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March 2010 Chirurgeon's Message

Leprosy

Unfortunately, the history of leprosy and its interaction with man is one of suffering and misunderstanding. The newest research suggests that at least as early as 4000 B.C. individuals had been infected with Mycobacterium leprae while the first known written reference to the disease was found on Egyptian papyrus in about 1550 B.C. The disease was well recognized in ancient China, Egypt, and India. Because the disease was poorly understood, very disfiguring, slow to show symptoms, and had no known treatment, many cultures thought the disease was a curse or punishment from the gods. 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.

The Romans and the Crusaders brought the disease to Europe, and the Europeans brought it to the Americas. 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. (for example, the leper colony on Molokai, Hawaii, and at Carville, La.), often because no effective treatments were available.

Leprosy is often termed "Hansen's disease" by many clinicians in an attempt to have patients forgo the stigmas attached to being diagnosed with leprosy. The early signs and symptoms of leprosy are very subtle and occur slowly. Numbness and loss of temperature sensation (cannot sense very hot or cold temperatures) 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).

Researchers suggest that M. leprae are spread person to person by nasal secretions or droplets. They speculate that infected droplets reach other peoples' nasal passages and begin the infection there. Some investigators suggest the infected droplets can infect others by entering breaks in the skin. M. leprae apparently cannot infect intact skin. Leprosy is not hereditary. There is no vaccine available to prevent leprosy. The majority of cases are treated with antibiotics. The recommended antibiotics, their dosages and length of time of administration are based on the form or classification of the disease and whether or not the patient is supervised by a medical professional.

Many people get exposed to leprosy throughout the world, but the disease in not highly contagious; researchers suggest that over 95% of exposures result in no disease. In the U.S., there are about 200-300 new cases diagnosed per year, with most coming from exposures during foreign travel. The majority of worldwide cases are found in the tropics or subtropics (for example, Brazil, India, and Indonesia). The World Health Organization reports about 500,000 to 700,000 new cases per year worldwide, with curing of about 14 million cases since 1985.


THL Blase di Angelo
Kingdom Chirurgeon


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