LEPROSY - HANSEN’S DISEASE

Leprosy according to Lewis (2011) is a chronic granulomatous disease principally affecting the skin and peripheral nervous system, caused by infection with Mycobacterium leprae, an acid-fast bacillus that like cool temperature (infects skin and superficial nerves) and can not be grown in vitrus (Le, Bhushan, & Grimm, 2011); and a newly discovered leprosy-causing organism, Mycobacterium lepromatosis which the preliminary analysis of its 16S rRNA gene and a few other gene segments revealed significant divergence from M. leprae. (Han, et al., 2009).

As mentioned above, leprosy affects the skin, peripheral nerves and eyes, often accompanied by systemic symptoms, which depend on the time of evolution and severity of the disease.

Essential for diagnosis:

.Pale, anesthetic macular (or nodular and erythematous) skin lesion.

.Superficial nerve thickening with associated anesthesia

.Acid-fast bacilli in skin lesions or nasal scraping; or characteristic histologic nerve changes.

Remember: history of residence in endemic area in childhood.

A general classification of disease is based on the number of skin lesions present and the number of bacilli found on tissue smears. Paucibacillary disease (indeterminate leprosy and tuberculoid leprosy) has fewer than 5 lesions and no bacilli on smear testing. Five or more lesions with or without bacilli (borderline leprosies and lepromatous leprosy) is considered multibacillary disease. (Lewis, 2011).

Classification:

·        Lepromatous Leprosy (presents diffusely over skin and is communicable, can be lethal, seen in patients with weak T-cell mediated immunity) (Le, T. 2011).

·        Tuberculoid Leprosy (limited to a few hypoesthetic skin nodules, seen in patients with intact T-cell response) (Le, T. 2011).

·        Borderline Tuberculoid Leprosy

·        Borderline Borderline Leprosy

·        Borderline Lepromatous Leprosy

·        Indeterminate Leprosy

·        Histoid Leprosy

·        Other

The management of leprosy includes early pharmacotherapy and physical, social, and psychological rehabilitation. The goals of pharmacotherapy are to stop the infection, reduce morbidity, prevent complications, and eradicate the disease.

Long-term oral dapsone (toxicity=hemolysis and methemoglobinemia), alternate treatment include rifampin, and combination of clofazimine and dapsone, according the recommendation of World Health Organization.

Treatment of leprosy with only one antileprosy drug will always result in development of drug resistance to that drug. Treatment with dapsone or any other antileprosy drug used as monotherapy should be considered as unethical practice. (WHO, 2011).

Bibliography

Han, X., Sizer, K., Thompson, E., Kabanja, J., Li, J., Hu, P., . . . Silva FJ. (2009, J bacteriol. 2009; 191 (19):6067-74 (ISSN:1098-5330)). Medscape reference. Retrieved from Comparative sequence analysis of Mycobaterium leprae and the new leprosy causing M. lepromatosis: http://reference.medscape.com/medline/abstract/19633074

Le, T., Bhushan, V., & Grimm, L. (2011). First AID for the USMLE step 1. usa: McGraw Hill.

Lewis, F. S. (2011, Aug 5). Medscape.com reference. Retrieved from Dermatologic Manifestation of Leprosy Clinical Presentation: http://emedicine.medscape.com/article/1104977-clinical#a0217

WHO. (2011, 12 19). World Health Organization. Retrieved from WHO Multidrug therapy: http://www.who.int/lep/en/