Leprosy Cured Person

The Rights of Persons with Disabilities Act, 2016(1) includes “leprosy cured” as a locomotor disability (a person's inability to execute distinctive activities associated with movement of self and objects resulting from affliction of musculoskeletal or nervous system or both). It’s been defined as:

A person who has been cured of leprosy but:

1. is suffering loss of sensation in hands or feet as well as loss of sensation and paresis in the eye and eye-lid but with no manifest deformity;
2. manifests deformity and paresis while having sufficient mobility in their hands and feet to enable them to engage in normal economic activity;
3. suffers extreme physical deformity as well as advanced age which prevents him/her from undertaking any gainful occupation.

Leprosy, also known as Hansen's disease (HD), is a chronic infectious disease caused by becteria affecting especially the skin and marginal nerves. It is characterized by the formation of nodules or macules that enlarge and spread with loss of sensation and eventually paralysis, wasting away of muscle, and production of deformities. This infection is caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. It is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external sign. If left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs and eyes.

It has the following symptoms:

• Skin lesions that may be faded/discoloured
• Growths on the skin
• Thick, stiff or dry skin
• Severe pain
• Numbness on affected areas of the skin
• Muscle weakness or paralysis (especially in the hands and feet)
• Eye problems that may lead toblindness
• Enlarged nerves (especially those around the elbow and knee)
• A stuffy nose
• Ulcers on the soles of feet

There are three systems for classifying leprosy:

1. Tuberculoid leprosy vs. lepromatous leprosy vs. borderline leprosy

The   first   system   recognizes   three   types   of   leprosy:   tuberculoid,   lepromatous,   and borderline. Aperson’s immune response to the disease determines which of these types of leprosy they have:

• In  tuberculoid  leprosy,  the  immune  response  is  good.  A  person  with  this  type  of infection   only   exhibits   a   few   lesions.   The   disease   is   mild   and   only   mildly contagious.
• In  lepromatous  leprosy,  the  immune  response  is  poor.  This  type  also  affects  the skin,  nerves,  and  other  organs.  There  are  widespread  lesions,  including  nodules (large lumps and bumps). This form of disease is more contagious.
• In   borderline   leprosy,   there   are   clinical   features   of   both   tuberculoid   and lepromatous leprosy. This type is considered to be between the other two types.

2. World Health Organization (WHO) classification

WHO categorizes the disease based on the type and number of affected skin areas:

• The   first   category   is   paucibacillary.   There   are   five   or   fewer   lesions   and   no bacterium detected in the skin samples.
• The  second  category  is  multibacillary.  There  are  more  than  five  lesions,  the bacterium is detected in the skin smear, or both.

3. Ridley-Jopling classification

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There’s also a form a leprosy called indeterminate leprosy that isn’t included in the Ridley-Jopling classification system. It’s considered to be a very early form of leprosy where a person will have only one skin lesion that’s just slightly numb to the touch. Indeterminate leprosy may resolve itself or progress further to one of the five forms of leprosy within the Ridley-Jopling system.

Mycobacterium leprae and Mycobacterium lepromatosis are the causative agents of leprosy. Mycobacterium can spread from person to person. It is not known exactly how Hansen’s disease spreads between people. At least until recently, the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. More recently scientists think it may happen when a person with Hansen’s disease coughs or sneezes, and a healthy person breathes in the droplets containing the bacteria. There are also other possibilities such as transmission through insects which cannot be completely ruled out.

Leprosy  is  curable  with  a  combination  of  drugs  known  as  multidrug  therapy  (MDT),  as the  treatment  of  leprosy  with  only  one  antileprosy  drug  (monotherapy)  will  result  in development of drug resistance to that drug. The combination of drugs used in the MDT depends  on  the  classification  of the  disease.  Rifampicin,  the most  important  antileprosy medicine,  is  included  in  the  treatment  of  both  types  of  leprosy.  For  the  treatment  of patients  with  multibacillary  leprosy,  WHO  recommends  a  combination  of  rifampicin, clofazimine   and   dapsone;   for   patients   with   paucibacillary   leprosy,   MDT   uses   a combination of rifampicin and dapsone.

Multidrug  therapy  (MDT),  first  recommended  by  a  WHO  Expert  Committee  in  1984, rapidly became the standard treatment of leprosy and has been supplied by WHO free of charge to all endemic countries since 1995.

The treatment will last for months and possibly up to 1 to 2 years. Antibiotics used during the  treatment  will  kill  the  bacteria  that  cause  leprosy.  But  while  the  treatment  can  cure the  disease  and  prevent  it  from  getting  worse,  it  does  not reverse  nerve  damage  or physical  disfiguration  that  may  have  occurred  before  the  diagnosis.  Thus,  it  is  very important  that  the  disease  be  diagnosed  as  early  as  possible,  before  any  permanent nerve damage occurs.

Prevention -The  BCG  vaccine  offers  a  variable  amount  of  protection  against  leprosy  in addition  to  tuberculosis.  This  vaccine  appears  to  be  about  25%  effective  with  two  doses working better than one. Development of a more effective vaccine is still ongoing.

A total of 1,35,485 new cases were detected during the year 2016-17, which gives Annual New Case  Detection  Rate  (ANCDR)  of  10.17  per  100,000  population. A  total  of  88,166 leprosy cases are on record as of 1st April 2017, giving a Prevalence Rate (PR) of 0.66 per 10,000 population.

1. Disability Affairs
2. National Health Portal
3. Healthline - Leprosy
4. World Health Organisation
5. Centers for Disease Control and Prevention
6. NATIONAL LEPROSY ERADICATION PROGRAMME
7. World Health Organisation - Weekly epidemiological record
8. YouTube - leprosy (mycobacterium leprae)-cause, symptoms, diagnosis,treatment and pathology.