Lepromatous leprosy

Related Terms

Antibiotics, bacteria, bacterial infection, bacterium, clofazimine, dapsone, Hansen's disease, immune response, leper, lepromatous, lepromatous leprosy, lepromin skin test, MDT, multidrug therapy, Mycobacterium leprae, nerve damage, nodules, peripheral nerve damage, peripheral nerves, tuberculoid, tuberculoid leprosy, reconstructive surgery, rifampin.

Background

Leprosy, also called Hansen's disease, is an infectious disease that is characterized by disfiguring skin sores and progressive nerve damage. Armauer Hansen discovered the disease-causing bacteria in 1873.
There are two types of leprosy: tuberculoid and lepromatous. Both forms cause skin sores and peripheral nerve damage, but lepromatous is more severe. It causes large, disfiguring lumps and bumps (nodules) on the skin. Only the lepromatous form is considered contagious.
Researchers estimate that more than one million people worldwide have leprosy. It is most common in Asia (especially Nepal and India), Latin America, and Africa. An estimated 4,000-6,000 Americans have leprosy. Nearly all cases of leprosy in the United States occur in patients who emigrated from developing countries. Leprosy is more common in developing countries because these areas are more likely to be unsanitary and highly populated.
According to the World Health Organization (WHO), access to information, diagnostic procedures, and treatment have helped decrease the prevalence of leprosy worldwide. Since 1985, 113 countries out of the 122 countries where leprosy was a public health concern have eliminated the disease. Since 2001, the number of new leprosy cases has decreased by 20% each year.
Individuals can develop leprosy at any age. However, it is most common among patients who are in their 20s and 30s. The severity of leprosy does not vary with age.
Individuals can become infected with either form of leprosy after coming into contact with Mycobacterium leprae when they are exposed to contaminated soil or armadillos that carry the bacteria. However, researchers have not discovered exactly how the disease spreads from person to person. It was initially believed that the disease was transmitted after physical contact with an infected individual. However, experts currently believe that the lepromatous form of leprosy is passed from person to person through expelled droplets from the mouth and nose of an infected person. Experts believe that most cases are spread after close, long-term contact with an infected individual. According to this new theory, individuals who inhale these droplets may become infected.
Leprosy is not considered a highly contagious illness. About 95% of people who are exposed to the bacteria that causes leprosy do not develop the disease. Healthcare workers often treat people with leprosy for many years without contracting the disease.
A combination of medications, called antibiotics, is used to kill the bacterium that causes leprosy. These medications cure the disease and prevent it from progressing, but they do not reverse nerve damage or physical disfiguration. Therefore, it is important to visit a healthcare provider as soon as symptoms develop.

Signs and symptoms

General: Symptoms of leprosy do not appear for at least one year after exposure to Mycobacterium leprae. In most patients, it takes five to seven years for symptoms to develop. This is because the disease-causing bacteria multiply very slowly. Once symptoms do develop, they slowly worsen over a long period of time.
Tuberculoid leprosy: Tuberculoid leprosy causes a rash, consisting of one or more flat, whitish areas on the skin. Areas that are affected are usually numb because the bacterium damages the peripheral nerves, which allow patients to feel sensations such as pain and temperature.
Lepromatous leprosy: Lepromatous leprosy is more disfiguring than tuberculoid leprosy. Lepromatous leprosy typically causes many small bumps (called nodules) or raised rashes on the skin. Symptoms of numbness and muscle weakness are generally much worse in patients who have lepromatous leprosy than patients who have tuberculoid leprosy. As a result of this decreased sensation, patients with lepromatous leprosy often develop blisters and skin wounds on the soles of the feet. Because patients cannot feel pain, these wounds often go unnoticed and eventually progress to disfiguring sores and eruptions.

Diagnosis

A skin scraping test is used to diagnose leprosy. During the procedure, a small sample of skin cells are removed from an area of affected skin. The sample is then analyzed in a laboratory. If the Mycobacterium leprae is present, the patient has leprosy.
Once leprosy is diagnosed, a lepromin skin test can be used to distinguish between tuberculoid and lepromatous leprosy. During the procedure, an extract of inactivated leprosy-causing bacteria is injected under the patient's skin. The healthcare provider observes the injection site three days and 28 days after the injection. Patients with tuberculoid leprosy will develop red and swollen skin at the injection site, indicating a positive reaction to the test. This is because the immune systems of patients with tuberculoid leprosy react differently to the antigen.

