8. Multi-bacillary

Multi-bacillary leprosy is found in people with poor CMI. Bacilli multiply and spread more widely resulting in a common disease: usually accompanied by widespread lesions in the skin, nerves, and at lower levels in other organs such as the eyes, respiratory mucosa, testes, and reticuloendothelial system in men and usually the central nervous system and the upper reproductive system in women. The skin lesions may be multiple (borderline) or uncountable (lepromatous). Lepromatous lesions may be symmetrical and unclear bilateral macules or diffuse infiltration, which may develop into plaque and nodule formation. In addition, there may be nasal bleeding and edema on both legs. If the patient does not receive treatment, the pauci-bacillary form of leprosy can be downgraded to the multi-bacillary form (from tuberculoid to lepromatous) through the borderline spectrum.

T2R occurs mostly in lepromatous (LL) and sometimes in borderline lepromatous leprosy (LL), which occurs mostly during the course of antileprosy treatment. A few cases present for the first time with features of reactions before leprosy is diagnosed and treatment started. In one third of the cases, pain and swelling in the joints precede or are a component of other constitutional symptoms. In cutaneous onset, there may be appearance of skin lesions in the form of maculopapular, popular, nodular, or plaque type lesions before appearance of constitutional signs and symptoms. Fever, joint pain and constitutional sign and symptom, and skin lesion appear together. T2R without ENL is possible that the manifestations of the reactions may not be confined to the skin, and the patients may develop neuritis or systemic involvement or both,

Leprosy: The Ancient and Stubborn Disease http://dx.doi.org/10.5772/intechopen.79984 15

depending upon the target organs where immune complexes deposition occurs [28].

Lucio phenomenon is a special type of reactions observed in uniformly diffuse shinny infiltrative nonnodular form of LL, which is chiefly encountered in Mexicans. Its unique feature is that it is seen only in untreated cases. The etio-pathogenesis is less well understood. M. leprae are found unusually in large numbers in the endothelial cells of superficial blood vessels, and this finding may be responsible for the serious vascular complications seen during the reactive phase. There is marked vasculitis and thrombosis of the superficial and deep vessel, resulting in hemorrhage and infarctions of the skin. Clinical manifestations begin with slightly indurated red-bluish plaques on the skin with an erythematous halo, sometimes larger inflamed bullous lesions, which burst leaving a deep ulcer with jagged edges. The lesion takes about 3 weeks to develop an ulcer from the initial lesion, and it heals slowly and secondary cellulitis

Findings on the meaning of leprosy show confusion about the concept of leprosy and the lack of knowledge about the disease, its causes, and the mode of transmission. In addition, the views and perceptions of leprosy that have been internalized or newly acquired cause fear. The perception that leprosy is a highly contagious disease that can be transmitted by touching the same objects that have been touched by lepers is very worrying. Therefore, increasing knowledge about leprosy in affected people, community members, and health workers remains an important goal for leprosy services, and although that is not the only answer to stigma, it is an important prerequisite. Some challenges arise in relation to seeking care, recognizing the symptoms, making the right diagnosis, and sharing the diagnosis with the patient and the treatment. What is visible is the strength and influence of leprosy workers and therefore the destructive impact of their stigmatization behavior on the people they care for. White calls this the "iatrogenic stigma" or stigma produced by meeting patients with health care workers [30]. Multidrug therapy (MDT) was recommended as the standard treatment. The recommended treatment duration for MB is 12 months; otherwise, the duration for PB is

10. Lucio phenomenon

may complicate. Patients remain afebrile [28].

11. Management by community approach
