Leprosy has always been a concern of public health throughout the world. This disease has been mistaken with the leprosy of the Old Testament, which is not the Hansen’s disease. The microbe that causes leprosy, Mycobacterium leprae, is an acid fast organism difficult to grow in vitro. In the United States, the armadillo is the animal that is able to carry the disease and transmit it to humans. Manifestations of leprosy depend on the host immune response ranging from tuberculoid to lepromatous leprosy (multibacillary to paucibacillary). The skin, nerves, and eyes are the parts mostly affected by the disease.
Skin lesions, loss of vision, numbness, weakness, and eye pain present in those affected. In order to diagnose patients, physical exams, skin biopsy/smear must be completed. There is a therapy that constitute a combination of drugs in order to treat leprosy. There are immunologic reactions where the disease worsens with different types. There is type 1 (reversal), type 2 (erythema nodosum leprosum). Antibacterial therapy have to be continued as these reactions develop. Introduction and Etiology Also known as Hansen’s disease, leprosy is a chronic infectious disease caused by a bacterium.
It is capable of influencing any tissue or organ in the body. M. leprae was discovered by Gerhard Armauer Hansen in 1873. The disease was named after him because he made the discovery. Even though the disease is less understood, the bacteria was the only one found to cause disease in man. This bacteria inhabit warm and wet environment in the tropics and subtropics. The bacteria also affect other organisms other than man such as mice rabbits, mangabe monkeys, and armadillos. It is an obligate intracellular, gram-positive organism.
This microbe is an acid-fast organism hat has a rod shape with sides that are parallel and ends that are round. It grows in the coolest parts of the body that are less than 37 degrees Celsius. Looking at it, it has the size and shape features of the tubercle bacillus. The bacteria is high in number in the macrophages especially in the lesions of lepromatous leprosy. They are grouped together, organized in a palisade. There are intracellular and extracellular clumps of bacilli forming capsules. Mycobacterium leprae cannot be cultivated in vitro. The method of culture employed here is in vivo being the mouse ootpad inoculation.
Stigma Rafferty (2005) states, “The stigma of leprosy is a real phenomenon in people’s lives that affects their physical, psychological, social and economic well-being. ” People fear leprosy because they don’t know and do not understand it. Because of fear, stigma and discrimination arise. There are so many misconceptions about the way leprosy is. Some of those affected by leprosy have been left untreated and lead to disabilities causing stigma. Many aspects of life of those affected have been influenced by stigma. Stigma causes inequality in ommunities.
Due to visible signs of leprosy, infected patients, regardless of their gender, age, and social class, they are treated as if they were not human beings. People with leprosy suffer emotional stress and anxiety, and this causes them to isolate from others. They may withdraw from treatment due to the lack of motivation. The status of patients with leprosy decrease and they think that the only way of survival will be to beg. Due to the misconceptions about leprosy, those affected along with their family members are denied opportunities as everyone else. Stigma causes patients to stop seeking further treatments denying their condition.
For this reason, the disease can get worse, the transmission can also increase. There are interventions that need to be used to fight stigma. These are rehabilitating patients, integrating programs, media campaigns, and changing the image of the disease. Epidemiology Tropical and subtropical temperate regions are places where leprosy is more developed. It is estimated that millions of people have been impaired due to leprosy. There is about 1-2% of the population where the clinical disease arise. The incubation period is about 3-5 years and can ensue after several years. Age groups vary, 10-15 and 30-60 years.
Generally, the male to female ratio is 2:1. Leprosy can be cured with the use of multidrug therapy. It cannot be totally eliminated because there are so many wild animals carrying the bacteria. Those at highest risks of leprosy have poor living conditions such as diseases that interfere with the immune system, the water is contaminated and there is a poor diet, and bedding may be deficient. In the United States, there is an increase in new cases every year. Many of those affected, about fifteen million have been treated using drugs and two million have prevented the development of impairment of this infection.
About 150 cases and more are diagnosed every year. According to the Registry of National Hansen’s Disease Programs (NHDP), more cases were added in 2010. The World Health Organization (WHO) also reported about 160 new cases the same year. Included were cases of females and children, but there were no relapse cases. The main focus of leprosy exist among immigrants, and in some parts of Mexico, Asia Californian populations, Spanish Americans, Texas, nd Florida. Most of the cases involve about 75% of those that have been in foreign countries such as Africa, Asia, and Latin America.
Some native US citizens have also been exposed due to their travel overseas. People can also be contracted with leprosy when in contact with the armadillo. The animal has a body temperature that is not too hot or too cold, so the bacteria is able to survive in that type of environment. Eating the infected animal can also transmit the infection. But, most of the time people are infected when traveling overseas and Americans have a low chance of being exposed. In the southern United States, leprosy can be passed on between animals and humans by the same strain of bacteria M leprae.
Armadillos are carriers of leprosy and able to transmit it to humans. According to WHO, detection rates have declined globally since 2004. About 95% cases were discovered worldwide in 2010. There were about 192,246 new cases. Countries of detection were Indonesia, Madagascar, Angola, Ethiopia, Bangladesh, Brazil, Mozambique, China, Myanmar, Democratic republic of Congo, United Republic of Tanzania, India, Nepal, Nigeria, Sri Lanka, Philippines, and Sudan. There is still a high prevalence in some of these countries, but cases are decreasing.
This means that many patients have been cured of the disease. India, followed by Brazil, some parts of Africa, and Indonesia account for the largest with this incidence. In Africa, the rate of elimination of the disease was very low in 2004 and some countries hadn’t eliminated leprosy. The highest concentration of leprosy cases is in Southeast Asia. Although most countries in this region have eliminated leprosy, there is still a high prevalence of 2. 84. Places n this region that have the highest population account for high rates of concentration. The Western Pacific has the lowest prevalence.
