Leprosy is characterized as a chronic infectious disease that may cause severe and disfiguring skin sores and neuropathy to the extremities. Because this disease is shrouded in terrifying stigmata in ancient times, lepers are often times out casted from the society. Any outbreaks of leprosy in any country are now met with substantial panic due to this negative stigmata in our past.
The main symptomatology in leprosy are the cutaneous pale sores and lumps which typically persist from weeks to months. In the same way, significant nerve damage leads to peripheral neuropathy that may lead to paresthesia or loss of sensation in arms and legs. Bacillary invasion of the eyes may occur and cause corneal ulcerations and iridocyclitis of the affected eyes . There will also be a consequent paralysis presenting as muscle weakness in the extremities. The symptoms will surface usually after 3 to 5 years from initial contact with an infected carrier.
Entire Body System
Here we report a case in which an elderly female presented with malar rash, intermittent fever, and arthralgia. Her diagnosis was significantly delayed due to a close clinical resemblance to systemic lupus erythematosus. [ncbi.nlm.nih.gov]
Gangrene may also follow, causing body tissue to die and become deformed. [medical-dictionary.thefreedictionary.com]
- Saddle Nose
BACKGROUND: Facial deformation as a sequela of leprosy is caused not only by a saddle nose but also by regression of the maxilla, as well documented in paleopathological observations of excavated skeletal remains of patients with leprosy. [ncbi.nlm.nih.gov]
[…] symptoms and signs 3,6: cutaneous erythematous plaques peripheral lower limb edema mixed peripheral neuropathy (often with resultant injuries) /- hypoesthesia/paresthesia /- neuralgia peripheral nerve thickening, which may be palpable corneal ulcers saddle-nose [radiopaedia.org]
The bone involvement may also lead to gross deformation of the nose skeleton and ensuing creation of a saddle-nose deformity. [news-medical.net]
In an advanced stage, the symptoms are similar to those observed in LL, with nasal obstruction and epistaxis followed finally by the ulceration of the septum, leading to a deformed ‘saddle-nose’ appearance. [internationaltextbookofleprosy.org]
A 42 year old male presented with multiple, discrete, hyperpigmented, firm, non elastic, non tender papules and plaques on the posterior trunk of 5 months duration, resembling keloid. [ncbi.nlm.nih.gov]
A variety of skin lesions may be seen but macules (flat), papules (raised), or nodules are common. Sensory loss is a typical feature of leprosy. The skin lesion may show loss of sensation to pin pick and/or light touch. [who.int]
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Both men noticed changes in the skin colouring and sensation but GPs initially thought it was due to skin infections or a form of eczema. [telegraph.co.uk]
For those with skin conditions, including eczema & psoriasis, physical contact with others can be missing in their lives. [skinema.com]
The skin patch is not eczema, which my own 10-year-old daughter suffers from, but leprosy. The disease causes nerve damage and creates what's called "anaesthetic skin". [news.bbc.co.uk]
- Skin Ulcer
He also had Lucio's phenomenon, characterized by vascular thrombosis and invasion of blood vessel walls by leprosy bacilli, causing extensive skin ulcers. [ncbi.nlm.nih.gov]
Leprosy produces skin ulcers, nerve damage, and muscle weakness. If it isn’t treated, it can cause severe disfigurement and significant disability. Leprosy is one of the oldest diseases in recorded history. [healthline.com]
ulcerations due to massive AFB burden in internal organs. M. lepromatosis, like M. leprae, has not been cultured in the laboratory because they both lack genes necessary to grow outside their hosts. [en.wikipedia.org]
Thickened or cracked skin, or skin ulcers, may be later complications and peripheral neuropathy, (inflammation of nerves in the limbs, which become thickened and damaged) is common. [doi.org]
Grossly, all these squirrels presented with bilateral areas of variable alopecia and cutaneous swelling of the snout area, lips, eyelids, pinnae and the distal aspect of all limbs (Fig 1). [doi.org]
With an Independent Minds subscription for just 5.99 6.99 9.99 a month Get the best of The Independent Without the ads – for just 5.99 6.99 9.99 a month The disease seems to cause similar symptoms in red squirrels, with individuals commonly exhibiting alopecia [independent.co.uk]
