Leprosy (Hansen's disease): An Update and Review

Abstract

Leprosy (Hansen's disease) is caused by infection with bacilli of the Mycobacterium leprae complex. It is considered an exotic and rare diagnosis in Missouri. Past leprosy patients diagnosed locally have typically acquired it in areas of the world where leprosy is endemic. However, a recent case in a native Missourian that appears to be locally acquired suggests that leprosy may now be endemic in Missouri, possibly due to the expanded range of its zoonotic vector, the nine-banded armadillo. Health care providers in Missouri should be aware of how leprosy manifests and suspected cases referred to centers such as ours for evaluation and early institution of appropriate treatment.

Figure 1

A roadkill nine-banded armadillo photographed on Stadium boulevard outside of Faurot Field, University of Missouri, Columbia, Mo.

Figure 2

Typical clinical findings of tuberculoid leprosy. Hypopigmented patches with loss of sensation. (Photo courtesy of the University ofMissouri collection)

Figures 3a and 3b

Typical clinical findings of lepromatous/ multlbaclllary leprosy. A-top. Erythematous, indurated granulomatous patches and plaques with facial infiltration and leonine facies. B-bottom. Taught acral skin with distal digital resorption and ulceration due to loss of sensation (Photo 3a courtesy of the University of Missouri collection)

Figure 4

A positive slit skin smear from a patient with multibacillary leprosy. Acid fast bacilli (AFB) are visible. Groups of organisms (globi) are present.