Leprosy, also known as Hansen's disease (HD), is a long-term infection by the

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...

'' Mycobacterium leprae'' or '' Mycobacterium lepromatosis''. Infection can lead to damage of the

nerves A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the e ...

respiratory tract The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa. Air is breathed in through the nose to ...

, skin, and eyes. This nerve damage may result in a lack of ability to feel pain, which can lead to the loss of parts of a person's extremities from repeated injuries or infection through unnoticed wounds. An infected person may also experience muscle weakness and poor eyesight. Leprosy symptoms may begin within one year, but, for some people, symptoms may take 20 years or more to occur. Leprosy is spread between people, although extensive contact is necessary. Leprosy has a low

pathogenicity In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a ger ...

, and 95% of people who contract ''M. leprae'' do not develop the disease. Spread is thought to occur through a cough or contact with fluid from the nose of a person infected by leprosy. Genetic factors and immune function play a role in how easily a person catches the disease. Leprosy does not spread during

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

to the unborn child or through sexual contact. Leprosy occurs more commonly among people living in poverty. There are two main types of the disease – paucibacillary and multibacillary, which differ in the number of bacteria present. A person with paucibacillary disease has five or fewer poorly-pigmented, numb skin patches, while a person with multibacillary disease has more than five skin patches. The diagnosis is confirmed by finding

acid-fast Acid-fastness is a physical property of certain bacterial and eukaryotic cells, as well as some sub-cellular structures, specifically their resistance to decolorization by acids during laboratory staining procedures. Once stained as part of a s ...

bacilli in a biopsy of the skin. Leprosy is curable with multidrug therapy. Treatment of paucibacillary leprosy is with the medications

dapsone Dapsone, also known as 4,4'-sulfonyldianiline (SDA) or diaminodiphenyl sulfone (DDS), is an antibiotic commonly used in combination with rifampicin and clofazimine for the treatment of leprosy. It is a second-line medication for the treatment ...

rifampicin Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), ''Mycobacterium avium'' complex, leprosy, and Legionnaires’ disease. It is almost always used ...

, and clofazimine for six months. Treatment for multibacillary leprosy uses the same medications for 12 months. A number of other antibiotics may also be used. These treatments are provided free of charge by the

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...

. Leprosy is not highly contagious. People with leprosy can live with their families and go to school and work. In the 1980s, there were 5.2 million cases globally but went down to less than 0.2 million by 2020. Most new cases occur in 14 countries, with India accounting for more than half. In the 20 years from 1994 to 2014, 16 million people worldwide were cured of leprosy. About 200 cases per year are reported in the United States. Separating people affected by leprosy by placing them in

leper colonies A leper colony, also known by many other names, is an isolated community for the quarantining and treatment of lepers, people suffering from leprosy. ''M. leprae'', the bacterium responsible for leprosy, is believed to have spread from East Af ...

still occurs in some areas of India, China, areas in the African continent, and Thailand. Leprosy has affected humanity for thousands of years. The disease takes its name from the

Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...

word grc, λέπρᾱ, label=none (), from grc, λεπῐ́ς, label=none (; 'scale'), while the term "Hansen's disease" is named after the Norwegian physician Gerhard Armauer Hansen. Leprosy has historically been associated with

social stigma Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, ra ...

, which continues to be a barrier to self-reporting and early treatment. Some consider the word ''leper'' offensive, preferring the phrase "person affected with leprosy". Leprosy is classified as a

neglected tropical disease Neglected tropical diseases (NTDs) are a diverse group of tropical infections that are common in low-income populations in developing regions of Africa, Asia, and the Americas. They are caused by a variety of pathogens, such as viruses, bac ...

World Leprosy Day World Leprosy Day is observed internationally every year on the last Sunday of January to increase the public awareness of leprosy or Hansen's Disease. This date was chosen by French humanitarian Raoul Follereau as a tribute to the life of Mahat ...

was started in 1954 to draw awareness to those affected by leprosy.

Signs and symptoms

Common symptoms present in the different types of leprosy include a runny nose; dry

scalp The scalp is the anatomical area bordered by the human face at the front, and by the neck at the sides and back. Structure The scalp is usually described as having five layers, which can conveniently be remembered as a mnemonic: * S: The s ...

; eye problems; skin lesions; muscle weakness; reddish skin; smooth, shiny, diffuse thickening of facial skin, ear, and hand; loss of sensation in fingers and toes; thickening of peripheral nerves; a flat nose from destruction of nasal cartilage; and changes in phonation and other aspects of speech production. In addition, atrophy of the testes and impotence may occur. Leprosy can affect people in different ways. The average

incubation period Incubation period (also known as the latent period or latency period) is the time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent. In a typical infectious disease, the in ...

is five years. People may begin to notice symptoms within the first year or up to 20 years after infection. The first noticeable sign of leprosy is often the development of pale or pink coloured patches of skin that may be insensitive to temperature or pain. Patches of discolored skin are sometimes accompanied or preceded by nerve problems including numbness or tenderness in the hands or feet.

Secondary infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

s (additional bacterial or viral infections) can result in tissue loss, causing fingers and toes to become shortened and deformed, as cartilage is absorbed into the body. A person's immune response differs depending on the form of leprosy. Approximately 30% of people affected with leprosy experience nerve damage. The nerve damage sustained is reversible when treated early, but becomes permanent when appropriate treatment is delayed by several months. Damage to nerves may cause loss of muscle function, leading to paralysis. It may also lead to sensation abnormalities or

numbness Hypoesthesia or numbness is a common side effect of various medical conditions that manifests as a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli. In everyday speech this is generally referred to as nu ...

, which may lead to additional infections, ulcerations, and joint deformities. File:Paucibacillary leprosy (PB).jpg, Paucibacillary leprosy (PB): Pale skin patch with loss of sensation File:Leprosy thigh demarcated cutaneous lesions.jpg, Skin lesions on the thigh of a person with leprosy File:Leprosy deformities hands.jpg, Hands deformed by leprosy

Cause

''M. leprae'' and ''M. lepromatosis''

Mycobacterium leprae in Magnification of 2000X

''M. leprae'' and ''M. lepromatosis'' are the mycobacteria that cause leprosy. ''M. lepromatosis'' is a relatively newly identified mycobacterium isolated from a fatal case of

diffuse lepromatous leprosy Diffusion is the net movement of anything (for example, atoms, ions, molecules, energy) generally from a region of higher concentration to a region of lower concentration. Diffusion is driven by a gradient in Gibbs free energy or chemical ...

in 2008. ''M. lepromatosis'' is indistinguishable clinically from ''M. leprae''. ''M. leprae'' is an intracellular, acid-fast

bacterium Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were a ...

that is aerobic and rod-shaped. ''M. leprae'' is surrounded by the waxy cell envelope coating characteristic of the genus ''

Mycobacterium ''Mycobacterium'' is a genus of over 190 species in the phylum Actinomycetota, assigned its own family, Mycobacteriaceae. This genus includes pathogens known to cause serious diseases in mammals, including tuberculosis (''M. tuberculosis'') and l ...