Occasionally, the scalp may be involved, in which case the hair loss may mimic alopecia areata. Nasal mucosa is involved insidiously with an initial congestive phase in which the mucosa is swollen with numerous telangiectasia. [internationaltextbookofleprosy.org]
The type of the disease which is white and thin, and is characterised by itching and does not create any disturbance (in the patient ), is called Sidhrna (Maculae atrophicae). [chestofbooks.com]
- Social Isolation
It's caused by a long-term bacterial infection, and though it was once viewed as a highly contagious disease that led to social isolation, today it is considered rare and easy to treat, according to the Centers for Disease Control and Prevention. [ibtimes.com]
For centuries, leprosy remained a poorly understood disease characterized by human suffering and social isolation. In 1873, G.A. Hansen discovered the bacterial cause of this infectious disease. [emedicinehealth.com]
- Peripheral Neuropathy
Here, we present the case of a patient with nephrotic syndrome caused by secondary amyloidosis, chronic peripheral neuropathy and a history of leprosy. [ncbi.nlm.nih.gov]
An 18-year-old man presented with a 4-year history of erythematous patches on the trunk, followed 2-years later by multiple nodules, mostly located on the limbs, and distal paresthesias. [ncbi.nlm.nih.gov]
[…] period of 3 years (range: 6 months-20 years) between infection and onset of multi-systemic symptoms and signs 3,6: cutaneous erythematous plaques peripheral lower limb edema mixed peripheral neuropathy (often with resultant injuries) /- hypoesthesia/paresthesia [radiopaedia.org]
Scott Smith, MD) Loss of sensation or paresthesias where the affected peripheral nerves are distributed Wasting and muscle weakness Foot drop or clawed hands (may result from neuritic pain and rapid peripheral nerve damage; as seen in the image below) [web.archive.org]
[…] branches, resulting in inability to close eye (lagophthalmos) Trigeminal Emerging from respective foramina Anesthesia of face, cornea, & conjunctiva Supraorbital Above the eyes Cosmetic importance only *Early manifestations of leprosy may include local paresthesias [atsu.edu]
In the same way, significant nerve damage leads to peripheral neuropathy that may lead to paresthesia or loss of sensation in arms and legs. [symptoma.com]
Some may experience muscle weakness, numbness and/or tingling in a body part, or upper respiratory problems (including a runny nose, eye, and ear problems). Combinations of the above symptoms may also occur. [aocd.org]
In particular, leprosy patients are susceptible to certain complications:  Neuritis, silent neuropathies (nerve damage without pain), pain, burning, tingling, and sudden numbness may occur. This can be treated with corticosteroids. [wikihow.com]
The symptoms of nerve involvement include diminished sensation or feeling in the affected areas (anesthesia) and, sometimes, burning and tingling sensations (paresthesias). [rarediseases.org]
Unexplained skin lesions or rash Loss of sensation or tingling of the skin Thickening of the skin Muscle weakness and/or numbness in the extremities Eye pain or vision changes It is important to note that the following findings may not be apparent for [emedicinehealth.com]
The hallmark signs of leprosy are hypesthesia (an abnormally weak sense of pain, cold, heat, or touch), skin lesions, and peripheral neuropathy. The first indications someone has leprosy are usually have to do with the skin. [todayifoundout.com]
- Burning Sensation
A case of Kilásam. due to the action of the deranged Pittam. is marked by eruptions, resembling the petals of a lotus flower (in shape and colour), and are attended with an extremely burning sensation. [chestofbooks.com]
The characteristic cutaneous lesions with history of exposure to an infected person may give the primary physician a clue that he is dealing with a leprosy case. To further confirm the diagnosis, the following diagnostic modalities and tests may be performed to patients presenting with signs and symptoms of leprosy:
- Skin biopsy or slit skin test will demonstrate the actual bacteria after an acid fast staining technique is applied overt the sample skin tissues under microscopy .
- Skin scrapings examination in which the surface of the cutaneous lesions are scraped using a scalpel and stained with acid fast demonstrate the Mycobacterium leprae organisms.
