Leprosy (patient information)

Leprosy

Overview

What are the symptoms?

What are the causes?

Who is at highest risk?

When to seek urgent medical care?

Diagnosis

Treatment options

Where to find medical care for Leprosy?

What to expect (Outlook/Prognosis)?

Possible complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  João André Alves Silva, M.D. [2]

## Overview

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Leprosy, also known as Hansen's disease, is an infectious disease which is characterized by disfiguring skin sores, nerve damage, and progressive debilitation. Most commonly affected areas include peripheral nerves, skin, eyes, upper respiratory tract and nasal mucosa.[1] Once known as a highly contagious and deadly disease, today it is very rare and is easily treated with medication. Accordingly, an early diagnosis and prompt treatment represent the standard approach to this condition, thereby preventing disability related to disease.[2]

## What are the symptoms of Leprosy?

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The bacteria responsible for leprosy grow very slowly, sometimes taking 2 to 10 years before signs and symptoms appear. The symptoms tend to affect mainly to the skin, nerves, and mucous membranes (the soft, moist areas just inside the body's openings).

When loss of sensation occurs, injuries (such as burns or fractures) may go unnoticed. You should always try to avoid injuries. However, if you experience loss of sensation due to leprosy (or another cause), you may not feel pain, which commonly warns you of harm to your body. So, extra caution is required to ensure your body is not injured.[3]

The disease may cause symptoms, such as:[3]

* Skin lesions that may be faded/discolored, than your normal skin tone. These lesions commonly have decreased sensation to touch, heat, or pain and do not heal after several weeks to months.
* Growths on the skin.
* Thick, stiff or dry skin.
* Severe pain.
* Numbness on affected areas of the skin.
* Muscle weakness or paralysis (especially in the hands and feet).
* Eye problems that may lead to blindness.
* Enlarged nerves (especially those around the elbow and knee).
* Stuffy nose.
* Nosebleeds.
* Ulcers on the soles of feet.
* Since leprosy affects the nerves, loss of feeling or sensation can occur.

## What causes Leprosy?

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Leprosy is caused by the organism Mycobacterium leprae. It is not very contagious (difficult to transmit) and has a long incubation period (time before symptoms appear), which makes it difficult to determine where or when the disease was contracted. Children are more susceptible than adults to contracting the disease.

Leprosy has two common forms, tuberculoid and lepromatous, and these have been further subdivided. Despite this classification, both forms produce sores on the skin, but the lepromatous form is most severe, producing large, disfiguring lumps and bumps (nodules). Also, forms of the disease eventually cause nerve damage in the arms and legs, which causes sensory loss in the skin and muscle weakness. People with long-term leprosy may lose the use of their hands or feet due to repeated injury resulting from lack of sensation.

The disease is common in many countries worldwide, and in temperate, tropical, and subtropical climates. Approximately 100 cases per year are diagnosed in the United States. Most cases are limited to the South, California, Hawaii, and U.S. island possessions. Today effective medications are available, and isolation of victims in "leper colonies" is unnecessary. The emergence of drug-resistant Mycobacterium leprae, as well as increased numbers of cases worldwide, has led to global concern about this disease.

### Transmission

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Evidence suggests that the bacteria that cause leprosy are able to spread from person to person. The transmission might happen when someone with the disease coughs or sneezes. This leads to the release of droplets into the air that carry the bacteria to another person. It might also happen if you are exposed to other nasal fluids (also known as secretions). Droplets and other body secretions can contain the bacteria that cause leprosy, thereby transmitting the infection.[4]

## Who is at highest risk?

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Children are more susceptible than adults to contracting the disease.

People who live in countries where the disease is widespread are at higher risk of contracting he disease. These countries include:

* Angola
* Brazil
* Central African Republic
* Democratic Republic of Congo
* Federated States of Micronesia
* India
* Kiribati
* Madagascar
* Mozambique
* Nepal
* Republic of Marshall Islands
* United Republic of Tanzania

People who have been in close contact with someone who has untreated Hansen’s disease are also at higher risk of contracting the disease, since they may have been exposed to the leprosy bacteria. However, as soon as patients start treatment, they are no longer able to spread the disease.

Yet, according to the CDC, most adults around the world might face very little risk of contracting leprosy, since evidence shows that 95% of all adults are naturally unable to get the disease, even if they’ve been exposed to the bacteria that causes it.[5]

### Contact with armadillos

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In the southern areas of the United States some armadillos are infected with leprosy. Despite the low risk of contracting the disease from contact with an armadillo, it is possible. In case of contact with an armadillo, if you decide to see a doctor, make sure to provide a complete history of armadillo contact. Your doctor can determine whether or not you have the disease. In the unlikely event that you get leprosy, your doctor can also help you get treatment.

Therefore, whenever possible, avoid contact with armadillos, in order to further decrease the risk of contracting the disease. [6]

## When to seek urgent medical care?

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Although cases of leprosy in the United States are rare, you should contact your health care provider in case you feel you are developing symptoms of leprosy, in particular if you have had recent contact with someone who has the disease. Cases of leprosy in the United States need to be reported to the Centers for Disease Control and Prevention.

## Diagnosis

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* Lepromin skin test can be used to distinguish lepromatous from tuberculoid leprosy, but is not used for diagnosis.
* Skin lesion biopsy.
* Skin scraping examination for acid fast bacteria.

## Treatment options

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Today leprosy is easily treatable with a combination of antibiotics, usually during a period of time that may last from 6 months to 2 years.

A number of different antibiotics, such as dapsone, rifampin, clofazimine, fluoroquinolones, macrolides, and minocycline are used to kill the bacteria that causes the disease. Aspirin, prednisone, or thalidomide are used to control inflammation.

When being treated for leprosy, it is important to:

* Let your doctor know about any potential symptoms of nerve damage. This is experienced by numbness or a certain loss of sensation in any part of the body, particularly in the hands and feet.
* Take the antibiotics prescribed by your doctor, until he says that the treatment is complete, otherwise you have the risk of becoming sick again.

In the United States, patients with leprosy may be treated at special clinics run by the Hansen's Disease Program.

## Where to find medical care for Leprosy?

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Directions to Hospitals Treating Leprosy

## What to expect (Outlook/Prognosis)?

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Early recognition is important. Early treatment limits damage by the disease, renders the person noninfectious (you can not get the disease from them), and allows for a normal lifestyle.

## Possible complications

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* Cosmetic disfigurement
* Permanent nerve damage

## Prevention

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Prevention consists of avoiding close physical contact with untreated people. People on long-term medication become noninfectious (they do not transmit the organism that causes the disease).

## Sources

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* http://www.nlm.nih.gov/medlineplus/ency/article/001347.htm
* http://www.cdc.gov/leprosy/index.html

## References

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1. ↑ "Leprosy (Hansen's Disease)".
2. ↑ "Hansen's Disease (Leprosy)".
3. ↑ 3.0 3.1 "Hansen's Disease (Leprosy)".
4. ↑ "Hansen's Disease (Leprosy) Transmission".
5. ↑ "Hansen's Disease (Leprosy) Risk of Exposure".
6. ↑ "Hansen's Disease (Leprosy) Risk of Exposure".

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