Leprosy

Leprosy is a chronic infectious disease caused by the acid-fast bacilli Mycobacterium leprae and Mycobacterium lepromatosis that has been historically associated with strong stigma in affected patients. The clinical manifestations of this disease vary significantly depending on the immunological response of the host to the pathogen, and the disease more often manifests as cutaneous lesions, with peripheral nerve and internal organ involvement. Patients affected by lepromatous/multibacillary leprosy have multiple skin lesions and a greater number of bacilli on biopsy examination, whereas patients with tuberculoid/paucibacillary leprosy have fewer skin lesions and fewer bacilli on microscopic evaluation. Individuals with significant hand mutilations or deformities often demand made-to-measure grip aids to allow them to use toothbrushes to prevent dental caries and periodontal disease. The occurrence of oral lesions usually manifests as asymptomatic plaques, papules, or nodules more often in the palate, tongue, and buccal mucosa. Hypopigmentation of the oral mucosa has also been reported. Microscopically, a diffuse lymphohistiocytic infiltrate is observed, and the presence of the microorganism is demonstrated by special histological stains. These patients are treated via a multidrug strategy consisting of bacteriostatic drugs (dapsone and clofazimine) and a bactericidal drug (rifampicin).