Clinics in Dermatology (2015) 33, 818

Leprosy: A glossary
Marcos Virmond, MD, PhD a,, Andrzej Grzybowski, MD, PhD b,c , Luiza Virmond, Mst d
a
Division of Rehabilitation, Instituto Lauro de Souza Lima, Rod Cmt Joao R de Barros, Km 226, Bauru-SP, 17034-971, Brazil
b
Department of Ophthalmology, Poznan City Hospital, ul., Szwajcarska 361-285 Poznan, Poland
c
Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
d
Department of Internal Medicine, School of Medicine, Pontifical Catholic University, Rua Imaculada Conceio 1155, Prado
Velho, Curitiba, Parana, 80215-901, Brazil

Abstract Leprosy continues to afflict residents from a number of countries in Africa, South America, and
southeast Asia, despite the marked reduction in the number of cases of leprosy worldwide, after the
introduction of the multidrug regimens as recommended by the World Health Organization (WHO-MDT).
With the increasing immigration of individuals from risk areas to Europe and the United States, knowledge
of the basic concepts of leprosy would be helpful to clinicians caring for immigrants in nonendemic areas.
We present a comprehensive, updated, and critical glossary of the most relevant terms related to leprosy.
2015 Published by Elsevier Inc.

Introduction The disease is caused by a slow-growingprobably the

The earliest written records of the disease come from India
and date back to 600 BCE,1 although recent archeological
findings in India reveal a skeleton dating back to 2000 BCE
with clear signs of leprosy.2 There is little doubt that leprosy
is an ancient disease. When the advances in medical sciences
are considered, it is perplexing that in the 21st century this
disease continues to affect large proportions of the world
population. Epidemiologic data demonstrate that, despite
important advances in the political, social, and economic
status of developing countries, leprosy is still a disease of
concern in many countries of Africa, southeast Asia, and the
Americas. According to official reports from 105 countries
and territories during 2012, the global registered prevalence
of leprosy at the beginning of 2012 stood at 181,941 cases and
the number of new cases detected during 2011 was 219,075
(excluding the small number of cases in Europe).3
Corresponding author. Tel.: 55 14 31035855; fax: 55 14 31035856.
E-mail addresses: mvirmond@ilsl.br (M. Virmond),
lullyvir@hotmail.com (L. Virmond).
slowest-growingmycobacteria that has a predilection to
affect skin and peripheral nerves. Mycobacterium leprae is an
intracellular parasite, and the cytoplasm of a Schwann cell is
its preferred target. Host immune response is responsible for
the clinical features of the disease. These can vary from mild
signs and symptoms to severe type 1 T helper cell (TH1) or
type 2 T helper cell (TH2) profile immunologic reactions. In
the 1940s, sulfone-derivative drug treatment was introduced,
and in the 1980s an effective multidrug regimen with three
drugs was implemented worldwide, producing a marked
modification in the epidemiologic features of the disease.
Although rare in Europe and North America, leprosy is
still a disease of concern among immigrants coming from
risk areas. Knowledge of basic concepts of the disease would
be helpful to clinicians caring for immigrants in these
regions4; moreover, uniform definitions of commonly used
terms would simplify discussions about the disease and its
consequences.
This glossary of leprosy-related terms was compiled to
define words and explore concepts that are commonly used to
describe leprosy, its pathogenesis, its epidemiology, the
treatments, M leprae, public health, and the social aspects of

http://dx.doi.org/10.1016/j.clindermatol.2014.07.006
0738-081X/ 2015 Published by Elsevier Inc.
Leprosy: A glossary 9

this disease. The glossary contains many up-to-date terms

associated with this disease. Not every technical term has been
included because of the enormity of such an undertaking. It is
hoped that this glossary will help readers define the most
common technical terms associated with leprosy.

