What is Leprosy and What Causes It?

Leprosy is a disease that is known to be as old as the human race. It is caused by specific bacterium called Mycobacterium leprae. This bacterium tends to grow slowly and mainly affect the body's nervous system, the skin and the body's mucous membranes. Leprosy is considered to be infectious, being transmitted through airborne particles, for instance when someone sneezes or coughs. But most people, approximately 95% of the population are naturally immune to the disease. Aspects that may cause the growth of mycobacteria and eventually lead to leprosy are; genetics, environmental/living conditions, and amount of exposure to other people with leprosy.


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Diagnosis

What will the Doctor Likely Ask?
In order for the doctor to make a proper diagnosis of leprosy he/she may ask about the following:
  • Symptoms
  • Medical history in family
  • Places you have traveled
  • Exposure to a person with leprosy 
  • If your on any medications







Tests
In order to determine whether a person has leprosy or another skin condition a "skin biopsy" test is conducted by the doctor. A skin biopsy test is when a sample of skin tissue is removed, processed, and examined under a microscope. This helps the doctor determine what type of skin condition the person has, whether its leprosy or another skin condition. 

A small piece of tissue is cut with a medical blade/ knife under medical supervision after sterilizing the surface of the skin. After a piece of skin is removed the affected area is stitched back together.

Delays of Diagnosis 
Many times the diagnosis of leprosy is delayed due to the following reasons:


  • Its resemblance with many other skin conditions
  • Its not a very common condition any longer
  • The Mycobacterium leprae cannot be developed in medical laboratories 
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Symptoms of Leprosy




The severity and type of the damage done to leprosy patients depends on the type of leprosy that they have (Tuberculoid Leprosy or Lepromatous Leprosy). They only start to see the physical alterations after 6 months of actually being infected with the Mycobacterium leprae (the bacteria that causes leprosy). The main areas that affected for types of leprosy include skin areas and peripheral nerves.

Tuberculoid Leprosy:
  • Muscle weakness in limbs
  • Loss of fingers and toes
  • Causes fingers and toes to shorten due to the absorption of cartilage into the body
  • Eye problems which often leads to blindness
  •  Skin stiffness and dryness
  •   Enlarged nerves, especially those around the elbow (ulnar nerve) and knee (peroneal nerve).
Lepromatous Leprosy (severe form of the disease)
Skin rashes (Skin lesions) can be found:
  • Face
  • Ears
  • Wrists
  • Knees
  • Buttocks
Types of rashes:
  • Small or large
  • Flat or raised
  • Light or dark
Other Symptoms and Complications:
  • Thinning of eyebrows and eyelashes
  • Collapsing of the nose
  • Bloody nose
  • Laryngitis (inflammation of larynx)
  • Swelling of lymph nodes in groin and armpits (causes infections)
  • Scarring of testes, which leads to infertility
  • Gynecomastia (enlargement of breasts in males)
  • Blindness
  • Arthritis


People, who are diagnosed with leprosy, face severe and permanent symptoms that alter their lifestyles. Almost all Leprosy patients are bound to lose toes and fingers which will make their everyday lives harder. In places such as India and Africa people make a living by doing a lot of physical labour. The loss or paralysis of limbs and damaged eyesight can stop them from making a living, leaving them with no other means of survival. Symptoms such as rashes and laryngitis bring severe pain and discomfort for the patient. Apart from physical dilemmas and complications, people diagnosed with leprosy face discrimination in their societies. Because leprosy has been around for centuries, dating back to the 15 hundreds, there are many stereotypes and prejudice directed towards them. People with leprosy in India say that they are ashamed to go outside because the community refers to them as someone who is cursed for all eternity. They are also looked at as people with ritual pollutions and sins. Most leprosy patients even hide the fact that they are diagnosed with leprosy in order to avoid being judged. A lot of the symptoms of Leprosy are very distinct, meaning; they could have rashes on their face and collapsed noses. As a result, leprosy patients become outcasts and are shunned from their society. 
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Treatments


