Leprosy

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What is leprosy?

Leprosy, or Hansen's Disease, is an ancient, chronic, bacterial infection of the nervous system and the skin, first reported in 600 BC, and is caused by Mycobacterium leprae. This microbe is very slow in replicating, taking two weeks to reproduce itself, unlike E. coli, for instance, which takes only 20 minutes to replicate itself. This explains why it takes two to 20 years for leprosy to manifest its symptoms and signs from the time the person acquires the infection.

Is leprosy infectious?

Yes, but contrary to myths, leprosy is one of the least contagious of the infectious diseases. The disease is not easily transmissible. It requires extremely prolonged close contact before it is transmitted to another person. Casual daily contact (including handshakes and hugs) does not cause transmission of the disease. The spread is by droplet of nasal mucus during sneezing, but this occurs only in the early stage of leprosy.

Is leprosy a sexually transmitted disease?

No, leprosy is not a sexually transmitted illness. One does not catch the disease by having sex with someone with leprosy.

How prevalent is leprosy?

It is estimated that there are about 20 million people around the world still with leprosy today. The current prevalence is 1 case per 10,000 population, which is statistically low, but the goal is still to eliminate leprosy totally from earth. If left untreated, leprosy can cause severe body tissue damage, like losing fingers and toes, blindness and other forms of disfigurement. The overall goal set by the World Health Organization Hanoi Declaration in 1991 (a 90% decrease of leprosy as an initial objective for the ultimate global eradication of the disease) has been met. A lot still has to be done by the world community to totally rid our planet of leprosy.

What are the symptoms and signs of leprosy?

Since Hansen's Disease affects the skin and nerves, the first sign may be the discovery that the fingers holding a lighted cigarettes have been burned, without the individual knowing or feeling it. This is because of the numbness, absence of sensation or feeling, that results from the damage to the nerves caused by leprosy. More obvious are the nodules, lumps, skin ulcers, blindness, and the disfigurement following damages to the tissues of the body, among others.

Does leprosy lead to cancer?

There is no medical evidence to show that persons afflicted with leprosy have an increased risk of developing cancer.

In which countries is leprosy still out of control?

Leprosy is still "endemic in sixteen countries in the world, representing 92% of the global dilemma where there is insufficient coverage of the network for control measures covering disease in the field, inadequate information and lack of education for patients and communities," says the Journal of the World Medical Association. Full control of Hansen's Disease has eluded the following countries: Brazil, India, Madagascar, Mozambique, Myanmar and Nepal. The key force in leprosy global elimination strategy is the Global Alliance for the Elimination of Leprosy chaired currently by India. While great strides have been made in lowering the incidence of this disease the past 15 years, there were still 800,000 new cases reported in 1998.

What was Leper Colonies all about?

Before science knew the truth about leprosy, its nature, transmission, etc., myths abound, spreading wrong reputation about the disease and its victims, making most people, including close relatives of those afflicted, ostracize and mercilessly drive these poor patients away, putting them in Leper Colonies, which were remote areas where lepers were camped and "cared for," but generally abandoned. Today, we know better and treat these persons with understanding and compassion. People now live safely with persons with leprosy, knowing it is hard to catch the disease, and that the disease is curable with modern day triple drug therapy. Among educated people who have current knowledge, the stigma of leprosy is practically gone.

What is the proper message to spread out there?

For leprosy to be totally eradicated from the face of the earth, like what science has done to the historical killer disease, small pox, we, the medical community and the lay people in general, must echo what the Nippon Foundation stated, as it reaffirms its commitment to help eradicate leprosy once and for all: "We must take every possible opportunity to raise our voices and spread the message: leprosy is curable, treatment is free, discrimination must end." Information is indeed fundamental, especially in high-risk regions of the world, so that patients and their families, who were historically ostracized from their communities, are encouraged to come forward and receive treatment, according to the editorial of the Journal of the World Medical Association.

What was that reported breakthrough on leprosy?

A major breakthrough has recently been accomplished with the mapping of the genome of the bacillus Mycobacterium leprae, which has given the medical community new venues for the development of diagnostic tests for leprosy, and possibly for potential discovery of future vaccine and cure for the disease.

Is there hope for persons with leprosy?

Yes, most definitely, now, more than ever before. Cure is now possible. Permanent complication, like blindness, will not recover, but many of the tissue damage that is present could be helped with plastic surgery and prosthetic devices and aids.

What is the current therapy for leprosy?

Chemotherapy with dapsone has been the regimen used with great success, but resistance to this is rapidly increasing. Now triple therapy with rifampicin, clofazimine and ethionamide is in the forefront of treatment, and has been found to be very effective. No vaccine has been developed as yet for prophylaxis. A vaccine would be ideal for the final eradication of the disease.

What are the types of leprosy?

The two forms of leprosy are lepromatous and tuberculoid. In the lepromatous form, there is no body immunity so the bacteria are present in enormous amount in the macrophages of the in the skin and nerves. This leads to large nodules and bumps, which can break down to form ulcers, causing extensive body tissue damage. The tuberculoid form happens when the body immune system is strong, and is therefore milder and probably non-infectious.

©2003Raoul R. Diez, M.A.O.D.