Leprosy diagnosis: Diagnosis and Treatment | Hansen’s Disease (Leprosy)
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.
NORD (National Organization for Rare Disorders)
The earliest symptoms are usually skin lesions that are typically flat, pale (hypopigmented) or reddish (erythematous) spots in the skin with slightly decreased sensitivity to touch or pain. These lesions typically do not present with other symptoms, such as burning or pain. There may be some hair loss in the affected area. As the skin lesions progress, they may become raised and, in some cases, nodules may form. The symptoms of nerve involvement include diminished sensation or feeling in the affected areas (anesthesia) and, sometimes, burning and tingling sensations (paresthesias). In more advanced cases, there may be weakness, paralysis, and atrophy of muscle in the hands or feet.
Persons with tuberculoid and borderline tuberculoid leprosy have limited disease with relatively few skin lesions and only a few affected nerves. However, early in the course of the disease, they may have significant sensory loss and muscle weakness, even though only one hand or foot is involved. Persons with lepromatous leprosy may have minimal loss of sensation at the onset; however, if untreated, they will develop extensive involvement of the skin and nerves. The complications that may occur include eye involvement and deformities of the face, hands, and feet. Deformities of the face can result from destruction of the partition in the nose that divides the nostrils (nasal septum) and other facial tissues. In advanced disease, persons with lepromatous leprosy may lose their eyebrows and eyelashes, and the eyelids may become paralyzed so that individuals cannot blink or close their eyes properly. The earlobes may enlarge or become wrinkled. Deformities of the hands and feet may result from muscle paralysis and repeated trauma that is not felt due to sensory loss.
The most serious complication of leprosy is the nerve damage that may occur sometimes even after treatment is begun. Much of the nerve damage occurs during a type of immunologic problem that occurs in 25 to 50% of patients during treatment and is commonly known as a reaction. Reactions are not drug reactions or allergies, but are the patient’s own immune system reacting against the dead bacteria that are still in the skin and nerves. Patients with the intermediate or borderline type of disease may get a type of reaction known as reversal reaction, in which there is redness and swelling of the skin lesions and swelling, tenderness, and pain in the nerves of the hands and feet. During this process, nerve damage can occur.
The second type of reaction occurs only in borderline lepromatous and lepromatous disease, and is known as erythema nodosum leprosum (ENL). This syndrome is characterized by fever and raised, red, painful skin nodules. There may also be pain and tenderness of the nerves with subsequent nerve damage in the hands and feet. ENL may also be associated with joint disease (polyarthralgia), eye inflammation, and inflammation of the testicles.
During reactions and at times without any signs of reaction, there may be damage to the nerves of the face resulting in weakness of closure of the eyelids and loss of feeling in the cornea (corneal anesthesia). This can result in corneal dryness and scarring and lead to blindness. Persons with lepromatous leprosy may also have inflammation of the iris and the sclera of the eye, which can lead to visual impairment and, in some cases, blindness.
Leprosy Symptoms, Treatments, History, and Causes
What Is Leprosy?
Leprosy is an infectious disease that causes severe, disfiguring skin sores and nerve damage in the arms, legs, and skin areas around your body. Leprosy has been around since ancient times. Outbreaks have affected people on every continent.
But leprosy, also known as Hanson’s disease, isn’t that contagious. You can catch it only if you come into close and repeated contact with nose and mouth droplets from someone with untreated leprosy. Children are more likely to get leprosy than adults.
Today, about 208,000 people worldwide are infected with leprosy, according to the World Health Organization, most of them in Africa and Asia. About 100 people are diagnosed with leprosy in the U.S. every year, mostly in the South, California, Hawaii, and some U.S. territories.
Leprosy primarily affects your skin and nerves outside your brain and spinal cord, called the peripheral nerves. It may also strike your eyes and the thin tissue lining the inside of your nose.
The main symptom of leprosy is disfiguring skin sores, lumps, or bumps that don’t go away after several weeks or months. The skin sores are pale-colored.
Nerve damage can lead to:
- Loss of feeling in the arms and legs
- Muscle weakness
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.
What Causes 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.
It isn’t clear exactly how leprosy is transmitted. When a person with leprosy coughs or sneezes, they may spread droplets containing the M. leprae bacteria that another person breathes in. Close physical contact with an infected person is necessary to transmit leprosy. It isn’t spread by casual contact with an infected person, like shaking hands, hugging, or sitting next to them on a bus or at a table during a meal.
Pregnant mothers with leprosy can’t pass it to their unborn babies. It’s not transmitted by sexual contact either.
Forms of Leprosy
Leprosy is defined by the number and type of skin sores you have. Specific symptoms and treatment depend on the type of leprosy. The types are:
- 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.
You may also hear doctors use this simpler classification:
- Single lesion paucibacillary (SLPB): One lesion
- Paucibacillary (PB): Two to five lesions
- Multibacillary (MB): Six or more lesions
If you have a skin sore that might be leprosy, the doctor will remove a small sample of it and send it to a lab to be examined. This is called a skin biopsy. Your doctor may also do a skin smear test. If you have paucibacillary leprosy, there won’t be any bacteria in the test results. If you have multibacillary leprosy, there will be.
You may need a lepromin skin test to see which type of leprosy you have. For this test, the doctor will inject a small amount of inactive leprosy-causing bacteria just underneath the skin of your forearm. They’ll check the spot where you got the shot 3 days later, and then again 28 days later, to see if you have a reaction. If you do have a reaction, you may have tuberculoid or borderline tuberculoid leprosy. People who don’t have leprosy or who have lepromatous leprosy won’t have a reaction to this test.
Leprosy can be cured. In the last 2 decades, 16 million people with leprosy have been cured. The World Health Organization provides free treatment for all people with leprosy.
Treatment depends on the type of leprosy that you have. Antibiotics are used to treat the infection. Doctors recommend long-term treatment, usually for 6 months to a year. If you have severe leprosy, you may need to take antibiotics longer. Antibiotics can’t treat the nerve damage that comes with leprosy.
Multidrug therapy (MDT) is a common treatment for leprosy that combines antibiotics. That means you’ll take two or more medications, often antibiotics:
- Paucibacillary leprosy: You’ll take two antibiotics, such as dapsone each day and rifampicin once a month.
- Multibacillary leprosy: You’ll take a daily dose of the antibiotic clofazimine in addition to the daily dapsone and monthly rifampicin. You’ll take multidrug therapy for 1-2 years, and then you’ll be cured.
You may also take anti-inflammatory drugs to control nerve pain and damage related to leprosy. This could include steroids, like prednisone.
Doctors sometimes treat leprosy with thalidomide, a potent medication that suppresses your immune system. It helps treat leprosy skin nodules. Thalidomide is also known to cause severe, life-threatening birth defects. Never take it if you’re pregnant or plan to become pregnant.
Without treatment, leprosy can permanently damage your skin, nerves, arms, legs, feet, and eyes.
