of feeling can increase chances of injury due to burns, cuts, and destructive pressure on hands and feet. (1)
• Facial Deformities If the disease is left untreated, bacteria can enter the mucous lining of the nose, leading to internal scarring that may cause the nose to collapse. (3)
• Sexual Dysfunction Men with more severe leprosy may have erectile dysfunction and become infertile. (8)

Causes and Risk Factors of Leprosy

M. leprae is the slow-growing bacterium behind leprosy. If a person’s immune response to the bacterium is weak — or does not occur at all — M. leprae can spread through the skin, the peripheral nerves, and, at times, into deeper tissues. (4) Fortunately, more than 95 percent of people around the world are naturally immune to M. leprae, making leprosy a rare disease. (8) Those who are more at risk for contracting leprosy include:

• People Living in High-Risk Areas In 2018, 71 percent of leprosy cases were in Southeast Asia. The Americas and Africa represented 15 and 10 percent of new cases, respectively. Meanwhile, the countries with the most new cases were India, Indonesia, and Brazil. In 2017, 14 countries reported at least 1,000 new cases of leprosy, including Brazil, India, Indonesia, Bangladesh, Democratic Republic of Congo, Madagascar, Myanmar, Philippines, Mozambique, Ethiopia, Nepal, Nigeria, Sri Lanka, and Tanzania. (9)
• Gene Susceptibility It’s thought that those who contract leprosy have genes that make them susceptible to the infection once exposed. (8) Susceptibility to leprosy tends to run in families, but the inheritance pattern is still unknown. (4)
• Ethnicity Individuals of Asian and Pacific Islander descent have elevated odds of contracting multibacillary leprosy (see more on this below). Right now, the reason is unknown. (10)
• Children They are more susceptible to developing leprosy than adults. (11) But in the United States, the occurrence of leprosy in children is still rare. (12)
• Individuals With Weakened Immune Systems People with chronic diseases like diabetes, HIV, or heart disease may be more likely to develop leprosy. (5)
• Contact With an Armadillo This may sound odd, but individuals who’ve either handled the animal or simply spent time outdoors in an area where armadillos live are at an elevated risk. (7) Armadillos carrying the bacteria have been found mostly in the Southern United States, including Arkansas, Alabama, Louisiana, Mississippi, Texas, and Florida. Scientists estimate that more than 100,000 armadillos carry the bacteria here. (13)

How Is Leprosy Diagnosed?

If you suspect that you may have leprosy and you are in the United States, know that your dermatologist or general practitioner may not have leprosy top-of-mind during the examination process, since the disease is so rare in this country. Physicians in the United States are likely unfamiliar with leprosy symptoms. (8) To diagnose leprosy, healthcare workers look for at least one of these fundamental signs:

• At least one discolored (pale or reddish) and numb patch of skin.
• One or more thickened or enlarged peripheral nerves with loss of sensation.
• Positive skin smear results. Here, a modest incision is made in the affected skin, and a sample is extracted. The sample is then examined for the presence of the bacterium. (1,15,16)

Next, to confirm a diagnosis of leprosy, a skin or nerve biopsy is performed. For the skin biopsy, a sample is taken from the edges of skin patches to be further examined under a microscope. And for the nerve biopsy, a small piece of material is extracted from a thickened peripheral nerve to be more closely examined. (16)

While some serological tests (blood tests that look for antibodies) have been developed to detect leprosy, right now they’re not sensitive enough to be relied upon for diagnosis. (16)

Leprosy occurs on a continuum: Some cases are mild, affecting a few areas of skin, while others are more severe, affecting many skin areas and causing damage to nerves and organs that can lead to disfigurement. While some physicians and researchers use a more complex system to define and categorize various forms of leprosy, most use the following two-pronged, more simplified classification. (5)

Paucibacillary Leprosy (PB) This classification, which includes indeterminate, tuberculoid, and borderline tuberculoid leprosy, is based on a negative skin smear, meaning patients have relatively few bacteria in the skin and nerves. With PB leprosy, individuals most likely have five or fewer affected skin areas, although sometimes there are more. (8)