- Lepromin test distinguishes lepromatous from tuberculoid type of leprosy.
The following anti leprosy medications or antibiotics are commonly used in the treatment of both forms of leprosy:
- Erythromycin and other macrolides
Medications may also be given to control the inflammations associated with leprosy, these include:
- Prednisone 
Leprosy as a disease is rarely fatal, complications of nerve damage predisposes patients to other morbid events. Early diagnosis and early treatment are paramount in all cases of leprosy. This will limit nerve damage and disability, limit the spread of the disease, and increase the chances of the patient to live a normal life.
Leprosy is caused by the acid fast mycobacterium leprae which is not very contagious. The incubation period of M. leprae may take months to years making it almost impossible to pinpoint with certainty where the disease was initially contracted. Children are more likely to contract the disorder compared to their adult counterparts. Leprosy occurs in two forms; the tuberculoid and the lepromatous form.
Both forms will present with skin sores and neuropathies, but the lepromatous forms are more severe in terms of cutaneous presentation. Leprosy is still common in tropical, subtropical, temperate countries. The emergence of the multidrug resistant strains of Mycobacterium leprae have raised global concerns regarding leprosy worldwide .
In the United States, around 205 new cases of leprosy were reported by the Registry of the National Hansen’s Disease Programs as of 2010 . Although majority of this cases are diagnosed among immigrants from foreign countries like Asia, Africa and Latin America. Anthrozoonotic transmission of leprosy has been noted from infected armadillos in the southern part of the United States . Internationally, there has been a significant decline in the prevalence rate of leprosy as of 2010 as compared to baseline data from 2004. In one of the recent prospective studies, newly diagnosed cases of leprosy may exhibit signs of impaired nerve function in up to 56% .
Leprosy is still considered to be the most common cause of hand crippling especially those involving the ulnar nerve . There is no racial predilection for leprosy worldwide. There is a 3:2 male to female ratio among leprosy infected patients globally, but in some areas of Africa women are more prone to the disease than men . Age specific incidence of leprosy has a mean age of 10 years old representing almost 20% of all the leprosy cases.
The clinical manifestation of leprosy differs significantly according to the cellular response of the infected host. When the host possess a hyperactive cellular response, patients tend to have the tuberculoid form or the paucibacillary form of leprosy characterized by dry cutaneous lesion and hypoesthetic nerves. Skin test and slit test will not reveal any actual bacteria on microscopy but the leprae antigen will test positive in this case. Patients having minimal response exhibit the lepromatous form or the multibacillary form of the disease which is characterized by extensive and severe skin involvement and symmetric nerve dysfunctions. Skin test will herald a positive results of the mycobacterium.
The ultimate approach to prevention is to avoid direct close contact with untreated leprosy patients. Patients should submit to immediate treatment after confirmatory diagnosis to reduce the risk of permanent disability and physical disfigurement.
Leprosy or Hansen’s disease is a chronic infection brought about by the acid fast rod bacilli Mycobacterium leprae. Leprosy is a disease that causes damage to both skin (acutely) and nerves (latent infection) which can manifest from several months to years from exposure.
The World Health Organization (WHO) has launched a global initiative to eradicate the disease and bring down the prevalence rate to less than 1 in 10,000 population in the year 2000. This campaign was successfully met in 2002, save for the 15 out of 122 countries that were previously endemic as of 1985 . Multidrug regimens were used worldwide to treat more than 14 million leprosy patients since 1985. Access to the multidrug medications is still the leading problem in the global leprosy campaign especially in some endemic regions of the world. The WHO is bent on reducing the worldwide incidence rate by 35% by 2015.
Leprosy is caused by the acid fast Mycobacterium leprae.
Diagnosis is done by a detailed clinical history and direct physical examination of the lesions. Confirmatory tests including skin biopsy, skin scraping tests, and lepromin tests may be implored.
Treatment and follow-up
Anti-leprosy medications like rifampicin, dapsone and clofazimine. Anti-inflammatory agents like aspirin, thalidomide, and prednisone may also be used to allay the symptoms.
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