Leprosy: Treatment, Diagnosis and Prevention

Leprosy

What Is Leprosy (Hansen’s disease)?
Leprosy is a mildly infectious disease associated with poverty. It is easily cured. Leprosy starts by damaging the small nerves on the skin’s surface resulting in a loss of sensation. Without the gift of pain, everyday activities are fraught with danger. Unnoticed burns and ulcers can lead to permanent disability. Due to the inability to detect grit in the eye, blindness is a common consequence of leprosy.


Leprosy (Hansen's disease) is a chronic infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract, eyes, and nasal mucosa (lining of the nose). The disease is caused by a bacillus (rod-shaped) bacterium known as Mycobacterium leprae.
It can only spread from persons who have untreated leprosy, to persons who have low resistance to the disease. In areas where leprosy is common, children should be checked every 6 to 12 months—especially children living with persons who have leprosy. It can affect individuals of all ages.

Causes of Leprosy
Leprosy is caused by a slow-growing type of bacteria called Mycobacterium leprae (M. leprae).
Mycobacterium leprae, a rod-shaped bacillus that is an obligate intracellular (only grows inside of certain human and animal cells) bacterium. M. leprae is termed an "acid fast" bacterium because of its chemical characteristics. When special stains are used for microscopic analysis, it stains red on a blue background due to mycolic acid content in its cell walls. The Ziehl-Neelsen stain is an example of the special staining techniques used to view the acid-fast organisms under the microscope.
Symptoms/Signs of Leprosy
It can only spread from persons who have untreated leprosy, to persons who have low resistance to the disease. In areas where leprosy is common, children should be checked every 6 to 12 months—especially children living with persons who the first sign of leprosy is often a slowly growing patch on the skin that does not itch or hurt. At first, feeling inside the patch may be normal. Keep watching it. If feeling in the patch becomes reduced or absent it is probably leprosy.

• Flat or raised skin lesions or nodules, often less pigmented than the surrounding skin, though they may appear reddish or copper colored
• Single or multiple skin lesions that are often found on cooler parts of the body such as the face, buttocks, and extremities
• Thickening of the skin and peripheral nerves
• Ulcerations of the skin
• Peripheral nerve involvement leading to loss of sensation
• Peripheral nerve involvement leading to muscle weakness (for example, clawed hand deformities, contractures, and foot drop)
• Hoarseness
• Testicular involvement leading to sexual dysfunction or sterility
• Eye involvement including eye pain, eye redness, inability to close the eyelids, corneal ulcers, and blindness
• Loss of eyebrows and eyelashes
• Destruction of the nasal cartilage Continue Reading

How to diagnose Leprosy
If you have a suspicious skin sore, your doctor will remove a small sample of the abnormal skin and send it to a lab to be examined. This is called a skin biopsy. A skin smear test may also be done. With paucibacillary leprosy, no bacteria will be detected. In contrast, bacteria are expected to be found on a skin smear test from a person with multibacillary leprosy.

How to Prevent Leprosy
So far, no specific preventative measures against leprosy have been found, So the best way to prevent leprosy is to avoid contact with body fluids and the rashes of people who have leprosy.
1. Protect hands and feet from things that can cut, bruise, blister, or burn them:

• Do not go barefoot, especially not where there are sharp stones or thorns. Wear shoes or sandals. Put soft padding inside shoes and under straps that may rub.
• When working or cooking meals, wear gloves.
• Never pick up an object that might be hot without first protecting your hand with a thick glove or folded cloth.
• If possible, avoid work that involves handling sharp or hot objects
• Do not smoke.

Note:
For example, if a person with normal feeling walks a long way and gets a blister, it hurts, so he stops walking or limps.
But when a person with leprosy gets a blister, it does not hurt.
Still without pain, the infection gets deeper and attacks the bone.
So he keeps walking until the blister bursts and becomes infected.
In time the bone is destroyed and the foot becomes more and more deformed.

