Leprosy

The overall likelihood of contracting leprosy is extremely low, as more than 95% of the global population has natural immunity to the disease. However, there are several risk factors that may increase the chances of infection:

• Prolonged Close Contact: Extended physical contact with an individual actively suffering from leprosy significantly raises the risk of contracting the disease.
• Living in Endemic Regions: Residing in areas where leprosy is common, such as parts of India, China, Japan, Nepal, and Egypt, increases the risk of exposure.
• Age: While adults are at a generally low risk, children between 5 to 15 years of age and older individuals over 30 are more susceptible.
• Genetic Factors: Certain genetic predispositions, such as defects in the immune system (notably at region q25 on chromosome 6), can make individuals more vulnerable to leprosy.
• Animal Exposure: Handling animals known to harbor the bacteria, such as the nine-banded armadillo, African chimpanzee, sooty mangabey, or cynomolgus macaque, can increase the risk, especially if proper protective measures, such as gloves, are not used.
• Immunosuppression: Individuals with weakened immune systems, due to conditions like HIV, chemotherapy, or organ transplantation, may have a higher risk of contracting leprosy.

A leprosy diagnosis typically starts with a detailed physical examination, focusing on skin lesions. To confirm the diagnosis, the following tests may be utilized:

• Skin Biopsy: A small sample of skin is collected and analyzed for the presence of leprosy-causing bacteria.
• Skin Slit Smear: This test is used for multibacillary leprosy. A slit is made in the skin of areas like the forehead, earlobe, or affected lesions. A sample is then taken and examined under a microscope for bacteria.
• Lepromin Test: A small amount of inactive leprosy bacteria is injected into the skin. The body’s immune response to this injection helps determine the type of leprosy but does not diagnose it.
• DNA PCR Test: This molecular test detects the DNA of the leprosy bacteria in blood samples, offering a definitive diagnosis.

Additional tests may be conducted to assess whether other organs have been affected by the disease:

• CBC (Complete Blood Count)
• Liver Function Tests
• Creatinine Test
• Nerve Biopsy
• Nerve Conduction Velocity Test

Leprosy is primarily spread through prolonged and close contact with someone who is actively infected. To reduce the risk of transmission:

• Minimize Close Contact: Avoid prolonged contact with infected individuals. However, casual interactions, like handshakes, do not transmit the disease.
• No Vaccine Available: While no dedicated vaccine for leprosy exists, the BCG vaccine, used for tuberculosis, offers some protection against leprosy, though it is not commonly used for this purpose.
• Avoid Contact with Certain Animals: Certain animals, such as nine-banded armadillos and African chimpanzees, may carry the bacteria. It’s best to avoid handling these animals.
• Prophylactic Medication: People who are at high risk of exposure to leprosy may be given preventive antibiotics like Rifampicin to reduce the likelihood of contracting the disease.

Specialists to Consult

If you notice symptoms such as skin lesions or loss of sensation, you should consult the following specialists:

• Dermatologist
• Infectious Disease Specialist
• Internal Medicine Specialist
• Neurologist

For some cases, a general surgeon may be needed for rehabilitation and surgical repair.

Leprosy is treated with antibiotics, and the length of treatment depends on the type of leprosy (Paucibacillary or Multibacillary). The World Health Organization (WHO) recommends a combination of rifampicin, dapsone, and clofazimine for all patients. The treatment duration is 6 months for paucibacillary leprosy and 12 months for multibacillary leprosy. Adhering to this regimen is crucial to avoid the development of antibiotic-resistant bacteria.

While antibiotics effectively kill the bacteria, they cannot reverse the nerve damage or physical deformities that may have occurred before the diagnosis. Early detection is critical to prevent permanent damage.

• Antibiotic Treatment: Depending on the type and severity, antibiotics such as Clofazimine, Rifampicin, and Dapsone are prescribed for 6 to 12 months.
• Neurotonics: These medications help manage symptoms related to nerve damage, though nerve damage is often irreversible.
• Treatment for Resistant Cases: In cases where the bacteria are resistant to standard treatments, therapy may last up to 24 months, with additional medications like Clarithromycin, Minocycline, Ofloxacin, Moxifloxacin, and Levofloxacin.

The complications associated with leprosy largely depend on how promptly the disease is diagnosed and treated. If treatment begins early, the risk of complications is minimal. However, if diagnosis and treatment are delayed, the following complications may arise:

• Wounds and ulcers on the hands or feet
• Permanent nerve damage in the extremities
• Progressive deformities affecting fingers, toes, and the nose
• Chronic nasal issues, including congestion, nosebleeds, and a collapsed nasal septum
• Glaucoma, a condition that damages the optic nerve
• Uveitis, an inflammation of the eye
• Potential vision loss leading to blindness
• Erectile dysfunction
• Infertility
• Kidney failure

Ayurveda:

In Ayurveda, leprosy is referred to as Kustha Roga. Several Ayurvedic treatments exist, including oral medicines made from Triphala, Khadira, Guduchi, and Pippali, or topical pastes composed of sulfur, mustard oil, and turmeric.

Physiotherapy:

Physiotherapy plays a vital role in maintaining the function and mobility of affected digits, preventing deformities such as claw hand. It can also assist in improving the functionality of already deformed hands.

At home, leprosy care focuses on preventing complications. Here are some tips for managing the disease:

• Eye Protection: Protect your eyes from dust, sunlight, and dryness. Clean them gently with a cloth every day and look for any changes in appearance.
• Hand and Foot Care: Protect your hands and feet from injuries, and inspect them daily for unnoticed wounds. If sensation is lost, take extra precautions to avoid burns or cuts.
• Skin Care: Wash hands and feet with lukewarm water daily. Soak them in water to soften hardened skin, and apply moisturizing creams to prevent dryness.
• Exercise: Perform daily exercises for your fingers and toes to prevent stiffness and preserve mobility.

Patients with leprosy must take special care due to the increased risk of injuries or burns resulting from reduced sensation. Extra caution is necessary for the extremities. For example, patients should wear gloves when handling hot items and seek prompt medical care for even minor cuts or injuries. Timely treatment is crucial for the best possible outcome.

Leprosy patients often face social stigma and discrimination due to misunderstandings surrounding the disease. Unfortunately, many avoid seeking medical help when symptoms first appear, leading to delays in diagnosis and treatment, which increases the risk of permanent disability.

Women and girls with leprosy experience additional gender-based discrimination, which further hinders their access to diagnosis and treatment. This stigma can severely impact the patient’s day-to-day life. As a result, mental health support is equally important. It is advisable for patients to consult a counselor or therapist to help manage their emotions. Joining a support group, either in person or online, can be beneficial, allowing individuals to connect with others facing similar challenges.