-Dr. Pooja Aggarwal, Consultant Dermatology, Artemis Hospitals Gurgaon
Leprosy, also known as Hansen’s disease caused by the bacteria Mycobacterium leprae is a chronic infection that primarily affects the skin, peripheral nerves, eyes, and the upper respiratory tract resulting in skin lesions, neuropathy, deformities and disabilities. The infection is thought to spread between people through droplet infection.
The disease develops gradually and can ultimately cause significant disability such as inability to use hands and feet if left untreated. Since it is a bacterial infection, it can be cured with the proper dose and duration of antibiotics.
Leprosy is a public health problem. It was eliminated globally in 2000 and India though declared itself free from leprosy in 2005, new cases continue to occur. According to the World Health Organization (WHO), over 2 lakh new leprosy cases were detected globally in 2016. India today accounts for more than half of all leprosy patients in the world.
Detection of leprosy in the early stage is difficult as the bacteria multiply slowly, the average incubation period of the disease is 5 years. Symptoms may take up to 20 years to appear. There is an unintentional delay in diagnosis and treatments symptoms may be subtle and the disease continue to develop.
Those people who come in repeated close contact with droplets from the nose and mouth of an untreated infected person over many months are at higher risk of developing the disease.
Awareness About Leprosy
One cannot get leprosy from casual contact with a leprosy patient. People residing in the endemic zone due to a greater prevalence of leprosy cases are more prone to getting the infection. However, it is not highly contagious, and about 95% of exposed people will not develop the disease. Some animals such as armadillos are known as the carrier of the bacteria and it can spread to people handling them without wearing safety kits, but the risk is low.
The symptoms include numbness, loss of sensation to temperature and touch, flat and discoloured patches or red patches or growth of lumps on the skin, painless ulcers on the soles, lump on the face or earlobes, loss of eyebrows or eyelashes, muscle weakness or paralysis in the hands and feet, thick cord-like thickening in the elbow, neck and knee, stuffy nose, nosebleeds, joint pain, eye symptoms among others. Trauma and burns may go unnoticed due to loss of sensation.
Diagnosis is primarily clinical and is aided by slit skin smear and skin biopsy. One must consult a doctor if any of the above symptoms develop. The WHO has classified leprosy into two categories- paucibacillary and multibacillary- based on the number of skin lesions, presence of nerve involvement and bacillary load.
There are defined criteria for this classification. Leprosy affects different people in different ways according to the immune response. People with PB leprosy has a high level of immunity and the low number of bacteria and those with MB leprosy has a lower level of immunity and the higher number of bacteria.
WHO has recommended multidrug therapy (MDT) consisting of three drugs which are supplied as blister calendar pack containing 4 weeks of treatment. The treatment duration is decided by the type of leprosy and is 6 months for PB leprosy and 12 months for MB leprosy.
Adherence to treatment and its successful completion is very important. Leprosy patients can develop a certain type of reactions or side effects or pain in the nerves while being on treatment and discontinue their treatment without consulting the doctor. Also, there could be other personal, economic or psychological factors or there could be poor access to health care facilities.
This leads to defaulters and disease continue to spread in the community and also lead to drug resistance. It is important that a patient understands the disease and its need for the whole prescribed course of treatment. Also, the prevention of deformities and disabilities and rehabilitation of those with disabilities (physical and psychological) is highly important.
To summarise, Leprosy can be cured if diagnosis and treatment are started early. Disabilities that develop can be permanent. It is considered to be a social stigma and the diagnosis can lead to psychosocial issues.
Patients are ostracized in the society that makes them hide the initial symptoms leading to progression and delay in treatment. However, patients should be provided with all necessary care and emotional support without any discrimination. As leprosy cases are rising in India, one must consult a doctor immediately once the symptoms come into notice.