Complications of leprosy can include:
- Blindness or glaucoma
- Hair loss
- 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 Studies, Other Tests, Procedures
Darvin Scott Smith, MD, MSc, DTM&H Adjunct Associate Clinical Professor, Department of Microbiology and Immunology, Stanford University School of Medicine; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Permanente Medical Group
Darvin Scott Smith, MD, MSc, DTM&H is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine
Disclosure: Nothing to disclose.
Jade Chee Riopelle BS Candidate, Stanford University
Disclosure: Nothing to disclose.
Specialty Editor Board
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine in New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center
Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for Physician Leadership, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physicians, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, The Foundation for AIDS Research
Disclosure: Receives royalties from Baxter International for: Takeda-receives royalties; UpToDate-receives royalties.
Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.
Fred A Lopez, MD Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine
Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, Louisiana State Medical Society
Disclosure: Nothing to disclose.
Shwetha Ravindranath Katta, MD JJM Medical College, Davangere, India
Disclosure: Nothing to disclose.
Emily Anderson Kelly Stanford University
Disclosure: Nothing to disclose.
Tara Ramachandra, MD Stanford University School of Medicine
Disclosure: Nothing to disclose.
Leprosy Diagnosis and Classification
Leprosy or Hansen’s disease is a chronic infection characterized by granuloma formation, caused by Mycobacterium leprae, which is an obligate intracellular bacillus. The disease attacks chiefly the peripheral nerves and the skin, though systemic involvement is known to occur, as well as damage to many other organs.
Closeup hands of asian old man suffering from leprosy, Thailand – Image Credit: Tidarat Tiemjai / Shutterstock
Classification of the type of leprosy is important in determining the right regimen of treatment, as well as predicting complications and providing a useful prognosis.
At present there are two systems of classification in use throughout the world. The Ridley-Jopling classification dates back to 1966, and is based upon the clinical features, histopathology, and the bacteriological index (BI). Its usefulness is compounded by its correlation with host immune activity. It provides room for ascending and descending leprosy reactions which can alter the stage of borderline patients.
LepClip English 3 How to Diagnose LeprosyPlay
It uses the following terms to describe the range of leprosy, from early localized (L) to generalized (LL), or from tuberculoid at one end of the spectrum to lepromatous at the other:
- indeterminate (I)
- tuberculoid (TT)
- borderline tuberculoid (BT)
- mid – borderline (BB)
- borderline lepromatous (BL)
- lepromatous (LL)
Tuberculoid leprosy is characterized by increased cellular immunity with localized infection, whereas lepromatous leprosy (LL) patients tend to have more disseminated infection and higher antibody levels, which are not effective, however, in checking bacillary proliferation.
The diagnosis of leprosy remains primarily clinical. In addition to skin lesions, the presence of anesthesia or hypoesthesia, thickening of peripheral nerves, and/or the presence of AFB on slit skin smears or biopsy, is noted. Mycobacterial culture has so far proved impossible in vitro. When a biopsy is required, it is taken from a sensory cutaneous nerve without muscular supply, such as the sural nerve or radial cutaneous nerve.
World Health Organization (WHO) Classification
This is the classification in use today for purposes of deciding treatment regimen, and has been widely adopted because of their supply of the WHO multi-drug regimen free of cost to endemic countries. It is simple and suitable for immediate assessment without the need for slit smears. It is based purely upon the number of skin lesions.
Single Lesion Paucibacillary (SLPB)
These patients have a single skin lesion and no other sign.
Paucibacillary (PB) Leprosy
This includes the following types in the Ridley-Jopling classification:
- indeterminate (I)
- polar tuberculoid (TT)
- borderline tuberculoid (BT)
Patients have 2-5 skin lesions, and a skin smear, if available, is negative.
Multibacillary (MB) Leprosy
This term refers to patients with 6 or more skin lesions, and a positive slit skin smear (if obtained). It includes the following subtypes of the Ridley-Jopling classification:
- polar lepromatous (LL)
- borderline lepromatous (BL)
- mid-borderline (BB) defined as having 6 or more skin lesions and a positive skin smear if available.
In the US, a biopsy result is also taken into consideration to define PB and MB patients. They are characterized as negative and positive, indicating less and more advanced disease respectively.
LL has a better prognosis than TT because it produces less destruction of nerves in the skin. Lesions often heal spontaneously.
Response to treatment is based on the bacteriological index (BI), which denotes the density of M. leprae on a slit-skin smear.
Hansen’s Disease Cardinal Signs & Symptoms
Delayed diagnosis of Hansen’s disease (leprosy) can have serious neurological consequences. The typical skin lesions and classic neuropathy of leprosy are readily recognized in countries where the disease is more common, but in the U.S., where leprosy is rare, it can be difficult to diagnose. Physician awareness is key to the early diagnosis and treatment that can prevent disability.
Consider the diagnosis of leprosy when …
Patient presents with non-responsive skin lesion and is
- Immigrant from country with high incidence of leprosy
- U.S. resident with history of foreign travel
- Resident of Texas or Louisiana
- Has referral history of multiple physician/specialist and/or frequent emergency room visits
- Localized skin lesions
- Raised or flat
- Light or pigmented
- Sensory loss in lesion
- Thickened peripheral nerves
- Demonstrated acid-fact bacilli in lesion
- There are no serological or skin tests
- Skin biopsy needed for definitive diagnosis
- PCR for M. leprae DNA may be needed in special circumstances
Patients with Delayed Diagnosis
Because of a delay in diagnosis, patients may present for diagnosis of Hansen’s disease who are already undergoing a Reversal or ENL reaction:
- Acute, immunological complications may confuse clinical picture
- Acute inflammation of lesions
- Edema, loss of sensation and weakness in the hands or feet
- Such patients often have seen other specialists before dermatologist referral
Seek prompt consultation with National Hansen’s Disease Program. Phone 1-800-642-2477, weekdays 9 AM to 5:30 PM ET (in Hawaii: 1-808-733-9831).
What Is Leprosy? Symptoms, Causes, Diagnosis, Treatment, and Prevention
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 (15) Here, a modest incision is made in the skin of the earlobes, elbows, or knees, (16) and a sample is extracted. The sample is then examined for the presence of the bacterium. (1)
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, afflicting 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, (8) although sometimes there are more.
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. (1) Those with MB leprosy tend to have six or more affected skin areas. (8) Patients may experience thickening of the peripheral nerves and organs, such as the eyes, nose, and testicles, and bones may also be involved. (1) Multibacillary leprosy encompasses mid-borderline, borderline lepromatous, and lepromatous leprosy. (5)
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)
Lepra is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast bacillus bacillus. The disease mainly affects the skin, peripheral nerves, the mucous membrane of the upper respiratory tract and the eyes. Leprosy is curable, and early treatment can prevent disability.
A Brief History – Disease and Treatment
Lepra has been known for a long time and is mentioned in written sources of ancient civilizations.Throughout history, people with leprosy have often been ostracized by their communities and families.
