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Knowing Leprosy or ​​Leprosy, Diseases That are Often Late Detected

Leprosy, better known as Morbus Hansen or leprosy is a chronic skin infection caused by the bacterium  Mycobacterium leprae. Leprosy is the oldest disease in history, known since 1400 BC. This infection attacks the peripheral nerves and skin, then the upper respiratory tract, and can also attack other organs except the brain.

Knowing Leprosy Alias ​​Leprosy, Diseases that are often late detected

The number of leprosy sufferers in the world in 2007 is estimated at more than 2-3 million people. In 2008, there were an estimated 22,359 leprosy patients in Indonesia or 0.73 cases out of every 100,000 population, with 16,668 new cases. This disease is found mainly in the islands of Java, Sulawesi, Maluku and Papua.

Leprosy is a disease that is feared because it can cause disability, mutilation (for example, a member of a limb, such as a finger), ulceration (ulcer wound), and others. This skin infection is caused by damage to large nerves in the facial area, limbs, and motor; followed by a feeling of numbness accompanied by muscle paralysis and muscle mass reduction.

What is the cause of leprosy?
psoriasis skin disease

The cause of leprosy is the Mycobacterium leprae bacteria  . The bacteria are transmitted through long and close skin contact with the patient. Another assumption states that this disease can also be transmitted through inhalation, aka breathing air, because the bacteria that  causes leprosy can live several days in the form of droplets in the air.

Leprosy-causing bacteria can also be transmitted through direct contact with certain animals such as armadilos. This disease requires a long incubation period, between 40 days to 40 years, on average requires 3-5 years after contracting until the onset of symptoms.

About 95 percent of people are immune to leprosy-causing bacteria, and only about 5 percent can contract the bacteria. Of the 5 percent of people who contract leprosy-causing bacteria, around 70 percent recover themselves, and only 30 percent are leprosy. That is, out of 100 people infected with this bacterium, only 2 people will fall ill.

How can leprosy occur?

Here are some developmental stages of leprosy that you need to see and know:

1. Bacteria enter the body

At first leprosy bacteria will enter the nose and then human respiratory organs. After that, bacteria will move to the nerve tissue and enter nerve cells. Because leprosy-causing bacteria like cold places, bacteria will enter peripheral nerve cells and skin nerve cells that have colder temperatures, for example around the groin or  scalp .

Then leprosy bacteria will make nerve cells as 'houses' and begin to multiply in them. This bacterium takes 12-14 days to divide into two. Usually, up to this stage, someone who is infected has not yet appeared the visible symptoms of leprosy.

2. The immune system reacts

Over time, the bacteria that causes leprosy will develop more and more. Automatically, the immune system naturally strengthens its defense. White blood cells that are the body's main protective force are produced more and more to attack leprosy-causing bacteria.

When the immune system has invaded the bacteria, leprosy can appear that can be seen in the body, such as the appearance of white patches on the skin. At this stage, symptoms of leprosy such as numbness have begun to appear. If this leprosy symptom is not treated immediately, the bacteria will quickly cause various other disorders in the body.

The bacteria that causes leprosy are indeed automatically attacked by the human immune system. However,  each person's immune system is different. When a person has a strong immune system, bacteria may not cause symptoms that are too severe.

Even so, the bacteria that causes leprosy continue to cause damage to the skin tissue and cause numbness.

Meanwhile, in people with a weakened immune system, it may be more prone to experience skin infections. Usually, this condition will cause skin infections in the nerves, eyes, kidneys, muscles, and blood vessels.

What are the signs and symptoms of leprosy?

This disease consists of two types, namely dry leprosy or basiler pausi (PB) and wet or multi bacillary leprosy (MB). The appearance of white spots like tinea versicolor is usually a symptom of dry leprosy. While the symptoms of wet leprosy are more like ringworm, namely reddish patches and thickening of the skin.

The most basic symptom of leprosy is numbness or numbness. This condition causes the sufferer not to feel the temperature change so that the sensation of touch and pain in the skin is lost. Well, this is what causes sufferers vulnerable to disability because their nerves are damaged, so they do not feel pain even though their fingers break.

In addition to those already mentioned, some of the signs and symptoms of leprosy to watch out for are:

  • Dry skin, and in areas that were previously covered with hair or hair can fall out
  • Eyelashes that fall out
  • Muscle weakness or paralysis
  • Face shape changes
  • Mutilation, numbness causes the patient to be unaware of the wound, so that it can cause untreated wounds, ulcers
  • Gynecomastia (enlarged breasts in men), due to hormonal balance disorders
  • Weight loss
  • Enlarged peripheral nerves, usually around the elbows and knees
  • Blisters or  rashes
  • A boil appears but does not hurt
  • Nasal congestion  or  nosebleeds
  • A wound appears but does not hurt

Signs and symptoms of leprosy often resemble other diseases, and sometimes cause a delay in diagnosis, therefore disease is also called the great immitator . Some diseases similar to leprosy are vitiligo , ptiriasis versicolor, ptiriasis alba, tinea corporis , and many more.

What should I do if I find signs and symptoms of leprosy?

Immediately consult with your doctor if you find any of the symptoms above, the doctor will do an examination to make a diagnosis. Here are some checks that can be done:

  • Bacteroscopic examination was made from scraping skin tissue in several places, examined under a microscope to see the presence of M. leprosy bacteria .
  • Histopathological examination aims to see tissue changes due to infection.
  • Serological examination is based on the formation of antibodies in a person's body due to infection.
  • To be able to make a diagnosis, the doctor usually looks for 3 cardinal signs of the leprosy: numbness of the skin, thickening of the peripheral nerves, and the results of bacterioscopic examination which results are positive.

