Leprosy - wikipedia Leprosy For the Biblical term and its varied meanings, see Tzaraath. For other uses, see Leprosy ( disambiguation ). `` Leper '' redirects here. It is not to be confused with Ieper, a Belgian city. Leprosy Synonyms Hansen 's disease ( HD ) A 24 - year - old man with leprosy ( 1886 ) Pronunciation / ˈlɛprəsi / Specialty Infectious disease Symptoms Decreased ability to feel pain Causes Mycobacterium leprae or Mycobacterium lepromatosis Risk factors Close contact with a case of leprosy, living in poverty Treatment Multidrug therapy Medication Rifampicin, dapsone, clofazimine Frequency 514,000 ( 2015 ) 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 present. 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 reaction. 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. It is classified as a neglected tropical disease. World Leprosy Day was started in 1954 to draw awareness to those affected by leprosy. Contents 1 Signs and symptoms 2 Cause 2.1 M. leprae and M. lepromatosis 2.2 Risk factors 2.3 Transmission 2.4 Genetics 3 Pathophysiology 4 Diagnosis 4.1 Classification 5 Prevention 6 Treatment 7 Epidemiology 7.1 Disease burden 8 History 9 Society and culture 9.1 India 9.2 Treatment cost 9.3 Historical texts 9.4 Middle Ages 9.5 19th century 9.5. 1 Norway 9.5. 2 Colonialism and imperialism 9.6 Stigma 9.7 Programs and treatment 9.8 Notable cases 10 Other animals 11 See also 12 References 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 Cause 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. Main articles : Mycobacterium leprae and Mycobacterium lepromatosis 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 Mycobacterium genus. 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 causation. 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 and armadillos. 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. Risk factors 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 population. Leprosy also occurs more commonly among those living in poverty. 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 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 epidemiology. 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. Genetics Name Locus OMIM Gene LPRS1 10p13 609888 LPRS2 6q25 607572 PARK2, PACRG LPRS3 4q32 246300 TLR2 LPRS4 6p21. 3 610988 LTA LPRS5 4p14 613223 TLR1 LPRS6 13q14. 11 613407 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 of 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 leprosy. Pathophysiology How the infection produces the symptoms of the disease is not known. Diagnosis 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 causes. 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. Classification Several different approaches for classifying leprosy exist, but parallels exist. The 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. WHO Ridley - Jopling ICD - 10 MeSH Description Lepromin test Paucibacillary tuberculoid ( `` TT '' ), borderline tuberculoid ( `` BT '' ) A30. 1, A30. 2 Tuberculoid 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. Positive Multibacillary midborderline or borderline ( `` BB '' ) A30. 3 Borderline 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. Multibacillary borderline lepromatous ( `` BL '' ), and lepromatous ( `` LL '' ) A30. 4, A30. 5 Lepromatous 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. Negative A difference in immune response to the tuberculoid and lepromatous forms is seen. Leprosy may also be divided into : Early and indeterminate leprosy Tuberculoid leprosy Borderline tuberculoid leprosy Borderline leprosy Borderline lepromatous leprosy Lepromatous leprosy Histoid leprosy Diffuse leprosy of Lucio and Latapí This disease may also occur with only neural involvement, without skin lesions. Prevention 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. Treatment 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 recommended. 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 blister packs. Relapse rates remain low, and no resistance to the combined drugs is seen. Epidemiology Main article : Epidemiology of leprosy World distribution of leprosy, 2003 Disability - adjusted life year for leprosy per 100,000 inhabitants in 2004 no data < 1.5 1.5 -- 3 3 -- 4.5 4.5 -- 6 6 -- 7.5 7.5 -- 9 9 -- 10.5 10.5 -- 12 12 -- 13.5 13.5 -- 15 15 -- 20 > 20 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 % ), followed by 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 Anti-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. Disease Burden 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. History 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 Caledonia. 