Leprosy (also known as Hansen’s disease) is an infection caused by bacteria called Mycobacterium leprae. These bacteria grow very slowly and can take up to 20 years to develop signs of infection.
The disease can cause damage to nerves, skin tissue, eyes, as well as the nasal membrane (mucosa). Bacteria attack the nerves that swell under the skin. This can cause the affected areas to lose their ability to touch and sense pain. This can directly lead to injuries such as cuts and burns. Usually, the affected skin changes color and can occur in two ways:
- Lighter or darker, usually dry or scaly, with loss of sensation
- Reddish due to inflammation of the skin.
If left untreated, nerve damage can lead to paralysis of the hands and feet. In very advanced cases, the person may suffer multiple injuries due to a lack of sensation, and eventually, the body can reabsorb the affected areas over time, which can result in visible finger loss. Corneal ulcer and blindness may also occur if facial nerves are affected. Other symptoms of advanced leprosy can include eyebrow loss from damage to the nasal septum and ridge-nasal deformity.
Early diagnosis and treatment often prevent disability from the disease, so people with leprosy can continue to work and live an active life. Once treatment has started, the disease is no longer contagious. However, it is extremely important to complete the entire treatment process directed by the doctor in order to achieve the treatment result.
In the past, 250,000 people worldwide would have suffered from leprosy each year. It was known and feared as a highly contagious, devastating disease, but now we know that it is difficult to spread and can be easily treated when noticed. Nevertheless, many prejudices about the disease still persist today, and those affected are isolated and discriminated against.
How do individuals get leprosy?
It is not known exactly how leprosy spreads among people. Scientists now think that a person with leprosy can become infected when they cough or sneeze, or when a healthy person breathes in droplets containing bacteria into their body. Prolonged, close contact with someone with leprosy who has not been treated for months is required to get the disease.
You cannot get leprosy from casual contact with a person with leprosy such as:
- Shaking hands or hugging,
- Sitting side by side in the bus,
- Eating together.
In addition, leprosy is not transmitted from the mother to her unborn baby during pregnancy and is not spread through sexual contact.
Because of the slow-growing nature of bacteria and the time it takes for symptoms to appear, the source of infection is often very difficult to find.
In South America, some Armadillos naturally become infected with the bacteria that cause Hansen disease in humans and can spread it to humans. However, the risk is very low and most people who come into contact with armadillos are unlikely to get Hansen disease.
For general health reasons, avoid contact with armadillos whenever possible. If you have come into contact with an armadillo and are concerned about Hansen’s disease, consult a healthcare professional. Your doctor will follow you over time and perform periodic skin exams to see if you develop the disease. If you have leprosy, your doctor can help you get treatment.
Who are at risk?
Overall, the risk of getting leprosy is very low for any adult in the world. Because more than 95% of all people have natural immunity against the disease.
If you live in a country where the disease is common, you may be at risk of the disease. The countries that reported more than a thousand Hansen’s disease to WHO between 2011 and 2015 are:
- Africa: Mozambique, Democratic Republic of Congo, Ethiopia, Madagascar, Nepal, Nigeria, Tanzania.
- Asia: Myanmar, Bangladesh, India, Indonesia, Philippines, Sri Lanka.
- Americas: Brazil.
You may also be at risk if you have been in close contact with people who have not been treated for leprosy for a long time. If they’re left untreated, you could be exposed to the bacteria that cause Hansen disease. However, as soon as patients start treatment, they no longer spread the disease.
Symptoms commonly affect skin tissue, nerve cells, and mucous membranes.
The disease can cause skin symptoms such as:
- Spots on the skin that may appear numb and colorless,
- Nodules (growths) in the skin
- Thickened, hardened or dried skin texture
- Ulcers on the sole of the foot
- Painless swelling on the face or earlobes
- Hair loss or eyelash loss
Symptoms that occur when nerves are damaged:
- Numbness in the affected areas of the skin
- Weakness or paralysis of the muscles (commonly hand and foot)
- Enlarged nerve cells
- Eye diseases that can cause blindness (when the nerves in the face are affected)
Symptoms that can be caused by leprosy on the mucous membranes can be:
- Blockages in the nose
- Bleeding in the nose
Loss of sensation or loss of sensation can occur because leprosy damages the nerves. When a sensory loss occurs, injuries such as burns may not be recognized. Make sure that the affected parts of your body are not injured, as you may not feel the pain that could hurt you.
If left untreated, symptoms of advanced leprosy can include:
- Paralysis and injury of the hands and feet
- Shortening of toes and fingers due to reabsorption
- Chronic nodules at the bottom of the feet that do not heal
- Vision loss
- Shedding of eyebrows
- Deformities in the nose
Other symptoms that may occur rarely include:
- Painful or sensitive nerves
- Redness and pain in the affected area
- Burning sensation in the skin
Diagnosis and treatment of leprosy
How is the disease diagnosed?
Leprosy can be recognized by the appearance of patches of skin that may appear lighter or darker than normal skin. Sometimes affected skin areas may be reddish. Loss of sensation is common in these skin spots. You may not even feel a light touch with the needle.
To confirm the diagnosis, your doctor will take a sample of your skin or nerve (through a skin or nerve biopsy) to look for bacteria under a microscope and perform tests to rule out other skin conditions.
How is the disease treated?
Hansen’s disease is treated with a combination of antibiotics. Typically, 2 or 3 antibiotics are used at the same time. These include dapsone containing rifampicin and clofazimine for some types of disease. This is called multi-drug therapy. This strategy also helps prevent the development of antibiotic resistance by bacteria that can occur due to the length of treatment.
Treatment usually takes one to two years. If the treatment is completed as prescribed, the disease can be cured.
If you have been treated for leprosy, it is important that you do the following:
- Tell your doctor if you experience numbness or loss of sensation in certain parts of the body. This can be caused by nerve damage from infection. If you have numbness and loss of sensation, take extra care to avoid injuries such as burns and cuts.
- Take antibiotics until your doctor tells you that your treatment is complete. If you stop earlier, the bacteria may start growing again and you could get sick again.
If left untreated, nerve damage can lead to paralysis and injury of the hands and feet. In very advanced cases, a person may suffer multiple injuries due to a lack of sensation. Corneal ulcers or blindness may also occur if the facial nerves are affected due to the loss of the corneal (outer) sensation of the eye.
Antibiotics used during the treatment will kill bacteria that cause leprosy. However, treatment can cure the disease and prevent it from getting worse, but it will not reverse nerve damage or physical deterioration that may occur prior to diagnosis. Therefore, it is very important to diagnose the disease as early as possible before any permanent nerve damage occurs.
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