''. Genetically, ''M. leprae'' and ''M. lepromatosis'' lack the

gene In biology, the word gene (from , ; "... Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation'' or ''birth'' or ''gender'') can have several different meanings. The Mendelian gene is a b ...

s that are necessary for independent growth. ''M. leprae'' and ''M. lepromatosis'' are obligate intracellular pathogens, and can not be grown (

cultured Culture () is an umbrella term which encompasses the social behavior, institutions, and norms found in human societies, as well as the knowledge, beliefs, arts, laws, customs, capabilities, and habits of the individuals in these groups.Tylor ...

) in the laboratory. The inability to culture ''M. leprae'' and ''M. lepromatosis'' has resulted in a difficulty definitively identifying the bacterial organism under a strict interpretation of

Koch's postulates Koch's postulates ( )"Koch"
''

While the causative organisms have to date been impossible to culture ''in vitro'', it has been possible to grow them in animals such as

mice A mouse ( : mice) is a small rodent. Characteristically, mice are known to have a pointed snout, small rounded ears, a body-length scaly tail, and a high breeding rate. The best known mouse species is the common house mouse (''Mus musculus' ...

and

armadillo Armadillos (meaning "little armored ones" in Spanish) are New World placental mammals in the order Cingulata. The Chlamyphoridae and Dasypodidae are the only surviving families in the order, which is part of the superorder Xenarthra, al ...

s. Naturally occurring infection has been reported in nonhuman primates (including the African chimpanzee, the

sooty mangabey The sooty mangabey (''Cercocebus atys'') is an Old World monkey found in forests from Senegal in a margin along the coast down to the Ivory Coast. Habitat and ecology The sooty mangabey is native to tropical West Africa, being found in Guinea, ...

, and the cynomolgus macaque), armadillos, and red squirrels.

Multilocus sequence typing Multilocus sequence typing (MLST) is a technique in molecular biology for the typing of multiple loci, using DNA sequences of internal fragments of multiple housekeeping genes to characterize isolates of microbial species. The first MLST scheme ...

of the armadillo ''M. leprae'' strains suggests that they were of human origin for at most a few hundred years. Thus, it is suspected that armadillos first acquired the organism incidentally from early American explorers. This incidental transmission was sustained in the armadillo population, and it may be transmitted back to humans, making leprosy a zoonotic disease (spread between humans and animals). Red squirrels (''Sciurus vulgaris''), a threatened species in

Great Britain Great Britain is an island in the North Atlantic Ocean off the northwest coast of continental Europe. With an area of , it is the largest of the British Isles, the largest European island and the ninth-largest island in the world. It is ...

, were found to carry leprosy in November 2016. It has been suggested that the trade in red squirrel fur, highly prized in the medieval period and intensively traded, may have been responsible for the leprosy epidemic in medieval Europe. A pre-Norman-era skull excavated in Hoxne, Suffolk, in 2017 was found to carry DNA from a strain of ''Mycobacterium leprae,'' which closely matched the strain carried by modern red squirrels on

Brownsea Island Brownsea Island is the largest of the islands in Poole Harbour in the county of Dorset, England. The island is owned by the National Trust with the northern half managed by the Dorset Wildlife Trust. Much of the island is open to the public an ...

, UK.

Risk factors

The greatest risk factor for developing leprosy is contact with another person infected by leprosy. People who are exposed to a person who has leprosy are 5–8 times more likely to develop leprosy than members of the general population. Leprosy also occurs more commonly among those living in poverty. Not all people who are infected with ''M. leprae'' develop symptoms. Conditions that reduce immune function, such as malnutrition, other illnesses, or genetic mutations, may increase the risk of developing leprosy. Infection with

HIV The human immunodeficiency viruses (HIV) are two species of '' Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immu ...

does not appear to increase the risk of developing leprosy. Certain genetic factors in the person exposed have been associated with developing lepromatous or tuberculoid leprosy.

Transmission

Transmission of leprosy occurs during close contact with those who are infected. Transmission of leprosy is through the upper

. Older research suggested the skin as the main route of transmission, but recent research has increasingly favored the respiratory route. Leprosy is not sexually transmitted and is not spread through pregnancy to the unborn child. The majority (95%) of people who are exposed to ''M. leprae'' do not develop leprosy; casual contact such as shaking hands and sitting next to someone with leprosy does not lead to transmission. People are considered non-infectious 72 hours after starting appropriate multi-drug therapy. Two exit routes of ''M. leprae'' from the human body often described are the skin and the nasal mucosa, although their relative importance is not clear. Lepromatous cases show large numbers of organisms deep in the dermis, but whether they reach the skin surface in sufficient numbers is doubtful. Leprosy may also be transmitted to humans by

s, although the mechanism is not fully understood.

Genetics

Not all people who are infected or exposed to ''M. leprae'' develop leprosy, and genetic factors are suspected to play a role in susceptibility to an infection. Cases of leprosy often cluster in families and several genetic variants have been identified. In many people who are exposed, the immune system is able to eliminate the leprosy bacteria during the early infection stage before severe symptoms develop. A genetic defect in

cell-mediated immunity Cell-mediated immunity or cellular immunity is an immune response that does not involve antibodies. Rather, cell-mediated immunity is the activation of phagocytes, antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines ...

may cause a person to be susceptible to develop leprosy symptoms after exposure to the bacteria. The region of DNA responsible for this variability is also involved in

Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...

, giving rise to current speculation that the two disorders may be linked at the biochemical level.

Mechanism

Most leprosy complications are the result of nerve damage. The nerve damage occurs from direct invasion by the ''M. leprae'' bacteria and a person's immune response resulting in inflammation. The molecular mechanism underlying how ''M. leprae'' produces the symptoms of leprosy is not clear, but ''M. leprae'' has been shown to bind to

Schwann cell Schwann cells or neurolemmocytes (named after German physiologist Theodor Schwann) are the principal glia of the peripheral nervous system (PNS). Glial cells function to support neurons and in the PNS, also include satellite cells, olfactory ...

s, which may lead to nerve injury including

demyelination A demyelinating disease is any disease of the nervous system in which the myelin sheath of neurons is damaged. This damage impairs the conduction of signals in the affected nerves. In turn, the reduction in conduction ability causes deficiency i ...

and a loss of nerve function (specifically a loss of

axon An axon (from Greek ἄξων ''áxōn'', axis), or nerve fiber (or nerve fibre: see spelling differences), is a long, slender projection of a nerve cell, or neuron, in vertebrates, that typically conducts electrical impulses known as action ...

al conductance). Numerous molecular mechanisms have been associated with this nerve damage including the presence of a

laminin Laminins are a family of glycoproteins of the extracellular matrix of all animals. They are major components of the basal lamina (one of the layers of the basement membrane), the protein network foundation for most cells and organs. The laminin ...

-binding

protein Proteins are large biomolecules and macromolecules that comprise one or more long chains of amino acid residues. Proteins perform a vast array of functions within organisms, including catalysing metabolic reactions, DNA replication, respon ...

and the glycoconjugate (PGL-1) on the surface of ''M. leprae'' that can bind to laminin on peripheral nerves. As part of the human immune response,

white blood cell White blood cells, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from mult ...