Multibacillary Leprosy (MB) Individuals in this category have a large number of bacteria present in their skin and nerves, and their symptoms are more widespread. Those with MB leprosy tend to have six or more affected skin areas. Patients may experience thickening of the peripheral nerves and organs, such as the eyes, nose, and testicles; bones may also be involved. Multibacillary leprosy encompasses mid-borderline, borderline lepromatous, and lepromatous leprosy. (1,5,8)

Prognosis of Leprosy

With oral antibiotics and prompt treatment, leprosy is curable. In fact, most individuals diagnosed with leprosy in the United States have little or no disability upon diagnosis. In addition, the majority of people with leprosy are able to carry on with normal activities during treatment with little interruption. (17)

If recent nerve damage is present at diagnosis, prompt treatment may be able to improve the damage or stave off further issues. Unfortunately, if nerve damage occurred years prior to diagnosis, recovery isn’t possible and disabilities become permanent. (17)

If significant nerve damage occurs, a long-term management plan involving a variety of healthcare professionals, such as physicians, an occupational therapist, physical therapist, ophthalmologist, and podiatrist, can help prevent disability. Some ways this can be achieved include:

• Splints to immobilize and protect specific nerves from harm
• Contoured eye mask at night to protect eyes from dryness
• Prescribed footwear and orthotics to shield feet from injury and ulceration
• Tendon release procedure, such as toe flexor release, to help relieve pressure
• Education on how to compensate for lack of pain sensation, such as frequent extremity inspection and protective equipment (17)

Duration of Leprosy

Once treatment begins, it usually takes one to two years to be completely rid of the disease. That said, nerve damage or physical disfiguration that occurs as a result of leprosy cannot be reversed. (18)

Treatment and Medication Options for Leprosy

Leprosy is a highly treatable — and even curable — disease, especially when diagnosed early before any permanent nerve damage has occurred. (8) Here’s how leprosy should be treated, according to the World Health Organization’s latest guidelines from 2018.

Leprosy should be combated with a combination of three drugs, consisting of rifampin (Rifadin), dapsone (Aczone), and clofazimine (Lamprene). (15) This plan of action, called multidrug therapy (MDT), is prescribed in order to prevent antibiotic resistance. After just a few doses — which are generally given at home — individuals become noninfectious. (1,3)

Treatment for paucibacillary leprosy should last six months; treatment for multibacillary leprosy should extend to 12 months. For those who are resistant to the above meds, alternatives like clarithromycin (Biaxin), minocycline (Minocin), or a quinolone may be used — and treatment may take longer. (15) Unlike in the past, when quarantine was a given, today individuals with leprosy do not require isolation. (1)

Side effects of MDT are generally mild and temporary — and serious side effects are rare. These side effects may include darkening of the skin, dry skin, or scaliness and are best treated with acetaminophen (Tylenol), ibuprofen (Advil), or corticosteroids. (19)

Prevention of Leprosy

It’s still not entirely known how leprosy is transmitted, but it’s widely believed that it’s spread through the respiratory tract. This means that people can contract leprosy by inhaling droplets expelled through the coughing or sneezing of an infected person. (8) Even then, roughly half of those with leprosy likely contracted the disease not through a rogue sneeze or cough, but through close, extended contact with an infected individual. (8) Transmission of the disease from mother to child during pregnancy has been reported. (9)

It’s also possible to contract leprosy through contact with an infected armadillo. Some of these animals, which are found in the southern United States, are naturally infected with the bacteria that cause leprosy. While the risk of getting leprosy from an infected armadillo is extremely low, it’s still advisable to avoid contact of any kind with these animals.

Leprosy is not spread via sexual intercourse or casual contact, such as shaking hands or sitting next to an individual with the disease. (20)

If left untreated, leprosy can produce catastrophic deformity.Ville Palonen/Alamy

Complications of Leprosy

As many as half of all those with leprosy have reactions to multidrug therapy; these reactions can include pain and swelling in the skin and nerves, fever, muscle aches, and pain and redness in the eyes. (3) These types of reactions, however, do not mean that the disease is worsening or that the medications aren’t working. Instead, they’re a sign that multidrug therapy is succeeding: These symptoms are the body’s reaction to the now dead M. leprae lingering in the system. (It can take years for the body to completely rid itself of all the dead bacteria.)

