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Leprosy: description

What is leprosy

Leprosy (leprosy) an infectious bacterial disease caused by Mycobacterium leprae; it occurs worldwide. The bacteria destroy the skin and mucous membranes and attack the nerve cells. The time between leprosy infection and the outbreak of the disease (incubation period) can be up to 20 years.

Leprosy occurs mainly in tropical and subtropical regions with high population densities and low hygienic standards. Countries particularly affected include India, Nepal, Brazil, the Republic of the Congo, Mozambique and Tanzania. In general, the number of illnesses in Africa, America, Southeast Asia and the southeastern Mediterranean has been falling since 2003.

However, around 220,000 people around the world still develop leprosy each year - many of them children. In Germany, however, only a few cases of leprosy have been registered in recent years; the disease was introduced.

Usually lepers do not need to be isolated. However, many sufferers are socially rejected in the countries where the leprosy is common. The risk of infection is low if you have only brief contact with the sick person. The infection usually occurs via secretions from wounds or the nose that contain bacteria.

Leprosy in the Middle Ages

Leprosy was also very widespread in Europe in the Middle Ages. It was considered a "punishment from God": The original name "Leprosy" presumably comes from the fact that infected people had to live (exposed) outside human settlements.

Leprosy: symptoms

Leprosy primarily affects the skin and the nervous system. But it can also affect the eyes, the upper respiratory tract, the bone marrow or the testicles. There are different forms of leprosy, which are expressed through different symptoms. The time from infection to the onset of the disease (incubation period) can be months to years.

Doctors differentiate between the following forms of leprosy:

The Leprosy indeterminata is a very mild form of the disease in which there are isolated, less pigmented (hypopigmented) patches of skin. In 75 percent of cases, these heal spontaneously.

The tuberculoid leprosy or nerve lepra is the milder form of the disease. Skin changes occur only sporadically and sharply delimited. The areas are less pigmented (hypopigmented) or red and do not itch. In this form of the disease, nerve damage is in the foreground as typical leprosy symptoms.

The tactile sensation (temperature, touch and pain sensation) is lost. Because those affected do not feel pain early enough, they often injure themselves. The muscles atrophy, paralysis and sometimes severe deformations occur. The skin changes can heal on their own. The risk of infection is low with this manifestation and the prognosis is good with appropriate treatment.

The lepromatous leprosy is a severe form of the infectious disease that occurs when the immune system is poor. Numerous lump-like nodules appear on the skin, giving the face the appearance of a lion's head ("Facies leontina"). The mucous membranes of the nose, mouth and eyes can also be affected. Mutilation of the face, hands, feet and back is common. The loss of feeling in the affected areas only occurs in the later course of the disease. In the final stage, lepromatous leprosy spreads to the entire organism.

The Borderline forms of leprosy are mixed forms that combine the various symptoms of the other course forms.

Leprosy: causes and risk factors

The cause of leprosy is the bacterium Mycobacterium leprae. The bacterium was discovered in 1873 by the Norwegian doctor Armauer Hansen as the cause of the infectious disease. Mycobacterium leprae is a slightly aggressive bacterium which, like the tuberculosis pathogen, lives in the infected host cells. As a result, the immune system can only fight the pathogen directly with defense cells ("cellular defense"), and a defense reaction via antibodies ("humoral defense") hardly takes place. Leprosy only occurs in the event of massive and prolonged exposure to the bacterium.

The exact route of infection has not yet been clarified. Long-term, close contact with untreated leprosy patients seems to play an important role. The infected excrete large amounts of the leprosy pathogen with the nasal secretions or through the skin ulcers that develop. The bacteria are then probably transmitted from person to person via small skin wounds or the respiratory tract as droplet infection. I.Contrary to popular belief, leprosy is not a highly contagious disease! It is therefore usually not necessary to isolate people with leprosy.

