Learn about the disease, illness and/or condition Leprosy including: symptoms, causes, treatments, contraindications and conditions at ClusterMed.info.
Leprosy (Hansen's disease) facts
Are there different forms (classifications) of leprosy?
There are multiple forms of leprosy described in the literature. The forms of leprosy are based on the person's immune response to M. leprae. A good immune response can produce the so-called tuberculoid form of the disease, with limited skin lesions and some asymmetric nerve involvement. A poor immune response can result in the lepromatous form, characterized by extensive skin and symmetric nerve involvement. Some patients may have aspects of both forms. Currently, two classification systems exist in the medical literature: the WHO system and the Ridley-Jopling system. The Ridley-Jopling system is composed of six forms or classifications, listed below according to increasing severity of symptoms:
How do health care professionals diagnose leprosy?
The majority of cases of leprosy are diagnosed by clinical findings, especially since most current cases are diagnosed in areas that have limited or no laboratory equipment available. Hypopigmented patches of skin or reddish skin patches with loss of sensation, thickened peripheral nerves, or both clinical findings together often comprise the clinical diagnosis. Skin smears or biopsy material that show acid-fast bacilli with the Ziehl-Neelsen stain or the Fite stain (biopsy) can diagnose multibacillary leprosy, or if bacteria are absent, diagnose paucibacillary leprosy. Other tests can be done, but most of these are done by specialized labs and may help a clinician to place the patient in the more detailed Ridley-Jopling classification and are not routinely done (lepromin test, phenolic glycolipid-1 test, PCR, lymphocyte migration inhibition test or LMIT). Other tests such as CBC test, liver function tests, creatinine test, or a nerve biopsy may be done to help determine if other organ systems have been affected.
How is leprosy transmitted? Is leprosy contagious?
Researchers suggest that M. leprae are spread person to person by nasal secretions or droplets. However, the disease is not highly contagious like the flu. They speculate that infected droplets reach other peoples' nasal passages and begin the infection there. Some investigators suggest the infected droplets can infect others by entering breaks in the skin. M. leprae apparently cannot infect intact skin. Rarely, humans get leprosy from the few animal species mentioned above. Occurrence in animals makes it difficult to eradicate leprosy from endemic sources. Routes of transmission are still being researched for leprosy. Recent genetic studies have demonstrated that several genes (about seven) are associated with an increased susceptibility to leprosy. Some researchers now conclude that susceptibility to leprosy may be partially inheritable.
Is it possible to prevent leprosy?
Prevention of contact with droplets from nasal and other secretions from patients with untreated M. leprae infection is currently the most effective way to avoid the disease. Treatment of patients with appropriate antibiotics stops the person from spreading the disease. People who live with individuals who have untreated leprosy are about eight times as likely to develop the disease, because investigators speculate that family members have close proximity to infectious droplets. Leprosy is not hereditary, but recent findings suggest susceptibility to the disease may have a genetic basis.Many people get exposed to leprosy throughout the world, but the disease in not highly contagious. Researchers suggest that most exposures result in no disease, and further studies suggest that susceptibility may be based, in part, by a person's genetic makeup. In the U.S., there are about 200-300 new cases diagnosed per year, with most coming from exposures during foreign travel. The majority of worldwide cases are found in the tropics or subtropics (for example, Brazil, India, and Indonesia). 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 commercially available vaccine available to prevent leprosy. However, there are reports that using BCG vaccine alone, the BCG vaccine along with heat-killed M. leprae organisms, and other preparations may be protective, help to clear the infection or possibly shorten treatment. Except for BCG being obtainable in some countries, these other preparations are not readily available.Animals (chimpanzees, mangabey monkeys, and nine-banded armadillos) rarely transfer M. leprae to humans. Nonetheless, handling such animals in the wild is not advised. These animals are a source for endemic infections.
What are leprosy early symptoms and signs?
What are the complications of leprosy?
The complications of leprosy depend on how quickly the disease is diagnosed and effectively treated. Very few complications occur if the disease is treated early enough, but the following is a list of complications that can occur when diagnosis and treatment is either delayed or started late in the disease process:
What are the risk factors for leprosy?
People at highest risk are those who live in the areas where leprosy is endemic (parts of India, China, Japan, Nepal, Egypt, and other areas) and especially those people in constant physical contact with infected people. In addition, there is some evidence that genetic defects in the immune system may cause certain people to be more likely to become infected (region q25 on chromosome 6). Additionally, people who handle certain animals that are known to carry the bacteria (for example, armadillos, African chimpanzee, sooty mangabey, and cynomolgus macaque) are at risk of getting the bacteria from the animals, especially if they do not wear gloves while handling the animals.
What causes leprosy?
Leprosy is caused mainly by Mycobacterium leprae, a rod-shaped bacillus that is an obligate intracellular (only grows inside of certain human and animal cells) bacterium. M. leprae is termed an "acid fast" bacterium because of its chemical characteristics. When special stains are used for microscopic analysis, it stains red on a blue background due to mycolic acid content in its cell walls. The Ziehl-Neelsen stain is an example of the special staining techniques used to view the acid-fast organisms under the microscope.Currently, the organisms cannot be cultured on artificial media. The bacteria take an extremely long time to reproduce inside of cells (about 12-14 days as compared to minutes to hours for most bacteria). The bacteria grow best at 80.9 F-86 F, so cooler areas of the body tend to develop the infection. The bacteria grow very well in the body's macrophages (a type of immune system cell) and Schwann cells (cells that cover and protect nerve axons). M. leprae is genetically related to M. tuberculosis (the type of bacteria that cause tuberculosis) and other mycobacteria that infect humans. As with malaria, patients with leprosy produce anti-endothelial antibodies (antibodies against the lining tissues of blood vessels), but the role of these antibodies in these diseases is still under investigation.In 2009, investigators discovered a new Mycobacterium species, M. lepromatosis, which causes diffuse disease (lepromatous leprosy). This new species (determined by genetic analysis) was found in patients located in Mexico and the Caribbean islands.