Some people experience these reactions before multidrug therapy has even started. In those cases, the body is reacting to bacteria that its own immune system has killed. Reaction may occur on and off for a period of time, and reactions can differ depending on the type of leprosy. (1) For instance:

• Those with paucibacillary leprosy may experience type 1 reactions or reversal reactions that involve swelling or reddening of preexisting lesions. (21)
• Those with multibacillary leprosy may experience type 2 reactions or erythema nodosum leprosum (ENL), (21) which is characterized by fever; raised, red, painful skin nodules; and possible nerve pain and tenderness. (Joint issues, eye inflammation, and inflammation of the testicles may also occur.) (1)
• People of Mexican ancestry may experience something called Lucio’s phenomenon. This is a rare reaction involving difficult-to-heal ulcers, and it affects those with multibacillary leprosy. (21)

Whether the reactions are experienced before or after MDT, it’s important to treat them quickly, as they increase one’s chances of nerve damage to the eyes, hands, and feet. Some reactions can be quelled with over-the-counter medicines, such as aspirin (Vazalore) or acetaminophen, while others require a prescription for prednisone (Deltasone) or thalidomide (Thalomid). (1)

Finally, it’s possible for leprosy relapse to occur 20 years after MDT: 0.8 percent of multibacillary patients and between 0.6 and 3 percent of paucibacillary patients experience relapse. Having a high bacterial load before starting treatment, experiencing a large number of lesions, and inadequate or irregular therapy increases the risk of relapse. (9)

Research and Statistics: Who Has Leprosy?

Roughly 250,000 new cases of leprosy are diagnosed every year, with between 100 and 250 occurring in the United States. (4)

Of new U.S. cases, 72 percent were reported in Arkansas, California, Florida, Hawaii, Louisiana, New York, and Texas. (23)

The largest proportion of people with cases of leprosy in the United States identified as Asian or South Pacific Islander.  (23)

Leprosy has been reported among individuals from every state. (17)

Since the 1990s, roughly 175 new leprosy cases are reported annually in the United States. (17)

Asian and Pacific Islanders and Leprosy

Compared with folks living in other nations, individuals residing in Asian and Pacific Island countries have a higher chance of contracting multibacillary leprosy. Right now, the reason for this remains unclear, but it’s been speculated that, perhaps, factors like genetics, comorbidities, micronutrient deficiencies, or a limited gene pool within an island nation may be contributing factors. (10)

Not much is known about the relationship between specific ethnic groups in the United States and their risk of leprosy. But it has been noted that individuals living in the States who are of Micronesian and Marshallese descent are also at an elevated risk of MB. Leprosy is more prevalent in Southeast Asian immigrants living in Toronto, as well. Still, there’s currently no research to show why this ethnic group is more susceptible to MB. (10)

Related Conditions of Leprosy

As discussed above, if left untreated, leprosy can lead to a number of other conditions, such as neuropathy, blindness, erectile dysfunction, hair loss, and muscle weakness.

Resources We Love

National Organization for Rare Diseases

This patient advocacy organization promotes education, awareness, treatment, and support for individuals with rare diseases. They also partner with patient organizations to better serve affected communities. In addition to detailed info about leprosy, NORD provides links to other supporting organizations.

World Health Organization

A vital source for the latest data on leprosy along with news about the infection, the WHO is actively working to eliminate leprosy worldwide by 2030, promoting better detection, contact tracing, and treatment.

FamilyDoctor.org

This website from the American Academy of Family Physicians provides a wealth of information on various conditions, including leprosy — from symptoms and treatment options to questions to ask your doctor if you think you might have leprosy or you have been diagnosed with it.

Centers for Disease Control and Prevention

The CDC provides up-to-date info on symptoms, transmission, diagnosis, and treatment, as well as a feature on World Leprosy Day, observed annually on the last Sunday of January: “Bust the Myths, Learn the Facts” examines the real burdens and challenges of Hansen’s disease while clearing up the misconceptions that still surround it.