In the past, leprosy has been treated in many ways, but the first real breakthrough in treatment came in the 1940s when dapsone, a drug that stops disease, was developed. But the treatment was many years, even lifelong, which made it difficult for patients. In the 1960s. M. leprae began to develop resistance to dapsone, the only antileprotic drug known in the world at that time.In the early 1960s, rifampicin and clofazimine were discovered and included in a regimen later called combination drug therapy (KLT).
In 1981, WHO recommended KLT. The currently recommended course of KLT includes the following drugs: dapsone, rifampicin, and clofazimine. The course of treatment lasts six months in the case of oligobacillary leprosy and 12 months in its multibacillary form. KLT kills the pathogen and cures the patient.
Since 1995, WHO has provided CRT free of charge to all leprosy patients worldwide. The free KLT was originally funded by the Nippon Foundation, and since 2000, the free KLT has been delivered under an agreement with Novartis, which recently pledged to extend it to at least 2020.
The target of eliminating leprosy as a public health problem (i.e. reducing its prevalence to less than 1 case in 10,000 people) was achieved globally in 2000.Over the past 20 years, more than 16 million patients have been treated with KLT.
In 2016, to accelerate efforts to control leprosy, WHO launched the Global Leprosy Strategy 2016–2020: Accelerating Action for Global Leprosy Elimination. The main focus of this Strategy is on children and on the prevention of disability.
At the heart of the Global Leprosy Strategy 2016-2020 there are three main components:
Component I: Strengthen government ownership, coordination and partnerships
- Ensure political commitment and adequate resources for leprosy control programs.
- Promote universal health coverage, with a focus on children, women and disadvantaged groups, including migrants and displaced persons.
- Strengthen partnerships with governmental and non-governmental actors and promote intersectoral cooperation and partnerships at the international level and within countries.
- Promote and conduct basic and operational research on all aspects of leprosy and maximize the evidence base for policy, strategy and intervention development.
- Strengthen surveillance and health information systems for program monitoring and evaluation (including geographic information systems).
Component II: Stop Leprosy and Its Complications
- Raise patient and community awareness of leprosy.
- Facilitate early case detection by proactively searching (eg campaigning) in areas of high endemicity and by monitoring people who have contact with patients.
- Ensure prompt initiation and adherence to treatment, including work to improve treatment regimens.
- Improve prevention and management of disabilities.
- Strengthen antimicrobial resistance surveillance, including the laboratory network.
- Promote innovative approaches to training, referral and continuing education in leprosy, such as e-health.
- Promote activities for the prevention of infections and diseases.
Component III: End discrimination and promote social inclusion
- Promote social inclusion by addressing all forms of discrimination and stigma.
- Empower people affected by leprosy and build their capacity to actively participate in leprosy treatment services.
- Engage communities in activities to improve leprosy treatment services.
- Facilitate the building of coalitions among people affected by leprosy and facilitate the alignment of these coalitions and / or their members with other organizations at the community level.
- Facilitate access to social and financial support services, such as facilitating income generation, for people affected by leprosy and their families.
- Support community-based rehabilitation of people with leprosy-related disabilities.
- Work to eliminate discriminatory laws and promote policies for the social inclusion of people affected by leprosy.
Objectives of the Global Leprosy Strategy
90,028 90,029 no new child patients with disabilities;
90,029 disability of the second group affects less than one in a million people;
In August 2016WHO has published Operational Guidelines to help adapt and implement the Global Leprosy Strategy 2016–2020. This guide provides guidance to managers of national leprosy programs (or similar) on how to adapt and implement the Global Leprosy Strategy to address the epidemiological burden in their countries.
In March 2017, the WHO Global Leprosy Control Program published the Guidelines for Monitoring and Evaluating the Implementation of the Global Leprosy Control Strategy.Under the leadership of the Global Leprosy Program, efforts are being made to expand the leprosy drug-resistance surveillance network, which is one of the key activities of the Global Leprosy Strategy. A guide to the surveillance of antimicrobial resistance in leprosy has also been published.
Lepra: symptoms, treatment, prevention
One of the oldest diseases known to medicine, leprosy (also called leprosy) has been considered incurable for centuries.Currently, this infectious disease with a chronic course, which is one of the types of granulomatosis, is quite treatable. The disease is systemic in nature, affecting mainly the skin, peripheral nervous system, visual organs and some internal organs.
The acid-resistant bacterium Mycobacterium leprae is the causative agent of leprosy disease, and its characteristics are now well known to bacteriologists and infectious disease specialists.The disease is most common in countries with hot climates. Currently, there are about 12 million patients in the world, the bulk of whom are residents of developing countries. Every year, doctors detect about 500-800 thousand new infections, and men get sick about twice as often as women.
The bacillus has low contagiousness: from a sick person to a healthy person, the disease is transmitted, as a rule, after prolonged direct contact or by airborne droplets.The patient excretes mycobacteria with physiological fluids and feces. Sources of infection are only infected people, cases of transmission of the disease in other ways have not been proven to date.
Signs of the disease
Doctors distinguish four clinical types of leprosy, which differ in symptoms and the scope of damage to internal organs. The course of the disease in each of the cases goes through four stages: stationary, progressive, regressive and, at the end of the disease, residual.During the first two stages, the foci of the disease may worsen, despite the intensity of therapy.
Let’s look at the leprosy symptoms for each of the varieties.
- Lepromatous. This form of the disease is characterized by extensive lesions of the skin, mucous membranes, organs of vision, lymph nodes, peripheral nerve fibers and internal organs. Skin changes appear as symmetrically located reddish-brown spots on the face, arms, legs, and back.Initially, the skin in these places becomes smooth and shiny, but after a few years it becomes thickened and becomes bumpy. A characteristic “lion mask” is formed on the face. The nasal passages are bent, the nose sags, the voice takes on a hoarse and nasal tone. Vision deteriorates, if left untreated, complete blindness can occur. In the future, the bumpy surface of the skin begins to peel off and become covered with ulcers, loses sensitivity.
- Tuberculoid. In the initial phase of the disease, clearly defined spots with weak pigmentation appear on the skin.The spots are localized on the face, arms and trunk. Over time, red-violet papules develop along the border of the spots, which later transform into ring plaques with a depigmented center. The skin of the affected area becomes dry and horny. Due to the defeat of the nerve endings, the sensitivity of the skin is lost, then the patient may develop paresis or paralysis of the limbs, trophic ulcers and contractures appear on the feet, and muscle tissues atrophy. Internal organs are usually not affected.
- Undifferentiated. Subsequent transformation into a lepromatous or tuberculoid form is possible, therefore, it is often considered as the initial stage of the disease, and not a separate variety. It manifests itself as rashes on the skin in the form of spots of different sizes and colors. The skin in these areas first becomes hypersensitive, then almost completely loses its sensitivity. Often, skin manifestations heal on their own, but the disease can become more severe.
