Leprosy

This is an infective disease due to Myco-bacterium leprce. It runs a very chronic course and occurs in two 0main forms. In lepromatous nodular leprosy there are bouts of fever, with nodules in the skin and mucous membranes. In tuberculoid leprosy there are at first areas of redness over the body, with a macular rash, malaise, chills and vague pains, and later areas of numbness develop, with insensibility to touch, heat and cold, and pain.

In later cases of both types ulceration is common, and in tuberculoid leprosy there may be loss of fingers and toes or other parts from gangrene. In lepromatous leprosy the mucous membrane of the nose and mouth is involved, with loss of speech, and ulceration and scarring of the lips and tongue. The skin becomes dry like parchment, and the general expression is grave and heavy. The disease is very chronic.

Leprosy is transmitted from man to man through prolonged personal contact. It is not hereditary. Without treatment there may be remissions or arrest of symptoms, but more commonly death occurs from tuberculosis, exhaustion, or renal failure after twenty years or more.

With treatment by the sulphone drugs, the outlook for leprous patients has changed from one of hopeless misery to one of steady but sure struggle against the bacteria.

Treatment consists in sanitary conditions, scrupulous cleanliness, nourishing diet, and medicinal treatment by the sulphone drugs, dapsone (DDS) and solapsone, by mouth and sometimes by injection. Iron and vitamin B should be given when patients are being given sulphone drugs. Treatment must be continuous over long periods, and permanent cures have been effected after five years in patients with tuberculoid leprosy.

Ditophal (Etisul) ointment has been used with some success. When it is rubbed on the skin it releases in the body a volatile sub stance which is lethal to the Mycobacterium. It is best used in conjunction with dapsone therapy and in courses of three months.

Physiotherapy and graduated exercises are of great help in keeping patients in better general health. Surgical treatment of various kinds may be necessary for amputation, eye operations, etc. Vaccination with B.C.G. greatly reduces the risk of acquiring leprosy. It is being increasingly used in developing countries.

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