Editorial Sources and Fact-Checking

1. Leprosy. National Organization for Rare Diseases. April 8, 2009.
2. Grzybowski A, Nita M. Leprosy in the Bible. Clinics in Dermatology. January–February 2016.
3. About Leprosy. American Leprosy Missions.
4. Leprosy. MedlinePlus. February 1, 2018.
5. Leprosy. World Health Organization. January 11, 2022.
6. Hansen’s Disease (Leprosy): Signs and Symptoms. Centers for Disease Control and Prevention. January 6, 2017.
7. Leprosy Still Occurs in the United States: Are You At Risk? American Academy of Dermatology. February 10, 2017.
8. Nardell EA. Leprosy (Hansen Disease; Hansen’s Disease). Merck Manual. September 2022.
9. Mungroo MR, Khan NA, Siddiqui R. Mycobacterium Leprae: Pathogenesis, Diagnosis, and Treatment Options. Microbial Pathogenesis. December 2020.
10. McCormick CD, Lea J, Stryjewska BM, et al. Trends of Leprosy and Multibacillary Infection in the State of Georgia Since the Early 1900s.  PLoS Neglected Tropical Diseases. October 11, 2019.
11. Leprosy. American Academy of Family Physicians. March 2021.
12. Recommended Treatment Regimens. Health Resources and Services Administration. April 2018.
13. Aslam S, Peraza J, Mekaiel A, et al. Major Risk Factors for Leprosy in a Non-Endemic Area of the United States: A Case Series. IDCases. 2019.
14. Deleted, January 12, 2023.
15. Guidelines for the Diagnosis, Treatment, and Prevention of Leprosy [PDF]. World Health Organization. 2018.
16. Hansen’s Disease (Leprosy): Laboratory Diagnostics. Centers for Disease Control and Prevention. February 10, 2017.
17. NHDP Guide to the Management of Hansen’s Disease: National Hansen’s Disease Programs [PDF]. Health Resources and Services Administration.
18. Hansen’s Disease (Leprosy): Diagnosis and Treatment. Centers for Disease Control and Prevention. January 30, 2017.
19. White C, Franco-Paredes C. Leprosy in the 21st Century. Clinical Microbiology Reviews. January 2015.
20. Hansen’s Disease (Leprosy): Transmission. Centers for Disease Control and Prevention. February 10, 2017.
21. Hansen’s Disease (Leprosy): Reactive Episodes. Centers for Disease Control and Prevention. February 10, 2017.
22. Deleted, January 12, 2023.
23. Hansen’s Disease Data and Statistics. Health Resources and Services Administration. April 2017.

Show Less

By subscribing you agree to the Terms of Use and Privacy Policy.

Why Are Vaccination Rates So Low for People of Color?

The reasons for America’s vaccination disparities are complex and deeply rooted. Here one expert tells what it might take to change the status quo.

By Sheryl Nance-NashMay 24, 2023

New Studies Confirm Mpox Vaccine’s Effectiveness

Two doses of the Jynneos mpox vaccine prevent infection up to 86 percent of the time, and also offer protection against severe disease.

By Lisa RapaportMay 23, 2023

What Is Smallpox? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Smallpox, a deadly and highly contagious disease caused by a virus, was eradicated in the late 1970s after global vaccination efforts. Its telltale symptom…

By Joseph Bennington-CastroApril 30, 2023

What Is Babesiosis? Causes, Symptoms, Diagnosis, Treatment, and Prevention

Babesiosis is a rare disease spread by ticks that are infected with a microscopic parasite. It can cause flu-like symptoms such as fever and chills.

By Don RaufApril 24, 2023

Leprosy. What is Leprosy?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Leprosy is a systemic infectious process with a chronic course, caused by mycobacterium leprosy and accompanied by epidermal, visceral manifestations, as well as signs of damage to the nervous system. There are 4 clinical forms of leprosy: lepromatous, tuberculoid, undifferentiated and borderline. Typical signs of leprosy are skin manifestations (erythematous-pigmented spots, nodules, tubercles), polyneuritis, severe deformity and disfigurement of the face, limbs, etc. The diagnosis of leprosy is facilitated by a lepromine test, bacterioscopy and pathohistological examination of a biopsy from the affected foci. Treatment of leprosy is carried out for a long time, with repeated courses of antileprosy drugs.

