Leprosy Leprosy or Hansen's disease (HD) is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis.

Named after physician Gerhard Armauer Hansen, leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external sign. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs and eyes. Contrary to folklore, leprosy does not cause body parts to fall off, although they can become numb or diseased as a result of secondary infections; these occur as a result of the body's defenses being compromised by the primary disease. Secondary infections, in turn, can result in tissue loss causing fingers and toes to become shortened and deformed, as cartilage is absorbed into the body. Although the mode of transmission of Hansen's disease remains uncertain, most investigators think that M. leprae is usually spread from person to person in respiratory droplets. Studies have shown that leprosy can be transmitted to humans by armadillos. Leprosy is now known to be neither sexually transmitted nor highly infectious after treatment. Approximately 95% of people are naturally immune and sufferers are no longer infectious after as little as 2 weeks of treatment. The minimum incubation period reported is as short as a few weeks, based on the very occasional occurrence of leprosy among young infants. The maximum incubation period reported is as long as 30 years, or over, as observed among war veterans known to have been exposed for short periods in endemic areas but otherwise living in non-endemic areas. It is generally agreed that the average incubation period is between three and five years. The age-old social stigma associated with the advanced form of leprosy lingers in many areas, and remains a major obstacle to self-reporting and early treatment. Effective treatment for leprosy appeared in the late 1930s with the introduction of dapsone and its derivatives. Leprosy bacilli resistant to dapsone soon evolved and, due to overuse of dapsone, became widespread. It was not until the introduction of multidrug therapy (MDT) in the early 1980s that the disease could be diagnosed and treated successfully within the community. MDT for multibacillary leprosy consists of rifampicin, dapsone, and clofazimine taken over 12 months. Dosages adjusted appropriately for children and adults are available in all primary health centres in the form of blister packages. Single dose MDT for single lesion leprosy consists of rifampicin, ofloxacin, and minocycline. The move toward single-dose treatment strategies has reduced the prevalence of disease in some regions, since prevalence is dependent on duration of treatment. Signs and Symptoms *long standing skin lesions that do not disappear with ordinary treatment * loss of feeling/numbness on the skin * loss of sweating and hair growth over the skin lesions * thickened and/or painful nerves in the neck, forearm, near elbow joint and the back of knees

Cause Mycobacterium leprae or leprosy bacilli

Mode of Transmission Airborne: inhalation of droplet/spray from coughing and sneezing of untreated leprosy patient Pathophysiology Leprosy can manifest in different forms, depending on the host response to the organism. Individuals who have a vigorous cellular immune response to M leprae have the tuberculoid form of the disease that usually involves the skin and peripheral nerves. The number of skin lesions is limited, and they tend to be dry and hypoesthetic. Nerve involvement is usually asymmetric. This form of the disease is also referred to as paucibacillary leprosy because of the low number of bacteria in the skin lesions (ie, < 5 skin lesions, with absence of organisms on smear). Results of skin tests with antigen from killed organisms are positive in these individuals.

Individuals with minimal cellular immune response have the lepromatous form of the disease, which is characterized by extensive skin involvement. Skin lesions are often described as infiltrated nodules and plaques, and nerve involvement tends to be symmetric in distribution. The organism grows best at 27-30C; therefore, skin lesions tend to develop in the cooler areas of the body, with sparing of the groin, axilla, and scalp. This form of the disease is also referred to as multibacillary leprosy because of the large number of bacteria found in the lesions (ie, >6 lesions, with possible visualization of bacilli on smear). Results of skin tests with antigen from killed organisms are nonreactive.

Patients may also present with features of both categories; however, over time, they usually evolve to one or the other (indeterminate or borderline leprosy). Interestingly, most individuals who are exposed to leprosy never develop the disease.

Classification of leprosy: Leprosy has 2 classification schemas: the 5-category Ridley-Jopling system and the simpler and more commonly used WHO standard.

