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World Leprosy Day 2020
Leprosy also known as Hansen’s Disease is an age-old disease. Once upon a time, it was incurable causing those who suffer from it to be ostracized from their families and communities. However, medical advancement has brought cure to this devastating disease so much so that we rarely hear of people suffering from this terrible disease that affects multiple body systems namely the nervous system, skin, eye and the inner lining of the nose. In recent years, statistic shows that nine out of a hundred cases are children which means that we need to do better in many ways to prevent and treat this debilitating disease. The good news is we are moving towards a leprosy free world with initiatives from the World Health Organization (WHO) under a strategy known as "Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world" which aims to decrease disabilities, end disabilities in paedetric patients and discrimination worldwide.
What is leprosy?
Leprosy is caused by a bacteria known as Mycobacterium Leprae. It develops slowly over a period of time (at least 5 years or more) before showing signs of infection. The disease affects nerve endings which destroys the body’s ability to feel pain and touch. While some countries have been free from this disease, there are others that are still at greater risks with reported new cases.
Countries that are at a greater risk include:
Africa: Democratic Republic of Congo, Ethiopia, Madagascar, Mozambique, Nigeria, United Republic of Tanzania
Asia: Bangladesh, India, Indonesia, Myanmar, Nepal, Philippines, Sri Lanka
How does it spread?
In ancient days, it is thought that leprosy is a highly contagious disease that spreads between humans therefore they were separated from their local community. While it is true that it spreads between humans, it requires close contact with an untreated individual over a few months to contract it. The bacteria is spread through droplets from coughing or sneezing.
Clinical features of leprosy
The disease affects multiple systems which we will discuss below starting with skin symptoms.
One will often notice a large, discolored lesion on the chest which looks like flat discolored (lighter than the skin around) patches of skin, with a sense of numbness.
Other skin symptoms include
Growths (nodules) on the skin
Thick, stiff or dry skin
Painless ulcers on the soles of feet
Painless swelling or lumps on the face or earlobes
Loss of eyebrows or eyelashes
Mucous membrane infection signs
Once it reaches the mucous membranes, signs include stuffy nose and nosebleeds.
Nervous system symptoms include
Numbness of affected areas of the skin
Muscle weakness or paralysis (especially in the hands and feet)
Enlarged nerves (especially those around the elbow and knee and in the sides of the neck)
Eye problems that may lead to blindness (when facial nerves are affected)
Loss of sensation and numbness poses a problem as injuries may occur without one noticing. Without the feeling of pain or touch, burns may go unnoticed until it is too late. Therefore, it is vital to be extra cautious to ensure the affected parts of your body are not injured.
Why is the disease devastating?
Hansen’s disease brings about social discrimination and stigma that affects one’s psychological being, work and social life. Moreover, if the disease is left untreated, paralysis of hands and feet would occur. While treating can cure the disease, it can not undo damaged nerves or deformity.
Other symptoms of untreated leprosy would include
Shortening of toes and fingers due to reabsorption
Chronic non-healing ulcers on the bottoms of the feet
Loss of eyebrows
Other complications that may sometimes occur are
Painful or tender nerves
Redness and pain around the affected area
Burning sensation in the skin
Why is recognising it important?
Early detection and treatment can help prevent disability.
A biopsy of the skin or nerve ending is usually done if one has suggestive symptoms. Treatment then starts if the results come back positive for M. Leprae. Treatment consists of multiple antibiotics (multidrug therapy (MDT)), it is used concurrently to prevent antibiotic resistance as treatment takes a long period of time, about one to two years to completely cure it. The course of MDT differs depending on the type of leprosy, Paucibacillar and Multibacillar. It is also important for patients to inform their healthcare provider of all the signs and symptoms that they are facing in order for them to approach the disease comprehensively to prevent worsening.
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