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 India and 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 afflictions. 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 syphilis. 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 ulcerated mucosa. Society and culture Two lepers denied entrance to town, 14th century India 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 Leprosy Control Programme, changed its methods from surveillance to the treatment of people with leprosy. India still accounts for over half of the global disease burden. Treatment cost 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. Historical texts 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 punishable. 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 instances of 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 ( 540 - 604 ) and Isidor of Seville ( 560 - 636 ) considered people with the disease to be heretics. Middle Ages 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 church. 19th century Norway 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 of infection. Early leprosy research throughout Europe was conducted by Norwegian scientists Daniel Cornelius Danielssen and Carl Wilhelm Boeck. Their work resulted in the establishment of the National Leprosy Research 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 reproduction. 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 by Surgeon - Mayor 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. Stigma See also : Leprosy stigma Despite effective treatment and education efforts, leprosy stigma continues to be problematic in developing countries where the disease is common. 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 information. 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. Notable cases 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 was a Christian king of Latin Jerusalem afflicted with leprosy. King Henry IV of England ( reigned 1399 to 1413 ) possibly had leprosy. 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 intensify it. '' Other animals 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. See also Noma ( disease ) References Jump up ^ `` Definition of leprosy ''. The Free Dictionary. Retrieved 2015 - 01 - 25. ^ Jump up to : 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. ^ Jump up to : `` Leprosy Fact sheet N ° 101 ''. World Health Organization. January 2014. Archived from the original on 2013 - 12 - 12. ^ Jump up to : `` 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. ^ Jump up to : 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. PMID 26773620. Jump up ^ 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. PMID 27733282. ^ Jump up to : `` Hansen 's Disease ( Leprosy ) Transmission ''. cdc.gov. April 29, 2013. Archived from the original on 13 March 2015. Retrieved 28 February 2015. Jump up ^ `` Global leprosy situation, 2012 ''. Wkly. Epidemiol. Rec. 87 ( 34 ) : 317 -- 28. August 2012. PMID 22919737. ^ Jump up to : Rodrigues LC ; Lockwood DNj ( June 2011 ). `` Leprosy now : epidemiology, progress, challenges, and research gaps ''. The Lancet Infectious Diseases. 11 ( 6 ) : 464 -- 70. doi : 10.1016 / S1473 - 3099 ( 11 ) 70006 - 8. PMID 21616456. Jump up ^ `` Hansen 's Disease Data & Statistics ''. Health Resources and Services Administration. Archived from the original on 4 January 2015. Retrieved 12 January 2015. Jump up ^ Walsh F ( 2007 - 03 - 31 ). `` The hidden suffering of India 's lepers ''. BBC News. Archived from the original on 2007 - 05 - 29. Jump up ^ Lyn TE ( 2006 - 09 - 13 ). `` Ignorance breeds leper colonies in China ''. Independat News & Media. Archived from the original on 2010 - 04 - 08. Retrieved 2010 - 01 - 31. ^ Jump up to : Byrne, Joseph P. ( 2008 ). Encyclopedia of pestilence, pandemics, and plagues. Westport, Conn. ( u.a. ) : Greenwood Press. p. 351. ISBN 978 - 0 - 313 - 34102 - 1. Jump up ^ `` Neglected Tropical Diseases ''. cdc.gov. June 6, 2011. Archived from the original on 4 December 2014. Retrieved 28 November 2014. Jump up ^ 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. ^ Jump up to : 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. ^ Jump up to : `` 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. ^ Jump up to : Kulkarni GS ( 2008 ). Textbook of Orthopedics and Trauma ( 2 ed. ). Jaypee Brothers Publishers. p. 779. ISBN 978 - 81 - 8448 - 242 - 3. Jump up ^ `` 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. Jump up ^ 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. Jump up ^ 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 September 2007. