Lepromatous leprosy is a chronic infection caused by the Mycobacterium leprae bacteria. Most forms of leprosy affect the skin and peripheral nerves, but typically leave the rest of the body’s organs unharmed. Lepromatous leprosy also affects the skin and nerves, but involves other organs, including the nose, eyes, testicles, and bones.
All forms of leprosy are contagious to a certain degree, depending on the load, or amount, of the organism in the body’s tissue. Lepromatous leprosy is one of the most contagious, because it carries the largest load, reaching as high as seven billion organisms per gram of tissue. In comparison, non-lepromatous leprosy carries less than one million organisms per gram. The disease is transmitted through the skin and nasal mucous.
Prior to advances in medicine, leprosy was often called a curse and sufferers were sent to live in isolation for fear of spreading the disease. Today, leprosy still affects more than 200,000 people a year, especially in Asia, Africa, and South America, but most people have a naturally acquired immunity to the bacteria. In cases of lepromatous leprosy, patients typically have little or no resistance to the bacteria and their bodies are not equipped to mount a response to the infection. In these patients, the defense cells that typically destroy the bacteria, called macrophages, work against the host by enabling the bacteria to multiply within the cell. The macrophages also provide transportation for the bacteria, allowing it to infect other areas of the body.
Early symptoms of lepromatous leprosy include nasal stuffiness or bleeding, and swelling of the legs and ankles. Numerous lesions, papules, and nodules may be seen across the skin. Unlike other forms of leprosy, early nerve damage may go unnoticed. Early diagnosis is vital to treating this form of leprosy.
When left untreated, lepromatous leprosy can cause a wide range of complications affecting several different organs. The skin on the eyebrows, forehead, and earlobes may thicken, and eyelashes may fall out. Skin on the legs can thicken and form ulcers. In males, the testicles may shrivel, leading to sterility. In the eyes, light sensitivity, glaucoma and blindness can occur. The disease can also affect the larynx and internal organs.
Treatment of lepromatous leprosy focuses on stopping the infection and reducing the potential for physical deformities. Antibiotics, sometimes several at a time, are given to kill the bacteria, and oral corticosteroids may help reduce swelling. Some patients may require surgery to drain abscesses and repair damaged nerves or tissue. Patients must be educated on how to take the medication, as it is essential to complete the entire antibiotic regimen. Once treatment begins, the disease is no longer infectious.