ICD-10

A30 Leprosy [Gansen’s disease]

• Causes of leprosy
• Classification
• Symptoms of leprosy
  • Lepromatous leprosy
  • Tuberculoid leprosy
  • Undifferentiated and borderline leprosy
• Diagnostics
• Treatment of leprosy
• Prognosis and prevention
• Prices for treatment

General information

Leprosy (leprosy, Hansen’s disease) is a low-contagious infection that leads to generalized granulomatous lesions of integumentary tissues, peripheral nerves, in severe cases – the musculoskeletal system, eyes and internal organs. Leprosy is considered one of the oldest diseases of mankind, which for many centuries inspired ominous horror. In the Middle Ages, “lepers” were declared “dead alive”, were ostracized or isolated for life in specialized hospitals – leper colonies. Today, the attitude towards the disease has changed significantly, however, despite the availability of specific treatment, the problem of the incidence of leprosy remains relevant for a number of countries in Asia, Africa, and Latin America. According to various data, in the world from 3 to 12-15 million people are sick with leprosy; more than 500-800 thousand new cases of the disease are diagnosed annually.

Leprosy

Causes of leprosy

The discovery of the causative agent of leprosy – Mycobacterium leprae, belongs to the Norwegian doctor A. Hansen (1874). Mycobacterium leprosy is a gram-positive rod-shaped bacterium 1-7 µm long and 0.2-0.5 µm in diameter, similar in morphology and properties to Mycobacterium tuberculosis. Bacillus Hansen is an obligate intracellular parasite that infects tissue macrophages and has a pronounced tropism for the skin and nervous tissue.

Sources of leprosy infection are sick people who excrete pathogens with nasal mucus, saliva, breast milk, seminal fluid, urine, feces, discharge of ulcerated skin leprosy. Also, animals – armadillos and monkeys can be natural reservoirs of infection. Infection with mycobacterium leprosy occurs mainly by airborne droplets, less often – with damage to the skin or bites of blood-sucking insects. Cases of infection during tattooing are described.

Leprosy is considered a low contagious disease; usually infection is preceded by regular and prolonged contact with the patient. Healthy people have a high natural resistance to leprosy. To a greater extent, children are susceptible to leprosy infection, as well as persons suffering from chronic intercurrent diseases, alcoholism, and drug addiction. The reliable duration of the incubation period has not been established; according to various authors, it can range from 2-3 months to 20 or more years (average 3-7 years).

Classification

According to the generally accepted classification, there are 4 main clinical types of leprosy: lepromatous, tuberculoid, undifferentiated and borderline (dimorphic). Undifferentiated leprosy is considered an early manifestation of the disease, from which two polar clinical and immunological variants develop later – lepromatous or tuberculoid. The most malignant type, lepromatous leprosy, is characterized by the presence of large amounts of mycobacteria in the body and the negative nature of the lepromine test. With a relatively favorable, tuberculoid type of leprosy, on the contrary, there is a small amount of the pathogen and a positive lepromine reaction.

During each of the variants of leprosy, there are stationary, progressive, regressive and residual stages. The first two stages are characterized by leprosy reactions – exacerbation of foci of the disease, despite ongoing therapy.

Symptoms of leprosy

Lepromatous leprosy

The most unfavorable clinical variant of leprosy, occurring with generalized lesions of the skin, mucous membranes, eyes, peripheral nerves, lymph nodes, internal organs. Skin syndrome is characterized by the presence of symmetrical erythematous spots on the face, hands, forearms, shins, buttocks. At first, they are red, round or oval in shape, with a smooth shiny surface, but over time they become brown-rusty in color. After months and even years, the skin in the area of ​​​​these rashes thickens, and the elements themselves turn into infiltrates and tubercles (lepromas).