Complications

General: Medical complications may occur with either type of leprosy. However, complications are more common and usually more severe in patients with the lepromatous form of leprosy.
Deformities: Leprosy may cause swelling and bumps or lumps (nodules) to form on the skin, which may be disfiguring, especially when the face is affected.
Nerve damage may cause muscle weakness, which may also lead to deformities. When the muscles become weak, the fingers may have a claw-like appearance, and the patient may have what is called a "drop-foot deformity." This means the patient is unable to flex the foot.
Eye damage: Leprosy may damage the nerves surrounding the eyes. As a result, the eyes are unable to blink properly. If blinking is impaired, the eyes become dry and may also become infected. If left untreated, permanent eye damage or blindness may result.
Erectile dysfunction (ED)/infertility: Males with leprosy may develop erectile dysfunction (ED). This means the patient is unable to achieve or maintain an erection. Some men may also become infertile because leprosy may reduce the amount of testosterone and sperm that is produced by the testes.
Women do not experience infertility as a result of leprosy.
Inflammation: Leprosy may trigger the immune system to launch an attack against the disease-causing bacteria. This response may lead to inflammation in many parts of the body, including the skin, peripheral nerves, eyes, and sometimes, the lymph nodes, joints, kidneys, liver, eyes, and testes. Severe inflammation may permanently damage the affected organs and lead to conditions such as erectile dysfunction. Patients may also develop fevers.
Nasal passageway: If left untreated, leprosy may damage the nasal passages. Patients may experience a chronically stuffy nose and decreased quality of life. Without treatment, the inside of the nose may become damaged and scarred. In rare cases, this may lead to complete collapse of the nose.
Nerve damage: Patients who do not receive prompt treatment may suffer from permanent peripheral nerve damage. When the peripheral nerves are damaged, a patient's ability to feel sensations, including pain and temperature, are decreased. As a result, patients have an increased risk of unknowingly hurting themselves. They may burn or cut the skin without realizing the severity of the condition because they have minimal or no feeling in some areas of the body.
Patients may also develop sores that can potentially become infected. If a severe infection develops, the affected part of the body (most commonly the feet) may need to be surgically amputated.
Nerve damage may also lead to muscle weakness in the affected areas of the body.

Treatment

Medications, called antibiotics, are used to kill the bacterium that causes leprosy. These medications cure leprosy and stop the disease from progressing, but they do not reverse nerve damage or disfiguration that has already occurred.
Patients should tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.
Antibiotics: Patients with either type of leprosy receive a combination of antibiotics, called multidrug therapy (MDT). The standard combination is dapsone, rifampin (Rifadin? or Rimactane?), and clofazimine (Lamprene?). A combination of medication is used in order to prevent the bacteria from becoming resistant to the drugs. Dapsone usually does not cause serious side effects. Rifampin is a stronger drug that may cause more serious side effects that may lead to liver damage. Symptoms of liver damage may include yellowing of the skin or eyes (jaundice) or fatigue.
Other antibiotics have also been used to treat leprosy. Examples include ethionamide (Trecator-SC?), minocycline (Dynacin?, Minocin?, or Myrac?), clarithromycin (Biaxin?), and ofloxacin (Floxin?).
Reconstructive surgery: Patients with leprosy may develop sores on their heels, which in severe cases, may lead to decreased tissue on the feet. In some cases, tissue from other parts of the body may be surgically removed from one part of the body, such as the leg, and transplanted to the heels.
Some patients with leprosy may develop a collapsed nose. This happens when the infection damages the cartilage of the nose. In such cases, surgery may be performed to reconstruct the nose.
Patients should discuss the potential health benefits and risks of surgery before making decisions about medical treatments.

