Leprosy natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Leprosy may lead to severe complications if not diagnosed and treated early, which will affect the prognosis.
Natural History
Leprosy, or Hansen's disease, is caused by Mycobacterium leprae, a gram-positive obligate intracellular, acid-fast bacillus.
Although the mechanism of transmission is not well understood, it is though that the respiratory mucosa and skin play an important role in the transmission of the disease.
The symptoms of the disease might not occur until 12 years after the exposure to the bacteria. Common initial symptoms may include loss of sensation of a hipopigmented skin patch and a thickened peripheral nerve concomitantly with weakness or loss of sensation of the area
Without treatment symptoms will develop and include skin ulcers, eye problems, nasal congestion, epistaxis, muscle contractures and eventually complicate into paralysis and blindness.
Complications
One to two million persons worldwide are permanently disabled as a result of leprosy.[1] The number and degree of complications will depend on how early the condition is diagnosed and treatment with multidrug therapy is started. A late diagnosis will increase the number and severity of the complications. These may include:[2][3]
- Cosmetic disfigurement with skin ulceration and scars.
- Permanent nerve damage, with sensory loss, numbness and pain particularly around skin lesions.
- Muscle weakness and paralysis with predominance in the hands and feet.
- Blindness - conditions such as corneal abrasion and corneal ulceration may occur, potentially leading to blindness.
- Burns and trauma - attending to the loss of sensation, following the nerve damage caused by this condition, a potential complication is the non voluntary self-inflicted trauma as a result of the absence of pain.
- Infection - following painless injuries, due to the nerve damage, that become infected by bacteria and complicate.
- Thick and dry skin
- Lucio phenomenon - rare but potentially fatal complication, occurring predominantly in untreated lepromatous patients, as an acute necrotizing vasculopathy. It is common to observe painful irregular patches that usually become pruritic, developing bullae. This phenomenon has been noted to occur predominantly in descendants from mexican populations.[4][5]
Prognosis
Leprosy is a curable disease when adequately treated. With early diagnosis and treatment, the damages inflicted in patients by the disease may be reduced. Therefore, early recognition and prompt treatment are essential to improve the prognosis of patients, increasing the chances of a normal lifestyle. To improve the chances of a better prognosis, physicians, particularly of endemic areas, must be aware of the early signs and symptoms of the disease and the population must be educated to avoid infection and search medical attention when such symptoms appear, thereby minimizing complications.
References
- ↑ Walker, Stephen L.; Lockwood, Dina N.J. (2007). "Leprosy". Clinics in Dermatology. 25 (2): 165–172. doi:10.1016/j.clindermatol.2006.05.012. ISSN 0738-081X.
- ↑ Daniel E, Ffytche TJ, Kempen JH, Rao PS, Diener-West M, Courtright P (2006). "Incidence of ocular complications in patients with multibacillary leprosy after completion of a 2 year course of multidrug therapy". Br J Ophthalmol. 90 (8): 949–54. doi:10.1136/bjo.2006.094870. PMC 1857220. PMID 16707521.
- ↑ "P Hansen's Disease (Leprosy)". line feed character in
|title=at position 2 (help) - ↑ Rea, Thomas H. (1977). "Current Concepts in the Immunology of Leprosy". Archives of Dermatology. 113 (3): 345. doi:10.1001/archderm.1977.01640030091017. ISSN 0003-987X.
- ↑ Sehgal VN, Srivastava G, Sharma VK (1987). "Contemplative immune mechanism of Lucio phenomenon and its global status". J Dermatol. 14 (6): 580–5. PMID 3329658.