-derived macrophages may engulf ''M. leprae'' by

phagocytosis Phagocytosis () is the process by which a cell uses its plasma membrane to engulf a large particle (≥ 0.5 μm), giving rise to an internal compartment called the phagosome. It is one type of endocytosis. A cell that performs phagocytosis i ...

. In the initial stages, small sensory and

autonomic nerve The autonomic nerve is a small nerve which carries postganglionic sympathetic and parasympathetic neurons from the zygomaticotemporal nerve; a branch of the maxillary nerve, to the lacrimal nerve; a branch of the ophthalmic nerve. These neurons ...

fibers in the skin of a person with leprosy are damaged. This damage usually results in hair loss to the area, a loss of the ability to sweat, and numbness (decreased ability to detect sensations such as temperature and touch). Further peripheral nerve damage may result in skin dryness, more numbness, and muscle weaknesses or paralysis in the area affected. The skin can crack and if the skin injuries are not carefully cared for, there is a risk for a secondary infection that can lead to more severe damage.

Diagnosis

In countries where people are frequently infected, a person is considered to have leprosy if they have one of the following two signs: * Skin lesion consistent with leprosy and with definite sensory loss."Diagnosis of Leprosy." WHO. from accessed on 14 July 2014. * Positive skin smears. Skin lesions can be single or many, and usually

hypopigmented Hypopigmentation is characterized specifically as an area of skin becoming lighter than the baseline skin color, but not completely devoid of pigment. This is not to be confused with depigmentation, which is characterized as the absence of all pi ...

, although occasionally reddish or copper-colored. The lesions may be flat (

macule A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of thi ...

s), raised (

papule A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some ha ...

s), or solid elevated areas ( nodular). Experiencing sensory loss at the skin lesion is a feature that can help determine if the lesion is caused by leprosy or by another disorder such as tinea versicolor. Thickened nerves are associated with leprosy and can be accompanied by loss of sensation or muscle weakness, but muscle weakness without the characteristic skin lesion and sensory loss is not considered a reliable sign of leprosy. In some cases,

leprosy

bacilli Bacilli is a taxonomic class of bacteria that includes two orders, Bacillales and Lactobacillales, which contain several well-known pathogens such as ''Bacillus anthracis'' (the cause of anthrax). ''Bacilli'' are almost exclusively gram-posit ...

in skin smears are considered diagnostic; however, the diagnosis is typically made without laboratory tests, based on symptoms. If a person has a new leprosy diagnosis and already has a visible disability caused by leprosy, the diagnosis is considered late. In countries or areas where leprosy is uncommon, such as the United States, diagnosis of leprosy is often delayed because healthcare providers are unaware of leprosy and its symptoms. Early diagnosis and treatment prevent nerve involvement, the hallmark of leprosy, and the disability it causes.U.S. Department of Health and Human Services, Health Resources and Services Administration. (n.d.). National Hansen's disease (leprosy) program Retrieved from There is no recommended test to diagnose latent leprosy in people without symptoms. Few people with latent leprosy test positive for anti PGL-1. The presence of ''M. leprae'' bacterial DNA can be identified using a

polymerase chain reaction The polymerase chain reaction (PCR) is a method widely used to rapidly make millions to billions of copies (complete or partial) of a specific DNA sample, allowing scientists to take a very small sample of DNA and amplify it (or a part of it) ...

(PCR)-based technique. This molecular test alone is not sufficient to diagnose a person, but this approach may be used to identify someone who is at high risk of developing or transmitting leprosy such as those with few lesions or an atypical clinical presentation.

Classification

Several different approaches for classifying leprosy exist. There are similarities between the classification approaches. * The World Health Organization system distinguishes "paucibacillary" and "multibacillary" based upon the proliferation of bacteria. (" pauci-" refers to a low quantity.) * The Ridley-Jopling scale provides five gradations. * The

ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms ...

, though developed by the WHO, uses Ridley-Jopling and not the WHO system. It also adds an indeterminate ("I") entry."What Is Leprosy?", from News-Medical.Net – Latest Medical News and Research from Around the World. Web. 20 Nov. 2010. . * In

MeSH A mesh is a barrier made of connected strands of metal, fiber, or other flexible or ductile materials. A mesh is similar to a web or a net in that it has many attached or woven strands. Types * A plastic mesh may be extruded, oriented, e ...

, three groupings are used. Leprosy may also occur with only neural involvement, without skin lesions.

Prevention

Early detection of the disease is important, since physical and neurological damage may be irreversible even if cured. Medications can decrease the risk of those living with people who have leprosy from acquiring the disease and likely those with whom people with leprosy come into contact outside the home. The WHO recommends that preventive medicine be given to people who are in close contact with someone who has leprosy. The suggested preventive treatment is a single dose of rifampicin (SDR) in adults and children over 2 years old who do not already have leprosy or tuberculosis. Preventive treatment is associated with a 57% reduction in infections within 2 years and a 30% reduction in infections within 6 years. The Bacillus Calmette–Guérin (BCG) vaccine offers a variable amount of protection against leprosy in addition to its closely related target of

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in w ...

. It appears to be 26% to 41% effective (based on controlled trials) and about 60% effective based on observational studies with two doses possibly working better than one. The WHO concluded in 2018 that the BCG vaccine at birth reduces leprosy risk and is recommended in countries with high incidence of TB and people who have leprosy. People living in the same home as a person with leprosy are suggested to take a BCG booster which may improve their immunity by 56%. Development of a more effective vaccine is ongoing. A novel vaccine called LepVax entered clinical trials in 2017 with the first encouraging results reported on 24 participants published in 2020. If successful, this would be the first leprosy-specific vaccine available.

Treatment

Anti-leprosy medication

A number of

leprostatic agent A leprostatic agent is a drug that interferes with proliferation of the bacterium that causes leprosy. The following agents are leprostatic agents: * acedapsone * clofazimine * dapsone * desoxyfructo-serotonin * diucifon * ethionamide * rifamp ...

s are available for treatment. A three-drug regimen of

and clofazimine is recommended for all people with leprosy, for six months for paucibacillary leprosy and 12 months for multibacillary leprosy. Multidrug therapy (MDT) remains highly effective, and people are no longer infectious after the first monthly dose. It is safe and easy to use under field conditions because of its presentation in calendar blister packs. Post-treatment relapse rates remain low. Resistance has been reported in several countries, although the number of cases is small. People with rifampicin-resistant leprosy may be treated with second line drugs such as fluoroquinolones, minocycline, or

clarithromycin Clarithromycin, sold under the brand name Biaxin among others, is an antibiotic used to treat various bacterial infections. This includes strep throat, pneumonia, skin infections, '' H. pylori'' infection, and Lyme disease, among others. Clar ...

, but the treatment duration is 24 months because of their lower

bactericidal A bactericide or bacteriocide, sometimes abbreviated Bcidal, is a substance which kills bacteria. Bactericides are disinfectants, antiseptics, or antibiotics. However, material surfaces can also have bactericidal properties based solely on their ...

activity. Evidence on the potential benefits and harms of alternative regimens for drug-resistant leprosy is not yet available.