What health care specialists treat leprosy?
Although pediatricians and primary care doctors usually follow patients with leprosy, initial diagnosis and treatment is often done in consultation with infectious disease specialists, dermatologists, neurologists, and/or immunologists. Some patients may require consultation with a surgeon to restore some functions of movement and/or do cosmetic repairs.
What is leprosy?
Leprosy is a disease mainly caused by the bacteria Mycobacterium leprae, which causes damage to the skin and the peripheral nervous system. The disease develops slowly (from six months to 40 years) and results in skin lesions and deformities, most often affecting the cooler places on the body (for example, eyes, nose, earlobes, hands, feet, and testicles). The skin lesions and deformities can be very disfiguring and are the reason that infected individuals historically were considered outcasts in many cultures. Although human-to-human transmission is the primary source of infection, three other species can carry and (rarely) transfer M. leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos. The disease is termed a chronic granulomatous disease, similar to tuberculosis, because it produces inflammatory nodules (granulomas) in the skin and nerves over time.
What is the history of leprosy (Hansen's disease)?
Unfortunately, the history of leprosy and its interaction with man is one of suffering and misunderstanding. The newest health research suggests that at least as early as 4000 B.C. individuals had been infected with M. leprae, while the first known written reference to the disease was found on Egyptian papyrus in about 1550 B.C. The disease was well recognized in ancient China, Egypt, and India, and there are several references to the disease in the Bible. Because the disease was poorly understood, very disfiguring, slow to show symptoms, and had no known treatment, many cultures thought the disease was a curse or punishment from the gods. Consequently, leprosy was left to be "treated" by priests or holy men, not physicians.Picture of a person with leprosy (Hansen's disease)Since the disease often appeared in family members, some people thought it was hereditary. Other people noted that if there was little or no contact with infected individuals, the disease did not infect others. Consequently, some cultures considered infected people (and occasionally their close relatives) as "unclean" or as "lepers" and ruled they could not associate with uninfected people. Often infected people had to wear special clothing and ring bells so uninfected people could avoid them.The Romans and the Crusaders brought the disease to Europe, and the Europeans brought it to the Americas. In 1873, Dr. Hansen discovered bacteria in leprosy lesions, suggesting leprosy was an infectious disease, not a hereditary disease or a punishment from the gods. However, patients with the disease were still ostracized by many societies and cared for only at missions by religious personnel. Patients with leprosy were encouraged or forced to live in seclusion up to the 1940s, even in the United States (for example, the leper colony on Molokai, Hawaii, that was established by a priest, Father Damien and another colony established at Carville, La.), often because no effective treatments were available to patients at that time.Because of Hansen's discovery of M. leprae, efforts were made to find treatments that would stop or eliminate M. leprae. In the early 1900s to about 1940, oil from Chaulmoogra nuts was used with questionable efficacy by injecting it into patients' skin. At Carville in 1941, promin, a sulfone drug, showed efficacy but required many painful injections. Dapsone pills were found to be effective in the 1950s, but soon (1960s-1970s), M. leprae developed resistance to dapsone. Fortunately, drug trials on the island of Malta in the 1970s showed that a three-drug combination (dapsone, rifampicin [Rifadin], and clofazimine [Lamprene]) was very effective in killing M. leprae. This multi-drug treatment (MDT) was recommended by the World Health Organization (WHO) in 1981 and remains, with minor changes, the therapy of choice. MDT, however, does not alter the damage done to an individual by M. leprae before MDT is started.Currently, there are several areas (India, East Timor) of the world where the WHO and other agencies (for example, the Leprosy Mission) are working to decrease the number of clinical cases of leprosy and other diseases such as rabies and schistosomiasis that occur in remote regions. Although health researchers hope to eliminate leprosy like smallpox, endemic (meaning prevalent or embedded in a region) leprosy makes complete eradication unlikely. In the U.S., leprosy has occurred infrequently but is considered endemic in Texas, Louisiana, Hawaii, and the U.S. Virgin Islands by some investigators.Leprosy is often termed "Hansen's disease" by many clinicians in an attempt to have patients forgo the stigmas attached to being diagnosed with leprosy.
What is the prognosis of leprosy?
The prognosis of leprosy varies with the stage of the disease when first diagnosed and treated. For example, early diagnosis and treatment limits or prevents tissue damage so the person has a good outcome. However, if the patient's infection has progressed to more advanced disease, the complications listed above can markedly affect the patient's lifestyle, and thus the condition has a fair to poor prognosis.
What is the treatment for leprosy?
Where can I find more information on leprosy?
"Leprosy Elimination," World Health Organizationhttp://www.who.int/lep/mdt/en/"Hansen's Disease," Centers for Disease Control and Preventionhttps://www.cdc.gov/leprosy/
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