Anhidrosis

Decreased secretion or even absence of sweat. Skin lesions Fig. 1 Blepharochalasis as a common finding in long-standing
lepromatous patients.
in leprosy show marked reduction of sweating as evidenced by
a simple test using 1% ninhydrin paper stamps.5
and nodules, which are usually found in combination with
the typical lesions (Figure 2).
Amyloidosis

Formation of amyloid substance in body tissues. Borderline lepromatous leprosy (BL)

Secondary amyloidosis is a complication of several chronic
diseases. Secondary amyloid change is a common finding in
long-standing multibacillary cases.
Armadillo
Dasypus novemcinctus (the nine-banded armadillo) and
other armadillos can be experimentally infected with
M leprae and develop a disease similar to leprosy. Armadillos
are the only animal model known for leprosy.
A leprosy presentation close to the lepromatous pole of the
spectrum. Because of reduced immunologic resistance, lesions
are disseminated and symmetrically distributed. Macular
lesions may increase in size to become erythematous and
infiltrated. The edges of the lesions are irregular and invade
normal skin. Plaque-like lesions, papules, and nodules may
appear, simulating lepromatous leprosy. Reversal reaction and
erythema nodosum leprosum (ENL) are common in these
cases. Skin smears shows strong positivity.

Borderline tuberculoid leprosy (BT)

Bacteriologic index (BI)
A logarithmic scale, from 0 to 6 + based on the average
number of bacilli per microscopic field, using an oil-
immersion objective while examining a slide with a skin
smear from a given leprosy patient.
Blepharochalasis
Skin lesions similar to those observed in tuberculoid
leprosy (TT) but larger and more abundant. Lesions may vary
in size, shape, and color, even in the same patient. Small
satellite lesions near the larger lesions may be observed, and
the color varies from hypochromic to red. Reversal reactions
with severe nerve involvement are common in this presenta-
tion of leprosy. Skin smears may be negative or positive, and
the bacteriologic index usually does not exceed 2 +.

Relaxed eyelid skin tissue secondary to elastic atrophy

(Figure 1).

Borderline leprosy (BB)

