Leprosy
Leprosy (also known as Hansen’s disease) is an infection caused by slow-growing bacteria called Mycobacterium leprae. It multiplies slowly and the disease incubation period, on average, is 5 years. Symptoms may occur within 1 year but can take as long as 20 years or more.
Leprosy is classified as paucibacillary (PB) or multibacillary (MB), based on the number of skin lesions, presence of nerve involvement, and identification of bacilli on slit-skin smear.
Leprosy is likely transmitted via droplets, from the nose and mouth, during close and frequent contact with untreated cases. It can affect the nerves, skin, eyes, and lining of the nose. With early diagnosis and treatment, the disease can be cured.
Nepal achieved the elimination of leprosy as a public health problem in December 2009 and declared elimination in 2010. However, it remains an ongoing threat. Despite being the oldest known disease, leprosy continues to affect millions of the world’s most vulnerable people, causing needless disabilities, and social and psychological harm.
The WHO reports that 127558 new leprosy cases were detected globally in 2020, according to official figures from 139 countries from the 6 WHO Regions. The new case detection rate among the child population was recorded at 4.4 per million child population (WHO,2022). Though the number of leprosy cases in Nepal has fluctuated significantly in recent years, it has tended to decline from 2007 to 2021, reaching 2,394 in 2021.
Clinical Features:
Leprosy affects multiple systems such as the skin, nervous system, mucous membranes, and eyes:
Skin: Discolored patches on the body that have lost sensation, nodules on the skin, dry skin, painless ulcers on the soles of feet, painless swelling or lumps on the face or earlobes as well as loss of eyebrows or eyelashes.
Nerves: Numbness of affected areas of the skin, muscle weakness or paralysis, enlarged nerves, when facial nerves are compromised, eye difficulties can progress to blindness.
Mucous membranes: Difficulty in swallowing, superficial ulcers, stuffy nose, epistaxis.
Diagnosis of leprosy
The WHO recommendations propose that no further tests be performed in addition to the standard methods of leprosy diagnosis. The presence of at least one of three cardinal symptoms continues to be used to diagnose leprosy.
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Definite loss of sensation in a pale (hypopigmented) or reddish skin patch;
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Thickened or enlarged peripheral nerve with loss of sensation and/or weakness of the muscles supplied by that nerve; or
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Presence of acid-fast bacilli in a slit-skin smear.
Treatment of leprosy
The disease is curable with multidrug therapy. The WHO guidelines recommend a 3-drug regimen of rifampicin, dapsone, and clofazimine for all leprosy patients, with a duration of treatment of 6 months for PB leprosy and 12 months for MB leprosy. This represents a change from the current standard treatment for PB leprosy, which is rifampicin and dapsone for 6 months, due to some evidence indicating better clinical outcomes with a 3-drug, 6-month regimen over a 2-drug, 6-month regimen.
Leprosy is treatable and, if treated quickly, has no long-term effects on a person. If untreated, the nerve damage can cause paralysis and crippling of the hands and feet. In severe situations, the person may sustain multiple injuries due to a lack of sensation. The body may finally reabsorb the damaged digits, culminating in the apparent loss of toes and fingers. Corneal ulcers or blindness can also arise if the facial nerves are damaged due to loss of sensation on the cornea (outside) of the eye. Other symptoms of severe leprosy include brow loss and saddle-nose deformity caused by nasal septum damage.
However, some critical responsibilities remain in the effort to avoid leprosy handicaps. The first objective continues to be early case detection, so that treatment may begin as soon as symptoms occur. Second, it is critical to adequately diagnose and manage leprosy responses and neuritis in order to preserve nerve function. A third task is primary leprosy prevention, which is gradually being developed as a viable option.
References:
Centers for Disease Control and Prevention. (2017, January 30). Diagnosis and treatment. Centers for Disease Control and Prevention. Retrieved January 27, 2023, from https://www.cdc.gov/leprosy/treatment/index.html
Department of Health Services. Leprosy control program. Retrieved January 25, 2023, from http://dohs.gov.np/divisions/leprosy-control-program/
Nepal leprosy cases, 1922-2022. Knoema. Retrieved January 27, 2023, from https://knoema.com/atlas/Nepal/topics/Health/Communicable-Diseases/Leprosy-cases
WHO guidelines for the diagnosis, treatment, and prevention of leprosy. Infolep. (2018). Retrieved January 27, 2023, from https://www.leprosy-information.org/resource/who-guidelines-diagnosis-treatment-and-prevention-leprosy
World Health Organization. (2022). Leprosy. World Health Organization. Retrieved January 27, 2023, from https://www.who.int/news-room/fact-sheets/detail/leprosy
World Health Organization. (2020). Leprosy/Hansen Disease: Management of reactions and prevention of disabilities. World Health Organization. Retrieved January 27, 2023, from https://www.who.int/publications/i/item/9789290227595
Rojina Chapagain
Registered Nurse
Danphe Care Pvt. Ltd