Leprosy

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Leprosy, also known as Hansen’s disease, is a chronic infectious disease which mainly affects the skin, the peripheral nerves, mucosal surfaces of the upper respiratory tract, and the eyes. Leprosy is known to occur at all ages ranging from early infancy to very old age. Leprosy is curable and early treatment averts most disabilities

Causes

Leprosy transmission is airborne, through droplets discharged from the respiratory tract of untreated infectious cases. Transmission may also occur through skin-to-skin contact with entry through broken skin

• Infection with Mycobacterium leprae

Classification

Depending on the bacillary load, the disease is classified as paucibacillary or multibacillary:

Paucibacillary leprosy	-          Milder -          Less or up to 5 skin lesions
Multibacillary leprosy	-          More than 5 symmetric skin lesions, nodules, plaques, thickened dermis, -          Frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis.

 

Signs and symptoms

Leprosy mainly affects the skin and peripheral nerves and it is characterized by:

• Hypopigmented skin patch with some sensory loss
• An enlarged or painful peripheral nerve (preferably with some evidence of nerve function loss)
• Nodules found mainly on nose, ears, face, limbs but can occur at any site
• Painless wounds, especially on the sole of the foot, palm of hand, and fingers
• Loss of sensation on hands, feet, or both
• Dryness of hands, feet, or both due to loss of sweating, accompanied by loss of feeling
• If left untreated, leprosy can lead to progressive and permanent damage of nerves, leading to loss of sensation and sweating in the extremities and paralysis of muscles in the hands, feet, and face.

Treatment objectives

• Cure the patient
• Interrupt transmission
• Prevent disabilities

Diagnosis

• Laboratory diagnosis is based on the detection of acid-fast bacilli in a Ziehl-Neelsen stained nasal smear and skin-split smear taken from the ear lobe or from a skin lesion.
• Diagnosis can be made on clinical signs alone based on the WHO clinical classification of the number of lesions

Pharmacological treatment

This is based on multidrug therapy as follows:

Regimen	Multibacillary		Paucibacillary
	Adult	Child	Adult	Child
Rifampicin	600mg once a month Supervised	450mg once a month Supervised	600mg once a month Supervised	450mg once a month Supervised
Clofazimine	300mg once a month and 50mg daily	150mg once a month and 50mg daily	-	-
Dapsone	100mg daily	50mg daily	100mg daily	50mg daily
Duration	24 months	24 months	6 months	6 months

Prevention

• Household contacts (anyone who has lived with the patient for at least 1 month since the onset of symptoms) should be screened for the disease

Notification

• This is a notifiable disease