Leprosy, also known as Hansen's disease (HD), is a long-term infection
by the bacterium
Mycobacterium leprae or Mycobacterium
lepromatosis. Initially, infections are without symptoms and
typically remain this way for 5 to 20 years. Symptoms that develop
include granulomas of the nerves, respiratory tract, skin, and
eyes. This may result in a lack of ability to feel pain, thus loss
of parts of extremities due to repeated injuries or infection due to
unnoticed wounds. Weakness and poor eyesight may also be
Leprosy is spread between people. This is thought to occur through
a cough or contact with fluid from the nose of an infected person.
Leprosy occurs more commonly among those living in poverty.
Contrary to popular belief, it is not highly contagious. The two
main types of disease are based on the number of bacteria present:
paucibacillary and multibacillary. The two types are differentiated
by the number of poorly pigmented, numb skin patches present, with
paucibacillary having five or fewer and multibacillary having more
than five. The diagnosis is confirmed by finding acid-fast bacilli
in a biopsy of the skin or by detecting the
DNA using polymerase chain
Leprosy is curable with a treatment known as multidrug therapy.
Treatment for paucibacillary leprosy is with the medications dapsone
and rifampicin for six months. Treatment for multibacillary leprosy
consists of rifampicin, dapsone, and clofazimine for 12 months. A
number of other antibiotics may also be used. These treatments are
provided free of charge by the World Health Organization. Globally
in 2012, the number of chronic cases of leprosy was 189,000, down from
some 5.2 million in the 1980s. The number of new cases was
230,000. Most new cases occur in 16 countries, with India
accounting for more than half. In the past 20 years, 16 million
people worldwide have been cured of leprosy. About 200 cases are
reported per year in the United States.
Leprosy has affected humanity for thousands of years. The disease
takes its name from the Greek word lepra, while the term "Hansen's
disease" is named after the Norwegian physician Gerhard Armauer
Hansen. Separating people by placing them in leper colonies still
occurs in places such as India, China, and Africa.
However, most colonies have closed, since leprosy is not very
contagious. Social stigma has been associated with leprosy for
much of history, which continues to be a barrier to self-reporting and
early treatment. Some consider the word "leper" offensive,
preferring the phrase "person affected with leprosy". It is
classified as a neglected tropical disease.
World Leprosy Day was
started in 1954 to draw awareness to those affected by leprosy.
1 Signs and symptoms
2.1 M. leprae and M. lepromatosis
2.2 Risk factors
7.1 Disease burden
9 Society and culture
9.2 Treatment cost
9.3 Historical texts
9.4 Middle Ages
9.5 19th century
9.5.2 Colonialism and imperialism
9.7 Programs and treatment
9.8 Notable cases
10 Other animals
11 See also
13 External links
Signs and symptoms
Leprosy is mostly a granulomatous disease of the peripheral nerves and
mucosa of the upper respiratory tract; skin lesions (light or dark
patches) are the primary external sign. If untreated, leprosy can
progress and cause permanent damage to the skin, nerves, limbs, and
eyes. Secondary infections, in turn, can result in tissue
loss, causing fingers and toes to become shortened and deformed, as
cartilage is absorbed into the body.
Hands deformed by leprosy
Leprosy in Tahiti, circa 1895
A 26-year-old woman with leprous lesions
A 13-year-old boy with severe leprosy
M. leprae and M. lepromatosis
M. leprae, one of the causative agents of leprosy: As an acid-fast
bacterium, M. leprae appears red when a
Ziehl-Neelsen stain is used.
Mycobacterium leprae and
M. leprae and M. lepromatosis are the causative agents of leprosy. M.
lepromatosis is a relatively newly identified mycobacterium isolated
from a fatal case of diffuse lepromatous leprosy in 2008.
An intracellular, acid-fast bacterium, M. leprae is aerobic and
rod-shaped, and is surrounded by the waxy cell membrane coating
characteristic of the
Due to extensive loss of genes necessary for independent growth, M.
leprae and M. lepromatosis are obligate intracellular pathogens, and
unculturable in the laboratory, a factor that leads to difficulty in
definitively identifying the organism under a strict interpretation of
Koch's postulates. The use of nonculture-based techniques such
as molecular genetics has allowed for alternative establishment of
While the causative organisms have to date been impossible to culture
in vitro, it has been possible to grow them in animals such as mice
Naturally occurring infection also has been reported in nonhuman
primates, including the African chimpanzee, sooty mangabey, and
cynomolgus macaque, as well as in armadillos and red squirrels.
Red squirrels (Sciurus vulgaris) - a threatened species - in England
were found to have leprosy in November 2016. However, no squirrel
cases have spread to a human for hundreds of years.
The greatest risk factor for developing leprosy is contact with
another case of leprosy. Contacts of people with leprosy are five to
eight times more likely to develop leprosy than members of the general
Leprosy also occurs more commonly among those living in
Other risk factors are poorly understood. However, conditions that
reduce immune function, such as malnutrition, other illnesses, or host
genetic differences, may increase the risk of developing leprosy.
Despite this, infection with
HIV does not appear to increase the risk
of developing leprosy.
Transmission of leprosy occurs during close contact with those who are
infected. Transmission is proposed to be by nasal droplets,
but many questions remain about its mode of transmission and
Leprosy is not known to be either sexually transmitted or highly
infectious. People are generally no longer infectious after the first
month of standard multidrug therapy.
Leprosy may also be transmitted to humans by armadillos.
Two exit routes of M. leprae from the human body often described are
the skin and the nasal mucosa, although their relative importance is
not clear. Lepromatous cases show large numbers of organisms deep in
the dermis, but whether they reach the skin surface in sufficient
numbers is doubtful.
The skin and the upper respiratory tract are most likely entry route.
While older research dealt with the skin route, recent research has
increasingly favored the respiratory route. Experimental transmission
of leprosy through aerosols containing M. leprae in immunosuppressed
mice was accomplished, suggesting a similar possibility in humans.
Several genes have been associated with a susceptibility to leprosy.