- Border. It is characterized by a variety of skin lesions, spots are combined with plaques and tuberosity, although the sensitivity is reduced, it remains. There is no symmetry of skin manifestations. The nose and brow ridges are enlarged, and the earlobes become thinner.
Do you have leprosy symptoms?
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Lepra is a disease with an extremely long incubation period, which lasts, on average, about 5 years, but there are cases when more than a decade has passed between infection and the appearance of external signs.The only way to diagnose is to identify the causative agent of leprosy in scrapings taken from the nasal mucosa, skin lesions and in the biomaterial of swollen lymph nodes. A bioassay can be carried out with the introduction of an isolated culture of mycobacteria to guinea pigs. The most accurate result is obtained by bacterioscopy and the study of histological preparations of the examined tissues. Determination of the type of leprosy allows the lepromin test, which gives a sharply positive result in the tuberculoid form of the disease and negative in the lepromatous form.Borderline forms give a weakly positive or negative answer.
Is recovery possible?
Modern medicine has an extensive arsenal of tools and techniques for the treatment of leprosy. In the presence of extensive skin lesions, a positive result of microscopic examination, or relapses of the disease, there is a need for hospitalization.
The course of treatment takes a long time and includes:
- taking antileprotic drugs of the sulfone series, which are prescribed in courses and periodically replaced so as not to cause addiction;
- taking antibiotics, vitamins, adaptogens, immunocorrectors, hepatoprotectors and other drugs, depending on the current state;
- BCG vaccination to improve immune reactivity;
- massage, exercise therapy, physiotherapy procedures to avoid disability;
- psychotherapeutic treatment.
In addition, there may be a need for fundus correction, reconstruction of tendons and nerve endings, surgical removal of contractures and other interventions. The patient needs to be monitored on an outpatient basis for several years after discharge from the anti-leprosy hospital in order to prevent relapses.
Frequently asked questions from patients
How is leprosy spread in the family?
If your family has a leprosy patient, prevention of the disease for him and for other members of the family consists of careful adherence to normal hygiene standards.The pathogen is not highly contagious, and the lack of close contact will allow loved ones to maintain health.
Is leprosy treated at home?
The need to isolate a patient with leprosy in a special medical institution depends on the form of the disease, on the degree of damage to the skin and internal organs. In the case of a mild course of the disease, therapy is carried out on an outpatient basis.
Is leprosy contagious to a fetus during pregnancy?
The causative agent of leprosy is not transmitted from a sick mother to a child.As a rule, children are born healthy if childbirth takes place in a medical institution in compliance with all antiseptic requirements. The child is immediately transferred to artificial feeding, because mycobacterium may be present in breast milk.
Science: Science and technology: Lenta.ru
Leprosy has left a deep mark on the history and culture of mankind. Until now, lepers are perceived as people who carry a threat and from whom you need to stay away.In the past, the disease was very common, and the only effective control was the expulsion of the sick from society, which is still practiced in some countries. “Lenta.ru” tells about leprosy, which became the scourge of Europe before the plague and cholera and continues to terrorize the poor, despite the efforts of international health organizations.
Compared to cholera and plague, lepra is a silent and latent disease. After infection, it can take ten or even twenty years before the first symptoms appear.First, pain-insensitive spots appear on the skin, the arms and legs begin to go numb. It is very important to start treatment as soon as possible, because a few months after the disease manifests itself, irreversible damage to the peripheral nerves occurs. The person loses control of the muscles and becomes paralyzed. But even earlier, the body is attacked by secondary infections that affect the eyes, skin, mucous membranes and articular cartilage in the hands and feet. The fingers are deformed and shortened due to the death of the phalanges, facial features are distorted, trophic ulcers are formed.
By itself, the causative agent of leprosy – mycobacterium Mycobacterium leprae – is not a deadly killer like the plague bacillus or Vibrio cholerae. It is an obligate parasite that cannot live outside human cells, so it is in its interest not to kill the host quickly. But it destroys the body’s primary protective barrier, leaving a person vulnerable to many other pathogens. Secondary infections are the leading cause of death in patients with leprosy.
Affected skin areas
A person with leprosy becomes a carrier of mycobacteria, infecting other people.The risk group includes people living in poor countries suffering from malnutrition and reduced immunity. Although it is still not entirely clear how M. leprae enters the body, it is believed that the infection occurs through the upper respiratory tract. It is now known that one-time close contact with someone with leprosy, such as shaking hands or being near an infected person, rarely leads to infection. M. leprae is not sexually transmitted or passed into the unborn child when the carrier is a pregnant woman.
Lepra is one of the oldest diseases that was known in ancient China, India, Egypt, Greece and Rome. The first mentions of it date back to 600 BC. At the same time, other fungal skin diseases were often confused with leprosy. The word “leprosy” itself comes from the ancient Greek Λέπος, which means “scales”, and literally translates as “a disease that makes the skin scaly.” This word was used to refer to any skin disease leading to peeling, but then it became associated with leprosy.
Before the advent of modern medicine in Africa and Eurasia, the fungus Trichophyton Trichophyton schoenleinii , which causes favus, or scab, in which a hard crust forms on the skin, was common. Patients with favus or psoriasis were also declared lepers, expelled from society, or ended up in leper colony. Sometimes syphilis has been confused with leprosy.
00:01 – May 6, 2020
In the Middle Ages, in the XI century, a major epidemic of leprosy broke out in Europe.Among the experts, there is still no single picture of where the disease came from. Many experts believe that the outbreak was caused by the Crusades, as a result of which M. leprae arrived in Europe from Palestine. Leprosy could get to England with the Vikings, who brought the fur of infected squirrels from the continent. According to an alternative hypothesis, leprosy originated in Europe itself and existed for several thousand years. In any case, the disease spread widely in the XII-XIV centuries, reached its peak in the XVI century, and then suddenly retreated, turning into a “forgotten disease”.It is now found only in poor countries.
The medieval epidemic led to the emergence of leper colony – treatment and isolation centers for the care of the sick. Leprosaria have become the main means of containing the disease. Leprosy was so widespread that in some regions it affected about three percent of the population. Naturally, all the sick leper colony could not accommodate, so often lepers were declared “untouchable”, they were forced to wear recognizable closed clothes and carry bells, which warned others about the approach of the patient with their ringing.
Picture of a leprosy patient
The myths about leprosy, popular at that time, made the disease worse than it is. It was believed that leprosy is a divine punishment, which means that the patient carries evil in himself, is sinful and is able to harm others. The infected were perceived by society as damned and unclean in spirit, they were expelled from the city, and experts on sins – priests – were engaged in diagnostics and “treatment”.
Lepra imposed on people the stigma of curses, they were considered almost dead and arranged a “live” funeral for them, after which they were forever expelled from society.There are also known cases of reprisals against the sick, when lepers were buried alive in the ground, burned at bonfires like sorcerers, thrown into gorges or drowned.
Leprosoria were created at monasteries, where the sick could feel relatively safe, and the healthy citizens felt relieved that the lepers stayed away from them. By the 13th century, up to twenty thousand leper colony appeared in Europe, including hospitals under the Order of Saint Lazarus, later called infirmaries.