Skin changes

For people with nerve damage, protective footwear may help prevent ulcers and secondary infection. Canvas shoes may be better than PVC boots. There may be no difference between double rocker shoes and below-knee plaster. Topical ketanserin seems to have a better effect on ulcer healing than clioquinol cream or zinc paste, but the evidence for this is weak.

Phenytoin Phenytoin (PHT), sold under the brand name Dilantin among others, is an anti-seizure medication. It is useful for the prevention of tonic-clonic seizures (also known as grand mal seizures) and focal seizures, but not absence seizures. The intr ...

applied to the skin improves skin changes to a greater degree when compared to saline dressings.

Outcomes

Although leprosy has been curable since the mid-20th century, left untreated it can cause permanent physical impairments and damage to a person's nerves, skin, eyes, and limbs. Despite leprosy not being very infectious and having a low pathogenicity, there is still significant stigma and prejudice associated with the disease. Because of this stigma, leprosy can affect a person's participation in social activities and may also affect the lives of their family and friends. People with leprosy are also at a higher risk for problems with their mental well-being. The social stigma may contribute to problems obtaining employment, financial difficulties, and social isolation. Efforts to reduce discrimination and reduce the stigma surrounding leprosy may help improve outcomes for people with leprosy.

Epidemiology

Leprosy new case detection 2016 rates, 2016 (cropped)

In 2018, there were 208,619 new cases of leprosy recorded, a slight decrease from 2017. In 2015, 94% of the new leprosy cases were confined to 14 countries. India reported the greatest number of new cases (60% of reported cases), followed by

Brazil Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...

(13%) and

Indonesia Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania between the Indian and Pacific oceans. It consists of over 17,000 islands, including Sumatra, Java, Sulawesi, and parts of Borneo and New Guine ...

(8%). Although the number of cases worldwide continues to fall, there are parts of the world where leprosy is more common, including Brazil, South Asia (India, Nepal, Bhutan), some parts of Africa (Tanzania, Madagascar, Mozambique), and the western Pacific. About 150 to 250 cases are diagnosed in the United States each year. In the 1960s, there were tens of millions of leprosy cases recorded when the bacteria started to develop resistance to

, the most common treatment option at the time. International (e.g., the WHO's "Global Strategy for Reducing Disease Burden Due to Leprosy") and national (e.g., the International Federation of Anti-Leprosy Associations) initiatives have reduced the total number and the number of new cases of the disease.

Disease burden

The number of new leprosy cases is difficult to measure and monitor because of leprosy's long incubation period, delays in diagnosis after onset of the disease, and lack of medical care in affected areas. The registered

prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...

of the disease is used to determine disease burden. Registered prevalence is a useful proxy indicator of the disease burden, as it reflects the number of active leprosy cases diagnosed with the disease and receiving treatment with MDT at a given point in time. The prevalence rate is defined as the number of cases registered for MDT treatment among the population in which the cases have occurred, again at a given point in time.

History

Historical distribution

Using

comparative genomics Comparative genomics is a field of biological research in which the genomic features of different organisms are compared. The genomic features may include the DNA sequence, genes, gene order, regulatory sequences, and other genomic structural ...

, in 2005, geneticists traced the origins and worldwide distribution of leprosy from East Africa or the Near East along human migration routes. They found four strains of ''M. leprae'' with specific regional locations. Strain 1 occurs predominantly in Asia, the Pacific region, and East Africa; strain 4, in West Africa and the Caribbean; strain 3 in Europe, North Africa, and the Americas; and strain 2 only in Ethiopia,

Malawi Malawi (; or aláwi Tumbuka: ''Malaŵi''), officially the Republic of Malawi, is a landlocked country in Southeastern Africa that was formerly known as Nyasaland. It is bordered by Zambia to the west, Tanzania to the north and northe ...

, Nepal, north India, and New Caledonia. This confirms the spread of the disease along the migration, colonisation, and slave trade routes taken from East Africa to India, West Africa to the New World, and from Africa into Europe and vice versa. Skeletal remains discovered in 2009 represent the oldest documented evidence for leprosy, dating to the 2nd millennium BC. Located at Balathal,

Rajasthan Rajasthan (; lit. 'Land of Kings') is a state in northern India. It covers or 10.4 per cent of India's total geographical area. It is the largest Indian state by area and the seventh largest by population. It is on India's northwestern s ...

, in northwest

India India, officially the Republic of India ( Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the ...

, the discoverers suggest that, if the disease did migrate from Africa to India during the

3rd millennium BC The 3rd millennium BC spanned the years 3000 through 2001 BC. This period of time corresponds to the Early to Middle Bronze Age, characterized by the early empires in the Ancient Near East. In Ancient Egypt, the Early Dynastic Period is follow ...

"at a time when there was substantial interaction among the Indus Civilization, Mesopotamia, and Egypt, there needs to be additional skeletal and molecular evidence of leprosy in India and Africa to confirm the African origin of the disease." A proven human case was verified by DNA taken from the shrouded remains of a man discovered in a tomb next to the

Old City Old City often refers to old town, the historic or original core of a city or town. Old City may refer to several places: Historical cities or regions of cities ''(by country)'' *Old City (Baku), Azerbaijan * Old City (Dhaka), Bangladesh, also ca ...

Jerusalem Jerusalem (; he, יְרוּשָׁלַיִם ; ar, القُدس ) (combining the Biblical and common usage Arabic names); grc, Ἱερουσαλήμ/Ἰεροσόλυμα, Hierousalḗm/Hierosóluma; hy, Երուսաղեմ, Erusałēm. i ...

, Palestine, dated by radiocarbon methods to the first half of the

1st century The 1st century was the century spanning AD 1 ( I) through AD 100 ( C) according to the Julian calendar. It is often written as the or to distinguish it from the 1st century BC (or BCE) which preceded it. The 1st century is considered part of ...

. The oldest strains of leprosy known from Europe are from Great Chesterford in southeast England and dating back to AD 415–545. These findings suggest a different path for the spread of leprosy, meaning it may have originated in Western Eurasia. This study also indicates that there were more strains in Europe at the time than previously determined.

Discovery and scientific progress

Literary attestation of leprosy is unclear because of the ambiguity of many early sources, including the

n Atharvaveda and Kausika Sutra, the Egyptian Ebers papyrus, and the

Hebrew Hebrew (; ; ) is a Northwest Semitic language of the Afroasiatic language family. Historically, it is one of the spoken languages of the Israelites and their longest-surviving descendants, the Jews and Samaritans. It was largely preserved ...

Bible The Bible (from Koine Greek , , 'the books') is a collection of religious texts or scriptures that are held to be sacred in Christianity, Judaism, Samaritanism, and many other religions. The Bible is an anthologya compilation of texts o ...

's various sections regarding signs of impurity (''

tzaraath ''Tzaraath'' (Hebrew צָרַעַת ''ṣāraʿaṯ''), variously transcribed into English and frequently mistranslated as leprosy, describes various ritually unclean disfigurative conditions of the skin, hair of the beard and head, clothing ma ...