Often, the immune system is able to eliminate leprosy during the early
infection stage before severe symptoms develop. A defect in
cell-mediated immunity may cause susceptibility to leprosy. The region
DNA responsible for this variability is also involved in
Parkinson's disease, giving rise to current speculation that the two
disorders may be linked in some way at the biochemical level. Some
evidence indicates not all people who are infected with M. leprae
develop leprosy, and genetic factors have long been thought to play a
role, due to the observation of clustering of leprosy around certain
families, and the failure to understand why certain individuals
develop lepromatous leprosy while others develop other types of
How the infection produces the symptoms of the disease is not
According to the World Health Organization, diagnosis in areas where
people are frequently infected is based on one of these main signs:
Skin lesion consistent with leprosy and with definite sensory loss
Positive skin smears
Skin lesions can be single or multiple, and usually hypopigmented,
although occasionally reddish or copper-colored. The lesions may be
macules (flat), papules (raised), or nodular. The sensory loss at the
skin lesion is important because this feature can help differentiate
it from other causes of skin lesions such as tinea versicolor.
Thickened nerves are associated with leprosy and can be accompanied by
loss of sensation or muscle weakness. However, without the
characteristic skin lesion and sensory loss, muscle weakness is not
considered a reliable sign of leprosy.
In some cases, acid-fast leprosy bacilli in skin smears are considered
diagnostic; however, the diagnosis is clinical.
Diagnosis in areas where the disease is uncommon, such as the United
States, is often delayed because healthcare providers are unaware of
leprosy and its symptoms. Early diagnosis and treatment prevent nerve
involvement, the hallmark of leprosy, and the disability it
Many kinds of leprosy are known, but some symptoms are common to them,
including runny nose, dry scalp, eye problems, skin lesions, muscle
weakness, reddish skin, smooth, shiny, diffuse thickening of facial
skin, ear, and hand, loss of sensation in fingers and toes, thickening
of peripheral nerves, and flat nose due to destruction of nasal
cartilage. Also, phonation and resonation of sound occur during
speech. Often, atrophy of the testes with resulting impotence occurs.
Several different approaches for classifying leprosy exist, but
World Health Organization
World Health Organization system distinguishes "paucibacillary"
and "multibacillary" based upon the proliferation of
bacteria.("pauci-" refers to a low quantity.)
The Ridley-Jopling scale provides five gradations.
The ICD-10, though developed by the WHO, uses Ridley-Jopling and not
the WHO system. It also adds an indeterminate ("I") entry.
In MeSH, three groupings are used.
It is characterized by one or more hypopigmented skin macules and
patches where skin sensations are lost because of damaged peripheral
nerves that have been attacked by the human host's immune cells.
Borderline leprosy is of intermediate severity and is the most common
form. Skin lesions resemble tuberculoid leprosy, but are more numerous
and irregular; large patches may affect a whole limb, and peripheral
nerve involvement with weakness and loss of sensation is common. This
type is unstable and may become more like lepromatous leprosy or may
undergo a reversal reaction, becoming more like the tuberculoid form.
borderline lepromatous ("BL"),
and lepromatous ("LL")
It is associated with symmetric skin lesions, nodules, plaques,
thickened dermis, and frequent involvement of the nasal mucosa
resulting in nasal congestion and nose bleeds, but, typically,
detectable nerve damage is late.
A difference in immune response to the tuberculoid and lepromatous
forms is seen.
Leprosy may also be divided into::344–346
Early and indeterminate leprosy
Borderline tuberculoid leprosy
Borderline lepromatous leprosy
Diffuse leprosy of Lucio and Latapí
This disease may also occur with only neural involvement, without skin
Early detection of the disease is important, since physical and
neurological damage may be irreversible even if cured. Medications can
decrease the risk of those living with people with leprosy from
acquiring the disease and likely those with whom people with leprosy
come into contact outside the home. However, concerns are known of
resistance, cost, and disclosure of a person's infection status when
doing follow-up of contacts. Therefore, the WHO recommends that people
who live in the same household be examined for leprosy and be treated
only if symptoms are present.
The Bacillus Calmette–Guérin (BCG) vaccine offers a variable amount
of protection against leprosy in addition to its target of
tuberculosis. It appears to be 26 to 41% effective (based on
controlled trials) and about 60% effective based on observational
studies with two doses possibly working better than one.
Development of a more effective vaccine is ongoing.
MDT antileprosy drugs: standard regimens
A number of leprostatic agents are available for treatment. For
paucibacillary (PB or tuberculoid) cases, treatment with daily dapsone
and monthly rifampicin for six months is recommended, while for
multibacillary (MB or lepromatous) cases, treatment with daily dapsone
and clofazimine along with monthly rifampicin for 12 months is
Multidrug therapy (MDT) remains highly effective, and people are no
longer infectious after the first monthly dose. It is safe and
easy to use under field conditions due to its presentation in calendar
Relapse rates remain low, and no resistance to the
combined drugs is seen.
Main article: Epidemiology of leprosy
World distribution of leprosy, 2003
Disability-adjusted life year
Disability-adjusted life year for leprosy per 100,000 inhabitants
In 2015, the number of cases of leprosy was about 175,000 and the
number of new cases was 210,000.
As of 2013, 14 countries contain 95% of the globally reported leprosy
cases. Of these, India has the greatest number of cases (59%),
Brazil (14%) and
Indonesia (8%). Although the number
of cases worldwide continues to fall, pockets of high prevalence
remain in certain areas such as Brazil, South Asia (India, Nepal,
Bhutan), some parts of Africa (Tanzania, Madagascar, Mozambique), and
the western Pacific.
The number of cases of leprosy was in the tens of millions in the
1960s; a series of national (the International Federation of
Leprosy Associations) and international (the WHO's "Global
Strategy for Reducing Disease Burden Due to Leprosy") initiatives have
reduced the total number and the number of new cases of the
disease. In 1995, two to three million people were estimated to
be permanently disabled because of leprosy.
Although the number of new leprosy cases occurring each year is
important as a measure of transmission, it is difficult to measure due
to leprosy's long incubation period, delays in diagnosis after onset
of the disease, and the lack of laboratory tools to detect it in the
very early stages. Instead, the registered prevalence is used.
Registered prevalence is a useful proxy indicator of the disease
burden, as it reflects the number of active leprosy cases diagnosed
with the disease and receiving treatment with MDT at a given point in
time. The prevalence rate is defined as the number of cases registered
for MDT treatment among the population in which the cases have
occurred, again at a given point in time.
