Definition

Leprosy (another name: Hansen's disease, leprosy) is an infectious disease that causes skin lesions and nerve damage in the arms, legs, and other parts of the body. This disease is found all over the world. Currently, worldwide, there are about 208,000 people infected with leprosy. Leprosy sufferers are most in Africa and Asia, and especially in areas with tropical or subtropical climates.

Cause

Leprosy is caused by bacteria Mycobacterium leprae. Leprosy has another name, Hansen's disease, according to the name of the scientist who discovered the bacteria in 1873. This bacterium divides slowly so that the disease usually only appears on average after 5 years. Symptoms of the disease can appear after 1 year, but can also appear after 20 years or more.

The spread of this disease is not yet known for sure, but it is suspected to be transmitted through droplets or water droplets that spread when a person coughs or sneezes. Not only that, close physical contact with people suffering from leprosy can also transmit leprosy. Short physical contact such as shaking hands, hugging, or sitting next to the person while riding public transportation or eating cannot transmit leprosy. A mother with leprosy cannot transmit the infection to her fetus, because the bacteria cannot move through the intestines. In addition, this disease is not transmitted through intimate relationships.

Risk Factors

The risk factors for leprosy are as follows:

• Close contact. Close contact directly with leprosy patients increases the risk of a person getting leprosy.
• Exposure to armadillo. In the southern United States, the bacteria Mycobacterium leprae It is found naturally in armadillos. However, it is not yet known for sure whether this bacterium is transmitted from armadillos to humans.
• Age. The older the age, the higher the risk of a person contracting leprosy. Several studies show a peak in transmission at the age of 5-15 years (children) and at the age of over 30 years
• Genetic influences. Genes influence a person's immune response to this bacterium, regardless of the contact distance
• Immunosuppression. Drugs that suppress the immune system or diseases in the immune system itself can make a person more susceptible to leprosy. Leprosy usually occurs after receiving organ transplants, chemotherapy, HIV/AIDS infection, and taking drugs for symptoms of autoimmune diseases (immune cells attacking parts of the body itself)

Symptoms

The main symptoms of leprosy are:

• Muscle weakness
• Feeling of numbness or tingling in the hands, arms, feet, and legs
• There is a visible wound on the skin
• This skin lesion has decreased tactile sensation, temperature, and pain. These symptoms do not disappear in a few weeks.
• Usually, these skin lesions appear brighter than the natural skin color or red due to inflammation.

To diagnose leprosy, doctors will count the number of lesions on the skin and nerves that are affected. Current medical science recognizes three leprosy classification systems, namely tuberculoid/lepromatosa, classification World Health Organization (WHO), and the Ridley-Jopling classification. This classification will differentiate leprosy therapy later.

The classification of tuberculous/lepromatous depends on the immune response of a person, which can be explained as follows:

• Tuberculous Leprosy. In this type, the immune response is good, so the disease has mild symptoms and is not very contagious. The number of lesions on the skin is also less
• Lepramatosa leprosy. In this type, the immune response is poor, so the symptomatic disease is more severe and highly contagious. This disease attacks the skin, nerves, and other organs. The wounds on the skin are numerous and can form lumps
• Borderline Leprosy. In this type, there are characteristics of both tuberculous and lepromatous types. This type is in between the two previous types

Meanwhile, the classification World Health Organization (WHO) is simpler, namely:

• Pausibasiler. In this type, the number of wounds on the skin is less than or equal to five, and no bacteria are detected on skin scraping examination
• Multibasiler. In this type, the skin lesions are more than five or bacteria are not detected on skin scraping examination

The Ridley-Jopling classification divides the disease into five based on the severity of symptoms. Usually, this classification is used for clinical studies.

People suffering from leprosy can also experience immune reactions before, during, and after undergoing treatment. There are two leprosy reactions, namely type 1 (reversal reaction) and type 2 (erythema nodosum leprosum, ENL). In type 1 reactions, patients can experience several of the following symptoms for several months:

• Redness and swelling of the skin with large nerves or face
• Redness on an existing skin wound
• Inflammation due to a reaction that causes changes in the shape of the skin and paralysis
• Open wounds on the skin
• Nerve function is weakened or lost.

Meanwhile, type 2 reactions (erythema nodosum leprosum), as the name implies, have symptoms in the form of red lumps that suddenly appear and feel painful. These lumps can be close to the surface of the skin or located deep inside. Usually, these lumps appear on the limbs and disappear in a few days.

Diagnosis

If you are suspected of having leprosy, the doctor will perform a nerve examination on the skin. If the skin is numb, the doctor can decide to continue the examination with a skin scraping. The wound on the skin will be scraped a little and examined in the laboratory. This examination is done to look for bacteria Mycobacterium leprae, which will then be used to determine the classification of leprosy.

In addition, doctors can also perform a lepromin test. In this examination, the inactive bacteria will be injected slightly under the skin. Furthermore, the doctor will observe the injected part after 3 days and 28 days, to see the immune response. The absence of a reaction will help the doctor in determining the classification of leprosy based on the Ridley-Jopling criteria. People who do not suffer from leprosy will not have any reaction to this test.

Procedure

The standard therapy for leprosy is fixed-dose combination antibiotics (KDT). These antibiotics are given simultaneously to prevent bacterial immunity to the drug (drug resistance). Commonly used drugs are dapson, rifampicin, and clofazimine. The doses of these drugs differ depending on the classification of leprosy. Not only that, these drugs are given for a long time, ranging from 12 months to 24 months.

The implementation is also carried out to deal with the reaction of leprosy. Usually, doctors will give medicines to reduce inflammation in the body due to the reaction.

Complications

Leprosy has quite severe complications if it is not treated immediately. The complications are:

• Change in the shape of body movement members
• Hair loss, especially on the eyebrows and eyelashes
• Muscle weakness
• Permanent nerve damage in the hands and feet
• Inability to use hands and feet
• Chronic nasal congestion, epistaxis, and collapse of the septum between the right and left nostrils
• Inflammation of the iris of the eye
• Glaucoma, an eye disease that causes damage to the eye nerves
• Blindness
• Erectile problems in men
• Infertility
• Renal failure

Prevention

The best way to prevent leprosy is to avoid long-term close contact with untreated leprosy sufferers.

When should you see a doctor?

If you have a wound on the skin that is followed by numbness or sudden numbness of the limbs, you can consult a doctor. The sooner leprosy is diagnosed, the sooner the treatment will be carried out before the disease spreads to other parts of the body and becomes more severe. Leprosy is a disease that is difficult to diagnose quickly because its appearance is similar to various other diseases, so it is called "the great imitator" (the ultimate imitator). You may need to observe the symptoms of your disease and check with the doctor several times before being diagnosed with leprosy.

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