In the area of ​​infiltrates, the skin has a bluish-brown color, increased greasiness, enlarged pores. Sweating in the areas of the affected skin first decreases, then completely stops. There is a loss of eyebrows, eyelashes, beards, mustaches. Diffuse infiltrative changes lead to a deepening of natural wrinkles and folds of the skin of the face, a thickening of the nose, superciliary and zygomatic arches, a violation of facial expressions, which is why the face of a patient with leprosy is disfigured and takes on a ferocious look (“lion’s face”). Already in the early stages, lepromas are formed in infiltrative foci – painless tubercles ranging in size from 1-2 mm to 2-3 cm, located hypodermally or dermally.

On the smooth glossy surface of leprosy, areas of skin peeling, telangiectasia can be determined. Left untreated, lepromas ulcerate; healing of ulcers occurs for a long time with the formation of a keloid scar. The skin of the armpits, elbows, popliteal, inguinal regions, scalp is not affected.

In lepromatous leprosy, the eyes are often involved in the pathological process with the development of conjunctivitis, episcleritis, keratitis, iridocyclitis. Typical interest of the mucous membrane of the oral cavity, larynx, tongue, red border of the lips and especially the nasal mucosa. In the latter case, nosebleeds, rhinitis occur; in the future – infiltration and leprosy. With the development of leprosy in the area of ​​​​the cartilaginous septum of the nose, its perforation may occur and deformity of the nose may occur. The defeat of the larynx and trachea in the lepromatous type of leprosy leads to a violation of the voice up to aphonia, stenosis of the glottis. Visceral lesions are represented by chronic hepatitis, prostatitis, urethritis, orchitis and orchiepididymitis, nephritis. Involvement in a specific process of the peripheral nervous system proceeds according to the type of symmetrical polyneuritis. With leprosy, sensitivity disorders, trophic and motor disorders (paresis of facial muscles, contractures, trophic ulcers, mutilations, atrophy of the sweat and sebaceous glands) develop.

The course of lepromatous leprosy is characterized by periodic exacerbations (lepromatous reactions), during which there is an increase and ulceration of leprosy, the formation of new elements, fever, polylymphadenitis.

Tuberculoid leprosy

Tuberculoid leprosy is more benign with lesions of the skin and peripheral nerves. Dermatological signs are characterized by the appearance of hypochromic or erythematous spots with clear contours on the skin of the face, trunk, upper extremities. Along the periphery of the spots, flat, dense papules of a reddish-violet hue appear, resembling lichen planus. Merging with each other, papules form plaques of an annular configuration (curly tuberculoid), in the center of which an area of ​​depigmentation and atrophy appears. In the affected areas of the skin, the functions of the sweat and sebaceous glands decrease, dryness and hyperkeratosis develop, and vellus hair falls out. Tuberculoid leprosy often affects the nails, which become dull gray, thickened, deformed, and brittle.

Due to damage to the peripheral nerves, leprosy is accompanied by a violation of temperature, tactile and pain sensitivity. The lesions of the facial, radial and peroneal nerves are more common: they thicken, become painful and well palpated. The consequence of pathological changes in the peripheral nerves are paresis and paralysis, muscle atrophy, trophic foot ulcers, contractures (“pincer hand”, “seal foot”). In advanced cases, resorption of the phalanges and shortening (mutilation) of the hands and feet may occur. Internal organs in tuberculoid leprosy, as a rule, are not affected.

Undifferentiated and borderline leprosy

In the undifferentiated type of leprosy, typical dermatological manifestations are absent. At the same time, asymmetric areas of hypo- or hyperpigmentation appear on the skin of patients with this form of leprosy, accompanied by a decrease in skin sensitivity and anhidrosis. Damage to the nerves proceeds according to the type of polyneuritis with paralysis, deformity and trophic ulceration of the extremities.

Skin manifestations of borderline leprosy are represented by asymmetric pigmented spots, individual nodes or prominent plaques of stagnant red color. Usually rashes are localized on the lower extremities. Neurological manifestations include asymmetric neuritis. In the future, undifferentiated and borderline leprosy can be transformed into both lepromatous and tuberculoid forms.

