Leprosy

Last reviewed: May 2019

Last updated: February 2018

Summary

Chronic infectious disease caused by the acid-fast bacteria Mycobacterium leprae , characterised by skin lesion(s) and involvement of peripheral nerves.

Skin lesions can be erythematous or hypopigmented, single or multiple macules, papules, or nodules, sometimes with loss of sensation.

Skin smear may or may not be positive for acid-fast bacilli (AFB) depending on the classification (multibacillary vs. paucibacillary).

Nerve damage to peripheral nerve trunks may occur, with loss of sensation in the skin and weakness of muscles supplied by the affected nerve, leading to disabilities.

Diagnosis is most commonly based on clinical signs and symptoms, and in practice, people usually report on their own to the health centre.

The standard WHO-recommended treatment for leprosy is with multi-drug therapy (MDT).

Definition

Leprosy (also know as Hansen’s disease) is a chronic infectious disease characterised by one or more of the following features: hypopigmented or erythematous skin lesion(s) with loss of sensation; involvement of the peripheral nerves, as demonstrated by loss of sensation, paraesthesias (tingling of hands and feet), and weakness of the muscles of hands, feet, or face. [1]

History and exam

Key diagnostic factors

presence of risk factors
typical skin lesions
nerve involvement
sensory loss

Full details

Other diagnostic factors

immunological reactions
eye lesions

Full details

Risk factors

close contact with a multibacillary leprosy patient
poverty
residence in endemic area
genetic predisposition
zoonotic transmission

Full details

Diagnostic investigations

1st investigations to order

skin smear
skin and/or nerve biopsy and histopathology

Full details

Investigations to consider

Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL 

Maria T. Ochoa, MD

Associate Clinical Professor

USC Keck School of Medicine

Department of Dermatology

Los Angeles

Disclosures

MTO declares that she has no competing interests.

Acknowledgements

Dr Maria T. Ochoa would like to gratefully acknowledge Dr Denis Paul Jacques Daumerie, a previous contributor to this monograph. DPJD declares that he has no competing interests.

Peer reviewers VIEW ALL 

Hubert Sansarricq, MD

Member of World Health Organization Panel of Experts on Leprosy

Saint-Armour Morlaas

France

Disclosures

HS declares that he has no competing interests.

David M. Scollard, MD, PhD

Chief

Clinical Branch

National Hansen's Disease Programs

Baton Rouge

Disclosures

DMS declares that he has no competing interests.

Alexandre Tiendrebéogo, MD, MPH

Medical Officer

Leprosy and Neglected Tropical Diseases in Central Africa Countries

World Health Organization

Country Office of Kinshasa

DR of Congo

Disclosures

AT declares that he has no competing interests.

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Leprosy

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

multibacillary (MB) (≥6 lesions)

paucibacillary (PB) (1 to 5 lesions)

type 1 reaction (reversal reaction)

type 2 reaction (erythema nodosum leprosum)

Lucio's phenomenon

Contributors

Authors VIEW ALL 

Maria T. Ochoa, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Hubert Sansarricq, MD

Disclosures

David M. Scollard, MD, PhD

Disclosures

Alexandre Tiendrebéogo, MD, MPH

Disclosures

Differentials

Guidelines

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