New case detection is another indicator of the disease that is usually
reported by countries on an annual basis. It includes cases diagnosed
with the onset of disease in the year in question (true incidence) and
a large proportion of cases with onset in previous years (termed a
backlog prevalence of undetected cases).
Endemic countries also report the number of new cases with established
disabilities at the time of detection, as an indicator of the backlog
prevalence. Determination of the time of onset of the disease is, in
general, unreliable, is very labor-intensive, and is seldom done in
recording these statistics.
Main article: History of leprosy
G. H. A. Hansen, discoverer of M. leprae
Using comparative genomics, in 2005, geneticists traced the origins
and worldwide distribution of leprosy from East Africa or the Near
East along human migration routes. They found four strains of M.
leprae with specific regional locations. Strain 1 occurs predominantly
in Asia, the Pacific region, and East Africa; strain 4, in West Africa
and the Caribbean; strain 3 in Europe, North Africa, and the Americas;
and strain 2 only in Ethiopia, Malawi, Nepal/north India, and New
On the basis of this, they offer a map of the dissemination of leprosy
in the world. This confirms the spread of the disease along the
migration, colonisation, and slave trade routes taken from East Africa
to India, West Africa to the New World, and from Africa into Europe
and vice versa.
The oldest skeletal evidence for the disease date from 2000 BCE, as
found in human remains from the archaeological sites of Balathal in
Harappa in Pakistan.
Although retrospectively identifying descriptions of leprosy-like
symptoms is difficult, what appears to be leprosy was discussed by
Hippocrates in 460 BC. In 1846, Francis Adams produced The Seven Books
of Paulus Aegineta which included a commentary on all medical and
surgical knowledge and descriptions and remedies to do with leprosy
from the Romans, Greeks, and Arabs.
Interpretations of the presence of leprosy have been made on the basis
of descriptions in ancient Indian (Atharva Veda and Kausika Sutra),
Greek, and Middle Eastern documentary sources that describe skin
Skeletal remains from the second millennium BC, discovered in 2009,
represent the oldest documented evidence for leprosy. Located at
Balathal, in Rajasthan, northwest India, the discoverers suggest that
if the disease did migrate from Africa to India, during the third
millennium BC "at a time when there was substantial interaction among
the Indus Civilization, Mesopotamia, and Egypt, there needs to be
additional skeletal and molecular evidence of leprosy in India and
Africa so as to confirm the African origin of the disease." A
proven human case was verified by
DNA taken from the shrouded remains
of a man discovered in a tomb next to the Old City of Jerusalem dated
by radiocarbon methods to 1–50 AD.
The causative agent of leprosy, M. leprae, was discovered by G. H.
Armauer Hansen in Norway in 1873, making it the first bacterium to be
identified as causing disease in humans. The first effective
treatment (promin) became available in the 1940s. In the 1950s,
dapsone was introduced. The search for further effective antileprosy
drugs led to the use of clofazimine and rifampicin in the 1960s and
1970s. Later, Indian scientist Shantaram Yawalkar and his
colleagues formulated a combined therapy using rifampicin and dapsone,
intended to mitigate bacterial resistance. MDT combining all three
drugs was first recommended by the WHO in 1981. These three
antileprosy drugs are still used in the standard MDT regimens.
Leprosy was once believed to be highly contagious and was treated with
mercury—as was syphilis, which was first described in 1530. Many
early cases thought to be leprosy could actually have been
Resistance has developed to initial treatment. Until the introduction
of MDT in the early 1980s, leprosy could not be diagnosed and treated
successfully within the community.
Japan still has sanatoriums (although Japan's sanatoriums no longer
have active leprosy cases, nor are survivors held in them by law).
The importance of the nasal mucosa in the transmission of M leprae was
recognized as early as 1898 by Schäffer, in particular, that of the
Society and culture
Two lepers denied entrance to town, 14th century
British India enacted the
Leprosy Act of 1898 which institutionalized
those affected and segregated them by gender to prevent reproduction.
The Act was difficult to enforce but was repealed in 1983 only after
MDT therapy had become widely available. In 1983, the National Leprosy
Elimination Programme, previously the National
Programme, changed its methods from surveillance to the treatment of
people with leprosy. India still accounts for over half of the global
Between 1995 and 1999, the WHO, with the aid of the Nippon Foundation,
supplied all endemic countries with free MDT in blister packs,
channeled through ministries of health. This free provision was
extended in 2000 and again in 2005, 2010 and 2015 with donations by
the MDT manufacturer
Novartis through the WHO. In the latest agreement
signed between the company and the WHO in October 2015, the provision
of free MDT by the WHO to all endemic countries will run until the end
of 2020. At the national level, nongovernment organizations affiliated
with the national program will continue to be provided with an
appropriate free supply of this WHO-supplied MDT by the government.
Written accounts of leprosy date back thousands of years. Various skin
diseases translated as leprosy appear in the ancient Indian text, the
Atharava Veda, as early as 2000 BC. Another Indian text, the Laws of
Manu (1500 BC), prohibited contact with those infected with the
disease and made marriage to a person infected with leprosy
Biblically speaking, the Hebraic root tsara or tsaraath (צָרַע,
--tsaw-rah' -- to be struck with leprosy, to be leprous) and the Greek
(λεπρός - lepros), are of broader classification than the more
narrow use of the term related to Hansen's Disease. Any progressive
skin disease (a whitening or splotchy bleaching of skin, raised
manifestations of scales, scabs, infections, rashes, etc.…) as well
as generalized molds and surface discoloration of any clothing,
leather, and/or discoloration on walls surfaces throughout homes all
came under the "law of leprosy" (
Leviticus 14:54-57). Ancient
sources also such as the
Talmud (Sifra 63) make clear that tzaraath
refers to various types of lesions or stains associated with ritual
impurity and occurring on cloth, leather, or houses, as well as skin.
It may sometimes be a symptom of the disease described in this article
but has many other causes, as well. The
New Testament describes
Jesus healing people with leprosy (Luke 5:10), although
the precise relationship between this, tzaraath, and Hansen's disease
is not established.
The biblical perception that people with leprosy were unclean may be
connected to a passage from
Leviticus 13: 44-46, among others.