''). Clearly leprotic symptoms are attested in the Indian doctor

Sushruta Sushruta, or ''Suśruta'' (Sanskrit: सुश्रुत, IAST: , ) was an ancient Indian physician. The ''Sushruta Samhita'' (''Sushruta's Compendium''), a treatise ascribed to him, is one of the most important surviving ancient treatises on ...

's ''Compendium'', originally dating to c. 600 BC but only surviving in emended texts no earlier than the 5th century. They were separately described by

Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history o ...

in 460 BC. However, Hansen's disease probably did not exist in Greece or the

Middle East The Middle East ( ar, الشرق الأوسط, ISO 233: ) is a geopolitical region commonly encompassing Arabia (including the Arabian Peninsula and Bahrain), Asia Minor (Asian part of Turkey except Hatay Province), East Thrace (Europ ...

before the

Common Era Common Era (CE) and Before the Common Era (BCE) are year notations for the Gregorian calendar (and its predecessor, the Julian calendar), the world's most widely used calendar era. Common Era and Before the Common Era are alternatives to the ...

. In 1846, Francis Adams produced ''The Seven Books of Paulus Aegineta'' which included a commentary on all medical and surgical knowledge and descriptions and remedies to do with leprosy from the Romans, Greeks, and Arabs. Leprosy did not exist in the Americas before

colonization Colonization, or colonisation, constitutes large-scale population movements wherein migrants maintain strong links with their, or their ancestors', former country – by such links, gain advantage over other inhabitants of the territory. When ...

by modern Europeans nor did it exist in

Polynesia Polynesia () "many" and νῆσος () "island"), to, Polinisia; mi, Porinihia; haw, Polenekia; fj, Polinisia; sm, Polenisia; rar, Porinetia; ty, Pōrīnetia; tvl, Polenisia; tkl, Polenihia (, ) is a subregion of Oceania, made up of ...

until the middle of the 19th century. Distribution of leprosy around the world Wellcome L0032805

The causative agent of leprosy, ''M. leprae'', was discovered by G. H. Armauer Hansen in Norway in 1873, making it the first bacterium to be identified as causing disease in humans.

Treatment

The first effective treatment ( promin) became available in the 1940s. In the 1950s,

was introduced. The search for further effective antileprosy drugs led to the use of clofazimine and

in the 1960s and 1970s. Later, Indian scientist Shantaram Yawalkar and his colleagues formulated a combined therapy using rifampicin and dapsone, intended to mitigate bacterial resistance. Multi-drug therapy (MDT) combining all three drugs was first recommended by the WHO in 1981. These three antileprosy drugs are still used in the standard MDT regimens. Leprosy was once believed to be highly contagious and was treated with mercury, as was syphilis, which was first described in 1530. Many early cases thought to be leprosy could actually have been syphilis. Resistance has developed to initial treatment. Until the introduction of MDT in the early 1980s, leprosy could not be diagnosed and treated successfully within the community. Japan still has sanatoriums (although Japan's sanatoriums no longer have active leprosy cases, nor are survivors held in them by law). The importance of the nasal mucosa in the transmission of '' M leprae'' was recognized as early as 1898 by Schäffer, in particular, that of the ulcerated mucosa.''Arch Dermato Syphilis'' 1898; 44:159–74 The mechanism of plantar ulceration in leprosy and its treatment was first described by Dr

Ernest W Price Dr Ernest Woodward Price MD, FRCSE, DTM&H, OBE (20 July 1907 31 January 1990) was a missionary doctor, orthopaedic surgeon, leprosy specialist and the discoverer of podoconiosis, one of the neglected tropical diseases. A list of his publicatio ...

Etymology

The word "leprosy" comes from the Greek word "λέπος (lépos) – skin" and "λεπερός (leperós) – scaly man".

Society and culture

India

British India The provinces of India, earlier presidencies of British India and still earlier, presidency towns, were the administrative divisions of British governance on the Indian subcontinent. Collectively, they have been called British India. In one ...

enacted the Leprosy Act of 1898 which institutionalized those affected and segregated them by sex to prevent reproduction. The act was difficult to enforce but was repealed in 1983 only after multidrug therapy had become widely available. In 1983, the National Leprosy Elimination Programme, previously the National Leprosy Control Programme, changed its methods from surveillance to the treatment of people with leprosy. India still accounts for over half of the global disease burden. According to WHO, new cases in India during 2019 diminished to 114,451 patients (57% of the world's total new cases). Until 2019, one could justify a petition for divorce with the spouse's diagnosis of leprosy.

Treatment cost

Between 1995 and 1999, the WHO, with the aid of the Nippon Foundation, supplied all endemic countries with free multidrug therapy in blister packs, channeled through ministries of health. This free provision was extended in 2000 and again in 2005, 2010 and 2015 with donations by the multidrug therapy manufacturer

Novartis Novartis AG is a Swiss-American multinational pharmaceutical corporation based in Basel, Switzerland and Cambridge, Massachusetts, United States (global research).name="novartis.com">https://www.novartis.com/research-development/research-loc ...

through the WHO. In the latest agreement signed between the company and the WHO in October 2015, the provision of free multidrug therapy by the WHO to all endemic countries will run until the end of 2025. At the national level, nongovernment organizations affiliated with the national program will continue to be provided with an appropriate free supply of multidrug therapy by the WHO.

Historical texts

Written accounts of leprosy date back thousands of years. Various skin diseases translated as leprosy appear in the ancient Indian text, the ''

Atharava Veda The Atharva Veda (, ' from ' and ''veda'', meaning "knowledge") is the "knowledge storehouse of ''atharvāṇas'', the procedures for everyday life".Laurie Patton (2004), Veda and Upanishad, in ''The Hindu World'' (Editors: Sushil Mittal and G ...

'', by 600 BC. Another Indian text, the ''

Manusmriti The ''Manusmṛiti'' ( sa, मनुस्मृति), also known as the ''Mānava-Dharmaśāstra'' or Laws of Manu, is one of the many legal texts and constitution among the many ' of Hinduism. In ancient India According to consen ...

'' (200 BC), prohibited contact with those infected with the disease and made marriage to a person infected with leprosy punishable. The Hebraic root tsara or

tsaraath ''Tzaraath'' (Hebrew צָרַעַת ''ṣāraʿaṯ''), variously transcribed into English and frequently mistranslated as leprosy, describes various ritually unclean disfigurative conditions of the skin, hair of the beard and head, clothing mad ...

(צָרַע, – tsaw-rah' – to be struck with leprosy, to be leprous) and the Greek (λεπρός–lepros), are of broader classification than the more narrow use of the term related to Hansen's Disease. Any progressive skin disease (a whitening or splotchy bleaching of the skin, raised manifestations of scales, scabs, infections, rashes, etc....), as well as generalized molds and surface discoloration of any clothing, leather, or discoloration on walls or surfaces throughout homes all, came under the "law of leprosy" (Leviticus 14:54–57). Ancient sources such as the

Talmud The Talmud (; he, , Talmūḏ) is the central text of Rabbinic Judaism and the primary source of Jewish religious law ('' halakha'') and Jewish theology. Until the advent of modernity, in nearly all Jewish communities, the Talmud was the cen ...

