Leprosy or leprosy is a chronic bacterial infection that attacks the skin, peripheral nerves, and respiratory tract. Leprosy or leprosy is also known as Hansen's disease or Morbus Hansen.

Leprosy or leprosy can be characterized by weakness or  numbness  in the legs and feet, followed by skin lesions. This disease caused by a bacterial infection can be spread through splashes of saliva or phlegm that comes out when the sufferer coughs or sneezes.

The incidence of leprosy in Indonesia is one of the highest. Based on WHO data for 2020, the number of leprosy cases in Indonesia is the third largest in the world, namely 8%. In addition, there were as many as 9.14% of the total new cases of leprosy occurring in children.

Leprosy is generally treatable and rarely causes death. However, this disease is at risk of causing disability. As a result, leprosy sufferers are at risk of experiencing discrimination which can have an impact on their psychological condition.

Causes of Leprosy

Leprosy or leprosy is caused by an infection with the  Mycobacterium leprae bacteria . This bacterium can be transmitted from one person to another through liquid droplets from the respiratory tract ( droplets ), namely saliva or phlegm, which comes out when coughing or sneezing.

A person can be infected with leprosy if exposed to droplets from the sufferer continuously for a long time. In other words, the bacteria that cause leprosy cannot be easily transmitted to other people. In addition, this bacterium also takes a long time to multiply in the patient's body.

It should be noted, leprosy can be transmitted if there is contact for a long time. Leprosy will not be transmitted just by shaking hands, sitting together, or having sexual intercourse with sufferers. Leprosy is also not transmitted from mother to fetus.

Apart from the causes above, there are several other factors that can increase a person's risk of developing leprosy, including:

  • Contact with animals that spread leprosy bacteria, such as armadillos
  • Residing in or visiting leprosy endemic areas
  • Have an immune system disorder

Leprosy Symptoms

Symptoms of leprosy are not obvious at first and usually develop slowly. In fact, in some cases, the symptoms of leprosy can only be seen after the leprosy bacteria have multiplied in the patient's body for 20 years or more.

Some of the symptoms of leprosy that sufferers can feel are:

  • The skin becomes numb, including losing the ability to feel temperature, touch, pressure, or pain
  • Skin does not sweat ( anhidrosis )
  • Skin feels stiff and dry
  • Painless sores on the soles of the feet
  • Swelling or lumps on the face and ears
  • Patches that appear pale and are lighter in color than the surrounding skin
  • Enlarged nerves, usually in the elbows and knees
  • Weak muscles, especially in the legs and arms
  • Permanent loss of eyebrows  and eyelashes
  • The eyes become dry and blink less
  • Nosebleed , stuffy nose, or loss of nasal bones

In leprosy that attacks the nervous system, sufferers can lose sensation of taste including pain. As a result, wounds or injuries to the hands or feet cannot be felt by sufferers.

Based on the severity of the symptoms, leprosy can be grouped into six types, namely:

  • Intermediate leprosy
    Leprosy is characterized by several flat lesions that are pale or lighter in color than the surrounding skin color, which can sometimes heal on their own.
  • Tuberculoid leprosy
    This leprosy is characterized by multiple flat lesions that are sometimes large in size, numb, and accompanied by enlarged nerves
  • Borderline tuberculoid leprosy
    This type of leprosy is characterized by the appearance of lesions that are smaller and more numerous than  tuberculoid leprosy
  • Mid-borderline leprosy
    This type of leprosy is characterized by randomly and asymmetrically distributed reddish lesions, numbness, and swollen lymph nodes around the leprosy.
  • Borderline lepromatous leprosy
    Leprosy is characterized by multiple lesions that are flat or raised in shape. This type of leprosy also sometimes causes numbness.
  • Lepromatous leprosy
    This leprosy is characterized by symmetrically distributed lesions. Generally, the resulting lesions contain a lot of bacteria and are accompanied by hair loss, nervous disorders, and weakness of the limbs.

When to see a doctor

Immediately consult a  doctor if you experience the symptoms of leprosy as described above. Also consult with your doctor if you have factors that increase your risk of developing leprosy. The sooner leprosy is treated, the higher the chance of recovery.

Leprosy Diagnosis

To diagnose leprosy or leprosy, the doctor will ask about the symptoms experienced, then examine the patient's skin. The doctor will check whether there are lesions on the skin as a symptom of leprosy or not. Leprosy lesions on the skin are usually pale or red ( hypopigmented ) and accompanied by numbness.

To determine whether the patient has leprosy, the doctor will take a skin sample by scraping it ( skin smear ). This skin sample will then be analyzed in the laboratory to check for the presence of the  Mycobacterium leprae bacteria . The method of analysis includes examination of acid-fast bacteria (BTA).

In areas where leprosy is endemic, a person may be diagnosed with leprosy even if a skin scraping examination shows negative results. This refers to the classification of the world health organization or the World Health Organization (WHO) for leprosy, namely:

  • Paucibacillary , namely there are skin lesions even though the skin scraping test results ( smear ) are negative
  • Multibacillary , namely there are skin lesions with positive skin scraping test results ( smears ).

If the leprosy is severe enough, the doctor will carry out supporting tests to check whether the  Mycobacterium leprae bacteria  has spread to other organs or not. Examples of checks are:

  • Complete blood count
  •  Liver or liver function tests
  • Creatinine test
  •  Nerve biopsy

Leprosy Treatment

The main method for treating leprosy or leprosy is with antibiotics. Leprosy sufferers will be given a combination of several types of antibiotics for 1-2 years. The type, dose, and duration of use of antibiotics will be determined based on the type of leprosy you are suffering from.

Examples of antibiotics used for the treatment of leprosy are:

  • Rifampicin
  • Dapsone
  • Clofazimine
  • Minocycline
  • Ofloxacin

In Indonesia, the treatment of leprosy is generally carried out using the MDT method or multidrug therapy , which is a treatment that combines two or more antibiotics.

After treatment with antibiotics, surgery will generally be carried out as further treatment. Surgery for people with leprosy aims to:

  • Normalizes the function of damaged nerves
  • Improve deformed body shape
  • Restore limb function

Leprosy Complications

Some of the complications that may occur if leprosy is treated late are:

  • Numb
  • Glaucoma
  • Blindness
  • Kidney failure
  • Deformed face
  • Permanent damage to the inside of the nose
  • Infertility in men
  • Weak muscles
  • Permanent damage to nerves outside the brain and spinal cord, including the arms, legs, and feet
  • Permanent defects, such as missing eyebrows, deformities on the toes, hands, and nose

In addition, the discrimination experienced by sufferers can result in psychological pressure or even  depression . This has the risk of bringing up the desire of the sufferer to attempt suicide .

Leprosy Prevention

Until now, there is no vaccine to prevent leprosy. Early diagnosis and appropriate treatment are the best efforts to prevent complications and transmission of leprosy. Apart from that, avoiding contact with animals carrying the leprosy bacteria is also important to prevent leprosy.

An integrated movement to provide information about leprosy to the public, especially in endemic areas , is an important step so that sufferers want to check themselves and get treatment.

Providing this information is also expected to eliminate the negative stigma about leprosy and discrimination against people with leprosy.

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