* Ridley-Jopling: Depending on the host response to the organism, leprosy can manifest clinically along a spectrum bounded by the tuberculoid and lepromatous forms of the disease. Most patients fall into the intermediate classifications, which include borderline tuberculoid leprosy, midborderline leprosy, and borderline lepromatous leprosy. The classification of the disease typically changes as it evolves during its progression or management. The Ridley-Jopling system is used globally and forms the basis of clinical studies of leprosy. It may also be more useful in guiding treatment regimens and assessing risk of acute complications. Physical findings in each subtype are presented in the Clinical section. WHO system: The WHO recommends classifying leprosy according to the number of lesions and the presence of bacilli on a skin smear. This method is useful in countries where biopsy analysis in unavailable. >Paucibacillary leprosy is characterized by 5 or fewer lesions with absence of organisms on smear. Paucibacillary leprosy generally includes the tuberculoid and borderline lepromatous categories from the Ridley-Jopling system. > Multibacillary leprosy is marked by 6 or more lesions with possible visualization of bacilli on smear. Lepromatous leprosy, borderline lepromatous leprosy, and midborderline leprosy on the Ridley-Jopling scale are included in the multibacillary leprosy category. Treatment Modern Drug Treatment It has been said that Promin was first synthesised in 1940 by Feldman of Parke-Davis and company. Although Parke-Davis did in fact synthesise the compound, it seems certain that they were not the first; in cooperation with J. Wittmann, Emil Fromm synthesised both dapsone and some of its derivatives, including promin, in 1908. He was however a chemist and not a medical worker, nor did anyone investigate its medical value till some decades afterwards. Until the introduction of treatment with promin in the 1940s, there was no effective treatment for leprosy. The efficacy of promin was first discovered by Guy Henry Faget and his co-workers in 1943 at Carville, Louisiana. In the 1950s dapsone was introduced to Carville by Dr. R.G. Cochrane. It is only weakly bactericidal against M. leprae and it was considered necessary for patients to take the drug indefinitely. When dapsone was used alone, the M. leprae population quickly evolved antibiotic resistance; by the 1960s, the world's only known anti-leprosy drug became virtually useless. The search for more effective anti-leprosy drugs led to the use of clofazimine and rifampicin in the 1960s and 1970s. Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone, intended to mitigate bacterial resistance. The first trials of combined treatment were carried out in Malta in the 1970s.

Multidrug therapy (MDT) combining all three drugs was first recommended by a WHO Expert Committee in 1981. These three anti-leprosy drugs are still used in the standard MDT regimens. None of them is used alone because of the risk of developing resistance.

This treatment was quite expensive, and was not quickly adopted in most endemic countries. In 1985, leprosy was still considered a public health problem in 122 countries. The 44th World Health Assembly (WHA), held in Geneva in 1991, passed a resolution to eliminate leprosy as a public-health problem by the year 2000 defined as reducing the global prevalence of the disease to less than 1 case per 10,000. At the Assembly, the World Health Organization (WHO) was given the mandate to develop an elimination strategy by its member states, based on increasing the geographical coverage of MDT and patients accessibility to the treatment. Prevention and Control * treat all leprosy cases to prevent spread of infection * young children should avoid direct contact with untreated patients * practice personal hygiene * maintain body resistance by healthful living o good nutrition o enough rest and exercises o clean environment KEY FACTS

Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae. Official figures show that more than 213 000 people mainly in Asia and Africa are infected, with approximately 249 000 new cases reported in 2008. M. leprae multiplies very slowly and the incubation period of the disease is about five years. Symptoms can take as long as 20 years to appear. Leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases. Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes. Early diagnosis and treatment with multidrug therapy (MDT) remain the key elements in eliminating the disease as a public health concern.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rodshaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes, apart from some other structures. Leprosy is curable and treatment provided in the early stages averts disability.

Multidrug therapy (MDT) treatment has been made available by WHO free of charge to all patients worldwide since 1995, and provides a simple yet highly effective cure for all types of leprosy. Leprosy today The diagnosis and treatment of leprosy today is easy and most endemic countries are striving to fully integrate leprosy services into existing general health services. This is especially important for those under-served and marginalised communities most at risk from leprosy, often the poorest of the poor.. Elimination of leprosy as a public health problem In 1991 WHO's governing body, the World Health Assembly (WHA) passed a resolution to eliminate leprosy as a public health problem by the year 2000. Elimination of leprosy as a public health problem is defined as a prevalence rate of less than one case per 10 000 persons. The target was achieved on time and the widespread use of MDT reduced the disease burden dramatically.

Over the past 20 years, more than 14 million leprosy patients have been cured, about 4 million since 2000. The prevalence rate of the disease has dropped by 90% from 21.1 per 10 000 inhabitants to less than 1 per 10 000 inhabitants in 2000. Dramatic decrease in the global disease burden: from 5.2 million in 1985 to 805 000 in 1995 to 753 000 at the end of 1999 to 213 036 cases at the end of 2008. Leprosy has been eliminated from 119 countries out of 122 countries where the disease was considered as a public health problem in 1985. So far, there has been no resistance to antileprosy treatment when used as MDT. Efforts currently focus on eliminating leprosy at a national level in the remaining endemic countries and at a sub-national level from the others.

Strategy for leprosy elimination The following actions are part of the ongoing leprosy elimination campaign:

ensuring accessible and uninterrupted MDT services available to all patients through flexible and patient-friendly drug delivery systems; ensuring the sustainability of MDT services by integrating leprosy services into the general health services and building the ability of general health workers to treat leprosy; encouraging self-reporting and early treatment by promoting community awareness and changing the image of leprosy; Monitoring the performance of MDT services, the quality of patients care and the progress being made towards elimination through national disease surveillance systems.

Source http://en.wikipedia.org/wiki/Leprosyce World Health Organizaation http://emedicine.medscape.com/article/220455-overview#a0104