How to treat this skin infection?

Leprosy is often considered a frightening disease. Even though along with the advancement of the medical world, leprosy is an easily treatable disease. Ironically, to date some regions in Indonesia are still considered as leprosy endemic areas by the World Health Organization or WHO.

The main goal of treatment for leprosy is to break the chain of transmission, reduce the incidence of disease, treat and cure patients, and prevent disability. To achieve healing and prevent resistance, leprosy drugs will use a combination of several antibiotics called multi drug treatment (MDT).

The combination of leprosy drugs commonly used in MDT therapy consists of dapsone , rifampicin , clofazamine, lamprene, ofloxacin , and / or minocycline. V variations of this antibiotic work to inhibit growth and kill M. leprae bacteria . In addition, most leprosy drugs are also anti-inflammatory. Using antibiotics simultaneously at one time is also intended so that bacteria are not immune to the drugs given so that the disease will also be quickly cured.

The doctor will determine the amount, type and dosage of the medication according to the type of leprosy you have. This type of leprosy will also affect the length of treatment. Leprosy should be taken regularly, generally within 6 months to 1-2 years.

Thanks to MDT, the total cases of leprosy in the world in the last 20 years have dropped sharply by 90 percent. Nearly 16 million patients with this disease have completely recovered after undergoing treatment with antibiotics prescribed by the doctor.

The reason is to take leprosy medication regularly

As explained above, people who have been diagnosed with this disease will usually be given a combination of antibiotics as a treatment step for six months to two years.

Being undisciplined in taking medicine makes leprosy bacteria stronger and immune to current and subsequent treatments. As a result, the symptoms of leprosy you experience can get worse because bacteria continue to multiply in the body.

Often forgetting or even stopping taking medication also risks transmission of leprosy to other people. Not only makes the condition worse, the stronger bacteria can easily move and infect other people's bodies. It could be that the people closest to you contract this disease later if you don't take leprosy.

In addition to routinely taking leprosy medicine as prescribed by the doctor, surgery can also be done as a follow-up therapy to normalize damaged nerve function. Surgery is also carried out to improve the body shape of a disabled person and restore limb function.

What happens if the disease is not treated?

Leprosy is a disease that can be cured. With a record of patients doing treatment regularly and thoroughly. Leprosy that is late to be detected or treated too late can cause disability in patients, both temporary and forever.

The Indonesian government has free treatment for this disease. So what is your reason not to seek treatment?

Based on the National Guidelines for Leprosy Control Program issued by the Ministry of National Health, disability due to this disease is divided into two, namely:

1. Cacat first

Primary disability is a type of disability that is caused directly by the infection of the bacterium M. leprae in the body. This type of disability causes the sufferer to experience eye taste, dry and scaly skin and claw hand alias and curved fingers.

In primary disability, the appearance of tinea versicolor skin patches usually occurs quickly in a relatively short time. These spots become inflamed, swell, and are accompanied by symptoms of fever. In addition, boils that appear as a sign of symptoms of leprosy can rupture and develop into ulcers. Muscle weakness and numbness (numbness) usually occur within the last six months since exposure to the initial infection.

If you experience the symptoms above, see your doctor immediately to get the best treatment.

2. Secondary disability

Secondary disability is the development of primary defects, especially those caused by nerve damage. This nerve damage can cause ulcer ulcers (open sores on the skin or ulcers) and limitations of joint motion. This occurs as a result of functional damage to the joints and soft tissues around the infected area.

Disability at this stage occurs through two processes, namely:

  • There is a direct flow of M. leprae bacteria to certain peripheral nerves and organs
  • Through leprosy reactions

If bacteria have entered the nerve, then the nerve function will gradually diminish and even disappear. In general, nerves function as sensory, motoric, and autonomous. Abnormalities that occur due to skin infection this one can cause interference in each nerve or a combination between the three. Here are some disorders or abnormalities in each nerve due to leprosy:

  • Motor nerve disorders.  Motor nerves function to provide muscle strength. Disorders or abnormalities in the motor nerve can be paralysis of the hands and feet, the fingers and toes are bent, and the eyes cannot blink. If the infection occurs in the part of the eye, then the patient can experience  blindness.
  • Sensory nerve disorders. Sensory function nerves are responsible for giving sensation in feeling, feeling pain, and feeling the temperature. Disorders of the sensory nerves can result in numbness of the hands and feet and reduced blinking reflexes.
  • Autonomic nerve disorders.  The autonomic nerves are responsible for sweat glands and oils in the body. Disorders of the nerves cause dryness and cracking of the skin due to damage to the oil glands and blood flow.

The severity of leprosy defects

In addition to being distinguished by type, this disease can also be distinguished from the severity of the defect that occurs. Every organ affected by this disease infection (usually eyes, hands and feet) has its own level of disability.

The level of disability of leprosy according to the world health organization ( WHO ) are:

  • Level 0.  At this level organs such as the eyes, hands and feet still function normally because they have not / have not experienced any abnormalities.
  • Level 1. Damage to the cornea of the eye generally occurs. Generally there has been a disturbance in visual acuity but not in a severe stage. Patients can still see something from a distance of 6 meters. Muscle weakness and numbness in the hands and feet have begun to feel.
  • Level 2.  At this level the eyelids cannot close completely. Vision has been very disturbed because usually patients with this level are no longer able to see something from a distance of 6 meters or more. Then there are also disabilities in the hands and feet such as open wounds and permanent bent fingers.