Leprosy symptoms and treatment
leprosy symptoms and treatment
Leprosy is a chronic infectious disease caused by a bacterium, the Mycobacterium leprae bacillus. This condition mainly affects the skin, nerves, limbs and eyes. Early treatment prevents the effects.
What is it ?
This infectious disease due to the Mycobacterium leprae bacillus (mycobacterium very close to the tubercle bacillus) is characterized by its slow evolution. The transmission of leprosy is interhuman. The sick man is the only reservoir.
There are two forms of leprosy:
Paucibacillary (1 to 5 insensitive skin lesions);
Multibacillary (more than 5 insensitive skin lesions).
Only subjects carrying the “lepromatous” form are contagious because they eliminate many bacilli in their nasal secretion and saliva (cough and expectoration, saliva droplets). Poor hygiene and promiscuity promote the spread of the disease.
The WHO estimates that there are 2.8 million lepers in the world today. This disease remains a major problem in 14 countries in Africa, Asia and Latin America. Six countries account for 83% of global prevalence and 88% of new global annual cases: India, Brazil, Indonesia, Nepal, Democratic Republic of Congo, Mozambique. Leprosy remains endemic in many other countries (Angola, Madagascar, Central African Republic, Tanzania, etc.)
Over the last 20 years, more than 12 million lepers have been cured, and leprosy has been eliminated in 108 of the 122 countries where it was considered by the WHO
The symptoms of leprosy
The incubation, very long, is silent, and lasts about 5 years. The symptoms of leprosy can appear after 20 years.
Leprosy begins with an undifferentiated “leprid”, it is about
Cutaneous lesions, nonspecific, dry (anhidrosis) well limited and flat. They may be preceded by tingling sensations.
At the level of the skin lesions, the patient presents a cutaneous anesthesia: he feels neither the pain nor the heat.
Treated skin lesions indeterminate leprosy repair in less than 2 years; the patient is then put under observation without treatment then considered definitively cured a year later.
Untreated, indeterminate leprosy will evolve differently depending on the subject’s resistance to:
“Tuberculoid” leprosy, non-contagious;
Leprosy leprosy contagious.
NON-CONTAGIOUS TUBERCULOIDAL LEPROSIS
It is the form of the resistant subject with skin allergy to lepromin (positive Mitsuda reaction).
There are no general symptoms.
The “maculo-anesthetic cutaneous leprids” are spots on the skin that have become insensitive. The rounded “papulonodular leprids” are hypopigmented and are seen mainly in children.
Nerve damage (hypertrophic peripheral neuritis) dominates the prognosis.
The most affected nerves are the cubital elbow, the external popliteal sciatica, the facial, the radial, the median … Anesthesia and paraesthesia (tingling) are the first symptoms. Motor disorders are later: they are muscle deficits. Trophic disorders (plantar perforating diseases, skeletal alteration, muscle wasting, keratitis – inflammation of the cornea – neuroparalytics) are possible
Lesions tend to regress spontaneously.
The treatment is very active and bleaching can be obtained, with the exception of neurological sequelae.
THE CONTAGIOUS LEPROMATOUS LEPROSY
This is the shape of the fragile subject. Mitsuda’s reaction to lepromin is negative. General signs are important.
The cutaneous lesions are the “lepromas”. It is infiltrated and shiny macules. The papulo-nodular lepromas touch the forehead, the eyebrows, the ears, the chin, the limbs etc … The nasal septum can collapse.
Neurological disorders are hypertrophic and painful neuritis.
The mucosal involvement is constant. Leprosy rhinitis is suggestive with purulent and haemorrhagic discharge.
Cartilage and bones can be reached.
Visceral disorders are numerous but asymptomatic: ganglions, liver, genital tract, keratitis, iridocyclitis.
The spontaneous evolution is made by successive febrile, painful and extensive outbursts towards death in 10 to 20 years. Specific treatment can achieve bleaching of lesions. Diagnosis is based on Mitsuda’s reaction to lepromin, skin or nerve biopsy, Hansen’s bacillus in nasal mucus, and dermal juice.
leprosy symptoms and treatment
As early as the fourth century, the Indians knew an effective drug against leprosy: the oil of Chaulmoogra, plant of Bengal, which is still used today.
Sulfones (of the sulphonamide family) are very active (DDS or Disulone).
The treatment recommended since 1981 by WHO is based on multidrug therapy (MDT) combining 3 antibiotics:
This treatment lasting 6 to 12 months allows the patient to be whitewashed: he can resume a normal social life provided he continues his treatment that can last for years.