**warning** – some images may be graphic
Once upon a time, when things were not as sophisticated and refined as the present time, when love letters had not been replaced by text messages, and when a lot of drugs were not invented to treat diseases yet, people used to live in darkness. It is unfortunate to say that not everyone has a “happily ever after” ending, particularly, in this case, those who had contracted diseases like leprosy.
Standing behind the steel bars of the cages were the faces that people were afraid of. They called it the leonine face, for the people with leprosy, had the look like the face of a lion. They were isolated from the society and quarantined in a sanatorium, at the same time being observed like an experimental specimen by the fellow doctors to figure out the disease. Though they were fed with food in the sanatorium, life was miserable as they were not allowed to go back home, nor to have children. Some of them died after a short time in the cage.
What is Leprosy all about? Here’s what you need to know
In all countries, the social stigma of leprosy has heightened the fear of the people towards the patients. Thus, another name to replace leprosy, which is also commonly mentioned, is called the Hansen’s disease. It is named after the physician Gerhard Armauer Hansen who had successfully identified the bacterium M. leprae that caused leprosy.
All cases of human and animal leprosy are caused by the same organism, M. leprae. This organism grows best at temperatures (30oc) below the core body temperature of humans. This explains the localization of Hansen’s disease lesions to cooler areas of the body such as the earlobes, elbows, and knees, sparing the midline and scalp.
There are a few classes of the disease for the patient to be classified into. It depends on the individual’s immune response to the organism. If the immune response of the person against M. leprae is strong, the number of organisms in the body will be low (paucibacillary), and conversely, if this response is weak, the number of organisms in the body will be high (multibacillary).
The spectrum of the disease has two stable poles, the tuberculoid and lepromatous forms. Patients classified under either one of the forms are in a relatively stable condition, which means the patient will remain in the form throughout the course of the disease. In tuberculoid form (TT), the immune response of the patient is strong enough to constrain the organisms and only form several tuberculous lesions, usually less than five. The other pole of the disease is lepromatous leprosy (LL), where the immune response is weak and limited that the lesions are numerous.
Between these two poles are three other forms of the disease which are unstable:
- borderline tuberculoid (BT)
- borderline borderline (BB)
- boderline lepromatous (BL)
The patient could move from BT to BL or vice versa.
The transmission of the disease is said to be through nasal secretion, long-term direct contact, and insect vectors. Rarely, tattooing or other penetrating injuries to the skin can be the route of transmissin too. Household contacts are at higher risk of acquiring the disease, though it at least takes 12 months to infect another person under direct contact. For example, here is a case scenario in the dermatology clinic. A kid was diagnosed with leprosy but the doctor couldn’t find the source of transmission. However, through further asking, he found out that the grandfather of the son has had a history of Hansen’s disease. Studies have shown that in 80% of all new cases of Hansen’s disease, there is a clear history of social contact with an untreated case of Hansen’s disease.
How armadillo can spread leprosy
The researchers found that most of the infected armadillos carried the same strain of bacteria that had previously been linked with probable transmission to humans. Additionally, the investigators identified a different strain of M. leprae in armadillos in southern Florida, which may have infected several leprosy patients in that area. People who consume armadillos for food, who hunt the wild animals and prepare them for cooking, seem to be more at risk for the infection.
For those who wonder what does leonine face looks like:
Other signs and symptoms of Hansen’s disease are:
- Skin lesions
- Nerve thickening
- Loss of sensation of affected part
- Deformities of limbs because they lose their sense of touch due to nerve damage
- Eyes involvement (inability to shut the affected eye tightly, corneal ulcer, conjunctivitis)
- Claw hand
- Wrist drop
- Foot drop
- Facial palsy
- Testicular dysfunction for males
- Enlargement of breasts for males
- Enlargement of lymph nodes
- Bone involvement
Ideally, to investigate this disease, a skin biopsy is required, which is known as slit skin smear. Also, the culture of the lesions and PCT testing to identify the organism can be done. Despite the severity of the disease, multiple drug courses have been implemented to treat the disease. Though relapse could occur, the medications currently are effective enough to suppress the symptoms as well as control the disease. The World Health Organization (WHO) has committed itself to eliminating Hansen’s disease as a public health problem. In fact, the last case of secondary transmission of Hansen’s disease in the UK was in 1923!
“The biggest disease today is not leprosy or tuberculosis, but rather the feeling of being unwanted. We can cure the physical diseases with medicine, but the only cure for loneliness, despair, and hopelessness is love.” – Mother Teresa
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