Also known as middle-borderline leprosy, BB leprosy is

highly unstable and rare. Characteristic of this type are the
Swiss cheese" skin lesions, characterized by infiltrated
plaques with an apparent normal skin in the center and well-
defined inner edge and uncertain defined outer edges. Amid Fig. 2 Borderline leprosy with typical Swiss cheese lesions in
the typical lesions, there may be macules, plaques, papules, the skin.
10
Cataract
Any opacification of the crystalline lens.
Chemoprophylaxis
A health promotion strategy for the prevention of leprosy
through the use of pharmaceutical agents among population
groups at risk. In the 1960s, dapsone was widely used as
chemoprophylaxis among children and adults in Uganda and
India. Later the use of a single doses rifampicin in contacts of
newly diagnosed leprosy patients reduced the overall incidence
of leprosy in the first 2 years by 57%.6 The combined use of
Bacillus Calmette-Gurin (BCG) and rifampicin should become
a powerful to tool in routine leprosy control in order to interrupt
the transmission of leprosy.7
Clawed hand
An abnormal hand position typical of an ulnar nerve lesion
at the elbow groove. Leprosy remains the major cause of the
ulnar clawed hand. There is hyperextension of the metacarpal
joints of the fourth and fifth fingers and flexion of the
proximal and distal interphalangeal joints. The condition is
highly disabling, inhibiting the performance of many daily
life activities (Figure 3).
Community-based rehabilitation (CBR)
A strategy within general community development for the
rehabilitation, equalization of opportunities, and social
inclusion of all people with disabilities. This strategy is
intended to enhance the quality of life for people with
disabilities through community initiatives, promoting the
concept of the inclusive community. Local resources are
used to support the rehabilitation of people with disabilities
within their own communities.
Fig. 3 Clawed hand caused by damage of the ulnar nerve.
M. Virmond et al.
Clofazimine conjunctival crystalline deposits
Side effects caused by the cumulative dose of clofazimine
and a form of ocular toxicity in patients receiving long-
standing antileprosy multidrug therapy.
Contact
A person living or working with someone with leprosy.
Contacts of patients with multibacillary (MB) leprosy have a
five to eight times greater risk of developing the disease
compared with the general population. Household contacts
also have greater epidemiologic relevance than other contacts.
Corneal nerve beading
Caused by a primary eye infection, leading to calcified
collections of large amounts of M leprae on the fine,
unmyelinated nerves of the corneal stroma. Corneal nerve
beading is generally associated with lepromatous leprosy and
high mycobacterial infection.
Cure of leprosy
A person diagnosed with leprosy who has completed a
full course of fixed-duration multidrug therapy (MDT)
(6 doses for paucibacillary [PB] leprosy and 12 doses for
MB) and is now considered cured.
Dapsone syndrome
A dangerous drug hypersensitivity syndrome that de-
velops in some patients receiving treatment. Features are
fever, lymphadenopathy, lymphocytosis, methemoglobine-
mia, hemolytic anemia, and later exfoliating dermatitis. This
drug eruption accompanied by eosinophilia and systemic
manifestations is termed DRESS syndrome. There may also
be a genetic component.
Demyelination
Loss of the myelin sheath of a nerve or nerves.
Demyelination results in severe disability in many neurode-
generative diseases and nervous system infections such as
leprosy. During M lepraeinduced demyelination, Schwann
cells proliferate significantly both in vitro and in vivo and
generate a more nonmyelinated phenotype, thereby securing
the intracellular niche for M leprae.8
Leprosy: A glossary
Dendritic cells
A cell from the immune system specialized in antigen
presentation to T cells and activation of the immune response.
Detection rate
The number of new cases of leprosy diagnosed in a given
population at a specific time of a given year, divided by the
population in which the cases occur. The new-case detection
rate is a better indicator of disease than prevalence rate,
because it is not affected by the operational aspects of the
control program, such as changing case definitions or
duration of treatment.9
Diagnosis of leprosy
A patient diagnosed with leprosy with one or more of the
following features: (i) hypopigmented or reddish skin lesions
with definite loss of sensation; (ii) damage to the peripheral
nerves, as demonstrated by loss of sensation and mobility to
hand, feet, or face; or (iii) a positive skin smear even with
treatment that has not been completed.
Disability
Difficulty or impossibility to carry out specified activities
because of primary or secondary impairments.
Disability grading
A World Health Organization (WHO) system of grading
of the leprosy-related disabilities involving the eyes, hands,
and feet. It consists of a three-point scale (0, 1, 2). The
highest grade of disability of any of these body sites is used
as an overall indicator of the disability status of a person
with leprosy. Its main use is to assess the disability burden in
the community for decision making, as an indirect indicator
for assessing the performance of early case detection, and
for grading the potential for preventing disabilities in
individual patients.
Drop foot
A disability that occurs in leprosy as a result of damage to
the lateral peroneal nerve. Paralysis of the dorsiflexion
musculature of the foot prevents a normal gait.
11
Drug resistance
The emergence of multidrug-resistant strains of M leprae
would pose a serious threat to leprosy control efforts because
control depends mainly on case findings and adequate
treatment with MDT. There is some evidence of emerging
strains in which the bacilli are resistant to dapsone and
rifampicin. WHO has developed a global initiative to
monitor drug resistance in leprosy.
Ectropion
An outward turning of the eyelid margin from the
globe (Figure 4).
Elimination of leprosy
A World Health Organization public health strategy
aimed at reducing the proportion of leprosy patients in the
community to very low levels, specifically to fewer than 1
case per 10,000 population. WHO hopes to show that leprosy
is not an endless problem, that it is even curable, and that,
within a foreseeable period and through the use of an
effective treatment regimen, it is possible to reduce the
prevalence of the disease to such a low level that it would no
longer constitute a public health problem.
The leprosy elimination strategy has polarized opinions. It
has it strengths, such as increased commitment by govern-
ments, donors, and health workers to focus on leprosy and
facilitate free drug treatment. New case detection has been
promoted with innovative approaches. Unfortunately, the
terminology of leprosy elimination is confusing and
misleading. Creating a target to eliminate leprosy should
be set only if it is realistic.10
Fig. 4 Ectropion. Note the outward turning of the lower eyelid
margin from the globe.
12 M. Virmond et al.