Leprosy: examinations and diagnosis

A Institute for Infection and tropical medicine is the right place to go if you suspect leprosy. For diagnosis is the medical history(Anamnese) very important. The question of staying in leprosy risk areas in the past few years is crucial, as leprosy disease has been eradicated in industrialized countries. In the physical exam the doctor pays attention to typical skin changes, nerve changes and sensory disorders.

Further investigations:

Cultivation (growing) of the leprosy pathogen is extremely difficult and is therefore not carried out. However, the bacterium can be found in swabs of the skin or mucous membrane or in tissue samples in the microscope detect according to special coloring (detection of "acid-resistant rods").

Another possibility for diagnosis are so-called molecular biological detection methods, for example the detection of the genetic material of Mycobacterium leprae by means of a polymerase chain reaction (PCR). This makes it possible to diagnose leprosy disease at an early stage. The procedure also serves to validate the diagnosis.

The Lepromine test (Mitsuda reaction) is an antibody search test that examines the body's defenses. This test makes it possible to differentiate between tuberculoid and lepromatous leprosy.

Leprosy: treatment

The therapy of leprosy depends on the amount of the pathogen. A combination of different antibiotics is used. In tuberculoid leprosy, the active ingredients are mostly dapsone and rifampicin, and in lepromatous leprosy, clofazimin is also used.

The World Health Organization (WHO) recommends therapy for six months for paucibacillary leprosy (low-pathogen leprosy). Multibacillary leprosy (pathogen-rich leprosy) should be treated with appropriate antibiotics for a period of two years. In individual cases, the treatment has to be continued even longer and, if necessary, substitute medication ("reserve leprostatics") has to be used.

Several years of therapy are often necessary to truly completely cure the leprosy. Supportive exercise therapy can help prevent leprosy paralysis. In addition, wound treatment is important. If the skin changes of the leprosy have healed after successful therapy, rehabilitation measures should take place.

Leprosy: disease course and prognosis

Leprosy is a chronic disease of the skin, mucous membranes and nerve cells. With timely diagnosis and treatment, the prognosis is Cheap. However, if the disease is not treated at an early stage, the likelihood of a lepromatous form increases. Close contacts should be tested for infection every six months if possible.

However, damage that has already occurred, such as mutilation or paralysis, cannot be reversed. Around two to three million people worldwide have passed through Leprosy permanently impaired.

Insidious tropical diseases

  • Ebola - deadly viruses

    The Ebola virus is one of the most dangerous pathogens in the world. It belongs to the group of hemorrhagic fevers - febrile diseases that are accompanied by internal bleeding. The virus spreads to the whole organism and destroys the blood vessels. Bleeding in the gastrointestinal tract, spleen and lungs is usually fatal.
  • Rapid infection

    There are repeated epidemics in Africa, as here in Zaire in 1995. Most infected people die within a few days. The Ebola virus is transmitted from person to person through direct physical contact, as well as when one comes into contact with body excretions from infected people. Since there are no drugs that fight the virus directly, only symptoms can be treated.
  • Malaria from mosquito bite

    Malaria is caused by single-cell blood parasites called plasmodia. They are transmitted through bites of the anopheles mosquito. The disease is usually characterized by regular attacks of fever. The most dangerous forms are fatal in many cases.
  • Insecticides against the spread of malaria

    This historical picture from 1961 shows two men spraying the insecticide DDT in an Indian village. However, since DDT accumulates in adipose tissue and is suspected of causing cancer, its use is now banned in many countries or only permitted to a very limited extent.
  • Leishmaniasis

    Leishmaniasis is caused by single-cell parasites, so-called leishmanias, which are transmitted by mosquitoes. Some species just stick to the skin. Then, as shown here, the so-called oriental bump (cutaneous leishmaniasis) occurs. However, other leishmanias affect important organs of the body and cause kala-azar (visceral leishmaniasis). Extreme enlargement, especially of the spleen, is possible, which is why many patients develop a large waist. Without treatment, this disease is fatal in 80 to 90 percent.
  • leprosy

    Leprosy - Leprosy is caused by the bacterium Mycobacterium leprae, a relative of the tuberculosis pathogen. The infection probably takes place via contaminated nasal secretions or via the resulting, weeping skin ulcers. However, leprosy is far less contagious than is usually assumed.
  • Marburg fever

