The course of leprosy is variable depending on several factors including characteristics of the bacteria and the patient (NIAID, 2008). The condition tends to produce a wide variety of manifestations and usually affect the skin, nerves and the upper respiratory tract (NIAID, 2008). In the paucibacillary type, the individual has good immunity and is characterized by skin discoloration (NIAID, 2008). This is also known as the ‘tuberculoid leprosy’. In the multibacillary type or ‘lepromatous leprosy’, the individual has T-cell dysfunction leading to poor immunity (CDC, 2007).
The individual develops a range of skin lesions. The nasal mucosa also seems to be involved leading to epistaxis, congestion, etc. The other forms of leprosy of moderate severity include borderline tuberculoid, borderline-borderline and the borderline lepromatous. In the lepromatous leprosy type several other signs and symptoms can also develop including decreased skin sensations to heat, touch and pain; lesions taking abnormally long to heal, numbness of the hands, feet and toes, muscle weakness, etc.
The titers to the bacteria are high (NIAID, 2008). People with long-term leprosy, would have faced a lot of trauma to their hands or feet (due to decreased sensations) and hence are more likely to lose their hands and feet. For this reason, leprosy is considered to be debilitating. A person suffering from leprosy is also concerned about permanent nerve damage (CDC, 2007). Diagnosis The diagnosis of leprosy is made based on the history, signs, symptoms, physical examination, blood tests, skin tests, etc (NIAID, 2008).
Physical examination involves studying skin for numb areas, thickened or enlarged skin lesions, hypo-pigmented areas, etc. The lepromin skin test involves injecting inactivated leprosy bacteria under the skin and looking for skin changes (Wener, 2007). In individuals suffering from leprosy, skin changes are not seen, whereas in individuals not affected with leprosy, skin changes are present. The acid fast test involves taking the skin scraping and subjecting it to acid fast staining procedures so that the bacteria can be stained and identified under the microscope (Wener, 2007).
Treatment One of the most effective treatment regimens for leprosy was suggested by the WHO in the year 1981 (NIAID, 2008). Three antibiotic (anti-leprosy drugs) drugs namely dapsone, rifampicin, and clofazimine are administered for long periods to get rid of the bacilli and help cure the patient (leprosy is curable but the damage to the skin are nerves are irreversible) (NIAID, 2008). In multibacillary cases, stronger doses of drugs are administered for one year, whereas in paucibacillary cases, milder doses are administered for 6 months (NIAID, 2008).
If the drugs are administered for shorter-duration in severe cases, then there are chances of relapses (NIAID, 2008). Inflammatory problems can be controlled by administering corticosteroids, NSAIDS or immunosuppressant (Wener, 2007). Early identification and prompt treatment plays a very important role in limiting the damage caused due to leprosy. Besides, prevention of contact with untreated serious cases has a high risk of transmitting the disorder to others (CDC, 2008). Conclusion
In the past, even since the biblical times, leprosy has been one of the most dreaded and misunderstood diseases. It faces a lot of social stigma due to the disfigurement, disabilities, mental trauma and contagious association of the disease. The person suffering from leprosy was unnecessary isolated and punished. However, modern medicine has demonstrated that leprosy can completely be cured if prompt diagnosis and treatment is provided. Research studies are developing more effective diagnostic, curative and preventive means for the disease.
CDC (2008). Leprosy (Hansen’s Disease): Technical Information, Retrieved on December 3, 2008 from CDC Web site: http://www. cdc. gov/nczved/dfbmd/disease_listing/leprosy_ti. html National Institute of Allergy and Infectious Diseases (2008). Leprosy (Hansen’s Disease), Retrieved on December 3, 2008 from NIAID Web site: http://www3. niaid. nih. gov/topics/leprosy/Understanding/whatis. htm Wenner, K. M. (2007). Medical Encyclopedia: Leprosy, Retrieved on December 3, 2008 from Medline Plus Web site: http://www. nlm. nih. gov/medlineplus/ency/article/001347. htm