Entropion Impairment

An inversion of the eyelid margin.
Genetics and leprosy
The existence of a strong genetic component in leprosy
susceptibility. To date, it is not clear what the exact nature
of the genetic factors involved may bethat is, the
identity and number of genes, plus the variants of such
genes involved.
Changes in the structure and functioning of certain
parts of the human body caused by a disease. There may
be primary and secondary impairments in leprosy. The
former results directly from the disease, such as nerve
damage or eye damage. The latter is secondarily related
to the initial damage of the disease, such as ulcers
resulting from unprotected use of insensitive hands or
feet12 (Figure 5).
Indeterminate leprosy

An early presentation of leprosy with macular and

Glaucoma
Optic nerve neuropathy of multifactorial origin, often
related to increased intraocular pressure and optic nerve
ischemia. It is an uncommon complication of leprosy and in
most cases secondary to uveitis.
Globi
hypopigmented lesions. It occurs in individuals who have
not developed cell-mediated immunity against M leprae.
Iris atrophy
Altered and denuded iris surface. It is the most common
ocular lesion occurring in many patients with the long-
standing MB form of leprosy.

Composed of closely packed acid-fast leprosy bacilli that

coalesce and become clinically visible as iris lepromas. Iris pearls

Also called miliary iris lepromata, these are pathogno-

Histoid leprosy monic features of chronic lepromatous eye involvement.

A presentation of leprosy characteristic of relapsed or

drug-resistant lepromatous cases. The clinical aspect in- Iridocyclitis
cludes firm, reddish, or skin-colored dome-shaped or oval
papules or nodules. On histologic examination, there are
Concurrent inflammation of the iris and ciliary body,
macrophage granuloma with the predominance of spindle-
usually characterized by the presence of flare and cells in the
shaped cells and a large number of AFB.
anterior chamber.

HIV-leprosy coinfection

Contrary to early expectations, data on the epidemio-

logic and clinical aspects of leprosy suggesting that HIV
infection have not greatly altered the course of leprosy in
coinfected patients. 11

HLA (human leucocyte antigen)

Immunologic polymorphic molecules involved in antigen

presentation and often associated with genetic susceptibility Fig. 5 A severely impaired hand secondary to structural and
to leprosy per se and its clinical forms. functional changes.
Leprosy: A glossary 13

Keratitis

Inflammation of the cornea. Corneal lesions are further

complicated by the presence of lagophthalmos, which leads
to exposure keratitis, repeated corneal ulcers, and eventu-
ally corneal scarring and vascularization. Interstitial
keratitis may also occur as a result of direct corneal
infiltration by M leprae.

Keratoconjunctivitis sicca

Also known as dry eye syndrome (DES) or keratitis sicca,

it is a multifactorial disease of the tear ducts and the ocular
surface. It is caused usually by either decreased tear
production or increased tear film evaporation. The disease
results in discomfort, visual disturbance, and tear film
instability with potential damage to the ocular surface.
Fig. 7 An enlarged cervical nerve, a typical feature of some cases
of leprosy.

Lagophthalmos
Inability to completely close the eyelids, leading to
persistent exposure of the ocular globe (Figure 6).
aspect to the patient; therefore, this clinical type of
lepromatous leprosy (LL) is also called lepra bonita
(pretty leprosy). Lepra bonita was supposed to be unique
to Mexico, but a few cases have been diagnosed in Brazil
and India.

Lepra bonita (pretty leprosy)

Also known as Lucio-Latapi leprosy, it is a polar type
of lepromatous leprosy. The skin shows a generalized
infiltration without nodules, which give a brilliant and
moist appearance. These characteristics provide a healthy
Leprosy
A chronic infectious disease caused by M leprae, an acid-
fast, rod-shaped bacillus. The disease mainly affects the skin,
the peripheral nerves, the mucosa of the upper respiratory
tract, and also the eyes, apart from some other structures,
depending on the type of the disease (Figures 7 and 8).

