Introduction:

Leprosy, also known as Hansen's disease, is a chronic infectious disease

caused by the bacterium *Mycobacterium leprae*. It primarily affects the
skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes,
leading to a wide spectrum of clinical manifestations.

Characteristics:

● **Microbiology**: *Mycobacterium leprae* is an acid-fast,

intracellular bacterium with a distinctive cell wall structure that
includes mycolic acids. This structure contributes to its resistance to
environmental stressors and the host immune response.
● **Growth Requirements**: The bacterium has a slow growth rate
and requires a cooler temperature (around 30°C to 33°C) for
optimal growth, which limits its ability to proliferate in warmer
body tissues.

Classification:

● *Mycobacterium leprae*: The causative agent of leprosy in humans.

It is closely related to *Mycobacterium lepromatosis*, another
species that can cause a similar disease phenotype.

Epidemiology:

● **Global Distribution**: Leprosy is found predominantly in tropical

and subtropical regions, with significant endemic areas in countries
like India, Brazil, Indonesia, and parts of Africa.

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 ● **Transmission**: The exact mode of transmission is not fully
understood, but it is believed to occur through prolonged close
contact with respiratory droplets from untreated individuals with
leprosy. Genetic susceptibility and immunological factors also
influence disease progression.

Pathogens:

● *Mycobacterium leprae* primarily affects:

● **Skin Lesions**: Manifestations vary from hypopigmented or
erythematous patches to nodules and plaques with variable sensory
loss.
● **Peripheral Nerves**: Neuropathy is a hallmark, leading to
sensory loss, muscle weakness, and trophic changes like claw hand
or foot drop.
● **Mucosa and Eyes**: Involvement of the nasal mucosa can cause
nasal congestion, epistaxis, and septal perforation. Eye
complications may include lagophthalmos, corneal ulcers, and
blindness if untreated.

Mode of Transmission:

Transmission of *Mycobacterium leprae* occurs primarily through

prolonged close contact with respiratory droplets from untreated
individuals with multibacillary leprosy (high bacterial load). The bacilli
are released into the air when infected individuals cough or sneeze.

Clinical Signs and Symptoms:

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 ● **Tuberculoid Leprosy**: Paucibacillary form characterized by
well-defined hypopigmented or erythematous skin lesions with
decreased sensation. Nerve involvement may lead to sensory loss
and muscle weakness in affected areas.
● **Lepromatous Leprosy**: Multibacillary form with widespread
skin lesions that are infiltrative, thickened nerves (especially facial
and peripheral nerves), and systemic involvement. Skin lesions often
lack sensation ("anaesthetic patches"), and systemic complications
may include orchitis, nephritis, and amyloidosis.

Lab Diagnosis:

● **Skin Biopsy**: Histopathological examination with special stains

(e.g., Fite stain) to visualize acid-fast bacilli within skin lesions.
● **Nerve Biopsy**: Direct visualization of *Mycobacterium leprae*
in affected nerves, confirming neural involvement.
● **Molecular Tests**: Polymerase chain reaction (PCR) assays to
detect specific DNA sequences of *Mycobacterium leprae* in clinical
samples, offering rapid confirmation of diagnosis.

Preventive Measures:

● **Early Diagnosis and Treatment**: Prompt identification of

leprosy cases through active case finding and community-based
surveillance. Early treatment reduces transmission and prevents
irreversible nerve damage.

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 ● **Chemoprophylaxis**: Administration of single-dose rifampicin to
household contacts of newly diagnosed leprosy patients to prevent
the development of clinical disease.

Treatment:

● **Multidrug Therapy (MDT)**: Standard treatment regimens

include a combination of antibiotics such as dapsone, rifampicin,
and clofazimine. The duration and combination of drugs depend on
the clinical form (paucibacillary or multibacillary) and severity of
disease.
● **Monitoring and Supportive Care**: Regular monitoring for
adverse effects of medications, management of complications such
as deformities, disabilities, and psychological support to address
social stigma associated with leprosy.