Diagnosis

Leprosy is not such a forgotten disease, and doctors of various specialties are likely to encounter it in clinical practice: infectious disease specialists, dermatologists, neurologists, etc. Therefore, one should be alert and exclude a leprosy process in patients with long-term non-regressing skin rashes (erythema, age spots, papules, infiltrates, tubercles, nodes), violation of various types of sensitivity in certain areas of the skin, thickening of the nerve trunks and other typical manifestations. A more accurate diagnosis allows bacterioscopic detection of mycobacteria leprosy in scrapings of the nasal mucosa and affected areas of the skin, histological preparations of leprous tubercles and lymph nodes.

The results of the reaction to lepromin allow differentiating the type of leprosy. Thus, the tuberculoid form of leprosy gives a sharply positive lepromine test; lepromatous form – negative. In undifferentiated leprosy, the reaction to the lepromatous antigen is weakly positive or negative; with borderline leprosy – negative. Functional tests with nicotinic acid, histamine, mustard plaster, Minor’s test have less specificity.

Leprosy should be differentiated from a number of diseases of the skin and peripheral nervous system. Among dermatological manifestations, rashes in the tertiary period of syphilis, exudative erythema multiforme, toxicoderma, tuberculosis and sarcoidosis of the skin, lichen planus, leishmaniasis, erythema nodosum, etc., have similarities with leprosy. Syringomyelia, neuritis of traumatic genesis, Charcot’s neural amyotrophy -Marie-Tuta, etc.

Treatment of leprosy

Leprosy is currently a curable disease. With widespread skin manifestations, positive microscopy results, or relapses of leprosy, patients are hospitalized in special anti-leprosy facilities. In other cases, patients receive outpatient therapy at the place of residence.

Treatment of leprosy is carried out for a long time and in a complex, course method. At the same time, 2-3 antileprosy drugs are prescribed, the main of which are sulfonic drugs (diaminodiphenylsulfone, sulfametrol, etc.). In order to avoid the development of drug resistance, drugs and their combination are changed every 2 courses of treatment. The duration of a course of specific treatment for leprosy is several years. Antibiotics (rifampicin, ofloxacin), immunocorrectors, vitamins, adaptogens, hepatoprotectors, iron preparations are also used. In order to increase immunoreactivity in patients with leprosy, BCG vaccination is indicated.

To prevent disability from the very beginning of treatment, patients with leprosy are prescribed massage, exercise therapy, mechanotherapy, physiotherapy, wearing orthopedic aids. Important components of complex rehabilitation are psychotherapy, professional reorientation, employment, overcoming leprophobia in society.

Prognosis and prevention

The prognosis of leprosy depends on the clinical form of the pathology and the timing of the start of therapy. Early diagnosis and initiation of treatment (within a year of the onset of leprosy symptoms) can avoid disabling consequences. In the case of later detection of leprosy, sensory disturbances, paresis, and disfiguring deformities persist. If untreated, the death of patients can occur from leprosy cachexia, asphyxia, amyloidosis, intercurrent diseases.

The leprosy prevention system provides for mandatory registration and registration of patients, hospitalization of newly diagnosed patients, dispensary monitoring of family members and contact persons. General preventive measures are aimed at improving the conditions and quality of life, strengthening immunity. Persons who have had leprosy are not allowed to work in the food and communal sectors, children’s and medical institutions; cannot change their country of residence.

You can share your medical history, what helped you in the treatment of leprosy.

Sources

1. treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

   Not only in books and movies: who and how is now infected with plague, leprosy and anthrax

   Plague

   The name of this disease has long become a household name – “like the plague” they were afraid of something very terrible, the plague “on both your houses” was called on the heads of the Montague and Capulet families by the wounded Mercutio (by the way, there is an opinion that in the first edition of the play he talked about syphilis, but then Shakespeare chose a more dangerous disease), fascism was called brown plague in the 20th century.

   Now we are more joking about plague doctor masks than we are really afraid of the plague. But, according to Yulia Minina, this disease remains relevant today.

   “The leaders in the spread of the disease are Madagascar, the Democratic Republic of the Congo and Peru. For example, in 2017, 681 cases of plague were registered, in 2018 – 243. In Russia in the last century, the greatest epidemic activity was noted in 1900-1938, isolated cases of infection occurred in 1947-1948, 1954, 1960, 1979. Then, for 35 years, there were no cases of human disease on the territory of our country, but from 2014 to 2016, single cases of the disease were again registered, ”the doctor said.

