Leprosy

(Hansen’s Disease)

Dr.Sagor Roy
MBBS(DU),BCS(Health)
Lecturer,Community Medicine Department
Sher-E-Bangla Medical College,Barisal
 What is Leprosy?
• It is a chronic infectious disease
Caused by Mycobacterium Laprae,
Affects mainly the peripheral nerve &
Also skin,Muscles,Eye,Bones,Testes &
Internal organs.eg,membrane of the
URT,oral & nasal mucosa.. s
• World's oldest recorded disease
• Stigmatized disease

Every year January 27 is World Leprosy Day

 Leprosy is characterized by one or
more cardinal features:
❑ Hypopigmented Patches
❑ Partial or Total loss of cutaneous sensation in
the affected areas (the earlyest sensation to be
affected is usually light touch)
❑Presence of thickened Nerve
❑Presence of Acid fast bacilli in the skin or nasal
smears.
M. leprae is discovered by Hansen from Norway in 1873
 Epidemiology
 In 2012 ~ 180,000 cases all over the world.
 Occurance: World wide
Most affected areas:
✓ Tropics
✓ Subtropics
✓ Travelling increases spread of leprosy to other areas of the
world
Affected countries:
✓ India (more than half of infections)
✓ In 2015 there were 14 countries reporting more than 1,000
new cases of leprosy: Bangladesh, Brazil, DR Congo,
Ethiopia, India, Indonesia, Madagascar, Mozambique,
Myanmar, Nepal, Nigeria, the Philippines, Sri Lanka and
Tanzania.
 Etiology & Bacteriology
 A chronic infection caused by
Mycobacterium leprae
✓Acid-fast, rod shaped
✓ M. leprae is an obligate intracellular acid-fast bacillus.
✓ Has never been grown in artificial media.
It grow in nine - banded armadillo
✓Replicate very slow (every 12 days once).
Has an affinity for macrophages & Schwann cell.
✓It grows best at 27-30 C, hence its predilection
for cooler areas of the body.
✓Skin, peripheral nerves, anterior chamber of the
eye, upper respiratory tract & testes..
Natural host?

• Humans

• Armadillos
are only known natural hosts
The nine - banded armadillo
 Natural History

❑ Reservoir: Cases .
❑ Source of Infection: Sin Lesions & Nasal
Discharge.
❑ Infection Period: Proling Period(As long
found in sin & nose)
❑ Incubation Period: 3-5 Years. Because-
 Incubation Period
• Mycobacterium leprare multiplies very slowly

• Symptoms can take as long as 20 years to appear

• Development of disease take from months to

years (1 year to 7 years)
 Mode of transmission
❑The exact rout of transmission is not fully known .
❑The spread of leprosy is believed to be via nasal
discharge (Droplets infection).
Every 1 cc of nasal secretion contains 1- 2millions
lepra bacilli
Other modes of transmissions
1. Contact through the skin (rare).
2. Arthropod-born infection (rare).
3. Through placenta and milk.
Leprosy is not STD or directly inherited.
 Types of Leprosy
❑ Epidemiologically Two Types of Leprosy :
✓ Tuberculoid: damages respiration, eyes, and skin
(Paucibacillary Leprosy (PB), (<5 lesions); Not
Infective,Low Bacilli Load,(-)ve skin smear

✓ Lepromatous: affects nerves in fingers and toes,

and surrounding skin (Multibacillary Leprosy
(MB), (>5 lesions); infective type,large number of
bacilli present,Generalized Disease,(+)ve skin smear.

• Borderline: (BL) has effects of both types

 Clinical Presentation
 Depends on immune response:
✓ Paucibacillary tuberculoid type → High
resistance
✓ Multibacillary repromatous type → Low
resistance
 Initially infections without symptoms
& typically remain this way for 5 to as
long as 20 years.
❑ Madrid Classification:
➢ Indeterminate
➢ Tuberculoid,Flat,Raised
➢ Borderline
➢ Lepromatous
❑ Immuno-histological Classification:
➢ Tuberculoid(TT)
➢ Borderline Tuberculoid(BT)
➢ Borderline(BB)
➢ Borderline Lepromatous(BL)
➢ Lepromatous(LL)
Spectrum of leprosy: Tuberculoid to
Lepromatous
❑Indian Classification:
➢ Indeterminate Type
➢ Tuberculoid Type
➢ Borderline Type
➢ Lepromatous Type
➢ Pure Neuritic Type
 Indeterminate Leprosy (IL)

▪ Usually single (multiple) macule / patche.