Judeo-Christian belief, for some, held that leprosy was of moral
consequence, and, as in many societies, early Christians believed that
those affected by leprosy were being punished by God for sinful
behavior. Moral associations have persisted throughout history. Pope
Gregory the Great
Gregory the Great (540-604) and
Isidor of Seville
Isidor of Seville (560-636) considered
people with the disease to be heretics.
Medieval leper bell
It is believed that a rise in leprosy in Europe occurred in the Middle
Ages based on the increased number of hospitals created to treat
leprosy patients in the 12th and 13th centuries. France
alone had nearly 2,000 leprosariums during this period.
The social perception in medieval communities was generally one of
fear, and those people infected with the disease were thought to be
unclean, untrustworthy, and morally corrupt. People with leprosy
were also often required to wear clothing that identified them as such
or carry a bell announcing their presence. Segregation from mainstream
society was common. The third Lateran Council of 1179 and a 1346 edict
by King Edward expelled lepers from city limits. Because of the moral
stigma of the disease, methods of treatment were both physical and
spiritual, and leprosariums were established under the purview of the
Norway was the location of a progressive stance on leprosy tracking
and treatment and played an influential role in European understanding
of the disease. In 1832, Dr. JJ Hjort conducted the first leprosy
survey, thus establishing a basis for epidemiological surveys.
Subsequent surveys resulted in the establishment of a national leprosy
registry to study the causes of leprosy and for tracking of the rate
Early leprosy research throughout Europe was conducted by Norwegian
Daniel Cornelius Danielssen
Daniel Cornelius Danielssen and Carl Wilhelm Boeck. Their
work resulted in the establishment of the National
and Treatment Center. Danielssen and Boeck believed the cause of
leprosy transmission was hereditary. This stance was influential in
advocating for the isolation of those infected by gender to prevent
Colonialism and imperialism
Father Damien on his deathbed in 1889
Though leprosy in Europe was again on the decline by the 1860s,
Western countries embraced isolation treatment out of fear of the
spread of disease from developing countries, minimal understanding of
bacteriology, lack of diagnostic ability or knowledge of how
contagious the disease was, and missionary activity. Growing
imperialism and pressures of the industrial revolution resulted in a
Western presence in countries where leprosy was endemic, namely the
British presence in India. Isolation treatment methods were observed
Henry Vandyke Carter
Henry Vandyke Carter of the British Colony in India
while visiting Norway, and these methods were applied in India with
the financial and logistical assistance of religious missionaries.
Colonial and religious influence and associated stigma continued to be
a major factor in the treatment and public perception of leprosy in
endemic developing countries until the mid-twentieth century.
Despite effective treatment and education efforts, leprosy stigma
continues to be problematic in developing countries where the disease
Leprosy is most common amongst impoverished or marginalized
populations where social stigma is likely to be compounded by other
social inequities. Fears of ostracism, loss of employment, or
expulsion from family and society may contribute to a delayed
diagnosis and treatment.
Folk beliefs, lack of education, and religious connotations of the
disease continue to influence social perceptions of those afflicted in
many parts of the world. In Brazil, for example, folklore holds that
leprosy is transmitted by dogs, it is a disease associated with sexual
promiscuity, and is sometimes thought to be punishment for sins or
moral transgressions. Socioeconomic factors also have a direct
impact. Lower-class domestic workers who are often employed by those
in a higher socioeconomic class may find their employment in jeopardy
as physical manifestations of the disease become apparent. Skin
discoloration and darker pigmentation resulting from the disease also
have social repercussions.
In extreme cases in northern India, leprosy is equated with an
"untouchable" status that "often persists long after (individuals with
leprosy) have been cured of the disease, creating lifelong prospects
of divorce, eviction, loss of employment, and ostracism from family
and social networks." 
Programs and treatment
The WHO states that diagnosis and treatment with MDT are easy and
effective, and a 45% decline in disease burden has occurred since MDT
has become more widely available. The organization emphasizes the
importance of fully integrating leprosy treatment into public health
services, effective diagnosis and treatment, and access to
In some instances in India, community-based rehabilitation is embraced
by local governments and NGOs alike. Often, the identity cultivated by
a community environment is preferable to reintegration, and models of
self-management and collective agency independent of NGOs and
government support have been desirable and successful.
Saint Damien DeVeuster, a Roman Catholic priest from Belgium, himself
eventually contracting leprosy, ministered to lepers who had been
placed under a government-sanctioned medical quarantine on the island
of Molokaʻi in the Kingdom of Hawaiʻi.
Baldwin IV of Jerusalem
Baldwin IV of Jerusalem was a Christian king of Latin Jerusalem
afflicted with leprosy.
King Henry IV of
England (reigned 1399 to 1413) possibly had
Vietnamese poet Hàn Mặc Tử
Ōtani Yoshitsugu, a Japanese daimyō
Forough Farrokhzad made a 22-minute documentary about a leprosy colony
in Iran in 1962 called The House Is Black. The film humanizes the
people affected and opens by saying that "there is no shortage of
ugliness in the world, but by closing our eyes on ugliness, we will
Wild nine-banded armadillos (Dayspus novemcinctus) in south central
United States often carry
Mycobacterium leprae. This is believed
to be because armadillos have such a low body temperature. Leprosy
lesions appear mainly in cooler body regions such as the skin and
mucous membranes of the upper respiratory tract. Because of
armadillos' armor, skin lesions are hard to see. Abrasions around
the eyes, nose and feet are the most common signs. Infected armadillos
make up a large reservoir of M. leprae and may be a source of
infection for some humans in the United States or other locations in
the armadillos' home range. In armadillo leprosy, lesions did not
persist at the site of entry in animals, M. leprae multiplied in
macrophages at the site of inoculation and lymph nodes.
^ "Definition of leprosy". The Free Dictionary. Retrieved
^ a b c d e f g h i j k l m n o p q r s Suzuki K, Akama T, Kawashima
A, Yoshihara A, Yotsu RR, Ishii N (February 2012). "Current status of
leprosy: epidemiology, basic science and clinical perspectives". The
Journal of dermatology. 39 (2): 121–9.
doi:10.1111/j.1346-8138.2011.01370.x. PMID 21973237.
