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Leprosy (from the Greek lepi (??p?), meaning scales on a fish), or Hansen’s disease, is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis.[1][2] Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external symptom.[3] Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs and eyes. Contrary to popular belief, leprosy does not actually cause body parts to simply fall off.[4]
Historically, leprosy has affected mankind since at least 600 BC, and was well-recognized in the civilizations of ancient China, Egypt and India.[5] In 1995, the World Health Organization (WHO) estimated that between two and three million people were permanently disabled because of leprosy.[6] Although the forced quarantine or segregation of patients is unnecessary—and can be considered unethical—a few leper colonies still remain around the world, in countries such as India, United States, Japan, Egypt, Nepal, Somalia, South Korea and Vietnam. It is now commonly believed that many of the people who were segregated into these communities were presumed to have leprosy, when they actually had syphilis.[citation needed] Leprosy is not highly infectious, as approximately 95% of people are immune and sufferers are no longer infectious after only a couple of days on treatment. They would not have spread leprosy through a community, whereas syphilis, which has similar symptoms, is more contagious.[citation needed]
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. However, leprosy bacilli resistant to dapsone gradually evolved and became widespread, and 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.[citation needed]
There is some confusion over classification because the WHO (World Health Organization) replaced an older, more complicated classification system with a simpler system that identifies two subtypes of leprosy: paucibacillary and multibacillary. The older system included six categories: Indeterminate Leprosy, Borderline Tuberculoid Leprosy, Midborderline Leprosy, Borderline Lepromatous Leprosy, Lepromatous Leprosy, and Tuberculoid Leprosy.
Paucibacillary leprosy encompasses indeterminate, tuberculoid, and borderline tuberculoid leprosy. It is characterized by one or more hypopigmented skin macules and anaesthetic patches, where skin sensations are lost because of damaged peripheral nerves that have been attacked by the human host’s immune cells.
Multibacillary leprosy includes midborderline, borderline lepromatous, and lepromatous leprosy. It is associated with symmetric skin lesions, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis (nose bleeds) but typically detectable nerve damage is late.
Borderline leprosy is of intermediate severity and is the most common form. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and peripheral nerve involvement with weakness and loss of sensation is common. This type is unstable and may become more like lepromatous leprosy or may undergo a reversal reaction, becoming more like the tuberculoid form.
Mycobacterium leprae and Mycobacterium lepromatosis are the causative agents of leprosy. M. lepromatosis is only the causitive agent in diffuse lepromatous leprosy, which can be lethal.[3][2]
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