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Leprosy in Adult
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Leprosy in Adult

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Contributors: T. P. Zulu BSc, MBChB, MMed, FCDerm, Natal, Anisa Mosam MBChB, MMed, FCDerm, PhD, Ncoza C. Dlova MBChB, FCDerm, PhD, Susan Burgin MD
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Synopsis

Leprosy (Tuberculoid Leprosy) : Numbness/tingling, Chronic duration lasting years, Foot drop, Hypopigmented patch, Neuropathy peripheral, Paresthesias, Annular configuration
Tuberculoid Leprosy
Leprosy, also known as Hansen disease, is a chronic granulomatous infection caused by Mycobacterium leprae (Hansen's bacillus), an acid-fast mycobacterium. Leprosy is endemic in the Middle East, India, Southeast Asia, Africa, the Pacific basin, Mexico, Central America, and South America. However, 83% of all cases come from 6 countries: Brazil, Nepal, India, Burma, Indonesia, and Madagascar, and most new cases are reported from Brazil, India, and Indonesia. Leprosy in returning tourists or travelers is exceedingly rare. Sporadic cases have been reported in the southern United States, Spain, and Portugal.

Leprosy spreads via human-to-human transmission. Armadillos are also a reservoir, and direct contact with armadillos is thought to be a risk factor for development of leprosy. The average incubation period for M leprae is about 5 years, with a range from 2 to over 30 years.

Mycobacterium leprae has a predilection for the cooler parts of the body, skin, peripheral nerves, upper respiratory system, anterior eye chambers, and testes.

Leprosy is classified into 5 disease types based on clinical, immunologic, and pathologic criteria:
  • Tuberculoid leprosy (TT)
  • Borderline tuberculoid leprosy (BT)
  • Midborderline leprosy (BB)
  • Borderline lepromatous leprosy (BL)
  • Lepromatous leprosy (LL)
These disease types represent a spectrum of disease activity, with tuberculoid leprosy representing intact cell-mediated immunity at one end of the spectrum, lepromatous leprosy representing poor immune response to M leprae at the other end of the spectrum, and 3 stages of intermediate immune response. Patients with lepromatous leprosy are the most contagious. Diffuse lepromatous leprosy occurs when the entire cutaneous surface is involved. Histoid leprosy is a very rare variant of lepromatous leprosy that presents with papules and nodules.

Peripheral neuropathy may occur across the spectrum before, during, and after treatment. Small nerve fibers conveying fine touch, temperature, and pain sensations are the most impaired. During immune exacerbations (reactions), fever, arthralgias, neuritic pain, uveitis, and orchitis may occur.

Type 1 lepra reaction and erythema nodosum leprosum (type 2 lepra reaction) are 2 types of reactive states seen during alteration of the patient's immune response. They can occur before, during, or after therapy. Lucio phenomenon is a rare reaction seen in patients with multibacillary leprosy due to endothelial invasion of M leprae.

Mycobacterium lepromatosis is a newly identified mycobacterium that usually causes diffuse LL or LL. Cases of BL leprosy have also been reported, as have those with Lucio phenomenon and erythema nodosum leprosum.

Codes

ICD10CM:
A30.9 – Leprosy, unspecified

SNOMEDCT:
81004002 – Leprosy

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Hypopigmented patches:
Erythematous macules:
Isolated plaques:
Nodules:
Infiltrative plaques:
Histoid leprosy clinically simulates:

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Therapy

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References

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Last Reviewed:07/04/2022
Last Updated:07/05/2022
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Leprosy in Adult
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A medical illustration showing key findings of Leprosy (Tuberculoid Leprosy) : Numbness/tingling, Chronic duration lasting years, Foot drop, Hypopigmented patch, Neuropathy peripheral, Paresthesias, Annular configuration
Clinical image of Leprosy - imageId=49440. Click to open in gallery. caption: 'Numerous reddish-brown plaques and nodules on the arm.'
Numerous reddish-brown plaques and nodules on the arm.

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