^ a b c d e f g h i j k l "
Leprosy Fact sheet N°101". World Health
Organization. January 2014. Archived from the original on
^ a b c d "New
Leprosy Bacterium: Scientists Use Genetic Fingerprint
To Nail 'Killing Organism'". ScienceDaily. 2008-11-28. Archived from
the original on 2010-03-13. Retrieved 2010-01-31.
^ a b c Schreuder, P.A.M.; Noto, S.; Richardus J.H. (January 2016).
"Epidemiologic trends of leprosy for the 21st century". Clinics in
Dermatology. 34 (1): 24–31. doi:10.1016/j.clindermatol.2015.11.001.
^ GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators.
(8 October 2016). "Global, regional, and national incidence,
prevalence, and years lived with disability for 310 diseases and
injuries, 1990-2015: a systematic analysis for the Global Burden of
Disease Study 2015". Lancet. 388 (10053): 1545–1602.
doi:10.1016/S0140-6736(16)31678-6. PMC 5055577 .
^ a b "Hansen's Disease (Leprosy) Transmission". cdc.gov. April 29,
2013. Archived from the original on 13 March 2015. Retrieved 28
^ "Global leprosy situation, 2012". Wkly. Epidemiol. Rec. 87 (34):
317–28. August 2012. PMID 22919737.
^ a b c d Rodrigues LC; Lockwood DNj (June 2011). "
epidemiology, progress, challenges, and research gaps". The Lancet
Infectious Diseases. 11 (6): 464–70.
doi:10.1016/S1473-3099(11)70006-8. PMID 21616456.
^ "Hansen's Disease Data & Statistics". Health Resources and
Services Administration. Archived from the original on 4 January 2015.
Retrieved 12 January 2015.
^ Walsh F (2007-03-31). "The hidden suffering of India's lepers". BBC
News. Archived from the original on 2007-05-29.
^ Lyn TE (2006-09-13). "Ignorance breeds leper colonies in China".
Independat News & Media. Archived from the original on 2010-04-08.
^ a b Byrne, Joseph P. (2008). Encyclopedia of pestilence, pandemics,
and plagues. Westport, Conn.[u.a.]: Greenwood Press. p. 351.
^ editors, Enrico Nunzi, Cesare Massone, (2012).
Leprosy a practical
guide. Milan: Springer. p. 326. ISBN 978-88-470-2376-5.
Archived from the original on 2017-09-08.
^ "Neglected Tropical Diseases". cdc.gov. June 6, 2011. Archived from
the original on 4 December 2014. Retrieved 28 November 2014.
^ McMenamin, Dorothy (2011).
Leprosy and stigma in the South
Pacific : a region-by-region history with first person accounts.
Jefferson, N.C.: McFarland. p. 17. ISBN 978-0-7864-6323-7.
Archived from the original on 2016-05-19.
^ a b Ryan, Kenneth J.; Ray, C. George, eds. (2004). Sherris Medical
Microbiology (4th ed.). McGraw Hill. pp. 451–3.
ISBN 0-8385-8529-9. OCLC 61405904.
^ a b "Lifting the stigma of leprosy: a new vaccine offers hope
against an ancient disease". Time. 119 (19): 87. May 1982.
PMID 10255067. Archived from the original on 2008-12-02.
^ a b Kulkarni GS (2008). Textbook of Orthopedics and Trauma (2 ed.).
Jaypee Brothers Publishers. p. 779.
^ "Q and A about leprosy". American
Leprosy Missions. Archived from
the original on 2012-10-04. Retrieved 2011-01-22. Do fingers and toes
fall off when someone gets leprosy? No. The bacillus attacks nerve
endings and destroys the body's ability to feel pain and injury.
Without feeling pain, people injure themselves on fire, thorns, rocks,
even hot coffee cups. Injuries become infected and result in tissue
loss. Fingers and toes become shortened and deformed as the cartilage
is absorbed into the body.
^ McMurray DN (1996). "Mycobacteria and Nocardia". In Baron S; et al.
Baron's Medical Microbiology (4th ed.). Univ of Texas Medical Branch.
ISBN 0-9631172-1-1. OCLC 33838234. Archived from the
original on 2009-02-12.
^ Bhattacharya S, Vijayalakshmi N, Parija SC (1 October 2002).
"Uncultivable bacteria: Implications and recent trends towards
identification". Indian journal of medical microbiology. 20 (4):
174–7. PMID 17657065. Archived from the original on 27
^ Meredith, Anna; Del Pozo, Jorge; Smith, Sionagh; Milne, Elspeth;
Stevenson, Karen; McLuckie, Joyce (September 2014). "
Leprosy in red
squirrels in Scotland". Veterinary Record. 175 (11): 285–286.
doi:10.1136/vr.g5680. PMID 25234460.
^ Red squirrels in the British Isles are infected with leprosy
bacilli, Dr. Andrej Benjak, Prof Anna Meredith and others, Science, 11
November 2016 Archived 11 November 2016 at the Wayback
Machine..Retrieved 11 November 2016.
Leprosy revealed in red squirrels across the British Isles, Damian
Carrington, 11 November 2016 Archived 11 November 2016 at the Wayback
Machine..Retrieved 11 November 2016.
^ Lockwood DN, Lambert SM (January 2011). "Human immunodeficiency
virus and leprosy: an update". Dermatologic clinics. 29 (1): 125–8.
doi:10.1016/j.det.2010.08.016. PMID 21095536.
^ a b c d e f g "Leprosy". WHO. 2009-08-01. Archived from the original
on 2010-02-09. Retrieved 2010-01-31.
^ Brosch, Roland; Stinear, Timothy P. (11 November 2016). "
red squirrels". Science. 354 (6313): 702–703.
doi:10.1126/science.aal0145. Archived from the original on 8 September
2017. Retrieved 2016-11-11.
^ Truman RW, Singh P, Sharma R, Busso P, Rougemont J, Paniz-Mondolfi
A, Kapopoulou A, Brisse S, Scollard DM, Gillis TP, Cole ST (April
2011). "Probable Zoonotic
Leprosy in the Southern United States". The
England Journal of Medicine. Massachusetts Medical Society. 364
(17): 1626–1633. doi:10.1056/NEJMoa1010536. PMC 3138484 .
