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Hansen’s Disease (Leprosy)

»	What causes leprosy?
»	Why is leprosy called Hansen’s disease?
»	How is leprosy transmitted?
»	Are children and adults equally susceptible to acquiring leprosy?
»	Are humans the only host for M. leprae?
»	Is leprosy a systemic disease?
»	How common is leprosy?
»	Are there endemic areas for leprosy in the United States?
»	How is leprosy recognized clinically?
»	Is there more than one kind of leprosy?
»	Does indeterminate leprosy mean that you do not know what type it is?
»	What are the two “polar” forms of leprosy? How do they differ?
»	Describe dimorphous leprosy.
»	What is the unusual feature of the cell-mediated immunity in lepromatous leprosy?
»	Define the cytokine response to M. leprae in tuberculoid versus lepromatous patients.
»	How is the diagnosis of leprosy usually made?
»	What area should be biopsied to detect M. leprae?
»	Can the same acid-fast stain used for Mycobacterium tuberculosis be used for the leprosy bacillus?
»	What are Virchow cells?
»	Is the lepromin skin test helpful in making a diagnosis of leprosy?
»	Is the neuropathy in lepromatous leprosy the same as that in diabetic neuropathy?
»	Describe a patient with advanced lepromatous leprosy.
»	What are the most common complications in leprosy?
»	What are the reactional states of leprosy?
»	What drugs are used in multidrug therapy for leprosy?
»	Do the recommendations of the World Health Organization (WHO) differ from those of the U.S.?
»	What are the side effects of the drugs for leprosy treatment?
»	What is the most bothersome cutaneous side effect of clofazimine?
»	How are the reactional states of leprosy treated?
»	Should family members of leprosy patients be treated?
»	Can leprosy be eliminated as a worldwide disease, as smallpox has been?

Describe a patient with advanced lepromatous leprosy.

Features of advanced lepromatous leprosy. A, Destruction of the cartilage of the nose producing a 'saddle nose' deformity. B, The hands often show contractures, and muscle atrophy of the thenar and hypothenar eminences. C, Accidental burn. Because of anesthetic extremities, patients with leprosy are subject to burns and other minor trauma. D, Mal perforans ulcers. Patients with lepromatous leprosy develop foot ulcers surrounded by thick keratin as a result of peripheral anesthesia. (Panel A courtesy of the Fitzsimons Army Medical Center teaching files.)

Fig. 29.5 Features of advanced lepromatous leprosy. A, Destruction of the cartilage of the nose producing a 'saddle nose' deformity. B, The hands often show contractures, and muscle atrophy of the thenar and hypothenar eminences. C, Accidental burn. Because of anesthetic extremities, patients with leprosy are subject to burns and other minor trauma. D, Mal perforans ulcers. Patients with lepromatous leprosy develop foot ulcers surrounded by thick keratin as a result of peripheral anesthesia. (Panel A courtesy of the Fitzsimons Army Medical Center teaching files.)

Madarosis (loss of eyebrows) is an important sign in leprosy. A, This patient has heavy eyebrows due to hair transplants and dark skin color due to the drug clofazimine. B, This patient has just received eyebrow transplants.

Fig. 29.4 Madarosis (loss of eyebrows) is an important sign in leprosy. A, This patient has heavy eyebrows due to hair transplants and dark skin color due to the drug clofazimine. B, This patient has just received eyebrow transplants.

The skin shows widespread, hyperpigmented papules and nodules with a predilection for cool parts of the body, such as the earlobes, nose, fingers, and toes. There may be loss of the lateral eyebrows (madarosis) (Fig. 29-4), redness of the conjunctiva, a stuffy nose, flattening of the nasal bridge (Fig. 29-5A), and a palpable postauricular nerve. There is marked anesthesia of the extremities with some atrophy of the thenar and hypothenar muscles (Fig. 29-5B). Contraction of the fourth and fifth fingers may be seen, resulting in difficulty in extending the fingers fully. Ulcers or sores of the hands and feet may be present secondary to minor trauma or burns (Fig. 29-5C). A plantar ulcer surrounded by hyperkeratotic skin (mal perforans ulcer) may be present over a pressure area (Fig. 29-5D). The physician should inquire whether the patient is from an endemic area for leprosy.