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Leprosy

Hansen disease

Definition

Leprosy is a disease caused by the bacterium Mycobacterium leprae. This disease causes skin sores, nerve damage, and muscle weakness that gets worse over time.

Causes

Although leprosy is due to an infection, it does not spread easily. It also takes a long time before symptoms appear, which makes it hard to know where or when someone caught the disease. Children are more likely than adults to get the disease.

Most people who come in contact with the bacteria don't develop the disease. This is because their immune system is able to fight off the bacteria. Experts believe that the bacteria spread when a person breathes in tiny airborne droplets released when someone with leprosy coughs or sneezes. The bacteria may also be passed through contact with the nasal fluids of a person with leprosy. Leprosy has two common forms: tuberculoid and lepromatous. Both forms produce sores on the skin. However, the lepromatous form is more severe. It causes large lumps and bumps (nodules).

Leprosy is common in many countries worldwide including India, Brazil and Indonesia. It is also found in temperate, tropical, and subtropical climates. About 170 to 200 cases per year are diagnosed in the United States. Most new cases in the United States were in:

Florida
California
Hawaii
New York
Oregon
Texas

Drug-resistant Mycobacterium leprae and an increased numbers of cases worldwide have led to global concern for this disease.

Symptoms

Symptoms include:

Skin lesions that are lighter than your normal skin color
Lesions that have decreased sensation to touch, heat, or pain
Lesions that do not heal after several weeks to months
Muscle weakness
Numbness or lack of feeling in the hands, arms, feet, and legs

Exams and Tests

Tests that are done include:

Skin lesion biopsy
Skin scraping examination

The lepromin skin test can be used to tell the two different forms of leprosy apart. This test is not used to diagnose the disease.

Treatment

Several antibiotics are used to kill the bacteria that cause the disease. These include:

Dapsone
Rifampin
Clofazimine
Fluoroquinolones
Macrolides
Minocycline

More than one antibiotic is often given together, and usually for months.

Aspirin, prednisone, or thalidomide may be used to control inflammation.

Outlook (Prognosis)

Diagnosing the disease early is important. Early treatment helps:

Limit the damage
Prevent a person from spreading the disease
Reduce long-term complications

Possible Complications

Health problems that may result from leprosy include:

Disfigurement
Muscle weakness
Permanent nerve damage in the arms and legs
Loss of sensation

People with long-term leprosy may lose the use of their hands or feet. This is due to repeated injury because they lack feeling in those areas.

When to Contact a Medical Professional

Contact your health care provider if you have symptoms of leprosy, especially if you have had contact with someone who has the disease. Cases of leprosy in the United States must be reported to the Centers for Disease Control and Prevention.

Prevention

People on long-term medicine become noninfectious. This means they do not transmit the organism that causes the disease.

References

Centers for Disease Control and Prevention website. Hansen's disease (leprosy). About Hansen's disease. www.cdc.gov/leprosy/about/index.html. Updated April 11, 2024. Accessed June 19, 2024.

Dogra S. Leprosy (Hansen disease). In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 301.

Dupnik K. Leprosy (Mycobacterium leprae). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 250.

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Review Date: 8/26/2023

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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