PMID 21524213. Archived from the original on 2011-11-02.
^ a b "What Is Leprosy?" THE MEDICAL NEWS from News-Medical.Net –
Latest Medical News and Research from Around the World. Web. 20 Nov.
2010. "Archived copy". Archived from the original on 2013-06-06.
Retrieved 2013-05-14. .
^ Rees RJ, McDougall AC; McDougall (1977). "Airborne infection with
Mycobacterium leprae in mice". J Med Microbiol. 10 (1): 63–8.
doi:10.1099/00222615-10-1-63. PMID 320339.
^ Cook, Gordon C. (2009). Manson's tropical diseases (22nd ed.).
[Edinburgh]: Saunders. p. 1056. ISBN 978-1-4160-4470-3.
Archived from the original on 2017-09-04.
^ Buschman E, Skamene E (Jun 2004). "Linkage of leprosy susceptibility
Parkinson's disease genes" (PDF). International journal of leprosy
and other mycobacterial diseases. 72 (2): 169–70.
ISSN 0148-916X. PMID 15301585. Archived (PDF) from the
original on January 5, 2012. Retrieved January 31, 2011.
^ Alcaïs A, Mira M, Casanova JL, Schurr E, Abel L (2005). "Genetic
dissection of immunity in leprosy". Curr. Opin. Immunol. 17 (1):
44–8. doi:10.1016/j.coi.2004.11.006. PMID 15653309.
^ "Diagnosis of Leprosy." WHO. from "Archived copy". Archived from the
original on 2014-06-05. Retrieved 2014-07-14. accessed on 14
^ U.S. Department of Health and Human Services, Health Resources and
Services Administration. (n.d.). National Hansen's disease (leprosy)
program Retrieved from "Archived copy". Archived from the original on
2011-02-10. Retrieved 2013-05-12.
^ Smith DS (2008-08-19). "Leprosy: Overview". eMedicine Infectious
Diseases. Archived from the original on 2010-02-18. Retrieved
^ Singh N, Manucha V, Bhattacharya SN, Arora VK, Bhatia A; Manucha;
Bhattacharya; Arora; Bhatia (June 2004). "Pitfalls in the cytological
classification of borderline leprosy in the Ridley-Jopling scale".
Diagn. Cytopathol. 30 (6): 386–8. doi:10.1002/dc.20012.
PMID 15176024. CS1 maint: Multiple names: authors list
^ Ridley DS, Jopling WH; Jopling (1966). "Classification of leprosy
according to immunity. A five-group system". Int. J. Lepr. Other
Mycobact. Dis. 34 (3): 255–73. PMID 5950347.
^ Modlin RL (June 1994). "Th1-Th2 paradigm: insights from leprosy". J.
Invest. Dermatol. 102 (6): 828–32. doi:10.1111/1523-1747.ep12381958.
^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews'
Diseases of the Skin: clinical Dermatology. Saunders Elsevier.
^ Jardim MR, Antunes SL, Santos AR, Nascimento OJ, Nery JA, Sales AM,
Illarramendi X, Duppre N, Chimelli L, Sampaio EP, Sarno EP; Antunes;
Santos; et al. (July 2003). "Criteria for diagnosis of pure neural
leprosy". J. Neurol. 250 (7): 806–9. doi:10.1007/s00415-003-1081-5.
PMID 12883921. CS1 maint: Multiple names: authors list
^ Mendiratta V, Khan A, Jain A; Khan; Jain (2006). "Primary neuritic
leprosy: a reappraisal at a tertiary care hospital". Indian J Lepr. 78
(3): 261–7. PMID 17120509. CS1 maint: Multiple names:
authors list (link)
^ Ishida Y, Pecorini L, Guglielmelli E; Pecorini l; Guglielmelli e
(July 2000). "Three cases of pure neuritic (PN) leprosy at detection
in which skin lesions became visible during their course". Nihon
Hansenbyo Gakkai Zasshi. 69 (2): 101–6. doi:10.5025/hansen.69.101.
PMID 10979277. CS1 maint: Multiple names: authors list
^ Mishra B, Mukherjee A, Girdhar A, Husain S, Malaviya GN, Girdhar BK;
Mukherjee; Girdhar; Husain; Malaviya; Girdhar (1995). "Neuritic
leprosy: further progression and significance". Acta Leprol. 9 (4):
187–94. PMID 8711979. CS1 maint: Multiple names: authors
^ Talwar S, Jha PK, Tiwari VD; Jha; Tiwari (September 1992). "Neuritic
leprosy: epidemiology and therapeutic responsiveness". Lepr Rev. 63
(3): 263–8. PMID 1406021. CS1 maint: Multiple names:
authors list (link)
^ a b c Rodrigues LC, Lockwood DNj; Lockwood (June 2011). "Leprosy
now: epidemiology, progress, challenges, and research gaps". Lancet
Infect Dis. 11 (6): 464–70. doi:10.1016/S1473-3099(11)70006-8.
^ Duthie MS, Gillis TP, Reed SG; Gillis; Reed (November 2011).
"Advances and hurdles on the way toward a leprosy vaccine". Hum
Vaccin. 7 (11): 1172–83. doi:10.4161/hv.7.11.16848.
PMC 3323495 . PMID 22048122. CS1 maint: Multiple
names: authors list (link)
^ Setia MS, Steinmaus C, Ho CS, Rutherford GW; Steinmaus; Ho;
Rutherford (March 2006). "The role of BCG in prevention of leprosy: a
meta-analysis". Lancet Infect Dis. 6 (3): 162–70.
doi:10.1016/S1473-3099(06)70412-1. PMID 16500597. CS1 maint:
Multiple names: authors list (link)
^ Merle CS, Cunha SS, Rodrigues LC; Cunha; Rodrigues (2010). "BCG
vaccination and leprosy protection: Review of current evidence and
status of BCG in leprosy control". Expert Review of Vaccines. 9 (2):
209–222. doi:10.1586/ERV.09.161. PMID 20109030. CS1 maint:
Multiple names: authors list (link)
Leprosy Vaccine". American
Leprosy Missions. Archived from the
original on November 15, 2015. Retrieved October 20, 2015.