Although leper colony has limited the spread of the disease to some extent, the main reason for the end of the epidemic, as shown by recent studies, was the development of resistance among the population of Europe. Reconstruction of the genome of mycobacterium showed that the causative agent of leprosy has hardly changed genetically, and modern strains are identical to the ancients. This means that the epidemic is not over because the pathogen itself has somehow changed. The high prevalence of leprosy has led to the fact that among Europeans, more and more people are resistant to the disease.This was influenced by natural selection, including the lifelong social isolation of the sick, who lost the opportunity to continue their race.
A breakthrough in understanding the disease was made in the 19th century, when the Norwegian doctor Gerhard Hansen discovered the true culprit of leprosy – M. leprae . He showed that the disease was not inherited, as some of his colleagues believed. Hansen demonstrated that the isolation of patients had a strong scientific basis: the disease was caused by microorganisms that could be transmitted from person to person.On the recommendations of a doctor in Norway, patients were prohibited from free movement around the country, they were required to be isolated in hospitals or stay at home. Such measures have shown high efficiency, because as a result, the incidence of leprosy fell sharply. The Norwegian experience was then adopted by other European countries.
There was no effective treatment for leprosy until the 1940s, when promin was synthesized – at that time the only known drug with bactericidal activity against M.leprae . However, already in the 60s, mycobacteria developed resistance to it, so doctors switched to other compounds: clofazimine and rifampicin. Then doctors began using all three drugs as combination therapy, which prevented the emergence of resistant strains of the bacterium.
Now around the world there are about 200 thousand cases of leprosy per year, but with timely diagnosis, the disease is completely curable. Despite international measures for prevention, treatment and education, the problem of stigmatization of patients remains acute in developing countries, where leprosy is still prevalent and common among poor and marginalized populations.
In many parts of the world, popular beliefs and religious interpretations of diseases still reign, due to the low level of education. In Brazil, it is believed that leprosy is associated with sexual immorality, and that illness is sent as a punishment for sins and moral transgressions. In India, lepers are equated with the untouchable caste, and this status persists even after a person is cured. As a result, those with leprosy become outcasts, they lose their jobs and homes, they are kicked out of the family.The justified fear of being alone makes it difficult to diagnose and treat leprosy early, and this is one of the explanations why humanity still has not been able to finally defeat the disease.
90,000 what is known about leprosy in the 21st century and why it is still difficult to cure it
World Leprosy Day is celebrated on January 30 as a reminder of the centuries-old disease. Leprosy did not disappear along with medieval unsanitary conditions: according to WHO, the number of new cases in 2016 was 173,358 people.Most cases of infection are in Africa and Asia, but the risk does not tend to zero in developed countries.
Drive him, taunt him
The history of leprosy, lazy death, mournful and Crimean disease – all these are the names of the same disease – began before our era. The first mentions of leprosy date back to 1550 BC, when symptoms similar to it appear in the Egyptian Papyrus. Hippocrates wrote about a skin disease that changes the appearance of an infected person, although, perhaps, confusing it with psoriasis.
The description of leprosy is found in numerous passages of the Bible, both in the New and in the Old Testament. For Christians and Jews, leprosy is God’s punishment for unrighteous behavior, so the sick were subjected to additional censure. Church Fathers Gregory the Great and Isidore of Seville wrote about lepers as heretics. Among commoners, leprosy has become synonymous with punishment for debauchery and lust.
Hansen’s disease (the same as leprosy – “Hi-tech”) destroyed the social life of a person.The sick were ostracized, expelled from the settlements and notified the residents of the approach with the help of a bell. The disease was considered hereditary: the children of the leper were also doomed to exile.
Still from the movie “Diary of a Motorcyclist” – the leader of the Cuban Revolution, Che Guevara, worked as a doctor in a leper colony during his trip to South America
Epidemics of leprosy happened periodically, as well as outbreaks of other infections. An increase in the incidence was recorded in the XII-XIII centuries, during the era of the Crusades.In France, there were about 2 thousand leper colony, while in England and Scotland there were 220 to accommodate about 1.5 million people.
Leprosorium is an endemic area and an organizational center for the fight against leprosy. In the Middle Ages – an isolated area for patients with leprosy, doomed to a slow death, rotting alive.
Today, the anti-leprosy strategy prohibits bullying at the legislative level. However, due to the low awareness of people, patients are still bullied and ostracized.In Russia, only four institutions deal specifically with Hansen’s disease: the research institute for the study of leprosy in Astrakhan, the Sergiev Posad branch of the State Scientific Center for Dermatovenereology, the Terek leper colony in the Stavropol Territory and the leper colony of the Krasnodar Territory.
Portrait of a “mischievous” disease
Leprue was considered a punishment for sinners, which radically changed the appearance of a person. An ugly appearance is only the most striking and final symptom of Hansen’s disease.The first symptom of all patients is numbness and loss of sensitivity to temperature changes, no feeling of heat or cold. Further, the affected areas lose sensations of light touch, pain and, finally, strong pressure. Further, the scenarios of the disease diverge: leprosy has three main types, each of which has different symptoms.
- Tuberculoid type. A mild version of leprosy. This form is accompanied by scaly pigment spots of a pinkish or red hue, the sensitivity of which is either reduced or absent altogether.The nerves in the affected areas thicken and lose function. The progression of the disease leads to the borderline type of the disease, and sometimes, without proper treatment, to the development of the lepromatous form of the disease.
- Lepromatous type. Severe form of the disease. At the first stages of the active period of the disease, small symmetrical spots appear, which grow into large and deep bacillary foci. The patient gradually loses eyebrows and eyelashes, hair all over the body, except for the head.Sensitivity to light appears, vision deteriorates. It is the lepromatous type of the disease that leads to the famous “lion mask” – sagging and ossification of the skin on the patient’s face. Unlike the borderline or tuberculoid type, the lepromatous type does not turn into another form of the disease and leads either to leprosy cachexia or to death.
- Border type. A mixed form of the disease in which the patient already has keratinization of the skin, but the numbness is not so severe.In the borderline type, plaques and scars, similar to injection marks, often appear on the patient’s skin.
Mycobacterium leprae is a type of bacterium with a high content of guanine and cytosine, which causes a chronic granulomatous disease – leprosy. It is the only known bacterium that attacks the nervous tissue of the body.
Mycobacterium leprae (Ziehl-Nelsen stain)
Even excluding infected people from the social circle, one cannot be sure of safety.The pathogenic bacterium can be transmitted not only by the respiratory route, but also through exposure to insects, contaminated soil or water. Although scientists do not have a complete list of the spread of the disease, most accurately recognize the air-capillary route of transmission.
The causative agents of leprosy appear in the body with the help of mucous membranes, entering the nerve endings, circulatory and lymphatic systems. At this stage, there are no visible changes in the skin or the body in general.