(Sifra 63) make clear that'' tzaraath'' refers to various types of lesions or stains associated with ritual impurity and occurring on cloth, leather, or houses, as well as skin. Traditional Judaism and Jewish rabbinical authorities, both historical and modern, emphasize that the ''tsaraath'' of Leviticus is a spiritual ailment with no direct relationship to Hansen's disease or physical contagions. The relation of ''tsaraath'' to "leprosy" comes from translations of Hebrew Biblical texts into Greek and ensuing misconceptions. All three Synoptic Gospels of the

New Testament The New Testament grc, Ἡ Καινὴ Διαθήκη, transl. ; la, Novum Testamentum. (NT) is the second division of the Christian biblical canon. It discusses the teachings and person of Jesus, as well as events in first-century Christ ...

describe instances of

Jesus Jesus, likely from he, יֵשׁוּעַ, translit=Yēšūaʿ, label=Hebrew/Aramaic ( AD 30 or 33), also referred to as Jesus Christ or Jesus of Nazareth (among other names and titles), was a first-century Jewish preacher and religiou ...

healing people with leprosy
Matthew 8:1–4Mark 1:40–45
an
Luke 5:12–16
. The Bible's description of leprosy is congruous (if lacking detail) with the symptoms of modern leprosy, but the relationship between this disease, ''tzaraath'', and Hansen's disease has been disputed. The biblical perception that people with leprosy were unclean can be found in a passage from Leviticus 13: 44–46. While this text defines the leper as impure, it did not explicitly make a moral judgement on those with leprosy. Some

Early Christians Early Christianity (up to the First Council of Nicaea in 325) spread from the Levant, across the Roman Empire, and beyond. Originally, this progression was closely connected to already established Jewish centers in the Holy Land and the Jewish ...

believed that those affected by leprosy were being punished by God for sinful behavior. Moral associations have persisted throughout history. Pope

Gregory the Great Pope Gregory I ( la, Gregorius I; – 12 March 604), commonly known as Saint Gregory the Great, was the bishop of Rome from 3 September 590 to his death. He is known for instigating the first recorded large-scale mission from Rome, the Gregori ...

(540–604) and Isidor of Seville (560–636) considered people with the disease to be heretics.

Middle Ages

The social perception of leprosy in the general population was in general mixed. On one hand, people feared getting infected with the disease and thought of people suspected of leprosy to be unclean, untrustworthy, and occasionally morally corrupt. On the other hand, Jesus' interaction with lepers, the writing of church leaders and the Christian focus on charitable works led to viewing the lepers as "chosen by God" or seeing the disease as a means of obtaining access to heaven. Early medieval understanding of leprosy was influenced by early Christian writers such as

Gregory of Nazianzus Gregory of Nazianzus ( el, Γρηγόριος ὁ Ναζιανζηνός, ''Grēgorios ho Nazianzēnos''; ''Liturgy of the Hours'' Volume I, Proper of Saints, 2 January. – 25 January 390,), also known as Gregory the Theologian or Gregory N ...

John Chrysostom John Chrysostom (; gr, Ἰωάννης ὁ Χρυσόστομος; 14 September 407) was an important Early Church Father who served as archbishop of Constantinople. He is known for his preaching and public speaking, his denunciation of a ...

whose writing were later embraced by Byzantine and Latin writers. Gregory for example did not only compose sermons urging Christians to assist victims of the disease but also condemned pagans or Christians who justified rejecting lepers on the allegation that God had sent them the disease to punish them. As cases of leprosy increased during these years in the

Eastern Roman Empire The Byzantine Empire, also referred to as the Eastern Roman Empire or Byzantium, was the continuation of the Roman Empire primarily in its eastern provinces during Late Antiquity and the Middle Ages, when its capital city was Constantin ...

, becoming a major health issue, the ecclesiastic leaders of the time discussed how to assist those affected as well as change the attitude of society towards them. They also tried this by using the name "Holy disease" instead of the commonly used "Elephant's disease" (elephantiasis), implying that God did not create this disease to punish people but to purify them for heaven. Although not always successful in persuading the public and a cure was never found by Greek medicians, they created an environment where victims could get

palliative care Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wi ...

and were never expressly banned from society, as sometimes happened in Western Europe. Theodore Balsamon, a 12th century jurist in

Constantinople la, Constantinopolis ota, قسطنطينيه , alternate_name = Byzantion (earlier Greek name), Nova Roma ("New Rome"), Miklagard/Miklagarth ( Old Norse), Tsargrad ( Slavic), Qustantiniya (Arabic), Basileuousa ("Queen of Cities"), Megalopolis ( ...

noted that lepers were allowed to enter the same churches, cities and assemblies that healthy people attended. As the disease became more prevalent in Western Europe in the fifth century, first efforts to set up permanent institutions to house and feed lepers were made for instance by bishops in France at the end of the sixth century, such as in

Chalon-sur-Saône Chalon-sur-Saône (, literally ''Chalon on Saône'') is a city in the Saône-et-Loire department in the region of Bourgogne-Franche-Comté in eastern France. It is a sub-prefecture of the department. It is the largest city in the department; h ...

. The increase in hospitals or leprosaria (sing. leprosarium) that treated people with leprosy in the 12th and 13th century seems to indicate a rise in cases, possibly in connection with the increase in urbanification as well as returning crusaders from the Middle East. France alone had nearly 2,000 leprosaria during this period. Additionally to the new leprosia, further steps were taken by secular and religious leaders to prevent further spread of the disease. The

third Lateran Council The Third Council of the Lateran met in Rome in March 1179. Pope Alexander III presided and 302 bishops attended. The Catholic Church regards it as the eleventh ecumenical council. By agreement reached at the Peace of Venice in 1177 the bitte ...

of 1179 required lepers to have their own priests and churches and a 1346 edict by

King Edward King Edward may refer to: Monarchs of England and the United Kingdom * Edward the Elder (–924) * Edward the Martyr (–978) * Edward the Confessor (–1066) * Edward I of England (1239–1307) * Edward II of England (1284–1327) * Edward III o ...

expelled lepers from city limits. Segregation from mainstream society became common, and people with leprosy were often required to wear clothing that identified them as such or carry a bell announcing their presence. As in the East, it was the Church who took care of the lepers due to the still persisting moral stigma and who ran the leprosaria. Although the leprosaria in Western Europe removed the sick from society, they were never a place to quarantine them or from which they could not leave: lepers would go beg for alms for the upkeep of the leprosaria or meet with their families.

19th century

Norway

Norway was the location of a progressive stance on leprosy tracking and treatment and played an influential role in European understanding of the disease. In 1832, Dr. JJ Hjort conducted the first leprosy survey, thus establishing a basis for epidemiological surveys. Subsequent surveys resulted in the establishment of a national leprosy registry to study the causes of leprosy and for tracking the rate of infection. Early leprosy research throughout Europe was conducted by Norwegian scientists Daniel Cornelius Danielssen and

Carl Wilhelm Boeck Carl Wilhelm Boeck (December 15, 1808 – December 10, 1875) was a Norwegian dermatologist. He was born at Kongsberg in Buskerud, Norway. In 1831 he earned his medical degree from the University of Christiania (now University of Oslo). From 183 ...