A historical treatment which people believed was a cure for leprosy in India was, chaulmoogra oil (a toxic acid) which only promises a 45 percent recovery .There was no known cure for leprosy until antibiotics were introduced as the main form of treatment for leprosy which is also known as a Multi Drug Treatment or MDT. There are three main antibiotics that are used to kill the Mycobacterium leprae: Dapsone, Rifampin and Clofazimine. Sometimes the bacteria can become resistant to a single antibiotic and so the patients are usually given a combination of the three. Patients are given the MDT for 6 months up to two years depending on factors such as: how long they have been diagnosed with the bacteria and the severity of their condition. The two types of MDT are:  Pauci-bacillary (PB) leprosy: 1-5 skin lesions (skin lesions include rashes and scars) – Rifampicin and Dapsone for 6 months, b) Multi-bacillary (MB) leprosy:  more than 5 skin lesions – Rifampicin, Clofazimine and Dapsone for 12 months. After two weeks of the treatment most people become less infectious, meaning, the chances that they will pass the bacteria on to another person will decrease. If the patient continues to take the treatment on a daily basis the bacteria will be weakened and eventually “destroyed”. The best results can only be achieved through early treatment because later on certain complications and symptoms such as nerve damage and disfigurement become irreversible.

Here are also some side effects that may come with the use of MDT treatment:
  • Red discoloration of the urine, sweat, sputum, and tears
  • Lack of coordination, headaches, dizziness, difficulty concentrating, confusion
  • Diarrhea, gas, stomach cramps, painful or irregular menstrual periods

Fatal side effects:
  • Swelling of the eyes, face, lips, throat, arms, hands, feet, lower legs, ankles
  • Nausea, vomiting, loss of appetite
  • Rash, hives, blisters
  • Dark urine
  • This treatment has also been made available for the less fortunate people in places such as India and Africa by the World Health Organization. 
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Interesting Facts

1.       Leprosy is also known as Hansen’s disease (Named after a physician named Gerhard Armauer Hansen).
  2.       Leprosy is a historical disorder 
   that was often seen demonic curses that people were given.
  3.       India has about 54 percent of all
   the new leprosy cases in the world.


4.       At least 3 million people are living with some sort of permanent disability due to leprosy.
5.       Leprosy was actually common in Europe at one point in history until it died out (the reason behind its disappearance is still unknown).
6.       Men are twice as likely to contract leprosy as women.
7.       One child is diagnosed with leprosy every 20 minutes.
8.       Leprosy can actually be prevented by going to annual checkups (although this may be difficult for people in
 third-world countries)
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REFERNCES--WEBSITES

1.        Answers Corporation. (2011). Skin biopsy. Retrieved from http://www.answers.com/topic/skin-biopsy

2.        Clinaero, Inc. (2006-2011).Diagnosis of leprosy. Retrieved from http://diseases.emedtv.com/leprosy/diagnosis-of-leprosy.html

3.        Clinaero, Inc. (2006-2011). Leprosy symptoms. Retrieved from http://diseases.emedtv.com/leprosy/leprosy-symptoms.html
4.        Clinaero, Inc. (2006-2011).Mycobacterium leprae. Retrieved from http://bacteria.emedtv.com/mycobacterium-leprae/mycobacterium-leprae.html
5.        Clinaero, Inc. (2006-2011).Treatment of leprosy. Retrieved from http://diseases.emedtv.com/leprosy/treatment-of-leprosy.html
6.                  Clinaero, Inc. ( 2006-2011). What causes leprosy? Retrieved from http://diseases.emedtv.com/leprosy/what-causes-leprosy.html
7.                  Glow Web Services Pvt. Ltd. (n.d.).Leprosy. Retrieved from http://www.whereincity.com/medical/topic/child-health/diseases/leprosy-78.htm
8.                  Organization, World Health. (2010, February). Leprosy. Retrieved from http://www.who.int/mediacentre/factsheets/fs101/en/
9.        Robert J. MacNeal, M. R. (2009, May). Description of skin lesions. Retrieved from http://www.merckmanuals.com/professional/dermatologic_disorders/approach_to_the_dermatologic_patient/description_of_skin_lesions.html
10.      The Leprosy Mission Canada. (n.d.).What is leprosy?  Retrieved from http://www.leprosy.ca/Page.aspx?pid=245


REFERENCES--BOOKS

1.                  Sehgal, S. A. (2006). Leprosy. (88 ed.). Philadelphia : Chelsea House Publishers.


2.                  Lynette, L. R. (2006). Leprosy . (p. 48). Detroit, MI: KidHaven Press.
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