Leprosy

This is a very slowly progressing disease, and it may take as many as 5 years on average for the symptoms to appear after the infection. You may be suffering from leprosy if you have the following symptoms:

Skin Changes

• Patchy discoloration of the skin.
• Skin lesions that are typically flat, pale (hypopigmented), or reddish (erythematous) spots.
• Skin lesions with slightly decreased sensitivity to touch or pain.
• Skin becomes thick, dry, and hard.
• Hair loss in the affected area.
• Extra growth of nodules on the skin.
• Growth of painless lumps on the face or earlobes.
• Ulcer formation on the soles of the feet that may be painless.
• Thinning of eyebrows and eyelashes, sometimes leading to loss of eyebrows.
• Change in the shape of the nose.

Neurological Symptoms

• Loss of sensation in the affected spots of the skin.
• Diminished sensation or feeling in the affected areas (anesthesia).
• Burning and tingling sensations (paresthesias).
• Non-healing ulcers on the soles of the feet.
• Muscle weakness and atrophy of the small muscles of the hands or feet, leading to paralysis or crippling.
• Loss of sensation in toes and fingers.
• Painful, tender, and enlarged nerves.
• Vision changes.

Leprosy is a chronic infectious disease caused by bacteria called Mycobacterium leprae complex, which comprises M. leprae and M. lepromatosis. Leprosy is also known as Hansen's disease, named after the scientist who discovered M. leprae in 1873. Lab tests show that M. leprae grow optimally at temperatures ranging from 27 to 33 °C. This explains its predilection for cooler regions of the body, such as:

• Skin
• Nerves close to the surface of the skin
• Eyes
• Thin tissue lining the nose

It divides very slowly and takes years to reach a number sufficient to show any signs of infection. The mode of transmission is not entirely understood. It is thought that disease transmission occurs when a person actively suffering from the disease sneezes or coughs, releasing the bacteria into the atmosphere, and a healthy person breathes in the droplets. However, it is not easily transmissible or highly contagious. Prolonged close contact with a person actively suffering from this disease is essential for transmission. The majority of people have a natural immunity to the disease and will not develop any symptoms even if they are exposed to it. Only about 5 percent of all people are susceptible to the disease.

Overall, the risk of contracting leprosy for any adult worldwide is very low, as more than 95% of people have natural immunity to the disease. However, the following risk factors are associated with leprosy:

• Close contact: Prolonged direct contact with an active leprosy patient significantly increases the chances of contracting the disease.
• Living in endemic areas: Residing in regions where leprosy is endemic, such as parts of India, China, Japan, Nepal, and Egypt, elevates the risk of infection.
• Age: Older individuals are more susceptible to leprosy, with increased risk observed in children aged 5 to 15 and continued risk for those over 30.
• Genetic factors: Genetic defects in the immune system, particularly in region q25 on chromosome 6, may predispose certain individuals to infection.
• Exposure to certain animals: Individuals who handle animals known to carry the leprosy bacteria, such as nine-banded armadillos, African chimpanzees, sooty mangabeys, and cynomolgus macaques, are at increased risk, especially if gloves are not worn.
• Immunosuppression: Leprosy is more likely to occur in individuals with suppressed immunity due to factors such as solid organ transplantation, chemotherapy, HIV infection, or the use of immunosuppressive agents for rheumatologic conditions.

Usually, a detailed observation and physical examination of the skin lesions are performed by the doctor, and the following supporting tests are used to confirm the diagnosis of leprosy:

• Skin biopsy: A tiny piece of skin from the affected area is taken and studied under a microscope to check for the presence of leprosy-causing bacteria.
• Skin slit smear: This test is used for multibacillary leprosy only. A small slit is made using a sharp blade over the skin of the forehead, earlobe, or lesions. Then a smear is made by scraping the exposed skin onto a glass slide and examined for bacteria under a microscope.
• Lepromin test: In this test, a small number of inactive leprosy bacteria are injected into the skin, and the patient's immune response is studied. This test determines the type of leprosy rather than diagnosing the condition.
• DNA PCR test: This is a very specific molecular test that checks for the presence of leprosy bacteria DNA in the blood sample and can establish the diagnosis with certainty.

The following tests might also be performed to help determine if any other organ systems have been affected by leprosy:

• CBC test
• Liver function tests
• Creatinine test
• Nerve biopsy
• Nerve conduction velocity test

Leprosy can be transmitted only via prolonged and close contact with an actively infected individual. It is possible to prevent the transmission of leprosy by reducing close contact with the infected person. However, it is essential to note that leprosy cannot spread through a mere handshake, and discrimination against leprosy patients is strongly discouraged.

There is no commercially available vaccine to prevent leprosy. However, the BCG vaccine, which is used to prevent tuberculosis, provides some protection against leprosy, although it is not commonly used for that purpose.

