Leprosy Frequently Asked Questions
Q: What causes leprosy?
A: A germ, or bacteria, called Mycobacterium leprae. It causes an infection that affects the skin, destroys nerves and can also cause problems in the eyes and nose.
Q: Why is leprosy also called Hansen’s disease?
A: The medical name for leprosy is Hansen’s disease. Norwegian doctor Armauer Hansen was the first to view the bacillus under a microscope in 1873.
Q: Do fingers and toes fall off when someone gets leprosy?
A: No. The bacteria attack nerve endings and destroy the body’s ability to feel pain and injury. Without feeling pain, people injure themselves and the injuries can become infected, resulting in tissue loss. Fingers and toes become shortened and deformed as the cartilage is absorbed into the body. Repeated injury and infection of numb areas in the fingers or toes can cause the bones to shorten. The tissues around them shrink, making them short.
Q: What are the signs of leprosy?
A: Early signs include spots on the skin that may be slightly red, darker or lighter than normal skin. The spots may also become numb and have lost hair. Often they appear on the arms, legs or back. Sometimes the only sign may be numbness in a finger or toe. If left untreated, hands can become numb and small muscles are paralyzed, leading to curling of the fingers and thumb. When leprosy attacks nerves in the legs, it interrupts communication of sensation in the feet. The feet can then be damaged by untended wounds and infection. If the facial nerve is affected, a person loses the blinking reflex of the eye, which can eventually lead to dryness, ulceration and blindness. Bacteria entering the mucous lining of the nose can lead to internal damage and scarring which in time causes the nose to collapse. Untreated, leprosy can cause deformity, crippling and blindness.
Q: How do you catch leprosy?
A: M. leprae is transmitted primarily through coughing and sneezing. In most cases, it is spread through long-term contact with a person who has the disease but has not been treated. Scientists don’t fully understand how leprosy is spread.
Q: Is leprosy very contagious?
A: Most people will never develop the disease even if they are exposed to the bacteria. Approximately 95% of the world population has a natural immunity to leprosy.
Q: How is leprosy treated?
A: Leprosy can be cured with multi-drug therapy (MDT), a combination of three antibiotics: rifampin, clofazimine and dapsone. Treatment can take from six months to a year, sometimes longer. People are no longer contagious after about one week of MDT.
Q: What side effects do the medications have?
A: Dapsone: Some people may have a mild anemia. Very rarely, other blood problems have been reported. Rifampin: Sometimes it will cause abnormal liver tests, but the problem clears when the medication is stopped. It may cause a harmless orange color in the urine, sweat or tears. Clofazimine: It has virtually no side effects except some darkening of the skin which slowly fades when the medication is stopped.
Q: Is there leprosy in the U.S.?
A: Approximately 5,000 people in the U.S. are cured but suffer from the effects of leprosy and continue to receive care through outpatient clinics and private physicians. Approximately 150 people are diagnosed with leprosy each year in the U.S.
Q: What happens to pregnant women who have leprosy?
A: Most women with leprosy have normal pregnancies and deliver healthy babies. Patients on treatment do not transmit leprosy to their babies.
Q: What types of damage does leprosy cause?
A: Leprosy can damage the peripheral nerves and nerves in the skin which can lead to:
- Loss of sweat and oil gland function which causes dry and cracked skin on the hands and feet.
- Loss of the ability to feel light touch or, with more severe damage, loss of protective sensation. Protective pain sensation prevents burns, cuts and exposure to destructive pressures to the hands and feet.
- Weakness of the eyelids, preventing proper closure of the lid and protection of the eye, which can lead to blindness.
- Loss of strength in the hands and feet. With severe nerve damage of the hands and feet, there is paralysis of the small muscles, leading to “clawing” of the fingers and toes.
Q: Can people get leprosy from armadillos?
A: In some states along the Gulf coast in the southern U.S., armadillos have been found to carry a certain strain of the M. leprae bacteria. Studies suggest that humans can get the bacteria from armadillos.
Q: Can other people get leprosy from a patient?
A: Patients taking Multi-Drug Therapy do not spread the disease. When a person is placed on medication, most of the bacteria are killed within a few days. Within one week of starting the medicine, there is no risk of spreading the disease to anyone else. It is not necessary to isolate a person with leprosy at any time. Also, it is not transmitted through sexual contact or pregnancy.
Q: What tests can be done to diagnosis leprosy?
A: A trained health worker diagnoses leprosy through a skin biopsy. In this test, a small piece of skin is taken and sent to a laboratory where it is examined for the bacteria. Skin smears are another test that can be used. This is done by making a small incision into the skin. A small amount of tissue fluid is obtained and examined in the laboratory for the bacteria. There are no blood tests for leprosy.
Q: Is it OK to use the word leper?
A: No. For centuries leprosy has been viewed with horror and the word leper has come to mean outcast. The word leper reinforces the already strong stigma against leprosy and contributes to the heartbreaking ostracism sufferers face. Using the word leper today is considered an offense to the hundreds of thousands affected by this disease. The terms “person affected by leprosy” and “Hansen’s disease” are used instead.
Q: What is a leprosy reaction?
A: Reaction is the body’s response to the dead bacteria in the body. When patients begin taking Multi-Drug Therapy (MDT) the bacteria are killed quite rapidly. Sometimes it takes years for the dead bacteria to be completely cleared from the body. During this time the body may react against these dead bacteria. This can cause pain and swelling in the skin and nerves and other parts of the body. Fever and muscle aches may also occur. The eyes could be red and painful. During reactions there is increased risk of damage to nerves in the eyes, hands and feet. Treating reaction quickly can prevent nerve damage.
Up to half of all people with leprosy have reactions. A reaction does not mean the disease is getting worse or that the medication has stopped working. It is not an allergic reaction to the medication. It means that the body is reacting or fighting against the dead bacteria. These bacteria may have been killed by the body’s resistance to the bacteria or by the medication. This is why some persons develop reactions before they even start MDT.
Q: Why are the medications continued if reactions occur?
A: If medications that kill bacteria were not given, the bacteria would begin growing again.
Q: How are reactions treated?
A: Some reactions can be treated with medicine such as aspirin or Tylenol. In some cases, medications such as prednisone or thalidomide may be required to prevent nerve damage during reaction. Episodes of reaction may occur off and on for a period of time.
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