People who become infected from the same source may develop different forms of leprosy under the same conditions with different consequences. This means that virulence, that is, the sum of the pathogenic properties of a microbe, does not affect the nature of the disease.
M. leprae survives in the human body for several hours or days, and then either takes root or interferes with the body’s immune defenses.
Human immunity prevents leprosy from taking root in the body.Even in endemic areas of the disease, leprosy spread is minimal, and the disease rarely progresses to clinical levels with the right treatment.
Diagnosis of leprosy
Due to the long incubation period of the disease, from 9 months to 20 years, leprosy used to go unnoticed until the appearance of obvious symptoms. Today, there are several effective, but rather laborious, methods for diagnosing the form of the disease.
- Bacterioscopic examination. The researcher makes scrapings from lesions on the skin and nasal mucosa, places the samples on a glass slide and stains according to Ziehl-Nielsen, a special method for detecting acid-fast microorganisms. This diagnosis does not work for patients with tuberculoid or borderline disease.
- Mitsud’s test, or lepromine reaction. The study shows the level of cellular immunity in the host’s body. The lepromine test is laborious: the substance itself is difficult to obtain, and intradermal administration remains painful and difficult.Samples are not always reliable: despite the need for a positive result, 10% of healthy people have negative reactions to the sample.
- Serological diagnostics. The disease is diagnosed by blood serum and the presence of microbial antigens in it. Accurate diagnosis based on the results of a serological study is impossible: if the disease has no clinical manifestations, “trace” antibodies are found in the blood of patients, demonstrating immunity to the disease.
- Polymerase chain reaction (PCR). The most sensitive and indicative method of direct diagnosis, suitable for any type of disease. The procedure requires a sample of the patient’s DNA, which is copied many times using enzymes. A specific fragment of DNA will dominate, which leads to a conclusion about the patient’s condition.
Lesions of the extremities in Hansen’s disease
In any of the types of diagnostics, doctors take into account the presence in an endemic area, contacts with patients, data from direct examination: the presence and duration of skin rashes, signs of disruption of the nerve endings.
Dr. Hansen Discovery
Norwegian Gerhard Henrik Armauer Hansen was the first person to discover the germ that causes leprosy. The bacterium Mycobacterium leprae was discovered by him in 1873 using a microscope. Although the methods of treating the disease remained unknown, the discovery of the pathogen brought relief to patients and their relatives: the found natural cause stopped the persecution of lepers and their children.
Gerhard Hansen is a Norwegian physician known for the discovery and identification of the bacterium Mycobacterium leprae in 1873 as the agent causing leprosy.
Leprosy before Hansen was generally regarded as a hereditary or miasmatic disease. From epidemiological studies, Hansen concluded that leprosy is a disease with a specific cause.
In February 1873, Gerhard Hansen, examining the patient’s material under a microscope, suddenly saw tiny rods in the cells. He announced the detection of Mycobacterium leprae in the tissues of all patients, although he did not recognize them as bacteria – and received little support.
In 1879, the young German scientist Albert Neisser came to Bergen to study the disease of leprosy. Hansen gave him tissue samples. Neisser successfully stained the bacteria and announced his findings in 1880, claiming that he had found the organism causing the disease without mentioning Hansen. This led to a serious dispute over the priority in the discovery of the bacillus of leprosy.
Thanks to Hansen’s efforts, the free movement of patients with leprosy around the country was prohibited in 1879, and in 1885 he achieved the adoption of a law providing for the mandatory isolation of patients with leprosy in hospitals or at home and systematic medical examinations of persons in contact with patients.This system has shown such effectiveness that it served as the basis for the legislation of many European countries in relation to patients with leprosy.
Colleagues did not support the doctor and did not understand the importance of his discovery. However, Hansen himself did not recognize the microbe as a bacterium, and therefore did not receive the support of the scientific community. In addition, the study of Mycobacterium leprae was hampered by the peculiarities of growth on nutrient media: unlike the tubercle bacillus similar in properties, the leprosy bacterium did not grow in the nutrient solution of a Petri dish.
Leprue was treated with practically folk methods until the 40s of the XX century. The patients were prescribed injections of Chaulmugra nut oil. The procedure was extremely unpleasant and caused great suffering for the patients. However, the usefulness of the method was questioned. The situation changed in 1941 when the sulfone drug Promin was first used as a medicine.
The promin test took place at the J. Long Disease Center in Carville, Louisiana. Established in 1921, the Center has become a site for leprosy research and control.
In the 1950s, the drug dapsone appeared on the market, which was proposed by Dr. R.G. Cochrane of Carville. At first, this treatment gave excellent results, but soon Mycrobacterium leprae adapted to the treatment. It was one of the few genome mutations: in 2013, scientists from the University of Tübingen proved that the bacterium remained practically unchanged for a thousand years. This “conservatism” of the bacteria made it possible to almost completely minimize the percentage of diseases after its appearance.
Modern leprosy treatment
After a decade of stagnation in research in the 70s, Malta conducted the first successful treatment for Hansen’s disease with polychemotherapy: a multi-drug combination therapy that combines a course of several drugs. In 1981, WHO created a recommended list of drugs for the treatment of multibacillary leprosy: dapsone, rifampicin, and clofazimine. Patients with an oligobacillary form of the disease take only rifampicin and dapsone. Monotherapy for leprosy is not acceptable.Treatment with just one drug on the list makes the bacteria resistant. They gain resistance, and the effect of leprosy on the body is exacerbated.
Each of the drugs has its own function in complex treatment. Dapsone stops bacteria from multiplying and slows down the enzymatic reaction of two dihydrofolates, key enzymes in the biosynthesis of M. leprae. Rifampicin kills bacteria and blocks RNA synthesis. Clofazimine has a mysterious effect – the not fully understood antibacterial property of the drug, most likely, blocks the matrix functions of DNA and gives results on dapsone-resistant forms of M.leprae.
In 1997, WHO set the duration of treatment for leprosy from six months to a year. Relapses of the disease are minimal, and leprosy is called an almost defeated disease. The study has moved to a new stage: the development of a vaccine that will prevent the development of the disease or can stop its long incubation period.
The illusion of a panacea must not deceive
If the treatment regimen is well thought out and works, and the number of patients around the world does not exceed 11 million, then the problem is almost solved.Nevertheless, Russian leper colony still exists, and the number of infections remains stable. Why is this happening and why do people continue to study leprosy?
Combination therapy does not exclude the development of resistance, and the patients themselves, who do not always move to leper colony, may disrupt the course of taking medications due to its duration and complexity. In addition, unstable clofazimine has not been registered in Russia, therefore, treatment is carried out only according to the scheme of the oligobacillary form of the disease.Today in Astrakhan, drug analogues and new therapy regimens, shorter and more effective, are being developed.
