Leprosy

Leprosy, also called Hansen’s disease, is one of the oldest recorded diseases. It is a chronic infectious disease that attacks the nervous system, particularly the nerves of the hands, feet and face. In very serious cases, the bacilli may be found in the lymph nodes, male testes, spleen, liver, and bone marrow. It is caused by Mycobacterium leprae bacteria. The name Hansen’s disease is after Armauer Hansen, a Norwegian doctor who was the first to view the leprosy microbe under a microscope in 1873.

There are two different initial reactions to the disease. Some people develop clearly defined pale skin patches indicating the bacterium is isolated in one area. In more extreme cases where the patient has no resistance to the disease, there is very little definition between the patches and the healthy skin. With these type of cases, it is much more difficult to detect the disease in its early stages. As the disease progress, the symptoms only get worse. Numbness in hands and feet make the patient vulnerable to cuts and infections that can’t be felt. Stiffened muscles cause clawed hands, loss of the blinking reflex leads to total blindness, and in some cases amputation of fingers, an arm or leg is necessary.

Depending on how much natural resistance a person has, leprosy appears in different types:

• Tuberculoid leprosy – in persons with relatively high resistance; no bacilli in skin smear; person cannot pass leprosy on to others; skin patches are few; feeling is usually reduced or absent in centers of the skin patches; skin patches usually lose hair and are dry; usually responds quickly to treatment because the body helps fight the disease.
• Lepromatous leprosy – in persons with very low resistance; many bacilli in skin smears; person can pass leprosy to others (until treated); there are usually very many skin patches-variable in appearance, but often with raised lumps or thickened areas; nerve damage and paralysis often appear late, if the leprosy is not treated; response to treatment is often slow.
• “Borderline” leprosy – combines features of both tuberculoid and lepromatous leprosy.

Leprosy occurs in all races. In adults, the lepromatous type of leprosy is more common in men than in women after puberty, with a male-to-female ratio of 2:1. In children, the tuberculoid form predominates, and no sex preference exists. Women tend to have a delayed presentation, which increases rates of deformity. Leprosy has a bimodal age distribution, with peaks of 10-14 and 35-44 years of age. The disease is rare in infants. Children appear to be most susceptible to disease.
Aside from humans, other creatures that are known to be susceptible to leprosy are the armadillo, mangabey monkeys, rabbits, and mice.

Transmission
The exact mechanism of transmission of leprosy is not known. Leprosy is thought to be infectious, transmitted through airborne droplets, such as when someone sneezes or coughs. But most people – about 95% of the population – are naturally immune.
The leprosy can spread only from some persons who have untreated leprosy, and only to other persons who have `low resistance` to the disease.
There are also other possibilities such as transmission through insects which cannot be completely ruled out.

From the time a person is first infected with leprosy germs, it often takes 3 or 4 years for the first signs of the disease to appear. But the incubation period can be to 40 years or longer. The leprosy is not hereditary and children of mothers with leprosy are not born with it.
Transmission usually requires prolonged close contact with an untreated person suffering from an infectious form of leprosy combined with an inherent immunological susceptibility to the disease in the exposed individual. Only 10% of patients with leprosy are infectious if left untreated.

Someone may think that it is a disease of the past. But leprosy is still highly prevalent affecting hundreds of thousands of people around the world, mainly in Asia, South America and Africa. Although eradicated from northern Europe, leprosy remains endemic in many developing countries, particularly affecting the poorest. In 2000, India alone accounted for 67% of prevalent cases worldwide. Yet there are over 1 100 new cases detected every day. Worldwide over 300,000 new patients are diagnosed and registered for the treatment every year.

Risk groups
At highest risk are those living in endemic areas with poor conditions such as inadequate bedding, contaminated water and insufficient diet, or other disease that compromise immune function. Recent research suggests that there is genetic variation in susceptibility. 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.

Treatment
The disease is curable, but the effectiveness of the treatment is dependant on an early diagnosis.
Since 1982 the WHO has recommended multidrug therapy – mix of strong antibiotics, which can completely cure the tuberculoid form of the disease within six months and the more infectious lepromatous form within two years. A combination of drugs must be used because the leprosy bacteria can develop resistance to antibiotics very quickly.
If treatment is started early, deformities and disabilities can be prevented. Multidrug therapy also makes the few highly infectious patients non-infectious very quickly, which helps prevent the spread of leprosy.

Caring for the patient with leprosy
People affected by leprosy need more than just medicine! Leprosy care involves many different aspects of medical treatment, as the disease touches patient not only physically, but also mentally. Even after the disease is cured physically, treatment must be continued to care for the patient emotionally and spiritually as well as dealing with the social effects within the community.
Reconstructive surgery is an important part of rehabilitation for many leprosy patients. Surgical procedures (such as tendon transplants to correct clawed hands, nose reconstruction and eye operations to save the blinking reflex) can all help the process.
Physiotherapy after surgery is also a vital part of treatment.
When medical care is sought too late, irreversible damage happens to limbs and amputation is necessary to save the patients life. Artificial limbs and special footwear is also available.
If multidrug therapy is administered as soon as leprosy symptoms appear, there is no lasting deformity or disability. But a patient can still lose feeling in hands and feet and that is the main problem.
Vocational training is vital to most leprosy patients. It helps anyone who has to change their line of work to protect their hands and feet, helps young people who are not given a chance in life simply because a member of their family has leprosy.

Leprosy and community
It has been a lot of fear and misunderstanding about leprosy, and myths and the fear of leprosy are kept alive. To correct the situation will require the efforts of all health and rehabilitation workers, schoolteachers, religious and community leaders, families of persons with leprosy, and organizations of the disabled.
It is needed to inform and educate schools, health centers, media, and community about leprosy; to integrate leprosy programs into general health care; regularly screen the children for skin patches and other early signs of leprosy; community pressure and government orders to let children being treated for leprosy attend school, find work, and take part in public life; community support groups to help persons with leprosy.