Introduction► Leprosy is also called as “Hansens disease”► It is chronic curable infectious disease caused by mycobacterium leprae.► It occurs mainly in tropical regions and developing countries.► The majority of the cases are located in Indian subcontinents► Patient suffer not only from the primary affect of disease but also from the social discrimination, sadly compounded by inappropriate term ‘leper’ for one who afflicted with that disease.
Pathology► The transmission occurs through nasal secretion► It is attributed to poor hygiene and unsanitary conditions► The incubation period is several years► The disease present with skin, upper respiratory and neurological symptoms► The infection occur in childhood or early adolescence► The bacillus is acid fast but so weakly when compared with mycobacterium tuberculosis.
Classification Of Disease► Thedisease is broadly classified into two groups. 1- Lepromatous 2- Tuberculoid
Lepromatous Leprosy► In lepromatous leprosy there is wide spread dissemination of abundant bacilli in the tissues with the macrophages and a few lymphocytes.► This denote a poor host immune reaction.
Tuberculoid Leprosy► In tuberculoid leprosy the pts show strong immune response with scant bacilli in tissues, epithelioid granuloma, numerous lymphocytes and giant cells.► Thus that condition occurs when host resistance is stronger than virulence of organisms.
Clinical Features► Disease is slowly progressive affecting skin, upper respiratory tract and peripheral nerves.► Tuberculoid Leprosy: There is damage to tissues occurs early and is localized to one part of the body, which limited deformity of that organ.► Neural involvement is characterized by thickening of the nerves which are tenders.► There may be asymmetrical well defined anesthetic hypopigmented or erythamatous macules with elevated edges and dry and rough surface lesion called “leprids”.► Lepromatous Leprosy: There is disease is symmetrical and extensive. Cutanous involvement occurs in the form of the several pale macules that form plaques called ‘lepromas’.
Deformities► The deformities produced by the disease which are divided into► Primary: These are caused by the leprosy or by its reactions► Secondary: These resulting from effects such as anesthesia of hands and feet.
Lesion involving Face► In the acute phase of lepromatous variety the nodular lesion on the face are known as “Leonine facies” (looking like lion)► Later there is wrinkling of skin and aged appearance to young individuals.► There is loss of eyebrows► Destruction of lateral cartilage and septum of nose with collapse of nasal bridge and lifting of tip of nose.► There may be paralysis of branches of facial nerves in bony canal or of zygomatous branches.► Paralysis of orbicularis occuli cause incomplete closure of eyes, epiphoras and conjunctivae.
Lesion Involve Hands & Feet► Lesions Involving Hands: The hands are typically clawed because of involvement of ulner nerve at elbow and median nerve at wrist.► Anesthesia of hands makes these pts susceptible to frequent burns and injuries.► Lesion Involving Feet: There is clawing of toes occurring as result of involvement of posterior tibial nerve. When lateral popliteal nerve is affected it leads to foot drop and nerve can be felt to be thickened behind the upper end of fibulae► Anesthesia of feet predispose to trophic ulceration, chronic infection, contraction and autoimputation.
Leprosy Diagnosis► Typical clinical features and awareness of the disease should help to make a diagnosis► The face has an aged look about it with collapse of nasal bridge and eyes changes.► Thickened peripheral nerves, patches of anesthetic skin, claws hands, foot drop and trophic ulcer are characteristic.► Microbiological examination of acid – fast bacillus and typical history on skin biopsy.
Treatment► Multiple drug therapy for 12 – months is key to treatment, this is carried out by WHO guideline using. 1- Rifampicin 2- Dapsone 3- Clofazimine► During treatment, pts may develop acute manifestation, which controlled by steroids► Surgical treatment is indicated in advance stage of disease for functional disability of limbs, cosmetic disfigurement of face and visual problems.► Surgical reconstruction requires the expertise of hand surgeon, orthopedic surgeon and plastic surgeon.► General surgeon may be called upon, when it require amputation or in emergency situation abscess drainage.
Prevention Of Disease► Educating the patient about the dreadful sequelae of the disease so that they seek medical help early as important.► Education of general public should be the keystone in prevention.