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. Jump up ^ 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. ^ Jump up to : `` Leprosy ''. WHO. 2009 - 08 - 01. Archived from the original on 2010 - 02 - 09. Retrieved 2010 - 01 - 31. Jump up ^ Brosch, Roland ; Stinear, Timothy P. ( 11 November 2016 ). `` Leprosy in red squirrels ''. Science. 354 ( 6313 ) : 702 -- 703. doi : 10.1126 / science. aal0145. Archived from the original on 8 September 2017. Retrieved 2016 - 11 - 11. Jump up ^ 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 New 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. ^ Jump up to : `` 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... Jump up ^ 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. Jump up ^ 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. Jump up ^ Buschman E, Skamene E ( Jun 2004 ). `` Linkage of leprosy susceptibility to Parkinson 's disease genes '' ( PDF ). International journal of leprosy and other mycobacterial diseases. 72 ( 2 ) : 169 -- 70. doi : 10.1489 / 1544 - 581X ( 2004 ) 072 < 0169 : LOLSTP > 2.0.CO ; 2. ISSN 0148 - 916X. PMID 15301585. Archived ( PDF ) from the original on January 5, 2012. Retrieved January 31, 2011. Jump up ^ 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. Jump up ^ `` Diagnosis of Leprosy. '' WHO. from `` Archived copy ''. Archived from the original on 2014 - 06 - 05. Retrieved 2014 - 07 - 14. accessed on 14 July 2014. Jump up ^ 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. Jump up ^ Smith DS ( 2008 - 08 - 19 ). `` Leprosy : Overview ''. eMedicine Infectious Diseases. Archived from the original on 2010 - 02 - 18. Retrieved 2010 - 02 - 01. Jump up ^ 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 ( link ) Jump up ^ 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. Jump up ^ Modlin RL ( June 1994 ). `` Th1 - Th2 paradigm : insights from leprosy ''. J. Invest. Dermatol. 102 ( 6 ) : 828 -- 32. doi : 10.1111 / 1523 - 1747. ep12381958. PMID 8006444. Jump up ^ James, William D. ; Berger, Timothy G. ; et al. ( 2006 ). Andrews ' Diseases of the Skin : clinical Dermatology. Saunders Elsevier. ISBN 0 - 7216 - 2921 - 0. Jump up ^ 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 ( link ) Jump up ^ 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 ) Jump up ^ 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 ( link ) Jump up ^ 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 list ( link ) Jump up ^ 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 ) ^ Jump up to : 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. PMID 21616456. Jump up ^ 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 ) Jump up ^ 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 ) Jump up ^ 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 ) Jump up ^ `` Leprosy Vaccine ''. American Leprosy Missions. Archived from the original on November 15, 2015. Retrieved October 20, 2015. Jump up ^ `` 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. Jump up ^ `` China 's Mars plans, leprosy vaccine and self - driving taxis ''. Nature. 2016 - 08 - 31. Archived from the original on 2016 - 09 - 02. Retrieved 2016 - 09 - 03. Jump up ^ `` 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. Jump up ^ `` Archived copy ''. Archived from the original on 2013 - 12 - 12. Retrieved 2014 - 01 - 01. ^ Jump up to : `` 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. Jump up ^ `` About ILEP ''. ILEP. Archived from the original on 2014 - 08 - 12. Retrieved 2014 - 08 - 25. Jump up ^ WHO ( 1995 ). `` Leprosy disabilities : magnitude of the problem ''. Weekly Epidemiological Record. 70 ( 38 ) : 269 -- 75. PMID 7577430. Jump up ^ World Health Organization. ( 1985 ). `` 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. Jump up ^ 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. Jump up ^ 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. PMID 19479078. Jump up ^ 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. Jump up ^ 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 Jump up ^ 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 Jump up ^ 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. Jump up ^ `` 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. Jump up ^ Irgens LM ( 2002 ). `` The discovery of the leprosy bacillus ''. Tidsskr nor Laegeforen. 122 ( 7 ) : 708 -- 9. PMID 11998735. Jump up ^ 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 on 2016 - 06 - 11. Jump up ^ 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 ) Jump up ^ 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 ) : 1199 -- 1202. doi : 10.1016 / S0140 - 6736 ( 82 ) 92334 - 0. PMID 6122970. CS1 maint : Multiple names : authors list ( link ) Jump up ^ Syphilis through history Archived 2013 - 05 - 13 at the Wayback Machine. Encyclopædia Britannica Jump up ^ `` Communicable Diseases Department, Leprosy FAQ ''. World Health Organization. 