Integrative therapies

Unclear or conflicting scientific evidence:
Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. A few studies have examined the efficacy of zinc treatment in leprosy. Studies of zinc taken by mouth report positive results, while one study of topical zinc reports negative results. Further research is needed before a conclusion can be drawn.
Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.
Traditional or theoretical uses lacking sufficient evidence:
Acacia: The name "acacia" comes from the Greek word akis, which means "sharp point." When this name was coined, the only known species of acacias were sharp thorny shrubs and trees of tropical Africa and Western Asia. Early laboratory studies warrant additional research into the effects of acacia on leprosy. Currently, it remains unknown if this is a safe and effective treatment for leprosy.
Acacia is generally considered safe when taken in the amounts typically found in foods. Avoid if allergic to acacia, pollen, or any members of the Fabaceae or Leguminosae family. Use cautiously if taking amoxicillin or iron. Use cautiously with gastrointestinal disorders, respiratory disorders, or pinkeye. Acacia may prevent the body from absorbing drugs, and tannins from acacia may increase the risk of certain cancers. Avoid if pregnant or breastfeeding.
Hops: The hop is a climbing plant native to Europe, Asia, and North America. The cone-like, fruiting bodies of the plant are most commonly used as a flavoring agent in beer. It has been suggested, but not scientifically proven, that hops may help treat leprosy.
Avoid if allergic to hops pollen, peanut, chestnut, or banana. Use cautiously with a history of breast cancer, uterine cancer, cervical cancer, prostate cancer, or endometriosis. Use cautiously while driving or operating heavy machinery. Use cautiously with a history of diabetes, stomach ulcers, seizures, or asthma. Hops may affect hormone levels (such as estrogen levels). Dust from hops may contain harmful bacteria. Avoid if pregnant or breastfeeding.
Omega-3 fatty acids: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Although it has been suggested that omega-3 fatty acid may help treat symptoms of leprosy, studies are lacking in this area. Until well-designed studies are performed, it remains unknown if this is a safe and effective therapy for humans.
Omega-3 fatty acid is generally considered safe if taken in doses that do not exceed the recommended dietary allowance (RDA). Avoid if allergic to fish, omega-3 fatty acid products that come from fish, nuts, linolenic acid, or omega-3 fatty acid products that come from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery.

Prevention

Individuals should avoid close, long-term contact with others who have lepromatous leprosy.
Patients should also avoid touching armadillos because some carry Mycobacterium leprae. For this reason, individuals should also avoid eating undercooked armadillo.
Patients who have symptoms of leprosy should seek prompt medical treatment. Quick diagnosis and treatment helps reduce the risk of permanent nerve damage and physical disfiguration.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Britton WJ, Lockwood DN. Leprosy. Lancet. 2004 Apr 10;363(9416):1209-19.
Centers for Disease Control and Prevention (CDC). .
Coeytaux A, Truffert A, Mueller Y, et al. [Leprosy, a neurologic disease.] [Article in French.] Rev Med Suisse. 2007 May 9;3(110):1178, 1180-4.
International Federation of Anti-Leprosy Association (ILEP). .
International Leprosy Association. .
Katoch VM. Advances in the diagnosis and treatment of leprosy. Expert Rev Mol Med. 2002 Jul 22;2002:1-14.
Kumar B, Naafs B, Dogra S. Leprosy.Lepr Rev. 2007 Mar;78(1):5-6.
Natural Standard: The Authority on Integrative Medicine. .
Stingl P. [Leprosy. Pathogenesis--classification--diagnosis--treatment.] [Article in German.] Hautarzt. 1990 Mar;41(3):126-30.
Ustianowski AP, Lockwood DN. Leprosy: current diagnostic and treatment approaches. Curr Opin Infect Dis. 2003 Oct;16(5):421-7.
Valles H, Blanc J, Fumanal L, et al. [Initial otorhinolaryngologic lesions of lepromatous leprosy.] [Article in Spanish.] An Otorrinolaringol Ibero Am. 1992;19(1):77-86.
World Health Organization (WHO). .

Causes

General: Leprosy is caused by an infection with a bacterium called Mycobacterium leprae. Patients may come into contact with this bacterium when they are exposed to contaminated soil or armadillos that carry the bacteria. Exposure may occur during gardening, hiking, or other outdoor activities.
Adults are more likely to become infected with leprosy than children because they are more likely to be exposed to the bacteria. However, children are more vulnerable to infections after exposure than adults.
Tuberculoid leprosy: The tuberculoid form of leprosy cannot pass from person to person. Instead, it can only be transmitted through direct contact with the bacteria in soil or on armadillos that carry the bacteria.
Lepromatous leprosy: The lepromatous form, on the other hand, may be passed from person to person. However, researchers do not consider the disease to be highly contagious. Most cases of transmission occur after close, long-term contact with an infected individual. Individuals are most likely to catch leprosy from someone else if they live with an infected person. This means it is unlikely that an individual will develop leprosy after short-term or casual contact with an infected individual. Contrary to popular belief, leprosy cannot be spread after touching someone who has the disease.
Other possible causes: It has also been suggested, but not proven, that leprosy may be transmitted through insects, such as mosquitoes or bedbugs. Further research is needed in this area.