Also known as leprosy, leprosy is one of the bacterial infectious diseases. It is highly contagious and not infrequently fatal if left untreated. However, through timely detection and treatment with antibiotics, leprosy is curable today. In Germany, leprosy occurs only very rarely due to very good hygienic conditions. In tropical countries, such as India, however, leprosy patients are found even more frequently.
What is leprosy?
Leprosy is called the disease of poor people because of its worldwide geographic occurrence. It is predominantly seen in warm climates due to the habitat of the disease vectors. Basically, leprosy is an infectious disease. It can therefore be transmitted by infection and is easily treatable both causally and symptomatically with today’s modern medical methods. Since leprosy can affect many people at the same time and about 12 million patients are affected by leprosy worldwide, the disease belongs to the category of epidemics. The disease is limited to certain areas of the human skin. The pathogens of leprosy cause the typical symptoms
predominantly on the nerve tracts and nerve endings, the mucous membranes and the skin of humans.
Causes
The cause of leprosy is a disease-causing pathogen known in bacteriology as the bacterium Mycobacterium leprae. This pathogen is related to the tubercle bacterium, the causative agent of tuberculosis. People become infected through constant contact with people who are already ill. It is believed that weakening of the immune system due to poor nutrition, inadequate hygienic conditions and limited existential care makes the organism susceptible to the outbreak of the disease. The secretions of the nose excreted by infected patients and the purulent skin irritations contain a massive amount of leprosy bacteria. Contact is enormously contagious for this reason. Open sores on the skin surface and ingestion of droplets through the respiratory tract allow almost unlimited transmission of the leprosy pathogen.
Symptoms, complaints, and signs
The symptoms and complaints of leprosy vary widely and are manifold. The most visible, of course, are the symptoms around the face. One of the first symptoms is characterized by numbness in the sense of tactile sensory disturbances. In the further course, typical skin spots appear, which can be darker or lighter in appearance, depending on the skin type. Typical symptoms of lepromatous leprosy are bacterially infected nodules caused by lepromatous lesions in the skin. This then leads to the well-known mutilations and scars or entire losses of individual body parts. In later stages, internal organs may also be affected by the disease, resulting in crippling of the affected person without treatment. These are often accompanied by signs of paralysis as well. In tuberculous leprosy, the symptoms and disease features tend to be localized. Discolorations of the skin in the form of spots often develop. Here, too, paralysis occurs in the later course. Unlike lepromatous leprosy, this form can heal on its own.
Course of the disease
In the course of leprosy, a distinction is made between the tuberculoid and lepromatous forms. The disease, which has become so terrible because of the mutilations, shows this characteristic picture exclusively in the tuberculoid course. Due to the impairment of the nerve tracts, the affected persons have no sense of touch in the fingertips. In addition, the terminal limbs are no longer sufficiently supplied with blood. Due to the insensitivity to pain, numerous injuries occur on the limbs, which lead to the mutilation symptoms. In contrast to tuberculoid leprosy, the lepromatous course of the disease is much more severe. The skin and mucous membranes show massive symptoms of disease. Nodule-like indurations appear, and due to the impairment of nerve functions, the extremities become partially paralyzed. As leprosy progresses, the nodule-like growths appear on the face, back, hands and feet. Patients suffer from reduced perspiration, episodic high fever, and rapidly emaciate. Hair loss is also a consequence of the disease of the skin and nerve supply systems.
Complications
Whether complications occur with leprosy depends on the particular form of the disease as well as the timing of the start of therapy. While tuberculoid leprosy tends to have a mild course and usually heals on its own, lepromatous leprosy, which is considered the most severe form of leprosy, can even cause the disease to take a fatal course. Without appropriate treatment, there is a risk of serious sequelae of leprosy. Often the eyes of the patient are affected by complications. For example, madarosis (loss of eyelashes and eyebrows) can occur, but this does not affect the eyesight. However, this is jeopardized by other effects such as iritis, iris atrophy, or facial paresis (facial paralysis). Furthermore, there is a risk of hair loss. Likewise, muscle weakness is possible. Among the most severe effects of leprosy are disfigurement and mutilation, which are secondary changes. They are the result of the destruction of sensitive fibers, which causes a sensory disturbance. That is why the patient has no sense of touch anymore. He cannot feel cold, heat or pain. Sometimes there is a complete anesthesia. Furthermore, rhagades are formed, which represent a high risk for secondary infections. Even minor injuries cause abscesses and necroses. As the disease progresses, the necrotic fingers or toes may fall off.
