Research Paper About Leprosy


The following three infectious agents are predicted based on the symptomology: a yeast infection which causes Pityriasis Versicolor; the bacterium Treponema pallidum that causes Syphilis; and Mycobacterium leprae that causes Leprosy. With this in mind, based on the patient's symptomology and lab results, the infectious agent is Mycobacterium leprae, and the disease is Leprosy. 

  To begin with, Pityriasis Versicolor, also recognized as tinea versicolor, is a common, recurrent fungal infection caused by Malassezia furfur, a lipophilic fungus naturally found on the skin of humans (Prajapati & Mydlarski 2008). It becomes pathogenic when it develops filaments and when subjected to high temperatures and humidity, or having a depressed immunity, genetic susceptibility or applying oily elements on the body (Karray, 2019). The pathogenic form of the fungus invades the skin to reach the stratum corneum, an outer layer of the skin, to produce azelaic acid. This is a natural skin brightener agent that inhibits melanin production that causes the skin discoloration visualized on the chest, back, neck, and arms characterized by several scaling patches of altered pigmentation, lesions, and mild itching (Rai & Wankhade 2009). The identification process begins with the naked eyes, or Wood’s light, and uses transillumination exposure of bacterial and fungal cells and observes a fluorescent green-yellow reaction to the presence of Malassezia furfur (Prajapati & Mydlarski 2008). If in doubt, skin scrapings are taken to be analyzed under a microscope to look for branching filaments of fungus, and yeast. The infection is universal, but it is mostly present in tropical locations with high temperatures and humidity and does not favor a specific gender or ethnicity. Young adults, aged 20-30 years, are the most susceptible due to high levels of sebum production governed by the sebaceous glands attached to the hair follicles on the epidermis to provide fungal growth with suitable lipid-rich habitat (Karray, 2019).

Furthermore, treatment varies but mainly include shampoos and lotions that contain antifungal ingredients put on for several hours to ensure results. Since the infection is recurrent, these are two treatment drugs that can be used. Tablets containing selenium sulfide, which inhibits M. furfur growth, and Ketoconazole (400 mg), an antifungal drug that inhibits the production of ergosterol, an essential component of the membrane, leading to the cessation of fungal cells (Rai & Wankhade 2009). Even so, the skin discoloration may remain for several weeks and months after treatment, and the infection can reappear if the patient has oily skin and poor hygiene. Consequently, the symptomology and epidemiology do not fully coincide with M. furfur infection and the lab analysis of the scraped lesions lacked fungal and yeast cells; thus, it rules out Malassezia furfur as the infectious agent.

  Secondly, Treponema pallidum is a microaerophilic, Gram-negative spirochete bacterium with subspecies pallidum that causes Syphilis. The bacterium is sexually transmitted and attacks several body organs and tissues resulting in manifestations characterized by different stages of primary, secondary, tertiary, and latent phases. Symptoms start with blisters around the genitalia, hands, and feet, and include skin rash, fatigue, fever, paralysis, dementia, stroke, aneurysm, and can lead to death if untreated (Foster, Aliabadi, & Slonczewski 2018). The bacterium can be identified by taking blood samples and using Dark Field Microscopy. Specimens collected from lesions, mucous membranes, or the swollen lymph nodes will contain T. pallidum that emerges as helical and in spiraling movement. Also, identification can be made using nontreponemal and treponemal tests that detect T. pallidum and Syphilis antibodies present in the blood. Syphilis is universal and affects males and females from all ethnic backgrounds, including infants that are born with congenital Syphilis received from the infected mother through the placenta (Fantry & Tramont). Treatment of Syphilis includes antibiotic drugs such as penicillin G benzathine and two grams of azithromycin (Foster, Aliabadi, & Slonczewski 2018). Treatments can fail if the patient has an autoimmune disease such as HIV because it provides the opportunity for mutation, resistance to drugs, and reinfection. Accordingly, Syphilis is unconsidered in this case because of undetectable syphilis antibodies, and white blood cells count in the lab.

  Lastly, Mycobacterium leprae is an acid-fast, aerobic, intracellular, rod-shaped bacillus that causes Leprosy that affects the skin, eyes, nose, muscles, and peripheral nerves. Symptoms include skin lesions, pain, numbness, fatigue, paralysis, enlarged nerves, and growths on the skin. The bacterium enters the body through a break in the skin caused by an injury, or nasal droplets, coughing, and sneezing then attacks the peripheral nerves, which control the sensory and motor neurons, causing neuropathy. Skin and nerve biopsies are used to look for foam cells, macrophages infected by M. leprae used as a host for replication and transportation. Besides, an acid-fast stain is used to identify the bacterium by applying five percent sulfuric acid and a decolorizing agent such as alcohol on the specimen and observing red foam cells. Transmission can occur through nasal droplets, skin erosions, and bodily fluids. Leprosy is universal but mainly found in underdeveloped countries and warm, tropical countries such as India, Brazil, and Madagascar (Ramos-e-Silva & Rebello 2001). A cure for Leprosy entails multidrug therapy such as rifampicin, an antibiotic agent what inhibits the ribonucleic acid production of pathogenic bacteria; dapsone, which is a bactericide; and clofazimine, an anti-inflammatory and antimicrobial agent (CDC, 2019). Obstacles to treat Leprosy include lack of awareness since the disease can stay hidden for 3-5 years and lack of access to proper healthcare and medications. Also, the pathogen can mutate and develop a drug resistant trait when the appropriate medications are stopped abruptly, or wrong dosages are given to the patient.

In conclusion, skin lesions with loss of sensation indicate the presence of M. leprae and the symptomology coincide with the patient's case. The patient is an immigrant from India where there are abundant cases of Leprosy. The investigation in lab show leprosy antibodies, rod-shaped bacillus microorganisms under the magnifying lens, and red colored foam cells demonstrating Leprosy infection brought about by Mycobacterium leprae.