Fig. 6 Lagophthalmos, the inability to close the eyes. Damage of

the orbicular branch of the facial nerve is involved in this disability. Fig. 8 A reddish patch in the frontal region.
14
Leprosy stigma
Stigma as a negative response to human differences.
These may be obvious visible signs or differences in
behavior, or they may be more subtle. If these are related
to a health condition, this response is labeled health-
related stigma.13
Lepromatous leprosy (LL)
LL is caused by a strong inability for an immunologic
reaction against M leprae. If untreated, the disease spreads
widely in the patient with systemic repercussions. Apart from
the skin lesions, eyes, nose, bones, testes, spleen, liver, and
adrenals may be compromised. Skin lesions are diffuse with
imprecise edges in the polar type (anergic) (LLp). In the
subpolar type (LLs), patients present some weak reaction to
the bacilli and macule, nodules, and plaques show more
precise limits, although lesions are widespread through the
body surface, except for the scalp, soles of the feet, and other
sites with higher temperatures (Figure 9).
Leprosy reactions
Immunologically mediated episodes of acute or subacute
inflammation that may occur during the course of both
paucibacillary and multibacillary cases of leprosy. Clinical
features of a reaction include nerve involvement with nerve
pain, loss of sensation, and loss of function. Nerve
involvement can be acute and may rapidly cause severe
and irreversible nerve damage.
Fig. 9 Nodules in the ear in a lepromatous leprosy patient.
M. Virmond et al.
Madarosis
Loss of eyebrows and eyelashes in leprosy caused by
direct M leprae invasion of the hair follicles with subsequent
atrophy (Figure 10).
Miotic pupils
Small pupils, poorly dilated or nondilatated with
mydriatic drugs, often encountered with iris atrophy in
patients with long-standing MB leprosy.
M leprae genome
Sequencing of the M leprae genome in 2001.14 The
genome is much smaller than the Mycobacterium tuberculosis
genome. The M leprae genome has undergone reductive
evolution, because 40% of the genes are inactivated and 50%
of the genes of the last common ancestor of M leprae and
M tuberculosis have been lost. Although the M leprae strains
come from geographically distant locations (eg, from Brazil,
Thailand, and the United States), comparison of their genomes
shows that they are 99.995% identical. This implies that
leprosy has arisen from a single clonal strain.
Mitsuda intradermal test
Measures the granulomatous immune response to intrader-
mally injected, heat-killed M leprae (lepromin). The reaction is
positive in cases of tuberculoid (TT) and borderline-tubercu-
loid (BT) leprosy and therefore is helpful in classification and
Fig. 10 Madarosis in a lepromatous leprosy patient.
Leprosy: A glossary
prognosis. It is negative in lepromatous (LL) and borderline
lepromatous (BL) types. In indeterminate cases, a negative test
may indicate that the lesion is differentiating into lepromatous
leprosy and may thus be helpful in assessing the direction in
which the disease will progress.
Mouse footpad test (Shepard method)
A system to detect drug resistance in leprosy and study the
viability of M leprae. A suspension of M leprae is inoculated
into the mouse footpad of normal or thymectomized, irradiated
mice. Animals receive a daily food ration with the studied
drug, and microscopic examination of a biopsy from the
footpad injected indicates the amount of bacilli after a period of
observation. The mouse footpad technique is labor intensive,
time consuming, and expensive in terms of the costs of animal
purchase and maintenance; however, it is still the gold standard
to study drug resistance and viability of the pathogen.
Multibacillary leprosy (MB)
A simplified classification of leprosy for field purposes
indicating cases with high bacillary load for purposes of
MDT treatment. MB patients are those leprosy patients with
more than five skin lesions.
Multidrug therapy (MDT)
A combination of rifampicin, clofazimine, and dapsone
for MB leprosy patients and rifampicin and dapsone for PB
leprosy patients. Rifampicin is a potent bactericidal drug
against M leprae and therefore is included in the treatment of
both types of leprosy.
Nerve conduction studies in leprosy
Assessment of nerve function. Nerve conduction studies are
more sensitive than clinical evaluation. With this method,
abnormalities can be seen in patients with leprosy without
clinical signs of neuropathy, even in nerves without enlarge-
ment. Although not specific for leprosy, the classic pattern seen
in leprosy is a sensorimotor, asymmetric, multiple neuropathy
with focal demyelination and distal axonal impairment.
Neuropathic pain
A direct consequence of a lesion or a disease affecting