. Their work resulted in the establishment of the National Leprosy Research and Treatment Center. Danielssen and Boeck believed the cause of leprosy transmission was hereditary. This stance was influential in advocating for the isolation of those infected by sex to prevent reproduction.

Colonialism and imperialism

Though leprosy in Europe was again on the decline by the 1860s, Western countries embraced isolation treatment out of fear of the spread of disease from

developing countries A developing country is a sovereign state with a lesser developed Industrial sector, industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is al ...

, minimal understanding of bacteriology, lack of diagnostic ability or knowledge of how contagious the disease was, and missionary activity. Growing

imperialism Imperialism is the state policy, practice, or advocacy of extending power and dominion, especially by direct territorial acquisition or by gaining political and economic control of other areas, often through employing hard power ( economic and ...

and pressures of the

industrial revolution The Industrial Revolution was the transition to new manufacturing processes in Great Britain, continental Europe, and the United States, that occurred during the period from around 1760 to about 1820–1840. This transition included going f ...

resulted in a Western presence in countries where leprosy was endemic, namely the British presence in India. Isolation treatment methods were observed by Surgeon-Mayor

Henry Vandyke Carter Henry Vandyke Carter (born 22 May 1831, Hull – 4 May 1897, Scarborough) was an English anatomist, surgeon, and anatomical artist most notable for his illustrations of the book '' Gray's Anatomy''. Childhood Henry Vandyke Carter was born on ...

of the British Colony in India while visiting Norway, and these methods were applied in India with the financial and logistical assistance of religious

missionaries A missionary is a member of a religious group which is sent into an area in order to promote its faith or provide services to people, such as education, literacy, social justice, health care, and economic development.Thomas Hale 'On Being a Mi ...

Colonial Colonial or The Colonial may refer to: * Colonial, of, relating to, or characteristic of a colony or colony (biology) Architecture * American colonial architecture * French Colonial * Spanish Colonial architecture Automobiles * Colonial (1920 a ...

and religious influence and associated stigma continued to be a major factor in the treatment and public perception of leprosy in endemic developing countries until the mid-twentieth century.

20th century

United States

The National Leprosarium at Carville, Louisiana, known in 1955 as the Louisiana Leper Home, was the only leprosy hospital on the mainland United States. Leprosy patients from all over the United States were sent to Carville in order to be kept in isolation away from the public, as not much about leprosy transmission was known at the time and stigma against those with leprosy was high (see Leprosy stigma). The Carville leprosarium was known for its innovations in reconstructive surgery for those with leprosy. In 1941, 22 patients at Carville underwent trials for a new drug called promin. The results were described as miraculous, and soon after the success of promin came

, a medicine even more effective in the fight against leprosy.

Stigma

Despite now effective treatment and education efforts, leprosy stigma continues to be problematic in developing countries where the disease is common. Leprosy is most common amongst impoverished populations where social stigma is likely to be compounded by poverty. Fears of ostracism, loss of employment, or expulsion from family and society may contribute to a delayed diagnosis and treatment. Folk beliefs, lack of education, and religious connotations of the disease continue to influence social perceptions of those affected in many parts of the world. In

, for example, folklore holds that leprosy is a disease transmitted by dogs, or that it is associated with sexual promiscuity, or that it is a punishment for sins or moral transgressions (distinct from other diseases and misfortunes, which are in general thought of as being according to the will of

God In monotheistic thought, God is usually viewed as the supreme being, creator, and principal object of faith. Swinburne, R.G. "God" in Honderich, Ted. (ed)''The Oxford Companion to Philosophy'', Oxford University Press, 1995. God is typically ...

). Socioeconomic factors also have a direct impact. Lower-class domestic workers who are often employed by those in a higher socioeconomic class may find their employment in jeopardy as physical manifestations of the disease become apparent. Skin discoloration and darker pigmentation resulting from the disease also have social repercussions. In extreme cases in northern India, leprosy is equated with an "untouchable" status that "often persists long after individuals with leprosy have been cured of the disease, creating lifelong prospects of divorce, eviction, loss of employment, and ostracism from family and social networks." File:Three Tahitians suffering from leprosy, Tahiti, approximately 1895.jpg, Leprosy in Tahiti, File:A 26 year old woman with leprous lesions Wellcome L0074857.jpg, A 26-year-old woman with leprous lesions File:13 year old boy with severe leprosy Wellcome L0074842.jpg, A 13-year-old boy with severe leprosy

Public policy

A goal of the World Health Organization is to "eliminate leprosy" and in 2016 the organization launched "Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world". Elimination of leprosy is defined as "reducing the proportion of leprosy patients in the community to very low levels, specifically to below one case per 10 000 population". Diagnosis and treatment with multidrug therapy are effective, and a 45% decline in disease burden has occurred since multidrug therapy has become more widely available. The organization emphasizes the importance of fully integrating leprosy treatment into public health services, effective diagnosis and treatment, and access to information. The approach includes supporting an increase in health care professionals who understand the disease, and a coordinated and renewed political commitment that includes coordination between countries and improvements in the methodology for collecting and analysing data. Interventions in the "Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world": * Early detection of cases focusing on children to reduce transmission and disabilities * Enhanced healthcare services and improved access for people who may be marginalized * For countries where leprosy is endemic, further interventions include an improved screening of close contacts, improved treatment regimens, and interventions to reduce stigma and discrimination against people who have leprosy.

Community-based interventions

In some instances in India, community-based rehabilitation is embraced by local governments and NGOs alike. Often, the identity cultivated by a community environment is preferable to reintegration, and models of self-management and collective agency independent of NGOs and government support have been desirable and successful.

Notable cases

Josephine Cafrine Theresa Josephine Cafrine (13 June 1877 – 14 January 1907) was a woman from Seychelles, known for writing about her suffering from leprosy. Her wounds were said to have miraculously healed upon her death. The journal that she kept documenting ...

Seychelles Seychelles (, ; ), officially the Republic of Seychelles (french: link=no, République des Seychelles; Creole: ''La Repiblik Sesel''), is an archipelagic state consisting of 115 islands in the Indian Ocean. Its capital and largest city, ...

had leprosy from the age of 12 and kept a personal journal that documented her struggles and suffering. It was published as an autobiography in 1923. * Saint Damien De Veuster, a Roman Catholic priest from Belgium, himself eventually contracting leprosy, ministered to lepers who had been placed under a government-sanctioned medical quarantine on the island of

Molokai Molokai , or Molokai (), is the fifth most populated of the eight major islands that make up the Hawaiian Islands archipelago in the middle of the Pacific Ocean. It is 38 by 10 miles (61 by 16 km) at its greatest length and width with a us ...

in the Kingdom of Hawaii. * Baldwin IV of Jerusalem was a Christian king of Latin Jerusalem who had leprosy. * Josefina Guerrero was a Filipino spy during

World War II World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the World War II by country, vast majority of the world's countries—including all of the great power ...