Diagnosis and prevention of leprosy is also important because humanity lives in an era of globalization. European migrants come from highly endemic countries in Africa and South America, and the only guarantee of health without a special examination is the absence of obvious signs of the disease. In Russia, those entering the country are required to undergo a medical examination, but there is still no developed methodology for this procedure.Moreover, is it possible to ignore the disease that still takes lives in South Asia and Africa? This is an ethical issue that determines the strategies for the development of medicine in developed countries. Leprosy for a European has become a nightmare from the past, but neglect of the disease in the present can lead to a deplorable repetition of the epidemics of the Middle Ages.
90,000 Leprosy: A Story of Illness and Medieval Misconceptions | Healthy life | Health
Leprosy is an outdated name for the disease, today the term “leprosy”, or Hansen’s disease, hansenosis, hanseniasis, is more relevant.This infectious disease affecting the skin and the peripheral nervous system of a person has been known to mankind since ancient times.
Leprosy has already been sufficiently studied, and it is known that the disease is not transmitted by a simple touch of the patient and does not always lead to death. But in Medieval Europe they feared leprosy more than modern people fear AIDS or cancer.
The first mentions of the disease are found in written records dating back to the 15th – 10th centuries BC.e. It is likely that in ancient times, leprosy was confused with other skin diseases, such as psoriasis.
Leprosy inspired fear and disgust, since for a long time it was incurable, leading to inevitable disability and death. This is what became the basis of prejudice, leprophobia and discriminatory attitudes towards patients.
The treatments of that time, such as cleansing the stomach and bloodletting, were powerless.
The peak incidence of leprosy falls on the period from the XII to the XIV century, when the infection affected the population of almost all European countries.
The fate of the sick was unambiguous – they inevitably became outcasts, the leper was considered “damned”. Patients were deprived of all social rights, they were forbidden to enter the church, visit markets and fairs, wash in running water or drink it, touch other people’s things, eat nearby or even talk with uninfected people, standing against the wind.
Lepra from one of the spouses was considered a legal reason for divorce, when the first signs of leprosy appeared, a person was buried in church as if it were dead, and a symbolic funeral was organized, after which the patient was given special clothes – a heavy hoodie with a hood.Lepers were required to warn of their appearance with a horn, rattle, bell or shouts: “Unclean, unclean!”
With the appearance of the first leper colony, the life of patients with leprosy acquired a more civilized outlook. Leprozoria became the places where the sick lived, usually they were located near monasteries.
By the end of the 16th century, leprosy had disappeared in most European countries. Why exactly leprosy receded is not completely clear, but many see the reason in the plague epidemic, which first of all struck the weakened organisms of people already sick with leprosy.
The rise in the incidence was noted only during the heyday of the African-American slave trade. Today, leprosy is most widespread in Africa, Asia and South America. In America, patients are treated only on an outpatient basis, in Russia cases of the disease are detected every few years, but there are four leper colony in the country.
Gerhard Hansen and Raoul Follero
Two people played a prominent role in the history of this disease. Gerhard Hansen, a Norwegian physician, is famous for his discovery of the causative agent of leprosy in 1873.He announced the detection of Mycobacterium leprae in the tissues of all patients, but he did not recognize them as bacteria and received little support from his colleagues. Later it turned out that mycobacterium leprosy is close in its properties to tuberculosis, but is not capable of growing on artificial nutrient media, which made it difficult to study leprosy.
“Saint Francis of the XX century” – this was the name of Raoul Follero, a French poet, writer and journalist who devoted his life to combating leprosy and discrimination against people with it.In 1948 he founded the Order of Mercy and in 1966 the Federation of European Anti-Leprosy Associations.
It is thanks to him that since 1953, January 30 is celebrated as World Day for Helping People with Leprosy. In another way, this date is called “Day of the rights of patients with leprosy.”
In addition, there are cases when doctors infected themselves in order to find out the patterns of development of this terrible disease. So, in the middle of the 19th century, the doctor Daniel Cornelius Danielsen conducted experiments for 15 years, injecting himself with the blood and pus of lepers, but he did not succeed in becoming a leper.
Contrary to prejudice
Leprosy is not transmitted by a simple touch of the patient and is not always fatal. Only about 10% of people at risk of infection actually get it. Most people have the necessary level of immunological protection against the pathogen.
Basically, infection occurs due to prolonged direct skin contact, less often – by inhalation of bacteria that enter the air from the nasal cavity or mouth of the patient. There are versions that only 30% of people are clinically susceptible to leprosy and that the disease itself is genetically determined.But, despite the fact that some features of the disease are still the subject of controversy among scientists, there are two main types of leprosy:
The face of a 24-year-old patient with leprosy. 1886 year. Photo: wikipedia.org
Lepromatous – affects the skin where mycobacteria multiply, causing the formation of nodes called lepromas. Large folds are gradually formed, and the patient develops a “lion’s face”. When lepromas decay, the nose is deformed, the phalanges of the fingers begin to fall off.This is the most severe and malignant form of the disease.
Tuberculoid – mainly the skin, peripheral nerves, and sometimes internal organs are affected. Formations on the skin are insensitive, asymmetrical, reddish-brown in color. Tuberculoid leprosy is 40 times less infectious than leprosy form.
A borderline form of the disease is also distinguished, which usually develops into one of two main types. The juvenile form of leprosy occurs in children, it is expressed in many subtle spots on the skin.An indefinite form is the most favorable – several spots appear on the skin, but after a few months the spots disappear, as if the disease goes away by itself.
For an accurate diagnosis against the background of clinical signs, bacterioscopic and histological studies are always carried out.
Treatment and personal prevention
In the 1950s, sulfone preparations came into practice, which ensured recovery after 2–8 years of treatment. Now in the arsenal of doctors there are effective drugs for the treatment of leprosy, and with timely diagnosis, the disease is completely cured.But the duration of the course takes about three years on average. A person is treated either in a leper colony, or at the place of residence, if the absence of the pathogen is established.
Prevention of leprosy consists in careful observance of the rules of personal hygiene. According to Gerhard Hansen himself, cleanliness and soap are the main enemies of leprosy.
Today, leprosy does not belong to mass diseases, but, according to the WHO, about 11 million people in the world suffer from it. On the one hand, the problem of mortality and the spread of leprosy has been resolved, on the other, it is important to remember the existence of this disease.And today, the problem of late diagnosis is relevant due to the fact that doctors began to forget about the possibility of individual cases of leprosy. At the same time, the disease in 42% of cases leads to severe disability, and if untreated, patients with a severe form of the disease die in 5-10 years.
symptoms, treatment, causes of the disease, first signs
Leprosy (leprosy, Hansen’s disease) is a chronic bacterial infection with a predominant lesion of the skin and peripheral nervous system.
The Russian word infection comes from the Semitic zaraath (leprosy), which was a collective definition of moral and physical impurity. Lepra is an ancient disease that was described in Chinese treatises 3000 years ago. This disease has long been equated with social death, tk. patients with leprosy were driven into deserted deserts, while they hung a bell around their necks so that other people would hear about the approach of a leper. There was also a second scenario: the patients were placed in well-known leper colony.Escape from the leper colony was always punishable by death, but people fled from there because of the actual prison conditions. However, these measures have borne fruit: since the beginning of the 14th century, the incidence of leprosy in Europe has dropped sharply.