There is still a public health concern in this region because some parts are exposed, but there is almost no leprosy in the majority of nations. Leprosy has been nearly eliminated in the American region. The prevalence rate of some countries of this region is close to zero. WHO have decided that leprosy be controlled but there is a need of equipment for collection of data. Pathology It is still unknown how leprosy is transmitted. Moschella (2004) tates, “The skin, superficial peripheral nerves, anterior chamber of the eyes, and testes, all cooler parts of the body are the most frequently affected organs. It affects some parts of the body such as the skin, the eyes, the mucosa of the respiratory tract, and the peripheral nerves.
Leprosy is able to leave a permanent damage to these parts. This can also result in impairment and deformities. Those affected have been isolated due to social stigma from history. It is believed that leprosy is transmitted when an infected person is in contact with a healthy person. The ost accurate close contact is made in the household. Bacteria are more likely to enter respiratory passages, and there are other routes such as a broken skin.
In the onset of leprosy, lesions are hypo-pigmented and look like patches with anesthesia. There can also be an appearance of multiple infiltrated patches. Sometimes, there is no appearance of skin patches when leprosy becomes obvious. Leprosy can be compared with tuberculosis in that they both have the absence of toxicity, and there is an excess number of bacilli that present in the body, but there are few signs that are apparent. The isease can affect a specific area of the skin or the prime nerve supply. Disturbances such as local pain, trophic, sensatory, and inflammatory swelling may be present.
The whole body and the patient may seem normal but the skin underneath contains numerous bacilli. The skin looks healthy and normal from the outside and the nerves do not look that thick. As the disease progresses, the skin erupts, fever and other symptoms develop. When leprosy becomes chronic and gradually increases, it develops to the point where abnormalities become apparent. These can be an area of anesthesia, the nerve becomes thick or ingles, tenderness, the skin starts changing, sensitivity is lost due to burns, and extremities may become numb.
Because the skin becomes discolored, it is sometimes confused with other skin conditions such as eczema. The size of these patches increase from time to time as leprosy progresses. The acute onset of leprosy is not common but lesions are multiple and with margins being less diffused allowing it to spread quicker holding multiple bacilli. Transient rash is the first sign of leprosy that becomes apparent. Other acute diseases or stress such as menopause, childbirth determine the onset by occurrence. Prognosis Outcomes of leprosy depends on its stage of diagnosis and treatment.
There is a chance of a good outcome if the disease is prevented and treated early. The prognosis can go from fair to poor if the patient’s complications have become more advanced, affecting the lifestyle. With the introduction and conclusion of the Multi-Drug Therapy (MDT), leprosy can be cured. Using this treatment prevent impairment from developing. Even after treatment with MDT, the skin becomes damaged and discolored. These lesions usually clear within the first year of using MDT. The progression of impairment can be diminished.
Muscle weakness and the loss of sensation can sometimes be partially recovered or not at all. After treatment, it is very rare that relapse occurs. Leprosy is barely deadly. Patients have to be educated about leprosy in order to be aware of the signs and symptoms, and how the disease aggravates. In order to avoid constant disability, patients have to learn and prevent injuries from occurring. In order to eliminate the social stigma and solitude resulted from the disease, public awareness and campaigns will help in detecting the disease and treating it early.
The WHO has taken initiatives in preventing leprosy worldwide. There is also a need of political and economic support for all to work. One deformity that remains in those affected by leprosy is the insensitivity of feet. People with diabetes also have this condition. Treatment There are two categories of leprosy disease: multibacillary (MB) where there is a high number of M. leprae because they multiply with positive skin smear and the presence of five lesions or more, and paucibacillary (PM) – the M. leprae number is small and the skin smear test appears negative with fewer skin lesions.
PM is the most common of these leprosy. On top of the multidrug therapy, there are drugs that need to be combined in order to treat leprosy. These drugs cannot be used alone for the treatment and are taken orally. Dapsone was one of the drugs used for treatment. It was meant to make the bacteria weak. When new strains of bacteria developed, this drug became inefficient. For this reason, Dapsone is now combined with another drug, Rifampicin to treat paucibacillary leprosy. Adding another drug, clofazimine, multibacillary leprosy will be treated.
The single dose combination therapy includes rifampicin (600 mg), ofloxacin (400 mg), and minocycline (100 mg). A child that has a single lesion of paucibacillary leprosy will be administered half the dose of each drug. A positive skin smear requires treatment with the MDT of multibacillary leprosy. The procedure of that of paucibacillary leprosy shouldn’t be used in any case to replace the other. In any case that the diagnosis is uncertain, the multibacillary regimen should be used. Normally, a patient is supposed to have monthly visits at the clinic for supervision when taking the drugs.
Coverage of health services in many countries is very poor disabling them to provide the supervision needed to monitor the patients’ monthly dose. In this case, a family member or someone in the community may be designated to supervise. Patients that decide to take their own responsibility have to be informed about the signs and symptoms and reactions, and they have to be warned about all potential risks. Conclusion Leprosy continues to be problematic not only in the United States, but also all over the world. It is uncommon that the disease be transmitted from one person to another.
In the United States, the prime reservoirs of this disease are the armadillos. It has become an issue to researchers because they cannot grow the bacteria from leprosy on the culture. Recognizing the disease in its early stages allow people to effectively treat those affected. Since the antibacterial therapy discovery, treatment of those infected has improved. There are multitude of healthcare professionals that patients can benefit from for a complete care. These healthcare professionals are able to adjust the treatment after recognizing any complication that arises. In order to eliminate leprosy, misconceptions about it need to be changed.