Leprosy

Leprosy is a disease caused by infection with Mycobacterium leprae damaging the skin and central nervous system.

leprosy

It is a slowly developing progressive disease.

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The disease is also termed as Chronic Granulomatus disease. At present it is most widespread in countries lying both to the north and to the south of the temperate zone and among the less enlightened people of the earth. Leprosy is essentially a chronic disease.

Humans are the primary reservoir of M leprae.

Animal reservoirs of leprosy have been found in 3 species: 9-banded armadillos, chimpanzees, and mangabey monkeys.

Basics –
The incubation period for leprosy is 6 months to 40 years or longer.
The mean incubation period is 4 years for tuberculoid leprosy and is 10 years for lepromatous leprosy.
Leprosy is not a highly infectious disease.

The principal means of transmission is by aerosol spread from infected nasal secretions to exposed nasal and oral mucosa. Leprosy is not generally spread by means of direct contact through intact skin, although close contacts are most vulnerable.
Classification of Leprosy

Borderline tuberculoid leprosy:
Lesions like tuberculoid leprosy but smaller and more numerous with less nerve enlargement.

Tuberculoid leprosy:
Hypopigmented macules, some are large and some become anesthetic (lose pain sensation); some neural involvement in which nerves become enlarged; spontaneous resolution in a few years.

Lepromatous leprosy:
Early lesions are pale macules (flat areas) that are diffuse and symmetric.Their can occur hair loss, involvement of nerve leading to weakness, formation of skin nodules.

Age / Sex of Leprosy

It occurs in age between  10-14 years and 35-44 years. Leprosy is rare in infants.

The lepromatous type of leprosy is more common in men than in women after puberty, with a male-to-female ratio of 2:1

Race of Leprosy

Leprosy occurs in persons of all races.

Causes of Leprosy

• The spread of disease is from person to person by nasal secretions.Some investigators suggest the infected droplets can infect others by entering breaks in the skin. It is not highly contagious disease.

• Exposure to the nasal discharge of individuals who remain untreated for years .

• In addition to exposure to respiratory secretions, exposure to insect vectors and infected soil has been suspected as a possible mode of transmission.

Mortality of Leprosy

Early diagnosis and effective antimicrobial treatment can arrest and even cure leprosy.

The WHO reports about 500,000 to 700,000 new cases per year worldwide, with curing of about 14 million cases since 1985.

There is no commercial vaccine for preventing Leprosy.

Leprosy Signs and Symptoms

• Dryness of eyes
• Ulcerations
• Nodules on skin
• Macules on skin
• Numbness in hands , feet
• Loss of sensation of temperature

Differential diagnosis of Leprosy

• Psoriasis
• Sarcoidosis
• Neurofibromatosis
• Leishmaniasis
• Vitiligo

Treatment for Leprosy

Treatment with standard antibiotic drugs is very effective such as dapsone, rifampicin, and clofazimine.

Majority of new cases were reported in California, New York and Texas. Early diagnosis and treatment prevents nerve involvement, and without nerve involvement it remains a skin disease.

Investigations for Leprosy

• Clinical diagnosis by patches on skin with loss of sensation ,skin smears or biopsy material that show acid-fast bacilli with the Ziehl-Neelsen stain or the Fite stain (biopsy) can diagnose multibacillary leprosy,
• CBC testing
• Liver function test
• Creatnine test

Complications of Leprosy

Progressive disfigurement
Sensory loss with permanent nerve damage
Good food and good hygienic surroundings are of the first importance in the treatment of leprosy.
Strychnine and chaulmoogra-oil are highly recommended by the old school.

Homeopathic treatment for Leprosy

Arsenicum  –
Yellow or white spots; tubercular swelling in nose;burning ulcers at the end of the fingers, at the toes, soles of feet, navel, cheek; raised up tubercles; loss of hair and eyebrows; livid tubercles on any part of the body; hyperaesthesia and anaesthesia alternating; general prostration.

Graphites   –
Leprous spots, coppery, annular, raised on the face, ears, buttocks, legs, and feet; ulcers on toes, crusts in nostrils; skin cracks and discharges a sticky fluid.

Kali bichromicum –
Brownish colored spots; ulcers with an unhealthy look; blisters on the extremities; little boil or pustules on any part of body; thick, tough discharge from nose; hard plugs in nose; thick, yellow, putrid discharge from the ears; ulcers on tongue and on cornea.

Lachesis  –
Spots yellow, red, green, lead and copper colored, pale livid; hard and pale swelling; large boils; ulcers surrounded by nodes and vesicles; the muscles fall off in shreds from the bones; bloody serum discharge from the nose, ears and mouth; obstinate ulcers with black spots in the granulations.

Phosphorus –
Later stages of the disease; brown spots on an even base; boils; spots like blood blisters on the body; tubercles on the trunk, buttocks; thick patches on face and arms; discolored borders around the white spots; hair falls out; tension in the fingers, and dullness towards the end; great debility with increase of sexual desire.

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