   How can you get plague today and how is it treated
   
   Minina said that the main source of infection is rodents. You can get infected through flea bites or when cutting animal carcasses, as well as from a person with a pulmonary form.

   Poor hygiene or a serious illness: why a person can smell bad

   Body odor can have different causes: in some cases it is a variant of the norm . ..

   25 May 16:45

   She explained that the name “plague” comes from the ancient Arabic word “jumma” – bean (a disease characterized by swollen lymph nodes that look like beans). For this reason, in a number of sources, the disease is called bubonic plague. This is not the only form, but the most common.

   “The incubation period is from several hours to seven days (on average 2–4 days). In all forms, the onset is sudden, severe intoxication is characteristic: fever, chills, severe weakness, headache, body aches, vomiting.

   In the Middle Ages, for the treatment of plague, buboes were opened, bloodletting, which was dangerous not only for the patient, but also for the doctor.

   Currently, plague is treated with medication, the choice of antibacterial drugs depends on the form of the disease,” Minina said.

   The doctor said that in our time, for prevention, control over natural foci of plague and vaccination of people living in unfavorable territories or traveling there, as well as those who are at risk due to the nature of their profession, are used.

   close

   100%

   Anthrax

   The disease became notorious after several senators in the United States received letters with anthrax spores in the mail. In addition, the disease appears in the book “Days of the Dog” and the eponymous film adaptation of the novel with Benedict Cumberbatch and Kirsten Dunst. Meanwhile, the disease is found not only in cinema and political intrigues.

   How can you get anthrax today and how is it treated
   
   “Anthrax is an acute infectious disease accompanied by fever, intoxication and occurring in humans with the formation of specific carbuncles (abscesses) on the skin and mucous membranes. Every year, more than a million animals and about 20,000 people in 82 countries get sick in the world.

   The main source of anthrax for humans are sick farm animals, as well as meat and skins obtained during their forced slaughter. You can become infected by eating infected meat, caring for sick animals, slaughtering livestock, inhaling infected dust, bone meal, and even through the bites of horseflies or mosquitoes,” Minina said.

   She said that the problem is also relevant for Russia.

   For example, in 2016, there were reports of an anthrax epidemic in the Yamalo-Nenets Autonomous District, and in 2020, five cases of anthrax were recorded in a Dagestan village.

   Most patients with anthrax have an incubation period of 1-6 days, but in the pulmonary form of this infection, the incubation period can be more than 6 weeks.

   Treatment of anthrax is complex, in addition, people at risk are given an anthrax vaccine.

   close

   100%

   Leprosy

   The expression “keep away like a leper” was not once allegorical. People with leprosy could be driven out of the city or subjected to lifelong isolation in specialized hospitals – leper colonies.

   “Because we are sick, our freedom is taken away. We obeyed the law. We didn’t offend anyone. And they want to lock us up in prison,” says the protagonist of Jack London’s story “Koolau the Leper”, based on real events. The description of sick people looks frightening: “they were monsters, mutilated and disfigured, as if they had been tortured for centuries in hell . .. Fingers – who still had them – resembled the claws of harpies; were like failed, rejected casts that some crazy god, while playing, smashed and flattened in the machine of life.

   It is no coincidence that the leper from Oscar Wilde’s The Star Boy hides his face. “His face was hidden by a gray linen hood, and his eyes burned in the slits like coals, and when he saw the Star-Boy approaching the gate, he rattled his wooden bowl, and rang his bell, and shouted to him like this:
   – Give me give me alms, or I will have to starve to death. For they drove me out of the city, and there is no one who would take pity on me, ”Wilde writes.

   How can you get leprosy today and how is it treated
   
   There are still people with leprosy. Leprosy (leprosy, Hansen’s disease) is a chronic infectious disease caused by mycobacterium leprosy. It affects not only the skin and internal organs, but also the nervous system. Today, despite the availability of treatment, the problem of leprosy incidence remains relevant for a number of countries in Asia, Africa, and Latin America.