What is leprosy?Leprosy,
also known as Hansen's Disease, is a chronic infectious disease caused by the
bacterium Mycobacterium leprae. Leprosy usually affects the skin
and peripheral nerves, but can manifest in a variety of ways. Multibacillary
(lepromatous) Hansen's disease is associated with symmetric skin lesions, nodules,
plaques, thickened dermis, and frequent involvement of the nasal mucosa, resulting
in nasal congestion and nose bleeds. Patients living with paucibacillary
(tuberculoid) Hansen's disease have a milder form, characterized by one or more
hypopigmented skin macules. Where is leprosy usually
found?In 2002 five nations were thought to have a major problem with leprosy;
Brazil, Madagascar, Mozambique, Tanzania, and Nepal. However, in 1995, the disease
was endemic in more than 100 countries, and it still occurs widely in southern
and south eastern asia, as well as the eastern mediterranean area, despite a WHO
eradication campaign. The campaign aimed to reduce the prevalence of the
disease to below 1 in 10,000 in affected countries by 2000; the target was achieved
in many, but there is now fear of under reporting in some countries, as the stigma
remains - and the project teams have moved on. How
common is leprosy?Theoretically, the disease has reached the 1 in 10,000
target in every nation - but this hides the fact that some areas have achieved
much lower prevalence, while others have failed; indeed, in parts of India, the
disease is thought to be increasing. How is leprosy
transmitted?The main route - possibly the only one - is droplet / aerosol
infection from the nose of an infected person. Can
leprosy be spread from person-to-person?As the disease is very slow in
its progress, prolonged close contact may be required. For centuries, it
was thought the disease was spread by touch, via the skin. This is now known to
be false. Neither is the disease spread by sexual activity or childbirth. Who
is most at risk from leprosy?People living in overcrowded, poorly ventilated
homes in warm or hot climates. Genetic research has shown that some people carry
five times the normal risk of catching the disease, if exposed to it. What
are the symptoms of leprosy?Lepromatous leprosy is characterized by a
chronically stuffy nose and many skin lesions and nodules on the front and back
of the body. Sensation loss starts at the extremeties - the fingers and
toes - and may initially affect a small area of skin. Most of the problems
of leprosy are caused by sensation loss, which inevitably leads to injuries being
unnoticied - or their seriousness unrealized - and so they become infected. In
advanced cases, gangrene will follow. Tuberculoid leprosy features well-defined
skin lesions with total sensation loss which can lead to unnoticed injuries and
infection. Dimorphous leprosy creates skin lesions characteristic of both
forms. What are the long term effects of leprosy?All
forms of the disease eventually cause peripheral neurological damage (nerve damage
in the extremities) manifested by sensory loss in the skin and muscle weakness.
People with long-term leprosy may lose the use of their hands or feet due to repeated
injury resulting from lack of sensation. What is
the mortality rate for leprosy?The statistics suggets that some 4000 people
die each year as a result of living with leprosy; but it is not the disease itself,
rather an aincreased risk of problems associated with the disease. For example,
blindness is a widespread feature of advanced disease, and studies suggest that
it increases mortality, compared to sighted people with Hansen's, by five times.
Young blind patients carried the highest relative risk. Similarly, the nerve damage,
specifically affecting sensation, means that burns scalds and other injuries may
not be treated appropriately, as the patient gets no pain. Even after relapse,
which occurs in some patients whose treatment is stopped before complete bacterial
negativity, death is not directly caused by the disease. How
is leprosy diagnosed? Diagnosis is established by isolating Mycobacterium
leprae from the mucous membranes of the nose or from skin lesions. The
Lepromin skin test can be used to distinguish lepromatous from tuberculoid leprosy,
but is not used for diagnosis. Is there
a treatment for leprosy?Leprosy management is based on three principles:
early detection, appropriate treatment, and the prevention of disabilities and
rehabilitation. For many years, Dapsone was the treatment of choice; however,
it did require very long-term treatment, it does have vicious side effects, and
in recent years, has been undermined by drug resistance. Since 1995, the
World health Organization has recommended and supplied two drug treatment regimens: For
aucibacillary leprosy (one to five skin lesions) Rifampicin and Dapsone for 6
months. For multibacillary leprosy : (more than five skin lesions) Rifampicin,
Clofazimine and Dapsone for 12 months. Thalidomide has been approved for
use against erythema nodosum leprosum, a complication of leprosy which causes
fever, skin lesions, and other symptoms. Is there
a way to prevent infection?Prevention consists of avoiding close physical
contact with untreated people. This works; for centuries, it was the only measure
against the disease, and it effectively eradicated the dsease from many countries
where it had been endemic. Now that the disease is better understood, isolation
is not permanent, and is less cruel - though the stigma of leprosy remains an
issue. People on long-term medication are not infectious. They do not transmit
Mycobacterium leprae. Is there a leprosy vaccine?Not
yet. Various projects have found possible lines of research, but there is no product
in sight at this time. Can leprosy be controlled
environmentally?The World health Organization is supporting an eradication
campaign which involves education and earlydiagnosis as well as treatment; as
with all diseases, early diagnosis reduces problems for the individual, as well
as reducing further spread and saving money. But the centuries-old stigma attached
to leprosy has produced modern problems - disease reporting is probably woefully
below the real levels in some endemic areas, and people still hide their skin
lesions rather than come forward for treatment and possible rejection by their
community. Is there legal protection for workers and others?Many
countries have had laws to protect people from leprosy; usually by restricting
the movement s of those living with the disease. In our more enlightened times,
most of these laws are obsolete, redundant and unenforceable. As with most dieases,
the laws of neglgigence where you live are the laws that matter. What
can be learned from history?First that it would be unwise to assume the
battle against leprosy is won. Statistics claim that 15,000,000 with leprosy and
its disabilities 20 years ago have been reduced to 500,000 now; many of them cured,
simply living with the disabilities that they've got from the disease. the truth
is almost certainly not so pleasant. Diagnosis is still late in many cases, the
stigma lives on, and treatment without adequate supervision and support can be
ineffective. The battle is NOT won. Not by a long way. Bibliography
and Further Information Sources
I regret I cannot assist with individual cases or essays and school projects,
but if it's something I've missed, I'll be happy to try and help.
Article written by Andrew Heenan BA (Hons), RGN, RMN
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