Editorial Leprosy: A Neurologist's Perspective: Leprosy :A Neurologist’s Perspective
Authors
Satish KhadilkarFiles
Key Information
Journal
Published in Vol. 67 No. 4 (2025) of Bombay Hospital Journal.
Bombay Hospital Journal (BHJ) is a peer-reviewed quarterly published Print and Online journal. It is an official Journal of Bombay Hospital institute of medical sciences. The aim of BHJ is to improve medical care by publishing sound scientific articles (both research and practice papers) and focusing on topics that are of great importance to its readership.
Editor-in-Chief- Dr Satish Vasant Khadilkar
About the JournalAbstract
Leprosy (Hansen’s disease) is a chronic infectious disease caused by Mycobacterium leprae that primarily affects the skin and
peripheral nerves. Despite availability of effective treatment, leprosy continues to be an important public health problem, particularly
in Southeast Asia. India accounts for a significant proportion of the global disease burden. Transmission typically occurs through
prolonged close contact with infected individuals, most commonly via respiratory droplets. The bacillus demonstrates a predilection
for cooler areas of the body and preferentially infects Schwann cells, leading to progressive peripheral nerve damage through
both direct bacterial invasion and immune-mediated mechanisms. Clinically, leprosy presents across a spectrum ranging from
tuberculoid to lepromatous disease, depending on the host’s cell-mediated immune response. Classical manifestations include
hypopigmented hypoesthetic skin lesions, thickened peripheral nerves, sensory loss, and painless ulcers. Peripheral neuropathy
is a hallmark of the disease and may manifest as mononeuritis multiplex, pure neuritic leprosy, or generalized polyneuropathy.
Early involvement of small sensory fibers results in loss of temperature sensation, often preceding impairment of other sensory
modalities. Diagnosis is primarily clinical and is supported by slit-skin smear examination for acid-fast bacilli, electrophysiological
studies, imaging, and histopathological evaluation. Early recognition is essential to prevent irreversible nerve injury, deformities,
and disability. Management involves multidrug therapy with dapsone, rifampicin, and clofazimine as recommended by the World
Health Organization. Additional management includes treatment of lepra reactions, control of neuropathic pain, rehabilitation, and
preventive strategies such as chemoprophylaxis and vaccination. A multidisciplinary approach and early diagnosis are crucial for
reducing long-term complications and social stigma associated with the disease.
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