, who used the Japanese fear of her leprosy to listen to their battle plans and deliver the information to the American forces under Douglas MacArthur. * King

Henry IV of England Henry IV ( April 1367 – 20 March 1413), also known as Henry Bolingbroke, was King of England from 1399 to 1413. He asserted the claim of his grandfather King Edward III, a maternal grandson of Philip IV of France, to the Kingdom of Fr ...

(reigned 1399 to 1413) possibly had leprosy. * Vietnamese poet

Hàn Mặc Tử Francis Nguyễn Trọng Trí, penname Hàn Mặc Tử (September 22, 1912 – November 11, 1940), was a Vietnamese poet. He was the most celebrated Vietnamese Catholic literary figure during the colonial era. He was born Nguyễn Trọng Trí, ...

* Ōtani Yoshitsugu, a Japanese ''

daimyō were powerful Japanese magnates, feudal lords who, from the 10th century to the early Meiji period in the middle 19th century, ruled most of Japan from their vast, hereditary land holdings. They were subordinate to the shogun and nominall ...

Leprosy in the media

* English author Graham Greene's novel '' A Burnt-Out Case'' is set in a leper colony in Belgian Congo. The story is also predominantly about a disillusioned architect working with a doctor on devising new cure and amenities for mutilated victims of lepers; the title, too, refers to the condition of mutilation and disfigurement in the disease. * Forugh Farrokhzad made a 22-minute documentary about a leprosy colony in Iran in 1962 titled '' The House Is Black''. The film humanizes the people affected and opens by saying that "there is no shortage of ugliness in the world, but by closing our eyes on ugliness, we will intensify it." *Moloka'i is a novel by

Alan Brennert Alan Brennert (born May 30, 1954 in Englewood, New Jersey) is an American author, television producer, and screenwriter. Brennert has lived in Southern California since 1973 and completed graduate work in screenwriting at the University of Cal ...

about a leper colony in Hawaii. This novel follows the story of a seven-year-old girl taken from her family and put on the small Hawaiian island of

's leper settlement. Even though this is a fiction novel it is based upon some very true and revealing incidents which occurred at this Leprosy settlement. *Jack London in 1909 published

Koolau the Leper John Griffith Chaney (January 12, 1876 – November 22, 1916), better known as Jack London, was an American novelist, journalist and activist. A pioneer of commercial fiction and American magazines, he was one of the first American authors to ...

in his ''Tales of Hawai'i'' about Molokai and people consigned to it circa 1893. * The lead character in

The Chronicles of Thomas Covenant ''The Chronicles of Thomas Covenant'' is a series of ten high fantasy novels written by American author Stephen R. Donaldson. The series began as a trilogy, entitled ''The Chronicles of Thomas Covenant, the Unbeliever''. This was followed by ano ...

by Stephen R. Donaldson suffers from leprosy. His condition seems to be cured by the magic of the fantasy land he finds himself in, but he resists believing in its reality, for example, by continuing to perform a regular

visual surveillance of extremities Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria '' Mycobacterium leprae'' or '' Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve da ...

as a safety check. Donaldson gained experience with the disease as a young man in India, where his father worked in a missionary for people with leprosy. * In George R. R. Martin's '' Fire and Blood'' and its TV adaptation ''

House of the Dragon ''House of the Dragon'' is an American fantasy drama television series created by George R. R. Martin and Ryan Condal for HBO. A prequel to ''Game of Thrones'' (2011–2019), it is the second TV show in the ''A Song of Ice and Fire'' franchi ...

'', King

Viserys I Targaryen ''The Princess and the Queen, or, the Blacks and the Greens'' is an epic fantasy novella by American novelist George R. R. Martin, published in the 2013 Tor Books anthology '' Dangerous Women''. The novella is presented in the form of writings ...

suffered a debilitating disease where parts of his body developed lesions and slowly rotted away over time. In the lore of the books, this was partly attributed to the Iron Throne, the physical and metaphorical seat of the ruler, rejecting monarchs unworthy of bearing the crown. However, the actor playing the role of Viserys in the TV series, Paddy Considine, explained on a

podcast A podcast is a program made available in digital format for download over the Internet. For example, an episodic series of digital audio or video files that a user can download to a personal device to listen to at a time of their choosing ...

with

Entertainment Weekly ''Entertainment Weekly'' (sometimes abbreviated as ''EW'') is an American digital-only entertainment magazine based in New York City, published by Dotdash Meredith, that covers film, television, music, Broadway theatre, books, and popular cult ...

that Viserys actually suffered from "a form of leprosy".

Infection of animals

Wild nine-banded armadillos (''Dasypus novemcinctus'') in south central United States often carry ''Mycobacterium leprae''. This is believed to be because armadillos have a low body temperature. Leprosy lesions appear mainly in cooler body regions such as the skin and mucous membranes of the upper respiratory tract. Because of armadillos' armor, skin lesions are hard to see. Abrasions around the eyes, nose and feet are the most common signs. Infected armadillos make up a large reservoir of ''M. leprae'' and may be a source of infection for some humans in the United States or other locations in the armadillos' home range. In armadillo leprosy, lesions do not persist at the site of entry in animals, ''M. leprae'' multiply in macrophages at the site of inoculation and lymph nodes. A recent outbreak in chimpanzees in West Africa is showing that the bacteria can infect another species and also possibly have additional rodent hosts. Recent studies have demonstrated that the disease is endemic in the UK red Eurasian squirrel population, with ''Mycobacterium leprae'' and ''Mycobacterium lepromatosis'' appearing in different populations. The Mycobacteria leprae strain discovered on

is equated to one thought to have died out in the human population in mediaeval times. Despite this, and speculation regarding past transmission through trade in squirrel furs, there does not seem to be a high risk of squirrel to human transmission from the wild population: although leprosy continues to be diagnosed in immigrants to the UK, the last known human case of leprosy arising in the UK was recorded over 200 years ago. It has been shown that leprosy can reprogram cells in mouse and armadillos models similarly as how

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Oct3/4 Oct-4 ( octamer-binding transcription factor 4), also known as POU5F1 (POU domain, class 5, transcription factor 1), is a protein that in humans is encoded by the ''POU5F1'' gene. Oct-4 is a homeodomain transcription factor of the POU family. ...

, Sox2 and Klf4.

References

External links

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Signs and symptoms

Cause

''M. leprae'' and ''M. lepromatosis''

Risk factors

Transmission

Genetics

Mechanism

Diagnosis

Classification

Prevention

Treatment

Anti-leprosy medication

Skin changes

Outcomes

Epidemiology

Disease burden

History

Historical distribution

Discovery and scientific progress

Treatment

Etymology

Society and culture

India

Treatment cost

Historical texts

Middle Ages

19th century

Norway

Colonialism and imperialism

20th century

United States

Stigma

Public policy

Community-based interventions

Notable cases

Leprosy in the media

Infection of animals

See also

References

Further reading

External links