the somatosensory system. In leprosy, neuropathic pain,
15
not directly associated with an acute reactive episode, may
be present in a considerable proportion of cases. Neural
inflammation can excite and sensitize nociceptors. In some
cases, there is severe destruction of nerve fibers. The partial
regeneration that follows may produce discharges, dimi-
nution of stimulus thresholds, and exaggerated responses
of nociceptors.
Orbital apex syndrome
Pathologic condition leading to deterioration of tissues
lying in superior orbital fissure (cranial nerve [CN] III, CN
IV, V1 branches of the CN V and CN VI) and in the optic
nerve canal (CN II), leading to ptosis, ophthalmoplegia, loss
of vision, decreased ocular sensations, and secondary corneal
ulceration and opacities.
Participation scale
A standardized interview tool for assessing the severity
of rehabilitation needs of people with disability and those
with other stigmatizing conditions. The instrument is based
on the Participation domains of the International Classifi-
cation of Functioning, Disability, and Health (ICF-WHO)
and aims to measure client-perceived participation in people
affected by leprosy, allowing collection of participation
data and impact assessment of interventions to improve
social participation.15
Participation restriction
Problems an individual may experience in involvement in
life situations. In leprosy the sensory and motor loss can lead
to difficulty in grasping objects, which is associated with the
leprosy stigma, leading to unemployment.12
Paucibacillary leprosy (PB)
A simplified classification of leprosy indicating
cases with low bacillary load for purposes of MDT
treatment. PB are those leprosy cases with five or fewer
skin lesions.
Phenolic glycolipid 1 (PGL-1)
PGL-1 of M leprae represents a specific antigen for leprosy
that may be of help for the detection of early leprosy.16
16
Plantar ulcer
Also known as trophic ulcer, representing a circumscribed
break of the skin continuity of the plantar surface (Figure 11).
It is usually seen in the sensory-deficient foot. The
pathogenesis includes continuous pressure causing tissue
necrosis and repetitive mechanical stress in areas of
concentrated high pressure in the plantar region. Long-
standing and untreated ulcers can undergo malignancy
(squamous cell carcinoma).
Prevalence rate
The number of cases of leprosy in a defined population at
a specific time, usually December 31 of a given year, divided
by the population in which the cases occur. Point prevalence
rate is the number of current new and preexisting cases at a
specified time.
Prevention of disabilities
A group of practices to prevent the development of
disabilities or to prevent the worsening of disabilities already
present because of loss of sensation and muscle strength.
Primary neural leprosy (PNL)
A leprosy patient with clinical presentation limited to
the peripheral nerves. PNL is also called neural leprosy,
Fig. 11 An ulcer in the plantar region.
M. Virmond et al.
pure (purely) neural (neuritic) leprosy, primary neuritic
leprosy, or polyneuritic leprosy. The clinical features
of PNL include nerve enlargement, tenderness, pain, and
sensorimotor impairment.
Pterygium
A wing-shaped growth of the conjunctiva that can spread
through the corneal limbus and cover the cornea, eventually
disturbing vision.
Ptosis
An abnormally low position of the upper eyelid.
Relapse
In multibacillary cases, relapse being the multiplica-
tion of M leprae in cases already treated. Clinical
deterioration is related to new skin patches or nodules
and/or new nerve damage and a clear increase in the
values of the bacteriologic index (at least 2 + over the
previous value).
Reversal reaction
Reactions in leprosy associated with the development of
M leprae antigenic determinants. They are delayed
hypersensitivity reactions and may occur in both pauciba-
cillary leprosy and multibacillary leprosy. In type 1 lepra
reactions, there is a high risk of permanent damage to the
peripheral nerve trunks. If the reaction is mild and there is
no evidence of neuritis (pain, loss of sensation or
function), the reaction should be treated with analgesics,
such as acetylsalicylic acid. If there is nerve involvement,
treatment should include analgesics and corticosteroids
(prednisolone) (Figure 12).
Ridley-Jopling classification
A leprosy classification proposed by Dennis S. Ridley
and William Jopling in 1966.17 The classification is based
not only on the clinical features but also on histopathology,
bacterial load, and the degree of cell-mediated immune
response against M leprae (Mitsuda test). Patients are
divided into five groups in the spectrum from tuberculoid
(TT) through borderline (BT, BB, BL) and to lepromatous
(LL). Indeterminate leprosy (I) does not fall into this
Leprosy: A glossary 17

