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Leprosy
Definition:
An infectious disease, known since Biblical times, which is characterized by disfiguring skin lesions, peripheral nerve damage, and progressive debilitation.

Alternative Names:
Hansen's disease

Causes, incidence, and risk factors:
Leprosy is caused by the organism Mycobacterium leprae. It is a difficult disease to transmit and has a long incubation period, which makes it difficult to determine where or when the disease was contracted. Children are more susceptible than adults to contracting the disease.

Leprosy has two common forms, tuberculoid and lepromatous, and these have been further subdivided. Both forms produce lesions on the skin, but the lepromatous form is most severe, producing large disfiguring nodules. All forms of the disease eventually cause peripheral neurological damage (nerve damage in the extremities) manifested by sensory loss in the skin and weakness of the muscles. People with long-term leprosy may lose the use of their hands or feet due to repeated injury which results from absent sensation.

Leprosy is common in many countries in the world, and in temperate, tropical, and subtropical climates. Approximately 100 cases per year are diagnosed in the United States. Most cases are limited to the South, California, Hawaii, and U.S. island possessions. Effective medications exist, and isolation of victims in "leper colonies" is unnecessary. The emergence of drug-resistant Mycobacterium leprae, as well as increased numbers of cases worldwide, have led to global concern about this disease.
Symptoms:
History of:
  • exposure or family members with leprosy
  • living or visiting areas of the world where leprosy is endemic (cases are known to occur in that area)

Symptoms include:

  • one or more hypopigmented skin lesions that have decreased sensation to touch, heat, or pain
  • skin lesions that do not heal after several weeks to months
  • numbness or absent sensation in the hands and arms, or feet and legs
  • muscle weakness resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)
Signs and tests:
Treatment:
Medications used to eliminate the microorganism and to reduce symptoms include:
  • Dapsone
  • Rifampin
  • Clofazimine
  • Ethionamide
  • Aspirin, prednisone, or thalidomide are used for the control of inflammation (e.g., "erythema nodosum leprosum") that may occur with therapy
Expectations (prognosis):
Early recognition is important. Early treatment limits damage by the disease, renders the person noninfectious, and allows for a normal lifestyle.
Complications:
  • permanent nerve damage
  • cosmetic disfigurement
Calling your health care provider:
Call your health care provider if signs or symptoms described here occur, especially following exposure. Cases of leprosy in the United States need to be reported to the Centers for Disease Control and Prevention.
Prevention:
Prevention consists of avoiding close physical contact with untreated people. People on long-term medication become noninfectious (they do not transmit the organism that causes the disease).
Review Date: 12/3/2001
Reviewed By: David N. Fisman, M.D., M.P.H., FRCP(C). Hamilton Department of Social and Public Health Services, and McMaster University Division of Infectious Diseases, Hamilton, Ontario, Canada. Review provided by VeriMed Healthcare Network.
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