Leprosy (cont.)
How is leprosy transmitted?
Researchers suggest that M. leprae are spread person to person by nasal
secretions or droplets. They speculate that infected droplets reach other
peoples'
nasal passages and begin the infection there. Some investigators
suggest the infected droplets can infect others by entering breaks in the skin.
M. leprae apparently cannot infect intact skin. Rarely, humans get leprosy from
the few animal species mentioned above. Routes of transmission are still being
researched for leprosy.
How is leprosy diagnosed?
The majority of cases of leprosy are diagnosed by clinical findings, especially
since most current cases are diagnosed in areas that have limited or no
laboratory equipment available. Hypopigmented patches of skin or reddish skin
patches with loss of sensation, thickened peripheral nerves, or both clinical
findings together often comprise the clinical diagnosis. Skin smears or biopsy
material that show acid-fast bacilli with the Ziel-Nelson stain or the Fite
stain (biopsy) can diagnose multibacillary leprosy, or if bacteria are absent,
diagnose paucibacillary leprosy. Other tests can be done, but most of these are
done by specialized labs and may help a clinician to place the patient in the
more detailed Ridley-Jopling classification and are not routinely done (lepromin
test, phenolic glycolipid-1 test, PCR, lymphocyte migration inhibition test or
LMIT). Other tests such as CBC test, liver function tests, creatinine test, or a
nerve biopsy may be done to help determine if other organ systems have been
affected.
How is leprosy treated?
The majority of cases (mainly clinically diagnosed) are treated with
antibiotics. The recommended antibiotics, their dosages and length of time of
administration are based on the form or classification of the disease and
whether or not the patient is supervised by a medical professional. In general,
paucibacillary leprosy is treated with two antibiotics, dapsone and rifampicin,
while multibacillary leprosy is treated with the same two plus a third
antibiotic, clofazimine. Usually, the antibiotics are given for at least six to 12
months or more. Each patient, depending on the above criteria, has a schedule
for their individual treatment, so treatment schedules should be planned by a
clinician knowledgeable about that patient's initial diagnostic classification.
Antibiotics can treat paucibacillary leprosy with little or no residual effects
on the patient. Multibacillary leprosy can be kept from advancing, and living M.
leprae can be essentially eliminated from the person by antibiotics, but the
damage done before antibiotics are administered is usually not reversible.
Recently, the WHO suggested that single-dose treatment of patients with only one
skin lesion with rifampicin, minocycline (Minocin), or ofloxacin (Floxin) is effective. Studies of
other antibiotics are ongoing.
The role for surgery in the treatment of leprosy occurs after medical treatment
(antibiotics) has been completed with negative skin smears (no detectable
acid-fast bacilli) and is often only needed in advanced cases. Surgery is
individualized for each patient with the goal to attempt cosmetic improvements
and, if possible, to restore limb function and some neural functions that were
lost to the disease.
Next: How is leprosy prevented? »
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