When should you go to the doctor?
If numbness or the characteristic nodules under the skin are noticed, a visit to the doctor is recommended. Leprosy is a serious disease that can lead to loss of fingers and toes if left untreated. Therefore, persons who have a concrete suspicion should definitely seek medical advice. If mutilation or scarring develops, a doctor must be consulted immediately. Relatives must monitor the affected person closely and call the emergency doctor or the medical emergency service in case of serious signs of the disease. Since leprosy is very rare nowadays, symptoms should be clarified first. People suffering from tuberculosis often also contract leprosy and should therefore consult closely with a medical professional. The loss of eyelashes and eyebrows indicates advanced leprosy, which must be treated immediately. Affected individuals should involve their primary care physician or consult an internist. Other contacts include the hepatologist or gastroenterologist, depending on the symptom pattern and trigger of the disease.
Treatment and therapy
The basic medical therapy to control leprosy is the use of high-dose and effective drugs. These are not administered individually, but usually in combination to increase therapeutic efficacy. Almost exclusively antibiotics are used by the physicians. These are intended to stop or reduce the division and thus the multiplication of the pathogens. In order to treat tuberculoid leprosy, it is necessary for the therapy to run for at least six months. For the more aggressive and severe form, therapy must continue for two years to achieve healing success. In order to be able to continue the treatment in case of insufficient cure, so-called reserve leprostatic drugs are offered by the pharmaceutical industry. Treatment of leprosy also includes wound care and active exercise treatment to minimize and stop any paralytic signs that occur early.
Outlook and prognosis
The occurrence of the disease leprosy is directly associated with poor living conditions. Currently, the infectious disease occurs mainly in South America, South Asia, and India. The World Health Organization has achieved the goal of virtually eradicating new cases by the year 2000. In the industrialized countries, it is almost impossible to contract leprosy. A strong immune system makes infection comparatively unlikely. After contracting the disease, the prognosis depends on the type of leprosy and the time of diagnosis. For example, tuberculoid leprosy largely cures on its own; without medical treatment, the lepromatous form leads to death. Early diagnosis is usually associated with a favorable outlook. However, patients must accept long-term treatment, which is sometimes associated with side effects. Thus, defensive reactions of the body are not uncommon.If affected persons start treatment only after mutilations and paralysis have already set in, they can no longer be reversed. If leprosy does not heal on its own without medical supervision, it progresses further and further. The skin and nerves are permanently damaged. Disabilities that lead to a life in need of assistance are common.
Aftercare
Since leprosy shows different manifestations, both the course of the disease and the aftercare can vary in intensity. This mostly focuses in the form of prevention to contain the symptoms as long as possible. Without medical treatment, those affected suffer considerable consequential damage. In most cases, complaints occur in the eyes, which lead to complications. The daily life of those affected is difficult to manage alone, which is why the help of relatives is indispensable. In addition, affected persons should be careful to be as cautious as possible in their actions in order to reduce their risk of injury. Even the smallest injury can lead to the development of an abscess. Affected persons should see a doctor regularly to check the setting of the medication as well as possible side effects. Psychological support for family members may also be advisable.
What you can do yourself
If leprosy is suspected, a doctor must be consulted immediately. Under no circumstances should the symptoms, which initially seem harmless, be self-treated. Because leprosy is extremely contagious, the patient must usually receive intensive medical care and be isolated. Most leprosy infections are counted in India and the neighboring countries Bangladesh and Myanmar, formerly Burma, as well as in Brazil. Tourists and business travelers are usually not at risk as long as they stay in the tourist districts and business centers of major cities. However, expeditions to the slums of Indian metropolises are strongly discouraged for medical reasons. Leprosy, as well as a number of other epidemics already extinct in Europe, are still commonplace here. In case of a confrontation with leprosy patients, any physical contact must be avoided. Because of the danger of droplet infection, even mere physical proximity to infected persons is dangerous. Anyone who notices symptoms such as numbness in the limbs or dark spots on the skin after such an incident must immediately seek medical treatment and be advised of the possibility of leprosy infection. A weakened immune system, especially due to malnutrition, is believed to increase susceptibility to leprosy. Measures that strengthen the immune system, especially a healthy diet rich in vitamins, may therefore reduce the risk of infection or contribute to a faster recovery.