The incubation period ranges from six months to forty years or longer, with the average period being two to three years (Harrop pp). Leprosy is probably spread primarily by airborne droplets from the nasal mucosa and upper airways, and may also be transmitted by insects, skin contact, breast milk and the placenta of infected mothers (Style pp). The communicability of leprosy is very low; perhaps 90% or more of humans are not susceptible to it, and established cases become non-communicable within one week of starting treatment (Style pp).

There are two classifications used to determine treatment strategies:

multibacillary, when acid-fast bacilli are present in skin biopsies or smears, and paucibacillary, when no bacteria are seen in biopsies or smears. The second classification of leprosy is based on the clinical features of the disease and includes three major types: tuberculoid, lepromatous and borderline" (Style pp). Tuberculoid type develops in individuals with a high level of cellular immunity, and usually presents as a solitary small plaque or macule, with a well-defined border and a healing center (Style pp). An important clinical finding is that the lesion's center is anesthetic or hypoesthetic (Style pp). Skin smears and biopsies are negative for acid-fast bacilli (Style pp). Another important clinical finding is an enlarge nerve near the skin lesion (Style pp). Enlargement may affect a sensory nerve supplying the lesion or a large peripheral nerve and this may result in permanent neuropathy (Style pp). A subtype of tuberculoid leprosy is called pure neural leprosy, without skin lesions, and is more common in patients from the Indian subcontinent (Style pp). Lepromatous leprosy develops in individuals with little or no cellular immunity, and their skin lesion are numerous and symmetrically located over the body and may ulcerate and have poorly defined edges, and the centers do not show healing and are not anesthetic (Style pp). Sensory nerve loss resembles "glove and stocking" anesthesia of the hands and feet (Style pp). Major deformities of the hands and feet are common, and repeated trauma, abnormal pressure points, ulcerations, and secondary infections lead to osteomyelitis, bone resorption, edema, fractures, and shortening of digits (Style pp)....

Moreover, bacteria can invade body organs such as the testes, causing testicular atrophy and secondary gynecomastia (Style pp). Untreated, this disease progresses slowly and death usually results from renal failure, acute infections, or tuberculosis (Style pp). Impairment and deformities may cause limitation daily activities and adverse social reaction, thus prosthesis may be necessary (Arora pp). Approximately 70% of leprosy patients can be diagnosed by means of a single sign of skin patch with sensory loss (Rao pp). Leprosy is generally treated with a standard schedule of multi-drug treatment for six to twelve months (Rao pp). Currently two drug regimens have been officially recommended by the World Health Organization:
1. WHO MDT-PB schedule, containing dapsone and rifampicin, and 2. WHO MDT-MB schedule, containing dapsone, clofazimine and rifampicin.

Rao pp).

Prevention of Leprosy consists of avoiding close physical contact with untreated people, however, people on long-term medication become noninfectious and do not transmit the organism that causes the diseases (Leprosy1 pp). Integration is considered more cost effective and feasible within national resources, thus ensuring sustainability of leprosy services, and all leprosy programs stress daily self-care of the effects of nerve function impairment (Rao pp).

Works Cited

Arora, Bhawna; Jaiwant, Shailja. "Use of Partial Hand Prosthesis/Orthosis by Leprosy Patients with Mutilated Hand." http://64.233.187.104/search?q=cache:8ZUxxPKb-g4J:medind.nic.in/iba/t03/i2/ibat03i2p3.pdf+required+adaptations+due+to+leprosy&hl=en

Harrop, Elyse. "Leprosy." http://www.emedicine.com/derm/topic223.htm

Leprosy1." Diseases and Conditions. http://health.allrefer.com/health/leprosy-prevention.html

Leprosy Today." World Health Organization. http://www.who.int/lep/

Rao, P. "Recent advances in the control programs and therapy of leprosy. Indian Journal of Dermatology, Venereology and Leprology. 9/1/2004.

Storrs, Eleanor E. "Leprosy Throughout the Ages." http://pandoras-box.org/my05002.htm

Style, Alec. "Early diagnosis and treatment of leprosy in the United States."

American Family Physician. 7/1/1995