A Family Doctor's Tale - LEPROSY

DOC I HAVE LEPROSY

Leprosy is no longer the feared disease as seen in the stories from the bible.

Because of modern antibiotics leprosy is usually treated easily.

There is seldom the deformities and nodular skin disease seen in the past.

In fact most leprosy patients can be cured 100 per cent if detected early.


Leprosy or Hansen's disease is a chronic granulomatous disease caused by the bacteria mycobacterium leprae.

At present 10 countries:

Brazil, Democratic Republic of the Congo, Guinea, India, Indonesia, Madagascar, Mozambique, Myanmar, Nepal and Tanzania account for 90 per cent of the disease in the world.

The disease affects mainly young people between 10-20 years of age, males more than females.

The exact mode of spread is unclear.

It is believed to be from person to person via nasal discharge, respiratory droplets and skin contact.

People prone to contacting the disease have:

1.weak immune system -these people develop multibacillary leprosy which is infectious,

Those with a stronger immune system develop paucibacillary leprosy which is non-infectious.

2.malnutrition and

3.unhygienic and crowded living conditions

Signs and Symptoms of Leprosy are:


The incubation period can vary from 1 year - 40 years.

Paucibacillary leprosy:

1.milder and non-infectious

2.one or more hypopigmented skin macules with loss of sensation.

3.Peripheral nerves may be damaged and enlarged.

Multibacillary leprosy :

1.numerous shiny, reddish nodules, thickened skin,

2.nasal discharge, nasal congestion and bleeding from the nose.

3.Distal peripheral nerves are thickened, enlarged and painful.

4.loss of eyelashes and eyebrows.

5.Skin smears are always positive for bacilli.

Diagnosis of leprosy is based on the following signs:

1.chronic skin lesions,

2.peripheral neuropathy,

3.thickened nerves,

4.muscle weakness

Confirmation of diagnosis is by

1.biopsy of skin lesions and thickened nerve.

2.Nasal and skin smears may show presence of leprosy bacteria.

Complications of Leprosy include

1.damage to the peripheral nerves

2.numbness,

3.muscle weakness

4.paralysis with consequent claw hand or foot drop

5.skin rashes

6. painful skin nodules.

7.loss of sensation, with resultant injuries

8.infections from injuries which can cause ulcers that damage the dermal tissues,

9.joints and bones infections resulting in the loss of extremities (toes and fingers)

10.secondary crippling deformities can occur in 25 per cent of cases not treated at an early stage.

Treatment of Leprosy is medically possible with modern treatment:


Leprosy can be cured.

Early Treatment averts disability.
Multidrug therapy (MDT) consists of three drugs:

dapsone,

rifampicin and

clofazimine.

This drug combination effectively kills leprosy bacteria.


It prevents mutilations and deformities.

The 80 per cent with paucibacillary leprosy (PB) are non-infectious and cured within six months.

The remaining 20 to 30 per cent with the multibacillary form (MB) are cured within one year.

The drugs are safe with little side effects.

After the first dose of MDT, the patients are no longer infectious .

There is virtually no recurrence of the disease with treatment.

No resistance of the bacillus to MDT has been detected.

The chain of transmission of the leprosy is stopped.

Prevention measures are:

1. early detection and treatment with MDT has prevented about 3 to 4 million people from being disabled.

2.Better hygiene and nutrition

3.Better living conditions