^ "Trial set for world's first leprosy vaccine". The Guardian. June 6,
2014. Archived from the original on October 11, 2015. Retrieved
October 20, 2015.
^ "China's Mars plans, leprosy vaccine and self-driving taxis".
Nature. 2016-08-31. Archived from the original on 2016-09-02.
^ "Mortality and Burden of Disease Estimates for WHO Member States in
2002" (xls). World Health Organization. 2002. Archived from the
original on 2013-01-16.
^ "Archived copy". Archived from the original on 2013-12-12. Retrieved
^ a b "Global
Leprosy Update, 2013: Reducing Disease Burden" (PDF).
Weekly Epidemiological Record. World Health Organization. 36 (89):
389–400. 5 September 2014. Archived (PDF) from the original on 3
February 2016. Retrieved 26 February 2016.
^ "About ILEP". ILEP. Archived from the original on 2014-08-12.
^ WHO (1995). "
Leprosy disabilities: magnitude of the problem". Weekly
Epidemiological Record. 70 (38): 269–75. PMID 7577430.
^ World Health Organization. (1985). "
Epidemiology of leprosy
Epidemiology of leprosy in
relation to control. Report of a WHO Study Group". World Health Organ
Tech Rep Ser. Geneva: World Health Organization. 716: 1–60.
ISBN 92-4-120716-7. OCLC 12095109. PMID 3925646.
^ Monot, Marc; Honoré, Nadine; Garnier, Thierry; Araoz, Romul;
Coppée, Jean-Yves; Lacroix, Céline; Sow, Samba; Spencer, John S.;
Truman, Richard W.; Williams, Diana L.; Gelber, Robert; Virmond,
Marcos; Flageul, Béatrice; Cho, Sang-Nae; Ji, Baohong;
Paniz-Mondolfi, Alberto; Convit, Jacinto; Young, Saroj; Fine, Paul E.;
Rasolofo, Voahangy; Brennan, Patrick J.; Cole, Stewart T. (13 May
2005). "On the Origin of Leprosy". Science. 308 (5724): 1040–1042.
doi:10.1126/science/1109759. PMID 15894530.
^ Robbins, G; Mushrif, V.; Misra, V.N.; Mohanty, R.K.; Shinde, V.S.;
Gray, K.M.; Schug, M.D. (May 2009). "Ancient skeletal evidence for
Leprosy in India (2000 B.C.)". PLoS ONE. 4 (5): e5669.
doi:10.1371/journal.pone.0005669. PMC 2682583 .
^ Robbins Schug, G; Blevins, K. Elaine; Cox, Brett; Gray, Kelsey;
Mushrif-Tripathy, Veena (December 2013). "Infection, Disease, and
Biosocial Process at the End of the Indus Civilization". PLoS ONE.
0084814 (12): e84814. doi:10.1371/journal.pone.0084814.
^ Francis Adams, The Seven Books of Paulus Aegineta: Translated from
the Greek with Commentary Embracing a Complete View of the Knowledge
Possessed by the Greeks, Romans and Arabians on all Subjects Connected
with Medicine and Surgery, 3 vols. (London: Sydenham Society, 1678
^ Roman: Celsus, Pliny, Serenus Samonicus, Scribonius Largus, Caelius
Aurelianus, Themison, Octavius Horatianus, Marcellus the Emperic;
Greek: Aretaeus, Plutarch, Galen, Oribasius, Aetius, Actuarius,
Nonnus, Psellus, Leo, Myrepsus; Arabic: Scrapion, Avenzoar, Albucasis,
the Haly Abbas translated by Stephanus Antiochensis, Alsharavius,
Rhases, and Guido de Cauliaco
^ Robbins, Gwen; Tripathy, V. Mushrif; Misra, V. N.; Mohanty, R. K.;
Shinde, V. S.; Gray, Kelsey M.; Schug, Malcolm D. (May 27, 2009).
"Ancient Skeletal Evidence for
Leprosy in India (2000 B.C.)". PLoS
ONE. 4 (5): e5669. doi:10.1371/journal.pone.0005669.
PMC 2682583 . PMID 19479078.
DNA of Jesus-Era Shrouded Man in Jerusalem Reveals Earliest Case of
Leprosy". ScienceDaily. 2009-12-16. Archived from the original on
2009-12-20. Retrieved 2010-01-31.
^ Irgens LM (2002). "The discovery of the leprosy bacillus". Tidsskr
nor Laegeforen. 122 (7): 708–9. PMID 11998735.
^ Andrew Baum; et al. (1997). Cambridge handbook of psychology, health
and medicine. Cambridge, Angleterre: Cambridge University Press.
p. 521. ISBN 978-0-521-43686-1. Archived from the original
^ Rees RJ, Pearson JM, Waters MF; Pearson; Waters (1970).
"Experimental and Clinical Studies on
Rifampicin in Treatment of
Leprosy". Br Med J. 688 (1): 89–92. doi:10.1136/bmj.1.5688.89.
PMC 1699176 . PMID 4903972. CS1 maint: Multiple
names: authors list (link)
^ Yawalkar SJ, McDougall AC, Languillon J, Ghosh S, Hajra SK,
Opromolla DV, Tonello CJ; McDougall; Languillon; Ghosh; Hajra;
Opromolla; Tonello (1982). "Once-monthly rifampicin plus daily dapsone
in initial treatment of lepromatous leprosy". Lancet. 319 (8283):
PMID 6122970. CS1 maint: Multiple names: authors list (link)
Syphilis through history Archived 2013-05-13 at the Wayback Machine.
^ "Communicable Diseases Department,
Leprosy FAQ". World Health
Organization. 2006-05-25. Archived from the original on 2010-02-01.
^ Japan repealed its "
Leprosy Prevention Laws" in 1996, but former
patients still reside in sanatoriums. "Koizumi apologises for leper
colonies". BBC News. May 25, 2001. Archived from the original on April
17, 2009. and Former Hansen's disease patients still struggling
with prejudice Japan Times June 7, 2007 Archived August 26, 2009, at
the Wayback Machine..
^ Arch Dermato
Syphilis 1898; 44:159–174
^ a b c Gussow, Zachary (1989). Leprosy, Racism, and Public Health.
Boulder, Colorado: Westview Press. ISBN 978-0-8133-0674-2.