2. At the end of each day (or more often if you work hard or walk far) examine your hands and feet very carefully—or have someone else examine them. Look for cuts, bruises, or thorns. Also look for spots or areas on the hands and feet that are red, hot, swollen or show the beginnings of blisters. If you find any of these, rest the hands or feet until the skin is completely normal again. This will help callous and strengthen the skin. Sores can be prevented.
3. If you have an open sore, keep the part with the sore very clean and at rest until it has completely healed. Take great care not to injure the area again.
4. Protect your eyes. Much eye damage comes from not blinking enough, because of weakness or loss of feeling. Blink your eyes often to keep them wet and clean. If you cannot blink well, close your eyes tightly often during the day, especially when dust blows. Wear sun glasses with side shades, and maybe a sun hat. Keep eyes clean and flies away.
If you do these things and begin treatment early, most deformities with leprosy can be prevented.
Prevention of damage to hands, feet, and eyes: The large open sores often seen on the hands and feet of persons with leprosy are not caused by the disease itself and can be prevented. They result because, when feeling has been lost, a person no longer protects himself against injury.

Treatment for Leprosy
According to WHO:
Dapsone, which is bacteriostatic or weakly bactericidal against M. leprae, was the mainstay treatment for leprosy for many years until widespread resistant strains appeared. Combination therapy has become essential to slow or prevent the development of resistance. Rifampicin is now combined with dapsone to treat paucibacillary leprosy. Rifampicin and clofazimine are now combined with dapsone to treat multibacillary leprosy.
A single dose of combination therapy has been used to cure single lesion paucibacillary leprosy: rifampicin (600 mg), ofloxacin (400 mg), and minocycline (100 mg). The child with a single lesion takes half the adult dose of the 3 medications.
WHO has designed blister pack medication kits for both paucibacillary leprosy and for multibacillary leprosy. Each easy-to use kit contains medication for 28 days. The blister pack medication kit for single lesion paucibacillary leprosy contains the necessary medication for the one time administration of the 3 medications.
Any patient with a positive skin smear must be treated with the MDT regimen for multibacillary leprosy. The regimen for paucibacillary leprosy should never be given to a patient with multibacillary leprosy. Therefore, if the diagnosis in a particular patient is uncertain, treat that patient with the MDT regimen for multibacillary leprosy.
Ideally, the patient should go to the leprosy clinic once a month so that clinic personnel may supervise administration of the drugs prescribed once a month. However, many countries with leprosy have poor coverage of health services and monthly supervision of drug administration by health care workers may not be possible. In these cases, it may be necessary to designate a responsible third party, such as a family member or a person in the community, to supervise the monthly drug administration. Where health care service coverage is poor and supervision of the monthly administration of drugs by health workers is not possible, the patient may be given more than the 28 days supply of multidrug therapy blister packs. This tactic helps make multidrug therapy easily available, even to those patients who live under difficult conditions or in remote areas. Patients who ask for diagnosis and treatment are often sufficiently motivated to take full responsibility for their own treatment of leprosy. In this situation, it is important to educate the patient regarding the importance of compliance with the regimen and to give the patient responsibility for taking his or her medication correctly and for reporting any untoward signs and symptoms promptly. The patient should be warned about possible lepra reactions.
OR
“Charts adapted from Snyder and Larocco www.emedicine.com”
For purposes of treatment leprosy disease is seperated into two catagories:
Paucibacillary (PB): the number of M. leprae in the body is small (less than 1 million) and a skin smear test is negative. The patient presents five or fewer skin lesions. Most cases of leprosy are PB.
Multibacillary (MB): M. leprae can multiple in the body almost without any check and is thus present in high numbers. The bacillus has likely spread to almost all areas of skin and peripheral nerves. A skin smear test is positive and the patient presents more than five skin lesions.
A multidrug treatment regimen is recommended for leprosy because resistance to the primary drug used has become common in the past twenty years.
Dapsone is the primary drug indicated for treatment of leprosy and it is almost always accompanied by at least one other medication. It works by preventing the formation of folic acid, thereby inhibiting the organism's replication. Two of the most common additional drugs for leprosy management are Rifampin and Clofazimine. Rifampin is one of the main drugs used in treatment of tuberculosis and Clofazimine is an antimicrobial that works by unknown mechanisms.
All three medications are taken orally and can be administered on an out-patient basis. Dose, and duration of these three medicines varies according to stage of the disease and whether the patient is an adult or child. Multidrug regimens are recommended for 6 months (for paucibacillary), to 2 years (for multibacillary).