▪ Hypopigmented or faintly erythematous.
▪ Sensation normal but sometimes imparied.
▪ The peripheral nerves normal.
▪ Slit skin smear negative.
Indeterminate leprosy :Hypopigmented patch, sensation normal,
.no palpable peripheral nerve and slit skin smear negative
 What can leprosy do to people?
• Leprosy attacks the cooler areas of the body
• Leprosy destroys neurons in these areas,
taking feeling away from them
• Leprosy also causes cartilage in those areas
to get absorbed back into the body, causing
fingers, toes, ears and noses to disappear
• Leprosy also causes large bumps in the skin
that do not feel pain and do not heal
How the human body is affected by
Leprosy
Nerve is Large bumps (legions)
damaged and on the skin that do
broken by not heel and cannot
Leprosy infection leprosy
feel pain.
Nerve infection.
 Signs & Symptoms
 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 pain
sensation
 Peripheral nerve involvement leading to muscle weakness
(for example, clawed hand deformities, contractures, and
foot drop)
 HoarsenessTesticular 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
 Deformities & disability
 Who is at risk?
• It can affect all ages and both sexes
• 95% of people who are exposed do not develop disease
• Mainly affects:
– Skin
– Eyes
– The peripheral nerves
– Mucosa of the upper respiratory tract
Predisposing or risk factors:
1. Residence in an endemic area.
2. Having a blood relative with leprosy.
3. Poverty (malnutrition).
4. Contact with affected armadillo.
 Diagnosis
 Biopsy of skin or sensory nerve.
 Lepromin test - no use in diagnosis of leprosy but helps
to decide which type of disease is present ((+)ve in
tuberculoid type).
 DNA PCR
 Skin or nasal smears, stained with Acid-Fast Stains
Ziehl–Neelsen or Fité stains, will show up the large
number of organisms seen in the lepromatous type
✓ Fité stain - combines peanut oil with the deparaffinizing
solvent (xylene), minimizing the exposure of the bacteria's cell
wall to organic solvents, thus protecting the precarious acid-
fastness of the organism.
✓ Ziehl-Neelsen stain - Lipoid capsule of the acid-fast organism
takes up carbol-fuchsin and resists decolorization with a dilute
acid rinse. The lipoid capsule of the mycobacteria is of such
high molecular weight that it is waxy at room temperature and
successful penetration by the aqueous-based staining
solutions (such as Gram's) is prevented.
 Who is at risk?

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http://www.leprosymission.o
rg/web/pages/leprosy/image
s/girlwithleprosypatch.jpg

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rosy/leprosy.html
 Cases around the World

http://upload.wikimedia.org/wikipedia/commons/9/91/Lepra_2003.png

A 20% annual decrease in new cases detected globally since 2001

Decline in Leprosy cases
1985-1997
Number of Cases

6000
(thousands)

4000

2000

1985 1989 1993

1997
Tuberculoid leprosy: Two hypopigmented patches, hypoasthetic
.well defined borders, palpable peripheral nerve and SSS negative
Tuberculoid Leprosy: Annular, erythematous, anasthetic patch with
.well defined and raised borders and SSS Negative
 Borderline Leprosy (BL)
(BT,BB,BL)

▪Few / many asymmetrical patches.

▪Partly well-defined borders.
▪Sensory impairments range from slight to
marked.
▪Slit skin smear usually positive.
▪P. nerves asymmetrically enlarged.
Borderline Tuberculoid Leprosy: Well-defined large anaesthetic patches
.with satellite lesions. SSS Negative
Borderline Borderline Leprosy: Less defined, asymmetrically distributed
.hypoaesthetic patches. SSS positive
 Borderline Lepromatous Leprosy: Numerous, hypoaesthetic almost
.symmetrically distributed patches . SSS positive
 Differential Diagnosis
 Unlike tuberculous leprosy, there is no loss
of sensation in:
✓ Vitiligo – usually complete loss of pigment
✓ Pityriasis versicolor – mycelia and spores in
scrapings examination
✓ Pityriasis alba – common cause of scaly
hypopigmented areas on the cheeks of children
✓ Postinflammatory depigmentation of any cause;
and borderline leprosy consider sarcoidosis,
granuloma annulare, necrobiosis lipiodica
 Differential Diagnosis
 Lepromatous leprosy
➢ Widespread leishmaniasis can closely simulate
lepromatous leprosy. The nodules seen in
neurofibromatosis and mycosis fungoides, and
multiple sebaceous cysts, can lead to confusion,
➢ Acral deformities seen in yaws (endemic
treponema) and systemic sclerosis (multisystem
autoimmune disorder) can lead to confusion also
✓ Leprosy is a great imitator.
 What are the symptoms?
• Mycobacterium leprare multiplies very slowly
• Symptoms can take as long as 20 years to appear

• Paucibacillary (PB) Leprosy symptoms are:

– Well defined skin lesions that are numb

• Multibacillary (MB) Leprosy symptoms

are:
– Chronically stuffy nose and many skin lesions and
nodules on both sides of the body
 How can you avoid getting
leprosy?
• To avoid Contracting leprosy, avoid
close contact with someone who has
untreated leprosy
 BCG inoculation
 Hygiene
 Sanitation
 Public awareness and education
Goals of Prevention & Treatment
• Major goals of treatments are:

1. Early detection of patients

2. Appropriate treatment
3. Adequate care for the
prevention of disabilities and
rehabilitation
Is there a cure?
• Yes! Leprosy is curable with MDT (multidrug therapy)
• Treatments include taking Rifampicine,Dapsone and
Clofimine together:
 Leprosy Treatment by MDT
(Multi-Drug Therapy)

• PB patient need
PB MDT
(Rifampicin &Dapsone)
for 6 months

• MB patient need MB MDT

(three drugs: Rifampicin,
Dapsone and Clofazimine) for
12 months
 Conclusion

• Fortunately, modern medicine has cured

most of the world of Leprosy
• People with Leprosy are being more accepted
by communities around the world
• Leprosy still Remains a problem in
undeveloped countries
– The World Health Organization is putting a stop to
this
– If they reach their goal, Leprosy should be
eliminated from the world within 20 years
DO YOU BELIEVE IN
MIRACLES?