Microbiology and Parasitology

Leprosy:
A Curse or a Disease

Ria-Lei D. Sto Tomas And Revic R. Salera

Mrs. Sophia L. Bensali

I.

Introduction
Leprosy is a chronic infectious disease of humans caused by the bacteria Mycobacterium leprae. For many years, it was considered a mysterious disorder associated with some type of curse, and persons with the disease were isolated and ostracized. Today, there is effective treatment and the disease can be cured. There is no longer any justification for isolating persons with leprosy.

Leprosy has long been one of the most feared diseases worldwide. The disease was well known in ancient China, Egypt and India. But because the disease was poorly understood, many cultures thought the disease was a curse or punishment from the gods. Largely due to ignorance, people wanted to protect themselves and so they pushed leprosy sufferers away to isolated spots and treat them as social outcasts. Consequently, leprosy was left to be treated by priests or holy men and not physicians.

Although leprosy was once widespread throughout the world, most previously highly endemic countries have now reached elimination (defined as a registered prevalence rate of <1 case/10 000 population). However, pockets of high endemicity still remain in some areas of Angola, Brazil, Central African Republic, Democratic Republic of Congo, India, Madagascar, Mozambique, Nepal, and the United Republic of Tanzania. These countries remain highly committed to eliminating the disease, and continue to intensify their leprosy control activities.

II.

Cause
Leprosy is caused by Mycobacterium leprae, a rod-shaped bacillus. Most bacteria that cause disease in humans thrive in the warm environment in the interior of the human body, but the leprosy bacterium prefers to live in cooler surroundings. The bacteria grow best at 80.9 F-86 F, so cooler areas of the body tend to develop the infection because it takes them an extremely long time to reproduce inside of cells (about 12-14 days as compared to minutes to hours for most bacteria). The bacteria grow best at 80.9 F-86 F, so cooler areas of the body tend to develop the infection.

Infection occurs when the bacteria is dispersed in the air, e.g. when an infected person sneezes. However close contact over a long period of time with an untreated person is needed in order to be infected with the disease. Infection can also come from soil and armadillo. But not everyone exposed to this bacterium is bound to be infected since most peoples immune system is able to fight against infection.

III.

Types of Leprosy
Leprosy has two main forms, known as tuberculoid and lepromatous disease. In tuberculoid leprosy, Whitish and flat rashes can be seen, with only a few bacteria present in each. The peripheral nerves (nerves outside of the brain and spinal cord) and sometimes the surrounding skin (e.g. on the face, arms, legs) are affected.

In lepromatous leprosy, the more severe form of the disease, Bumps or raised rashes appear and damages are done on the eyes, nerves, skin, upper respiratory tract and testes. The lesions may be much more widespread and contain many leprosy bacteria. As 3

lepromatous leprosy progresses, hard nodules and folds of skin may form on the face and the nose may collapse, giving a person a characteristic lion-like appearance.

IV.

Signs and Symptoms

Unfortunately, the early signs and symptoms of leprosy are very subtle and occur

slowly (usually over years). Numbness and loss of temperature sensation are some of the first symptoms that patients experience. As the disease progresses, the sensation of touch, then pain and eventually deep pressure are decreased or lost. Signs that occur, such as relatively painless ulcers, skin lesions of hypopigmented macules (flat, pale areas of skin), and eye damage (dryness, reduced blinking) are experienced before the large ulcerations, loss of digits, and facial disfigurement develop. This long-time developing sequence of events begins and continues on the cooler areas of the body (for example, hands, feet, face, and knees).

V.

Treatment and Prevention

The first effective drug for treating leprosy, called promin, was developed in the mid-1940s by scientists at the United States Public Health Service Hospital in Carville, Louisiana. Within several years, painful daily promin injections were replaced with oral doses of a related drug, called dapsone. By the early 1980s, strains of the leprosy bacterium resistant to dapsone had become widespread, and multidrug therapy, a combination of several medications, became necessary to treat the disease. Three antibiotics, dapsone, rifampin, and clofazimine, are currently used to treat leprosy. The drugs must be taken for a long period, typically six months in cases of tuberculoid 4

leprosy and two years for lepromatous leprosy. Treating leprosy using multidrug therapy is much more effective than using any one drug alone, and this treatment helps ensure that a drug-resistant form of the leprosy bacterium will not develop. These drugs cannot reverse the nerve damage and deformities of the hands, feet, and face that are characteristic of the disease. However, they can often halt the progression of the disease and help prevent it from being passed on to anyone else.

The role for surgery in the treatment of leprosy occurs after medical treatment (antibiotics) has been completed with negative skin smears (no detectable acid-fast bacilli) and is often only needed in advanced cases. Surgery is individualized for each patient with the goal to attempt cosmetic improvements and, if possible, to restore limb function and some neural functions that were lost to the disease.

Currently the only strategy for preventing the spread of leprosy is treatment of existing cases. Development of a test to detect infection with the leprosy bacterium before signs and symptoms appear would bolster this strategy. A vaccine developed to fight tuberculosis, which is caused by a bacterium closely related to the leprosy bacterium, appears to offer some protection against leprosy. Although the vaccine is not very effective against tuberculosis itself, scientists hope that improved antituberculosis vaccines currently being developed will also offer protection against leprosy. In addition, they are continuing to search for a vaccine directed specifically against leprosy.

VI.

History

Unfortunately, the history of leprosy and its interaction with man is one of suffering and misunderstanding. A research suggests that at least as early as 4000 B.C. individuals had been infected with M. leprae while the first known written reference to the disease was found on Egyptian papyrus in about 1550 B.C. Consequently, leprosy was left to be "treated" by priests or holy men, not physicians.

Since the disease often appeared in family members, some people thought it was hereditary; other people noted that if there was little or no contact with infected individuals, the disease did not infect others. Consequently, some cultures considered infected people (and occasionally their close relatives) as "unclean" or as lepers" and ruled they could not associate with uninfected people. Often infected people had to wear special clothing and ring bells so uninfected people could avoid them.

In 1873, Dr. Hansen discovered bacteria in leprosy lesions, suggesting leprosy was an infectious disease, not hereditary or a punishment from the gods. However, patients with the disease were still ostracized by many societies and cared for only at missions by religious personnel. Patients with leprosy were encouraged or forced to live in seclusion up to the 1940s, even in the U.S., often because no effective treatments were available. Because of Hansen's discovery of M. leprae, efforts were made to find treatments that would stop or eliminate M. leprae.

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