Introduction:

Leprosy, also known as Hansen’s disease, is a chronic

infectious disease caused by Mycobacterium leprae, a

microorganism that has a predilection for the skin and

nerves. Though nonfatal, leprosy is one of the most

common causes of nontraumatic peripheral neuropathy

worldwide. The disease has been known to man since time

immemorial. DNA taken from the shrouded remains of a

man discovered in a tomb next to the old city of Jerusalem

shows him to be the earliest human proven to have suffered

from leprosy.

The remains were dated by radiocarbon methods. The

disease probably originated in Egypt and other Middle

Eastern countries as early as 2400 BCE. An apparent lack

of knowledge about its treatment facilitated its spread

throughout the world. Mycobacterium leprae, the causative

agent of leprosy, was discovered by G. H. Armauer Hansen

in Norway in 1873, making it the first bacterium to be

years, the WHO implementation of MDT has rendered

leprosy a less prevalent infection in 90% of its endemic

countries with less than one case per 10,000 population.

Though, it continues to be a public health problem in

countries. like Brazil, Congo, Madagascar, Mozambique,

Nepal, and Tanzania .

The definition:

Leprosy, also known as Hansen’s disease, is a chronic

infectious disease caused by Mycobacterium leprae. The

disease mainly affects the skin, the peripheral nerves,

mucosal surfaces of the upper respiratory tract and the eyes.

Leprosy is known to occur at all ages ranging from early

infancy to very old age. Leprosy is curable and early

treatment averts most disabilities.

The major source of infection is patients with lepromatous

leprosy who shed large numbers of bacilli in their nasal

secretions. Leprosy is caused mainly by Mycobacterium

leprae (only grows inside of certain human and animal

cells). M. leprae is genetically related to M. tuberculosis

(the type of bacteria that cause tuberculosis) and other

mycobacteria that infect humans. M. leprae and M.

lepromatosis are the mycobacterium that causes leprosy.

Risk factors:

Patients in the nonpolar borderline groups, people who live

in the areas where leprosy is endemic, especially those

people in constant physical contact with infected people,

genetic defects in the immune system, people who handle

certain animals known to carry the bacteria.

The exact mechanism of transmission of leprosy is not

known. At least until recently, the most widely held belief

was that the disease was transmitted by contact between

cases of leprosy and healthy persons. More recently the

possibility of transmission by the respiratory route is

gaining ground. There are also other possibilities such as

transmission through insects which cannot be completely

ruled out.

Classification of leprocy:

Lepromatous leprocy (LL), Borderline lepromatous leprocy

(BL), Borderline leprocy (BB), Borderline tuberculoid

leprocy (BT), and Tuberculoid leprocy (TT).

There is limited evidence to determine the mechanism

underlying how M. leprae produces the symptoms of

leprosy.

M. leprae has been shown to bind to schwann cells, which

may lead to nerve injury including demylination and a loss

of nerve function (specifically a loss of axonal

conductance). Numerous molecular mechanisms have been

associated with this nerve damage including the presence of

a laminin-binding protein and the glycoconjugate (PGL-1)

on the surface of M. leprae that can bind to laminin on

peripheral nerves.

As part of the human immune response, white blood cell-

derived macrophages may engulf M. leprae by

phagocytosis.
Signs & symptoms:

Numbness (among the first symptoms), Loss of

temperature sensation (among the first symptoms), Touch

sensation reduced (among the first symptoms), Pins and

needles sensations (among the first symptoms), Pain

(joints), Deep pressure sensations are decreased or lost,

Nerve injury, Weight loss, Blisters and/or rashes, Ulcers,

relatively painless, Skin lesions of hypo pigmented macules

(flat, pale areas of skin that lost color), Eye damage

(dryness, reduced blinking), Large ulcerations (later

symptoms and signs), Hair loss (for example, loss of

eyebrows), Loss of digits (later symptoms and signs),

Facial disfigurement (for example, loss of nose) (later

symptoms and signs), Erythema nodosum leprosum: tender

skin nodules accompanied by other symptoms like fever,

joint pain, neuritis, and edema.

continues on the cooler areas of the body (for example,

hands, feet, face, and knees).

Complications of leprosy can 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.

Leprosy can be cured by :antibiotics, Anti-inflammatory

drugs, thalidomide: a potent medication that suppresses the

body's immune system that helps treating leprosy skin

nodules.

Anti-leprosy medication: A number of leprostatic agents

are available for treatment. A 3-drug regimen of rifampicin,

dapsone and clofazimine. People with rifampicin-resistant

leprosy may be treated with second line drugs such as

fluoroquinolones, minocycline, or clarithromycin.

Skin changes: protective footwear , Canvas shoes, Topical

ketanserin, and Phenytoin applied to the skin.

Surgical Care:

The goals of surgical treatment in patients with leprosy are

to prevent further deterioration, to improve motor function,

and, in some cases, to improve sensation.

sensation, Draining of acute nerve abscesses and fascicular

dissection, longitudinal epineurotomy may relieve some

sensory loss, Calcaneal bands can be slit to relieve distal

compression of branches on the sole of the foot, and Nerve

grafts may be of some benefit in patients with localized

lesions.

Reconstruction and functional restoration : Clawed hands

are repaired with arthrodesis or with a tendon transfer to 1

of 4 insertion sites on the finger, Contractures of the hand,

such as the thumb web contracture, can be repaired with Z-

plasty, and joint stability can be improved with tenodesis,

and . Possible treatment options include removal of the

carpal tunnel roof, ulnar nerve transposition anteriorly, and

epicondylectomy. The last resort is ambutation.

Eye procedures: Tarsorrhaphy may help narrow the

opening of the eyelid, and canthoplasty reduces sagging of

the eyelids.
Cosmetic surgery: Nasal reconstruction, Removal of excess

skin, Replacement of eyebrows using transplants of scalp

hair, Removal of breast tissue formation due to

gynecomastia.