Leprosy - Types, Manifestations, Diagnosis And Management

Mycobacterium leprae, the bacterium that causes leprosy, also goes by the name Hansen's disease. It is a chronic infection that shows weakly positive results on acid-fast staining. India is a leading contributor, responsible for around 78% of cases of leprosy worldwide.
Spread
M. leprae is mostly spread by respiratory droplets, especially nasal secretions, which means that infection requires extended close contact. The nasal mucosa, ear skin, and facial nerve are among the colder regions of the body where the bacteria typically lives. 

Incubation Period

Leprosy is notable for having a prolonged incubation period, lasting seven to ten years, during which the germs may enter the body but do not show symptoms for years.

Leprosy can be adequately treated with combination therapy despite being a chronic disease; this highlights the significance of early detection and action in managing the disease and averting subsequent problems. Even though leprosy is becoming less commonplace worldwide, efforts to eradicate this age-old disease must continue. This includes raising awareness and comprehending how the disease spreads.

Manifestations:

With fewer neurological symptoms, Mycobacterium leprae mostly affects the skin or upper respiratory tract. Based on their clinical presentation, lepromatous leprosy and tuberculoid leprosy are the two main categories of leprosy patients. Widespread skin lesions, a high bacterial load, and a weakened immune system that results in significant tissue damage are the hallmarks of lepromatous leprosy.

Contrarily, tuberculoid leprosy has less lesions, restricted skin involvement, and a strong immune system that stops the bacterial spread. Since leprosy reactions and complications can differ across the two types, these categories help to customize treatment regimens. Comprehending the discrete clinical attributes of lepromatous and tuberculoid leprosy is imperative for efficient administration and customized therapy for those impacted by this persistent infectious ailment.

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Types of Leprosy

1. Lepromatous Leprosy

The immune system is noticeably weak in lepromatous leprosy, which compromises the body's capacity to build a strong fight against the invasive Mycobacterium leprae. Lepromatous leprosy patients have widely distributed bacteria in their tissues, and because of their compromised immune system, they have a larger concentration of lymphocytes and macrophages in their bodies.

Patients with lepromatous leprosy are classified as having an insufficient immune response. Loss of tissue resistance is a hallmark of the illness because the compromised immune system is unable to offer the required protection. As a result, the germs can spread quickly throughout the body's organs. 

Given that people with lepromatous leprosy are more susceptible to broad bacterial dissemination, an understanding of these immunological components of the disease is essential for developing successful treatment plans and managing lepromatous leprosy.

2. Tuberculoid Leprosy

Bacilli are scarce in tuberculoid leprosy, and the immune system mounts a strong defense. Increased tissue resistance is correlated with an effective immune response, which stops Mycobacterium leprae from spreading widely. Bacteria in this type of leprosy are usually restricted to a particular tissue, and the host (the tissue) and the bacteria fight it out, resulting in epithelioid granulomas. Large cells and a profusion of lymphocytes are visible in these granulomas, which indicate the host's attempts to fight the germs.

In leprosy, the immune response of the host is inversely correlated with the degree of tissue destruction. Larger tissue areas may be affected with lepromatous leprosy, where the immune response is lower, yet symptoms may not show up right away because of low resistance. On the other hand, tuberculoid leprosy only affects one tissue, which indicates a stronger immunological response from the patient. 

Although leprosy patients are generally classified as either tuberculoid or lepromatous, the illness actually manifests as a spectrum, with many cases falling somewhere in between. Comprehending the immunological and clinical subtleties is essential for customizing treatment regimens and managing the various leprosy symptoms in afflicted individuals.

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Clinical Features    

Tissue destruction in tuberculoid leprosy typically starts early and is confined to a single area of the body. Nerves may be affected by lepromatous or tuberculoid leprosy, frequently growing thicker and more sensitive. Leprosy is characterized by the involvement of nerves.

Leprids are skin lesions that have a distinct boundary and function as an anesthetic patch. They are among the skin symptoms of leprosy. These asymmetrical lesions have a rough, dry surface and might appear as hypo- or erythematous macules with a raised edge. 

Leproma
Leproma is a unique skin manifestation of leprosy characterized by many whitish macules that eventually develop into plaques and nodules.

Deformities

Leprosy is known to have important cutaneous symptoms, including leproma and leprids. Primary and secondary deformities are two categories for leprosy. Primary deformities are the direct outcome of leprosy-related reactions or the bacteria's impact. Conversely, the anesthesia of the hands or feet causes subsequent abnormalities. When a limb is under anesthesia, the patient might not be aware of damage to it, which could result in infections, bone abnormalities, or skin lesions unrelated to Mycobacterium leprae. Leprosy causes the affected area to lose sensation, which leads to secondary deformities. This highlights the significance of early detection and treatments in preventing long-term consequences and deformities.

Terminologies:

Leonine Facies: During the acute stage of lepromatous leprosy, a nodular lesion on the face develops. Skin wrinkling, eyebrow loss, and damage to the nose's septum and lateral cartilage are the main symptoms of this illness. When these nasal structures are destroyed, the nasal bridge collapses and the nose appears to have an elevated tip.

Other Terminologies

• Paralysis of face Nerve Branches: Mycobacterial leprosy frequently involves the face nerves, which can lead to facial paralysis.
• Blindness: Iridocyclitis or exposure keratitis, which are brought on by paralysis of the orbicularis oculi, might result in blindness.
• Paralysis of the Orbicularis Oculi: The orbicularis oculi can become paralyzed due to incomplete eyelid closure.
• Clawded Hands and Toes: Bilateral clawed hands can be caused by involvement of the ulnar or median nerve, which affects hand function. The posterior tibial nerve is involved with clasped toes.
• Foot Drop: The lateral popliteal nerve can become involved in foot drop, which can lead to foot damage and difficulty walking.
• Testis Atrophy → Gynecomastia: Hormonal abnormalities can cause both gynecomastia and testis atrophy.

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Management of Leprosy:

• Hydrocarpus wightiana, also known as Chaulmoogra oil: Traditionally used in leprosy herbal therapy.
• Dapsone: Often given in combination with rifampicin and clofazimine, this crucial leprosy treatment component.
• Steroids: Applied during the acute phase of treatment to control drug-induced symptoms.
• Reconstructive Surgery: Plastic, orthopedic, and hand surgeons work together to perform reconstructive surgery on patients with leprosy who have abnormalities such as clawed hands, clawed feet, foot drop, and trophic ulcers. This procedure is critical to improving patient outcomes and quality of life.

Reconstructive surgeons—such as plastic surgeons—then play a crucial role. For a successful reconstructive result, the plastic surgeons and the orthopedic and hand surgeons must collaborate.

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