Leprosy is a chronic bacterial infection caused by Mycobacterium leprae. This disease entity is known to the human civilization for a long time. This disease primarily affects the cooler tissues of human body like skin, peripheral nerves, anterior chamber of the eye and testis. It is a major burden to the developing countries mainly. In developed countries, leprosy is not a major concern.
Mycobacterium leprae is a slowly multiplying acid-fast bacillus like Mycobacterium tuberculosis. But, these two bacilli can be differentiated under the microscope by globi formation and this is surely a unique property of Lepra bacillus.
There are four major forms of leprosy. They have been mentioned below in the increasing order of severity:
Polar tuberculoid
Borderline tuberculoid
Borderline lepromatous
Polar lepromatous
In polar tuberculoid, the immunity of the affected person remains more or less intact. It may present with hypo pigmented macular anesthetic patches, four or less in number. The patches are asymmetrical in distribution.
In borderline, leprosy nerves may be affected along with the skin patch. Commonly involved nerves are ulner nerve, greater auricular nerve, and common peroneal nerve. The nerve may be swollen and one can feel the cord like structure at specific distribution. Polar lepromatous leprosy is a systemic illness comprising of symmetrically distributed skin patches, five or more in number, multiple nerve nerve thickening, anterior uveitis, and destruction of nasal breeze and loss of eyebrow. A patient may go downhill from one form of leprosy to other when immunity decreases. These are known as lepra reactions. There are two types of lepra reaction, Type I and Type II. Type II lepra reaction is known as erythema nodosum leprosum.
Spread of leprosy mainly takes place by means of droplet infection. Lepra bacilli can survive in the soil of a place where leprosy is an endemic disease. Leprosy can spread even by direct skin contact with the soil.
Early and specific treatment can cure leprosy completely. WHO has classified leprosy into two groups for treatment purpose:
Paucibacillary leprosy
Multibacillary leprosy
Duration of treatment of paucibacillary leprosy is generally 6 months, whereas multibacillary leprosy requires more prolonged treatment usually for 1- 2 years. The drugs, which are effective against Lepra bacilli, are:
Dapsone
Rifampicin
Clofazimine
To treat lepra reaction NSAIDs, clofazimine or Thalidomide is used. There is no effective vaccine against leprosy. BCG vaccine, which is used mainly for the Tuberculosis, gives partial protection against leprosy. The developing countries should unite and take initiatives to fight this curse.
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