Certain animals, such as:

• Nine-banded armadillos
• African chimpanzees
• Sooty mangabeys
• Cynomolgus macaques

can rarely transfer M. leprae to humans. It is advisable not to handle such animals in the wild.

If someone is extensively exposed to the bacteria, they may be started on prophylactic medications to prevent the occurrence of the disease. Using Rifampicin can reduce the development of paucibacillary leprosy by almost 50%.

As leprosy is a bacterial disease, it is treated with a combination of antibiotics for a period of 6 months or 12 months depending upon the type of leprosy and can be extended as per individual case. According to WHO guidelines, a 3-drug regimen of rifampicin, dapsone, and clofazimine is recommended for all patients, with a treatment duration of 6 months for paucibacillary leprosy (PB) and 12 months for multibacillary leprosy (MB). This therapy helps to prevent the development of antibiotic resistance by the bacteria, which may further increase the course of treatment. The condition can be cured if the treatment is followed and completed as recommended by the doctor. Antibiotics used to treat leprosy act by killing the bacteria, thereby curing the disease and preventing it from worsening. However, it does not reverse the nerve damage or any physical deformation that has occurred prior to the diagnosis of the condition. Hence, it is extremely important to diagnose the condition at the earliest to prevent permanent nerve damage.

1. Antibiotics

Depending on the type and severity of leprosy (PB and MB), a combination of the following drugs is given for 6 or 12 months:

• Clofazimine
• Rifampicin
• Dapsone

2. Nerve Tonics (Neurotonics)

Nerve tonics can help ease symptoms caused by nerve damage. However, the damage to the nerve is permanent.

3. Treatment of Resistant Cases

In cases that are resistant to one or two of the above first-line drugs, treatment can be extended to 24 months, and the following drugs can be included in the multi-drug therapy:

• Clarithromycin
• Minocycline
• Ofloxacin
• Moxifloxacin
• Levofloxacin

The aim of leprosy care at home is to minimize the occurrence of serious complications of the disease. You can do the following things at home:

• Protect your eyes from dust, harsh sunlight, and dryness. Clean your eyes gently with a clean cloth every day. Look in the mirror to check for any changes in the eyes.
• Protect your hands and feet from injuries, and check for any undetected injuries daily. If there is a loss of sensation in the hands or feet, take extra care to prevent burns and injuries.
• Clean your hands and feet daily with lukewarm water. Soak hands and feet in lukewarm water and scrape away the hardened skin. Apply an emollient cream to your hands and feet to prevent dryness.
• Perform finger and toe exercises daily to prevent stiffness and loss of mobility of the digits.

The complications of leprosy depend on the speed of diagnosis and the effectiveness of treatment. Very few complications occur if physicians treat the disease early enough, but the following complications can arise when diagnosis and treatment are delayed or initiated late in the disease process:

• Wounds and ulceration in the hands or feet
• Permanent damage to the nerves of extremities
• Progressive deformities in the fingers, toes, and nose
• Chronic nasal congestion, nosebleeds, and collapse of the nasal septum
• Glaucoma, an eye condition that damages the optic nerve
• Uveitis, or inflammation of the eye
• Blindness
• Erectile dysfunction
• Infertility
• Kidney failure

Ayurveda

Leprosy is known as Kustha Roga in Ayurveda. There are several treatments in Ayurveda for leprosy, which include:

• Medicines for oral consumption, such as the compounds of Triphala, Khadira, Guduchi, and Pippali.
• Topical applications, including pastes made from sulfur, mustard oil, and turmeric.

Physiotherapy

Physiotherapy exercises help maintain the function and mobility of the affected digits. It also helps prevent deformities, such as claw hand, and can improve the function of an already deformed hand.

Leprosy patients need to be extra careful when taking care of their health as they are at an increased risk of injuries or burns due to reduced sensations. This necessitates special care for the extremities. Patients must:

• Wear gloves while handling hot utensils or other hot objects.
• Seek prompt medical care for even minor cuts and injuries.

Early treatment is key to a successful outcome in leprosy.

Patients suffering from leprosy often battle social stigma and discrimination due to prevalent misconceptions about the disease. This stigma often prevents individuals from seeking medical help when symptoms first appear, which delays diagnosis and treatment, increasing the risk of disabilities.

Moreover, girls and women with leprosy face additional social and gender discrimination, further impacting diagnosis and treatment. In some cases, this stigma can interfere with the patient's daily life. Therefore, it is crucial to prioritize mental health. Do not hesitate to consult a counselor or therapist. Sharing your feelings can help you cope better. It may also be beneficial to connect with someone experiencing similar feelings.

Consider joining a support group or interacting online if you prefer to connect with others from the comfort of your own home.