World Leprosy Day was observed internationally on January 30, to increase the public awareness of the Leprosy or Hansen's disease. This day was chosen in commemoration of the death of Gandhi, the leader of India who understood the importance of understanding and raising awareness on leprosy.
According to Niaid, Leprosy also known as Hansen's Disease is a chronic infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract, eyes, and nasal mucosa (lining of the nose). The disease is caused by a bacillus (rod-shaped) bacterium known as Mycobacterium leprae.
Although human-to-human transmission is the primary source, through respiratory droplets, three other species can carry and (rarely) transfer M. leprae to humans: chimpanzees, mangabey monkeys, and nine-banded armadillos. The disease is termed a chronic granulomatous disease, similar to tuberculosis, because it produces inflammatory nodules (granulomas) in the skin and nerves over time.
Where Did Leprosy Come From?
Leprosy has terrified humanity since ancient times and was reported as early as 600 BC in India, China, and Egypt. Hansen’s disease is still a major health problem in many parts of Africa, Asia, and Latin America. For many centuries, leprosy was considered a curse from God, often associated with sin. It did not kill, but neither did it seem to end. Instead, it lingered for years, causing the tissues to degenerate and deforming the body.
Dr. Gerhard Henrik Armauer Hansen of Norway was the first person to identify the germ that causes leprosy under a microscope. Hansen's discovery of Mycobacterium leprae proved that leprosy was caused by a germ, and was thus not hereditary, from a curse, or from a sin.
As a tribute to this great researcher, the disease is now named after him. The term hanseniasis was first put forward by Abraao Rotberg in 1967, with the additional purpose of taking the sting out of the diagnosis.
Leprosy originated either in Africa or Asia, but reached Europe through the conquering armies of Alexander the Great, circa 300 BC. It ravaged Europe and the Middle East during the Dark Ages, until approximately 1870.
During this period, the overcrowding, poor sanitation, and malnutrition of the poor people who made up the majority of the population contributed to a high incidence of leprosy. Improved socioeconomic conditions led to a dramatic fall in the number of new cases. Leprosy reached South America from colonial invaders, mostly through African slaves brought into the country.
Types Of Leprosy
The WHO classification system is widely used as it has only two forms or classifications of leprosy. The 2009 WHO classifications are simply based on the number of skin lesions, as follows:
Paucibacillary leprosy: skin lesions with no bacilli (M. leprae) seen in a skin smear
Multibacillary leprosy: skin lesions with bacilli (M. leprae) seen in a skin smear
However, the WHO further modifies these two classifications with clinical criteria because "of the non-availability or non-dependability of the skin-smear services. The clinical system of classification for the purpose of treatment includes the use of number of skin lesions and nerves involved as the basis for grouping leprosy patients into multibacillary (MB) and paucibacillary (PB) leprosy." Investigators state that up to about four to five skin lesions constitutes paucibacillary leprosy, while about five or more constitutes multibacillary leprosy.
Multidrug therapy (MDT) with three antibiotics (dapsone, rifampicin, and clofazimine) is used for multibacillary leprosy, while a modified MDT with two antibiotics (dapsone and rifampicin) is recommended for paucibacillary leprosy and composes most current treatments. Paucibacillary leprosy usually includes indeterminate, tuberculoid, and borderline tuberculoid leprosy from the Ridley-Jopling classification, while multibacillary leprosy usually includes the double (mid-) borderline, borderline lepromatous, and lepromatous leprosy.
Unfortunately, the early signs and symptoms of leprosy are very subtle and occur slowly, usually over years. The symptoms are similar to those that may occur with syphilis, tetanus, and leptospirosis. The following are the major signs and symptoms of leprosy:
- Numbness (among the first symptoms)
- Loss of temperature sensation (among the first symptoms)
- Touch sensation reduced (among the first symptoms)
- Pins and needles sensations (among the first symptoms)
- Pain (joints)
- Nerve injury
- Weight loss
- Blisters and/or rashes
- A skin lesion of hypopigmented macules (flat, pale areas of skin that lost color)
- Eye damage (dryness, reduced blinking)
- Large ulcerations (later symptoms and signs)
- Hair loss (for example, loss of eyebrows)
- Loss of digits (later symptoms and signs)
- Facial disfigurement (for example, loss of nose) (later symptoms and signs)
This long-term developing sequence of events begins and continues on the cooler areas of the body (for example, hands, feet, face, and knees).
