Leprosy: The disease and its history

The history of leprosy goes back to as long as history can retrace. The earliest mentions of the disease were found on Egyptian papyruses dated 1550 BC. Later, the Indian writings from around 600 BC have also identified a disease that resembles leprosy to a greater extent. The European records trace back the disease to the times of Alexander the Great and then again in the troupe of Pompeii returning from Asia Minor to Rome, dating to about 62 BC.

During those times, leprosy was considered a punishment from God and the patients had to live in a tremendous stigma. The family of the patient could also be out-casted because the disease was considered to be hereditary. The patients in Europe had to wear special clothing so as to identify themselves from the rest of the crowd. They needed to ring warning bells when they were near by and walk on the road as per the direction of the wind.

The situations have not improved too much even today in spite of all our scientific endeavors. The leprosy patients are mostly treated in different hospitals. Leprosarium has been formed so that the patients do not come in contact with “healthy” individuals. To the horror of all those sufferers, leprosy has inspired art and cultural practices too.

A Norwegian, Dr. Gerhard Henrik Armauer Hansen, first identified the disease. He obviously proved that leprosy was neither hereditary nor a sin. In fact, it occurred due to Microbacterium Leprae. Till about the early 1900s, the injection of chaulmoogra nut oil was the only treatment for the disease. In 1921, the U.S. Public Health Service was established for extensive study in leprosy and research for a cure of the disease was done in Gillis W. Long Hansen’s Disease Center. By 1941, a sulfone drug, Promin, was invented to cure leprosy. However, there were many painful injections to be injected, which eventually led to the fall in its popularity.

Then, Dapsone pills were introduced and were being used pretty successfully till M. Leprae started getting resistant to Dapsone. Drug trials on the island of Malta led to the development of Multi Drug Treatment (MDT) for leprosy, which has been referred by the World Health Organization (WHO) for a period of six months or more depending on the acuteness of the infection.

Characteristics:

Leprosy infection can be of the very simplest in nature to the most complicated in forms. The symptoms vary a lot in patients, depending on which stage of the disease they are in. In fact, the early stages of leprosy infection is so mild that most of the times patients do not even know of the disease till they have cutaneous eruptions on the skin.

In about ninety percent of the cases, the patients experience a feeling of numbness even before the first signs of a lesion are seen. The first sensation lost is that of temperature whereby patients fail to feel the extremities of whither heat or cold. Then, they happen to lose the sense of touch following which there is a pain. Finally there is a deep sense of pressure mostly on their hands and feet.

Causes:

Leprosy is caused by an intracellular bacterial pathogen named Microbacterium Leprae. The bacterium, besides humans, affects armadillos, probably because of their low body temperature.

Till date, the process by which the bacteria transmit themselves has been an unknown quantity to most researchers. However, M. Leprae like bacteria has been observed to bite insects. Intracutaneous inoculation leading to the transmission of the pathogen has been noted in the mouse footpad model. In spite of all this, whether the vector of the bacteria is insects or not is still doubtful.

Many researchers, however, agree to the fact that this disease transmits itself from an infected person to a healthy individual through the nasal discharge or respiratory droplets. Strangely, the pathogen can survive outside the host body for quite a long period of time making it even more dangerous. However, one point of importance is to be noted here: only the lepromatous form of bacteria can cause the disease. In spite of most conclusions leading to the transmission of the disease by nasal infected droplets, the experts ask non-infected people to stay away from infected soil, insect vectors and animal reservoirs as these also may be the possible forms of vectors that can cause the disease.

By this time, most of the world population is immune to leprosy. There are just a few handfuls of cases that are needed to be handled by the professionals and clinical levels.

Having said that, it does not mean people, who live in close contact with the infected people do not run a risk to acquire the disease. People, who live in a country that is prone to leprosy endemically, have a high risk of getting the disease too.

Treatment:

WHO recommends a multi drug treatment for leprosy, which includes a dose of Dapsone, Rifamin and Clofazimine.

Dapsone prevents the formation of folic acids and inhibits the growth of bacteria. It is used as one of the two-drug schedules for paucibacillary leprosy and one of the tree drugs for multibacillary leprosy. However, to continue this medicine, a check on the red blood cell and white blood cell count has to be kept.

Rifamin is used as an antituberculous drug and it goes on to restrict the growth of RNA ploymerase that is DNA dependent. A cross-resistance possibility cannot be ignored for this medicine. So, a negative sputum test is to be carried out from time to time. This medication can prove fatal and cause cerebral hemorrhage or even death for liver patients.

Clofazimine can prevent the growth of bacteria, keeping itself bound to preferential mycobacterial DNA. This certain medicine can go on to discolor skin and other body fluids. Such discoloration often leads people into depression so much that they even commit suicide. So, try massaging the dry skin areas with oil regularly.

Global Situations with Recent Statistics:

In spite of all the precautions that have been taken and the treatment that has been put in use, the global population affected by leprosy stands at a staggering 12 million, if not more. Countries in South America, like Venezuela, Argentina and Mexico have had the highest number of occurrences of the disease. However, as per the reports by WHO, the death rate remains the highest in South East Asia at an alarming figure of 3,000.

Nothing can really be done unless we really wake up to it and try removing it as a stigma from our society. Change in attitude is a must to modify the statistics and dream of a leprosy-free world!

Health Centers:

1. American Leprosy Missions: http://www.leprosy.org/index.html

2. World Health Organization: Leprosy Site: http://www.who.int/topics/leprosy/en/

3. National Institute of Health and Leprosy Site: http://www.niaid.nih.gov/dmid/leprosy/default.htm

4. International Federation of Anti-Leprosy Associations: http://www.ilep.org.uk/content/home.cfm

5. International Leprosy Association: Global Project on the History of Leprosy: http://www.leprosyhistory.org/english/publications.htm