Skin smears

A test in which a portion of lymph and a few cells are

collected by scratching a small cut in the earlobes, from the skin
of the elbow, or from an active patch. The material is smeared
on a glass slide, fixed, and stained by the Ziehl-Neelsen
method. Skin smear examination in the microscope (bacillo-
scopy) is used to identify the presence of M leprae. If positive,
the case is classified as multibacillary leprosy (Figure 13).

Staphyloma

A protruding defect of the sclera or cornea.

Tarsorrhaphy
Fig. 12 Type 1 leprosy reaction (reversal reaction).
Surgical approximation of the upper and lower eyelids
with sutures. The primary aim of tarsorrhaphy is protection
of the cornea.

spectrum because there is a lack of correlation between the

clinical and histopathologic features. Although still widely Treatment of leprosy
used today, Ridley-Jopling classification is mostly restrict-
ed to research purposes. Leprosy as a curable disease with MDT. Multidrug
therapy for leprosy includes dapsone, rifampicin, and
clofazimine. Alternative treatment schemes use ofloxacin,
minocycline, and clarithromycin.
SALSA scale (Screening of Activity Limitation
and Safety Awareness)
Trichiasis
A cross-cultural questionnaire used to assess activity
restrictions resulting from leprosy or other conditions. It is
Supernumerary lashes that turn inward toward the cornea
composed of 20 items of daily activities, related to the three
and that can lead to ulcers in an insensitive cornea.
domains of mobility, self-care, and work, allowing the
patient to perceive his or her functional level.18
Tuberculoid leprosy (TT)

Schirmer test A type of leprosy of individuals with intense cell-

mediated immunity. It is characterized by the presence of a
A simple clinic evaluation of tear production based
on the quantitative wetting (during a 5-minute interval)
of a piece of folded filter paper positioned in the lower
lid fornix.

Schwann cells

A peripheral nerve cell that is part of the nerve fiber. The

Schwann cell wraps around the axon and produces myelin
membrane in the so-called myelinated nerve fibers.
Schwann cells are the key point of the pathogenesis of
nerve injury in leprosy. Fig. 13 A skin smear stained by Ziehl-Neelsen technique.
18
Fig. 14 Uveitis in a reaction case of leprosy.
unique or a few small-sized lesions, showing well-defined
and elevated borders (papules and plaques). Lesions may
show decreased sweating, loss of body hair, and character-
istically present diminished sensation. Pure tuberculoid cases
(TT of Ridley-Jopling classification) are rare.
Uveitis
Inflammation of the uveal layer of the eye (Figure 14).
ZiehlNeelsen staining
A standard staining method for evidencing M leprae in
skin smears. The property of acid-fastness is based on the
presence of mycolic acids in the cell wall of M leprae.
Primary stain (fuchsin) binds to cell-wall mycolic acids.
Intense decolorization (strong acid or acid/alcohol) does not
release the primary stain from the cell wall and the
mycobacteria retain the red color of fuchsinhence, acid-
fastness. For providing a contrasting background, the slide is
counterstained with methylene blue.
M. Virmond et al.
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Churchill Livingstone. 1989.
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