2006 - 05 - 25. Archived from the original on 2010 - 02 - 01. Retrieved 2010 - 01 - 31. Jump up ^ 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... Jump up ^ Arch Dermato Syphilis 1898 ; 44 : 159 -- 174 ^ Jump up to : Gussow, Zachary ( 1989 ). Leprosy, Racism, and Public Health. Boulder, Colorado : Westview Press. ISBN 978 - 0 - 8133 - 0674 - 2. Jump up ^ 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 2017 - 02 - 20. Jump up ^ ( See : Orr, James, M.A., D.D. General Editor. `` Entry for ' LEPER ; LEPROSY ' ''. `` International Standard Bible Encyclopedia ''. 1915. Access - date = January 6, 2017 ^ Jump up to : 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. Jump up ^ Le Goff, Jacques ( 1990 ). The Medieval world. London : Collins & Brown. ISBN 1 - 85585 - 081 - 8. Jump up ^ Clay, Rotha ( 1909 ). The Mediaeval Hospitals of England. Cornell University Library. ISBN 1 - 112 - 20443 - 1. Jump up ^ Rubin, Stanley ( 1974 ). Medieval English medicine. New York : Barnes & Noble Books : Newton Abbot : David & Charles. ISBN 0 - 06 - 496016 - 1. Jump up ^ Moore, R.I. ( 2007 ). The Formation of a Persecuting Society. Oxford : Blackwell. ISBN 1 - 4051 - 2964 - 6. Jump up ^ Alter, Andrea ( 2010 ). Genetic susceptibility to leprosy. McGill University ( Canada ) : ProQuest Dissertations Publishing. ISBN 978 - 0 - 494 - 72613 - 6. Jump up ^ Svein Atle Skålevåg. `` Daniel Cornelius Danielssen ''. Store norske leksikon. Archived from the original on January 13, 2017. Retrieved January 1, 2017. Jump up ^ Svein Atle Skålevåg. `` Carl Wilhelm Boeck ''. Store norske leksikon. Archived from the original on January 13, 2017. Retrieved January 1, 2017. Jump up ^ 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. JSTOR 3655365. Jump up ^ 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. JSTOR 3655487. Jump up ^ `` World Health Organization ''. Archived from the original on 2014 - 03 - 14. Jump up ^ 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. doi : 10.1080 / 01459740.2012. 714021. Jump up ^ 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 2016 - 01 - 02. Jump up ^ 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. Jump up ^ 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. Jump up ^ Cung giu Nguyên ( 1955 ). `` Contemporary Vietnamese Writing ''. Books Abroad. University of Oklahoma. 29 ( 1 ) : 19 -- 25. doi : 10.2307 / 40093803. JSTOR 40093803. Jump up ^ 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. Jump up ^ Truman, Richard ( 2005 ). `` Leprosy in wild armadillos ''. Lepr Rev. 76 : 198 -- 208. Jump up ^ 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. Jump up ^ 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. External links Classification V T D ICD - 10 : A30 ICD - 9 - CM : 030 OMIM : 246300 MeSH : D007918 DiseasesDB : 8478 External resources MedlinePlus : 001347 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 Growths Epidermal wart callus seborrheic keratosis acrochordon molluscum contagiosum actinic keratosis squamous - cell carcinoma basal - cell carcinoma Merkel - cell carcinoma nevus sebaceous trichoepithelioma Pigmented Freckles lentigo melasma nevus melanoma Dermal and subcutaneous epidermal inclusion cyst hemangioma dermatofibroma ( benign fibrous histiocytoma ) keloid lipoma neurofibroma xanthoma Kaposi 's sarcoma infantile digital fibromatosis granular cell tumor leiomyoma lymphangioma circumscriptum myxoid cyst Rashes With epidermal involvement Eczematous contact dermatitis atopic dermatitis seborrheic dermatitis stasis dermatitis lichen simplex chronicus Darier 's disease glucagonoma syndrome langerhans cell histiocytosis lichen sclerosus pemphigus foliaceus Wiskott -- Aldrich syndrome Zinc deficiency Scaling psoriasis tinea ( corporis cruris pedis manuum faciei ) pityriasis rosea secondary syphilis mycosis fungoides systemic lupus erythematosus pityriasis rubra pilaris parapsoriasis ichthyosis Blistering herpes simplex herpes zoster varicella bullous impetigo acute contact dermatitis pemphigus vulgaris bullous pemphigoid dermatitis herpetiformis porphyria cutanea tarda epidermolysis bullosa simplex Papular scabies insect bite reactions lichen planus miliaria keratosis pilaris lichen spinulosus transient acantholytic dermatosis lichen nitidus pityriasis lichenoides et varioliformis acuta Pustular acne vulgaris acne rosacea folliculitis impetigo candidiasis gonococcemia dermatophyte coccidioidomycosis subcorneal pustular dermatosis Hypopigmented tinea versicolor vitiligo pityriasis