• Treatment Summary:

  Drug Name Dapsone (Avlosulfon): Bactericidal. Mechanism of action is the prevention of formation of folic acid, inhibiting bacterial growth. Part of a 2-drug regimen for treatment of paucibacillary leprosy; part of a 3-drug regimen for treatment of multibacillary leprosy. Adult Dose Paucibacillary leprosy: 100 mg/day orally for 6 months Multibacillary leprosy: 100 mg/day orally for 24 months Pediatric Dose 1-2 mg/kg/day orally; not to exceed 100 mg/day Contraindications Documented hypersensitivity Pregnancy Safety for use during pregnancy has not been established. Precautions Perform weekly blood counts (first month), then perform white blood cell counts monthly (for 6 months), then semiannually; discontinue if significant reduction in platelets, leukocytes, or hematopoiesis occurs. Peripheral neuropathy can occur (rare) Phototoxicity may occur when exposed to UV light. Drug Name Rifampin (Rifadin, Rimactane): For use in combination with at least 1 other antituberculous drug. Inhibits DNA-dependent bacterial RNA polymerase. Cross-resistance may occur. Treat for 6-9 months or until 6 months have elapsed from time of negative sputum test. Part of 2-drug regimen for treatment of paucibacillary leprosy; part of 3-drug regimen for treatment of multibacillary leprosy. Adult Dose Paucibacillary leprosy: 600 mg/month orally or IV for 6 months Multibacillary leprosy: 600 mg/month orally or IV for 24 months Pediatric Dose 10-20 mg/kg orally or IV; not to exceed 600 mg/day Contraindications Documented hypersensitivity Pregnancy Safety for use during pregnancy has not been established. Precautions If patient has liver disease serious health risks occur such as cerebral hemorrhage or death; may cause red-orange discoloration of urine, feces, saliva, sweat, sputum, and tears   Drug Name Clofazimine (Lamprene): Inhibits mycobacterial growth, binds preferentially to mycobacterial DNA. Has antimicrobial properties, but mechanism of action is unknown. Part of 3-drug regimen for treatment of multibacillary leprosy. Adult Dose 50 mg/day orally for 24 months in combination with Dapsone and Rifampin Pediatric Dose 1 mg/kg/day orally in combination with Dapsone and Rifampin Contrindications Documented hypersensitivity Interactions Dapsone may inhibit anti-inflammatory activity of clofazimine Pregnancy Safety for use during pregnancy has not been established. Precautions Patients should be warned that clofazimine may discolor skin, body fluids, and excrement; color ranges from pink to brownish-black; caution in patients with GI problems (eg, abdominal pain, diarrhea); skin discoloration due to drug may result in depression or suicide; apply oil to skin for dryness.

Leprosy Home Remedies/Home Cure
Rhizome is one of the effective natural remedies for leprosy treatment. Make a paste of rhizome and rub it on the skin to prevent the bacterial infection. Chaulmoogra oil, which is obtained from Taraktogenos tree, is also a helpful natural remedy. It helps to eliminate inflammation and ulcer from the skin throughout our body.
Hydrocotyle, which is called Gotu Kola, is widely used to prevent skin diseases like leprosy. The seed of Psoralia or Babchi plant is very effective as well. Crush these seeds into powder and use it to get relief. The Vibhitaki fruits, which are also found in triphala powder, can be taken in the form of tea or with milk.
Make a mixture of five grams of pepper and ten grams of neem leaves with boiled water. Drink it twice daily and you will gradually start feeling better.
Complications of Leprosy
Without treatment, leprosy can permanently damage your skin, nerves, arms, legs, feet, and eyes.
Its complications may include:

• Blindness or glaucoma.
• Disfiguration of the face (including permanent swelling, bumps, and lumps).
• Erectile dysfunction and infertility in men.
• Kidney failure.
• Muscle weakness that leads to claw-like hands or an inability to flex the feet.
• Permanent damage to the inside of the nose, which can lead to nosebleeds and a chronic, stuffy nose.
• Permanent damage to the nerves outside the brain and spinal cord, including those in the arms, legs, and feet.
• Nerve damage can lead to a dangerous loss of feeling. A person with leprosy-related nerve damage may not feel pain when the hands, legs, or feet are cut, burned, or otherwise injured.