The Stigma Attached to Leprosy
Leprosy has always been linked with stigma. The fear of leprosy leads to the stigma and discrimination and this is due to lack of understanding and knowledge about leprosy - which increases misconceptions about the disease’s transmission and treatment. The fact that most of those with untreated leprosy end up with severe deformities and disfigurements has contributed to the stigma
Some studies have concluded that stigma affects many aspects of the lives of people affected by leprosy including “mobility, interpersonal relationships, marriage, employment, leisure activities, and attendance at social and religious functions”
Fear and stigma are difficult to remove. They can only be dealt with through a combination of strategies like changing the image of the diseases, integrating programmes, rehabilitating patients and media campaigns.
Myths About Leprosy
Myth 1: Leprosy is not curable
Leprosy is completely curable through a 12 month course of treatment called multi-drug therapy, which consists of a combination of two or three drugs. Once someone starts treatment, they are very quickly no longer infectious.
Myth 2: Leprosy causes your fingers, toes and limbs to drop off
Leprosy does not cause anything to fall off. It can however cause nerve damage in three main areas of the body (face, hands and feet). This nerve damage means that the sensory (hot/cold/pain) and motor function (movement) are compromised in these areas. This may mean that a person loses the ability to blink, move their fingers or grasp objects.
Simple injuries can lead to ulcers and infection. This can lead to shortening of digits (not dropping off). In time muscle wastage can result in wrists or ankles becoming locked in place, affecting the ability to walk or even perform basic tasks. Where nerves in the face are affected, the loss of blinking function can lead to blindness.
Myth 3: Leprosy only affects older people
Leprosy can affect people of any age, but it does have a long incubation period. This means that sometimes visible symptoms only appear later in life. However, 10% of newly diagnosed people are children.
Myth 4: Leprosy is the result of past sins or immoral behavior
This is simply not true. Leprosy is caused by bacteria called Myobacterium leprae (M. lepra).
Myth 5: You can catch leprosy from touching someone who is affected.
You cannot catch leprosy just from touching someone. In fact, 95% of humans are naturally immune to Mycobacterium leprae, the germ that causes leprosy. While it is still not known exactly how the disease is spread, long-term exposure in unsanitary conditions is one of the contributing factors. According to the World Health Organization, the most likely way the disease is spreads is through airborne water droplets. Still, short-term exposure is very unlikely to transmit the disease.
Facts About Leprosy
Fact 1: Leprosy is totally curable
The isolation that once went hand in hand with a diagnosis of leprosy was devastating to patients. But today, the disease is easily treated with a combination of antibiotics.
However, treatment does take a long time to complete: Patients diagnosed with leprosy should expect to take antibiotics for six months to two years, according to the Centers for Disease Control and Prevention (CDC).
Fact 2: Most people are immune to it
Yes, leprosy is contagious — people can become infected if they inhale the bacteria. However, one reason the disease is not widespread is that an estimated 95 percent of all humans are immune to the disease, according to the NHDP.
Fact 3: Today's leprosy is not the same kind as that in the Bible
Although leprosy is mentioned in the Bible, the references do not appear to describe the same disease people experience today.
Rather, the word "leprosy" in the Bible appears to have been translated from a Hebrew word that referred to general uncleanliness, and could be applied to people, clothing or even buildings, according to the Nepal Leprosy Trust. When the word appears in the Bible in reference to people, it appears to refer to a wide range of skin conditions. The NHDP notes that Hansen's disease is not the "leprosy of the Old Testament."
Treatment Of Leprosy
Early diagnosis and full antimicrobial courses, with prompt treatment of leprosy reactions, now makes a full cure possible in almost every case of leprosy. Thus the treatment of leprosy has evolved greatly from the former method of management i.e., isolation of the leprosy patient.
Current medical treatment focuses on providing a combination of powerful drugs (multi-drug therapy, MDT) for a period ranging from six months to two years, based on the type and clinical severity of the disease. The establishment of MDT is based on the sound premise that MDT will effectively and rapidly eliminate the bacteria and slow, if not prevent, the development of resistance.
Continuing research has led to the WHO recommendation to reduce the period of therapy from 24 to 12 months.