alba postinflammatory hyperpigmentation tuberous sclerosis idiopathic guttate hypomelanosis leprosy hypopigmented mycosis fungoides Without epidermal involvement Red Blanchable Erythema Generalized drug eruptions viral exanthems toxic erythema systemic lupus erythematosus Localized cellulitis abscess boil erythema nodosum carcinoid syndrome fixed drug eruption Specialized urticaria erythema ( multiforme migrans gyratum repens annulare centrifugum ab igne ) Nonblanchable Purpura Macular thrombocytopenic purpura actinic / solar purpura Papular disseminated intravascular coagulation vasculitis Indurated scleroderma / morphea granuloma annulare lichen sclerosis et atrophicus necrobiosis lipoidica Miscellaneous disorders Ulcers Hair telogen effluvium androgenic alopecia alopecia areata systemic lupus erythematosus tinea capitis loose anagen syndrome lichen planopilaris folliculitis decalvans acne keloidalis nuchae Nail onychomycosis psoriasis paronychia ingrown nail Mucous membrane Aphthous stomatitis oral candidiasis lichen planus leukoplakia pemphigus vulgaris mucous membrane pemphigoid cicatricial pemphigoid herpesvirus coxsackievirus syphilis systemic histoplasmosis squamous - cell carcinoma Gram - positive bacterial infection : Actinobacteria ( primarily A00 -- A79, 001 -- 041, 080 -- 109 ) Actinomycineae Actinomycetaceae Actinomyces israelii Actinomycosis Cutaneous actinomycosis Tropheryma whipplei Whipple 's disease Arcanobacterium haemolyticum Arcanobacterium haemolyticum infection Actinomyces gerencseriae Propionibacteriaceae Propionibacterium acnes Corynebacterineae Mycobacteriaceae M. tuberculosis / M. bovis Tuberculosis : Ghon focus / Ghon 's complex Pott disease brain Meningitis Rich focus Tuberculous lymphadenitis Tuberculous cervical lymphadenitis cutaneous Scrofuloderma Erythema induratum Lupus vulgaris Prosector 's wart Tuberculosis cutis orificialis Tuberculous cellulitis Tuberculous gumma Lichen scrofulosorum Tuberculid Papulonecrotic tuberculid Primary inoculation tuberculosis Miliary Tuberculous pericarditis Urogenital tuberculosis Multi-drug - resistant tuberculosis Extensively drug - resistant tuberculosis M. leprae Leprosy : Tuberculoid leprosy Borderline tuberculoid leprosy Borderline leprosy Borderline lepromatous leprosy Lepromatous leprosy Histoid leprosy Nontuberculous R1 : M. kansasii M. marinum Aquarium granuloma R2 : M. gordonae R3 : M. avium complex / Mycobacterium avium / Mycobacterium intracellulare / MAP MAI infection M. ulcerans Buruli ulcer M. haemophilum R4 / RG : M. fortuitum M. chelonae M. abscessus Nocardiaceae Nocardia asteroides / Nocardia brasiliensis Nocardiosis Rhodococcus equi Corynebacteriaceae Corynebacterium diphtheriae Diphtheria Corynebacterium minutissimum Erythrasma Corynebacterium jeikeium Group JK corynebacterium sepsis Bifidobacteriaceae Gardnerella vaginalis GND : 4035392 - 8 HDS : 7983 NDL : 00569249 Retrieved from `` https://en.wikipedia.org/w/index.php?title=Leprosy&oldid=835645533 '' Categories : Bacterial diseases Leprosy Hidden categories : Webarchive template wayback links CS1 maint : Multiple names : authors list Infobox medical condition ( new ) Pages using div col without cols and colwidth parameters Articles with Curlie links Wikipedia articles with GND identifiers RTT RTTID Talk Contents About Wikipedia Afrikaans Akan অসমীয়া Azərbaycanca تۆرکجه বাংলা Bân - lâm - gú Беларуская Беларуская ( тарашкевіца ) ‎ Български བོད ་ ཡིག Bosanski Brezhoneg Català Čeština Chi - Chewa ChiShona Cymraeg Dansk Deutsch ދިވެހިބަސް Eesti Ελληνικά Español Esperanto Euskara فارسی Français Gaeilge Galego ગુજરાતી 한국어 Հայերեն हिन्दी Hrvatski Ido Igbo Bahasa Indonesia IsiXhosa Íslenska Italiano עברית ಕನ್ನಡ ქართული Kaszëbsczi Қазақша Kiswahili Kurdî Кыргызча Latina Latviešu Lietuvių Lingála Magyar Македонски മലയാളം मराठी Bahasa Melayu Baso Minangkabau Mìng - dĕ̤ng - ngṳ̄ Монгол မြန်မာဘာသာ Nederlands नेपाली 日本 語 Norsk Norsk nynorsk Occitan ଓଡ଼ିଆ Oromoo Oʻzbekcha / ўзбекча ਪੰਜਾਬੀ پښتو Polski Português Română Runa Simi Русский Саха тыла संस्कृतम् Scots Sesotho Sesotho sa Leboa Sicilianu සිංහල Simple English سنڌي SiSwati Slovenčina Slovenščina Српски / srpski Srpskohrvatski / српскохрватски Basa Sunda Suomi Svenska Tagalog தமிழ் తెలుగు ไทย Türkçe Українська اردو Tiếng Việt Võro Winaray Xitsonga Yorùbá 粵語 中文 डोटेली Kabɩyɛ 103 more Edit links This page was last edited on 9 April 2018, at 22 : 49. Text is available under the Creative Commons Attribution - ShareAlike License ; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia ® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization. About Wikipedia

Question: where is leprosy most commonly found in the world
Answer: India