^ Jacob, Jesse; Franco-Paredes, Carlos (2008). "The stigmatization of
leprosy in India and its impact on future approaches to elimination
and control". PLoS Neglected Tropical Diseases. 2: e113.
doi:10.1371/journal.pntd.0000113. Archived from the original on
^ [See: Orr, James, M.A., D.D. General Editor. "Entry for 'LEPER;
LEPROSY'". "International Standard Bible Encyclopedia". 1915.
Access-date=January 6, 2017
^ a b c Covey, Herbert C. (2001). "People with leprosy (Hansen's
disease) during the Middle Ages" (PDF). Social Science Journal. 38
(2): 315–321. doi:10.1016/S0362-3319(01)00116-1. Archived from the
original (PDF) on August 15, 2016. Retrieved June 25, 2016.
^ Le Goff, Jacques (1990). The Medieval world. London: Collins &
Brown. ISBN 1-85585-081-8.
^ Clay, Rotha (1909). The Mediaeval Hospitals of England. Cornell
University Library. ISBN 1-112-20443-1.
^ Rubin, Stanley (1974). Medieval English medicine. New York: Barnes
& Noble Books: Newton Abbot: David & Charles.
^ Moore, R. I. (2007). The Formation of a Persecuting Society. Oxford:
Blackwell. ISBN 1-4051-2964-6.
^ Alter, Andrea (2010). Genetic susceptibility to leprosy. McGill
University (Canada): ProQuest Dissertations Publishing.
^ Svein Atle Skålevåg. "Daniel Cornelius Danielssen". Store norske
leksikon. Archived from the original on January 13, 2017. Retrieved
January 1, 2017.
^ Svein Atle Skålevåg. "Carl Wilhelm Boeck". Store norske leksikon.
Archived from the original on January 13, 2017. Retrieved January 1,
^ White, Cassandra (2005). "Explaining a Complex Disease Process:
Talking to Patients about Hansen's Disease (Leprosy) in Brazil".
Medical Anthropology Quarterly. 19: 310–330.
doi:10.1525/maq.2005.19.3.310. ISSN 0745-5194.
^ Barret, Ronald (June 2005). "Self-Mortification and the Stigma of
Leprosy in Northern India". Medical Anthropology Quarterly. 19:
216–230. doi:10.1525/maq.2005.19.2.216. ISSN 1548-1387.
^ "World Health Organization". Archived from the original on
^ Staples, James (2014). "Communities of the afflicted: constituting
leprosy through place in South India". Medical Anthropology:
Cross-Cultural Studies in Health and Illness. 33: 6–20.
^ Tayman, John (2007). The Colony: The Harrowing True Story of the
Exiles of Molokai. New York: Simon and Schuster.
ISBN 978-0-7432-3301-9. Archived from the original on
^ Hamilton, Bernard (2000). The leper king and his heirs: Baldwin IV
and the Crusader Kingdom of Jerusalem. Cambridge, UK: Cambridge
University Press. ISBN 0-521-64187-X.
^ Webber, Roger (2015). Disease Selection: The Way Disease Changed the
World. CABI. p. 8. ISBN 978-1-78064-682-4. Archived from the
original on 2017-09-08.
^ Cung giu Nguyên (1955). "Contemporary Vietnamese Writing". Books
Abroad. University of Oklahoma. 29 (1): 19–25. doi:10.2307/40093803.
^ Bryant A (1995). Sekigahara 1600: The Final Struggle for Power
(Campaign Series, 40). Osprey Publishing (UK).
ISBN 1-85532-395-8. Retrieved 2010-02-28.
^ Truman, Richard (2005). "
Leprosy in wild armadillos". Lepr Rev. 76:
^ Sharma, Rahul; Lahiri, Ramanuj; Scollard, David M.; Pena, Maria;
Williams, Diana L.; Adams, Linda B.; Figarola, John; Truman, Richard
W. (2013-01-01). "The armadillo: a model for the neuropathy of leprosy
and potentially other neurodegenerative diseases". Disease Models
& Mechanisms. 6 (1): 19–24. doi:10.1242/dmm.010215.
ISSN 1754-8403. PMC 3529335 . PMID 23223615. Archived
from the original on 2016-11-13.
^ Job, C. K.; Drain, V.; Truman, R.; Deming, A. T.; Sanchez, R. M.;
Hastings, R. C. (2016-06-01). "The pathogenesis of leprosy in the
nine-banded armadillo and the significance of IgM antibodies to
PGL-1". Indian Journal of Leprosy. 64 (2): 137–151.
ISSN 0254-9395. PMID 1607712.
V · T · D
eMedicine: med/1281 derm/223 neuro/187
Patient UK: Leprosy
Wikimedia Commons has media related to Leprosy.
Leprosy at Curlie (based on DMOZ)
Links and resources Links to information about leprosy selected by the
World Health Organization
Diseases of the skin and appendages by morphology
epidermal inclusion cyst
dermatofibroma (benign fibrous histiocytoma)
infantile digital fibromatosis
granular cell tumor
lichen simplex chronicus
langerhans cell histiocytosis
systemic lupus erythematosus
pityriasis rubra pilaris
acute contact dermatitis
porphyria cutanea tarda
epidermolysis bullosa simplex
insect bite reactions
transient acantholytic dermatosis
pityriasis lichenoides et varioliformis acuta
subcorneal pustular dermatosis
idiopathic guttate hypomelanosis
hypopigmented mycosis fungoides
systemic lupus erythematosus
fixed drug eruption
disseminated intravascular coagulation
lichen sclerosis et atrophicus
systemic lupus erythematosus
loose anagen syndrome
acne keloidalis nuchae
mucous membrane pemphigoid
Gram-positive bacterial infection:
A00–A79, 001–041, 080–109)
Arcanobacterium haemolyticum infection
Tuberculosis: Ghon focus/Ghon's complex
Tuberculous cervical lymphadenitis
Tuberculosis cutis orificialis
Primary inoculation tuberculosis
Extensively drug-resistant tuberculosis
Leprosy: Tuberculoid leprosy
Borderline tuberculoid leprosy
Borderline lepromatous leprosy
M. avium complex/
Nocardia asteroides/Nocardia brasiliensis
Group JK corynebacterium sepsis