What is the treatment for leprosy?
Leprosy (also called Hanses's disease) is usually treated with oral antibiotics for six months to two years, although the duration of treatment depends on the clinical circumstances and the choice of regimen. In the United States, the National Hansen's disease Program operates clinics that specialize in leprosy, although treatment can be directed by local physicians. An experienced physician should oversee therapy. Although cure rates are high, relapse may occur months or years after treatment has been stopped.
It is also important that people with numbness or nerve damage take care of their skin and avoid inadvertent trauma. Small cuts or burns that are not felt can become infected, leading to enlarging sores or even loss of a digit or limb.
Mycobacterium leprae can become resistant to standard antibiotics. This is especially true if treatment is inadequate due to irregular availability of medication or noncompliance with therapy. It is possible, but difficult, to test directly for antibiotic resistance because the organism can only be cultured in a few living organisms such as in the footpads of mice.
Treatment may cause an immune reaction in some people. Milder reactions cause an inflammatory response marked by skin redness and swelling. Painful red nodules may arise in a condition known as erythema nodosum leprosum. Immune reactions can occur at any point in treatment. In severe cases, such reactions may be fatal if not treated. Thus, patients under treatment should be warned to be vigilant for symptoms of immune reactions.
What is the prognosis of leprosy?
Leprosy is curable with oral antibiotics and prompt therapy reduces the risk of complications. Complications are related to loss of sensation in limbs and digits, causing people to overlook small sores or burns until they are infected. Sores on the soles of the feet are particularly problematic. Nerve involvement may also cause weakness, especially in the hands and feet. Programs that educate patients about how to protect affected areas have resulted in lower rates of limb or digit loss.
Prolonged infection of the nose may lead to destruction of the cartilage. This can be treated with plastic surgery after the infection is cured. The eyes may also become numb and insensitive to trauma. Muscles around the eye may also become weak. Bacteria may invade the eye resulting in direct scarring or glaucoma and eventual blindness.
Is it possible to prevent leprosy?
The most effective way to prevent leprosy is to treat infected patients and thus render them noncontagious. The bacille Calmette-Guérin (BCG) vaccine has had variable efficacy in clinical trials and is not in widespread use to prevent leprosy.
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Longo, D.L., et al. Harrison's Principles of Internal Medicine, 18th ed. New York: McGraw-Hill Professional, 2011.