The causative agent of leprosy – Mycobacterium leprae – is an acid-resistant bacillus, develops exclusively inside the cell and does not grow on nutrient media, it can be isolated only from granulomas by scraping biomaterial. After scraping from the lesion in a smear under a microscope, mycobacterium leprosy has a specific location in the form of a “pack of cigars”.This phenomenon got its name from the parallel arrangement of bacteria relative to each other. For the first time, the causative agent of leprosy was isolated in 1873 by the Norwegian physician Gerhard Hansen, in honor of the discoverer of leprosy, and received its name “Hansen’s disease”.
The only source of infection is humans. The transmission paths remain unexplored to the end, tk. leprosy is a low-contagious disease (low risk of contracting leprosy with a single contact). However, contact and airborne transmission of the pathogen have been proven with constant household contact with an infected person.As practice shows, children do not get sick when separated from infected parents immediately after birth. The main preventive measure for the spread of leprosy remains the isolation of an infected person, but if hygiene rules are observed on the part of the patient and the people around him, infection does not occur (seen in the examples of Norway and Iceland). Experimental leprosy infections of animals were crowned with success only with the infection of armadillos. The rest of the animals are resistant to the causative agent of leprosy.
Since 1985, the number of people affected by leprosy has decreased by 90%, and during this period more than 15 million people have been cured with the help of combination drug therapy.
The incubation period of the disease (the time from infection to the onset of the disease) can last from 4 – 6 to 10 – 15 years. This is due to the slow multiplication of the microorganism. Depending on the course of the disease, 5 forms of leprosy are distinguished: polar tuberculoid, borderline tuberculoid, undifferentiated, borderline lepromatous, polar lepromatous.With a normal immune status of the patient, a relatively favorable tuberculoid form develops, the lepromatous form of leprosy is considered unfavorable.
Tuberculoid form : most often there is one focus of growth of granulation tissue in the skin or mucous membranes. In the polar tuberculoid form, anesthesia (absence of pain) in granulomas is expressed, but in borderline forms, anesthesia is not so pronounced and may be absent, and neuritis may also be observed.
Undifferentiated form : characterized by lesions of the peripheral nerve trunks and extensive skin rashes, which are clearly limited in shape.The disease can turn into a tuberculoid or lepromatous form. Skin rashes are specific to an undifferentiated form and are called leprida. The increased sensitivity and soreness of leprida is quickly replaced by anesthesia. The nerve trunks can be unevenly thickened due to neuritis.
Lepromatous form : For this form, typical localizations are the face and distal extremities. The resulting infiltrates have a reddish-brown color and give the face a specific look, which is called the “lion’s face”.Eyes are also affected, resulting in impaired vision and blindness. Anesthesia with granulomas is not observed. The affected areas can dissolve and undergo scarring.
A reliable diagnosis can only be made after isolating M. leprae. Material for research is obtained by scraping from the affected area of the skin, while first making a small incision with a depth of 2 – 3 mm. You can also take a puncture from the enlarged lymph nodes.The resulting material is stained according to Ziehl-Nielsen (stains acid-fast bacteria). You can also make sure that only M. leprae is present in the smear by infecting guinea pigs (resistant to M. leprae and not resistant to M. tuberculosis). In addition, to differentiate the form of the disease, a skin test with the M. leprae allergen is performed. With the tuberculoid form, the test is positive, with the lepromatous form – negative.
Treatment of leprosy is a long and difficult process that includes repeated intensive chemotherapy.The choice of medicines is small. Therefore, it is worth paying attention to the prevention of leprosy.
The basis for the prevention of infection with leprosy is the timely identification of the infected, the isolation of patients, the immediate start of treatment with effective antibiotics. Family members who have been in contact with the patient must be examined at least once a year. In places endemic for leprosy, mass examinations and examinations are periodically carried out to identify patients.
In the 1940s, dapsone was discovered, which belongs to sulfones (dapsone, solusulfone). They are the main drugs for the treatment of leprosy. Over the course of 20 years, M. leprae has developed resistance to the only known drug for the treatment of leprosy. In the 1960s, rifampicin and clofazimine were discovered. These drugs were included in the treatment regimen for KLT, a combination drug therapy.
Since 1995, WHO has pledged to provide combination drug therapy (CRT) for treatment free of charge to all leprosy patients worldwide.At the moment, WHO has signed an agreement with a pharmaceutical company only until 2020. Over the past 20, KLT has been provided to over 16 million patients.
For non-traditional methods of treating leprosy, various means using aloe are used. Its juice has an immunostimulating effect, so its use as a concomitant treatment for the lepromatous form of the disease is quite acceptable. Aloe leaves are eaten, compresses with the juice of this plant are applied to the affected skin.
It is also possible to use other folk remedies that increase the immune response. It can be a decoction from calamus root, a decoction based on ginseng root.
Lubrication of infiltrates with celandine juice also contributes to the healing of lesions.
The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, see your doctor.
- Medical Microbiology Pozdeev O.K. / Ed. acad. RAMS V.I. Pokrovsky. – M .: GEOTAR-MED, 2002.- 768 p.
- WHO website https://www.who.int/ru/news-room/fact-sheets/detail/leprosy
Your comments on symptoms and treatment
Lepra (Leprosy) – signs, causes, symptoms, treatment and prevention
The disease occurs due to an obligate intracellular parasite, it is the main cause, but the source of the infection is a sick person.It is a mistake to believe that leprosy (leprosy) can be transmitted through tactile contact. Infection occurs by airborne droplets or through blood-sucking insects.
It is worth noting that children are more susceptible to the disease. The incubation period for leprosy is 3-7 days. But due to the fact that most people have good immunological protection, then a maximum of 10% of people who were at risk of infection fall ill with leprosy.
With leprosy, air-cooled tissues of the body are mainly affected: superficial nerves, the mucous membrane of the upper respiratory tract and, of course, the skin.In cases where the disease has not been treated, the destruction of nerves and infiltration of the skin leads to a pronounced deformation of the appearance. However, leprosy bacteria alone cannot cause toes or toes to die. But secondary bacterial infections in cases where the tissue deprived of sensitivity is injured, as a result, and leads to the loss of body parts.
There are two polar types of the disease (lepromatous and tuberculoid), as well as borderline and indeterminate.An indefinite leprosy begins with skin lesions, although the lesions are not very noticeable. And its first symptom is paresthesia or hyperesthesia on any part of the skin. On very close examination, it is possible to detect several hyperpigmented spots. Rashes can go away on their own after one to two years. The borderline type of leprosy is characterized by the appearance of hypochromic, mixed, erythematous spots on the skin. Damage to the peripheral nerves at the beginning is absent, but then specific polyneuritis develops, which leads to a disorder of sensitivity in the extremities, muscle atrophy, contractures of the fingers and trophic ulcers.