    Together with Ebola, Marburg fever is one of the most serious infectious diseases in humans. Patients suffer from fever with disorientation and impaired consciousness up to coma. The mortality rate with Marburg fever is between 30 and 90 percent. The incubation period is only four to seven days. There is a risk of infection for the entire duration of the illness. Even corpses can still be infectious.
  • Elephantiasis

    Lymphatic filariasis is caused by roundworms. Transferred by mosquito bites, the larvae migrate into the lymphatic system where they trigger inflammation. The permanent lymph congestion causes the affected parts of the body to swell. This massive enlargement of arms, legs, testicles or breasts is called elephant disease (elephantiasis).
  • Zika

    The Zika virus (here in red in the picture) was actually considered a harmless pathogen for a long time. Because normally infected people get a maximum of a little fever and a rash. However, it has been known since 2015 that the fetuses of pregnant women who become infected can develop malformations of the brain. And: It is spreading more and more, especially in South America at the moment.
  • Yellow fever

    The yellow fever virus is transmitted through mosquito bites. In severe cases, bleeding from the skin and mucous membranes occurs. In some cases there are also neurological and psychological symptoms, meningitis, kidney and liver failure.
  • Sleeping sickness

    The pathogens causing sleeping sickness (trypanosomes) are transmitted to humans through the bite of the tsetse fly. Sleeping sickness itself develops several months to years after the infection. The patients suffer from concentration disorders, personality changes (noticeable irritability) and disorders in the sleep-wake rhythm. In addition, they can no longer take in food and lose weight. Usually an increasing need for sleep develops, in addition to which there are often paralysis, cramps or muscle tremors. The disease is almost always fatal.
  • Chagas

    Chagas disease is caused by unicellular parasites (trypanosomes). They are transmitted through the bite of bedbugs. The pathogen causes fever, abdominal pain and diarrhea. The kidneys and liver also enlarge. If the disease does not heal, it can develop serious long-term effects that can even lead to heart failure.
  • Dysentery

    Bacterial dysentery is triggered by rod-shaped bacteria, the Shigella. The group A specimens found in the tropics form a poison that can severely damage the intestinal mucosa. Violent, slimy-bloody diarrhea are the result. If the poison gets into the bloodstream, it can cause circulatory shock and various nerve disorders. This severe form is fatal in up to ten percent of cases.
  • River blindness

    River blindness is caused by the nematode Onchocerca volvulus. The larvae (microfilariae) are transmitted to humans by blood-sucking black flies. The adult worms encapsulate themselves under the skin, but can also migrate into the eye, where they lead to blindness.
  • Dengue

    Dengue fever is a viral infection that is transmitted by mosquitoes such as the female Aedes aegypti shown here. The symptoms are usually similar to those of severe flu. In rare cases, internal bleeding can occur, which can be fatal.
  • Schistosomiasis

    The pathogens of schistosomiasis are pair leeches (schistosomes) - a genus one to two centimeters long. When bathing in contaminated water, the worm larvae penetrate the body through the skin and initially cause severe itching. If left untreated, the leeches nest in various organs, for example in the liver.
  • Schistosomiasis infestation of the liver

    If the parasite attacks the liver, as in the case of the boy pictured here, it can lead to considerable water retention in the abdomen.
  • Lassa fever

    The photo shows the treatment of a woman suffering from Lassa fever in Sierra Leone. The virus is transmitted by certain African rats and causes severe flu-like symptoms. Among other things, edema (water retention) forms in the eyelids and face. In severe cases, bleeding of the internal organs, skin and mucous membranes eventually occurs, which can be fatal.
  • West Nile fever

    West Nile fever is a viral infection that is transmitted by mosquitoes. It does not cause any symptoms in most infected people. Around 20 percent suffer from flu-like symptoms such as fever, headache, chills, nausea or vomiting. However, complications such as encephalitis or meningitis can occur.

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