Leprosy: What is this disease?

Leprosy: What is this disease?

Leprosy – from today’s perspective, this disease seems to exist only in the stories of biblical prehistory. Nowadays, if at all, it only infects a few small ethnic groups in far-off corners of the Far East. This or something like that probably comes to mind when they think of leprosy – also known by the formerly common name. Leprosy is associated with highly severe physical suffering and social exclusion for those affected, who used to be called lepers. But what is leprosy, and what is the significance of this disease today?

What is leprosy?

Leprosy, also known as Hansen’s disease or Morbus Hansen, is an infectious disease transmitted from person to person. Changes in the skin and nerve tissue are characteristic of the disease: Depending on the type of leprosy, a rash or skin lumps form that can burst open. The infestation of the nerve tissue leads to injuries, infections and mutilations, sensory disturbances and paralysis.

The causative agent is Mycobacterium leprae and is found in infected people, particularly in the nasal and wound secretions. The bacterium can be transmitted via the so-called droplet infection. Since leprosy is only weakly contagious, the risk of infection is shallow. Decades can sometimes elapse between the time of infection and the onset of the disease. The so-called incubation period is, therefore, relatively long.

 

Symptoms and Types: How do you recognize leprosy?

There are two primary forms of leprosy, but the same pathogen triggers them. Both forms cause skin lesions and affect the nervous system. In addition, mixed forms of these two primary forms are also distinguished in professional circles.

Tuberculoid leprosy

Leprosy tuberculosis is the more benign form of the disease and also the most common form of leprosy: the course is relatively slow and prevails when the affected person has an excellent immune system (i.e. a correspondingly good immune system ). This form of leprosy manifests itself as follows:

  • The skin lesions appear as large so-called maculae (spots) with a lightened centre.
  • The disease triggers palpable thickening of the nerves, especially in the ear and forearm.
  • Sensory disturbances (reduced sensation through the skin) and paralysis can occur.
  • The sensory disturbances can lead to accidental injuries and, thus, mutilations.
  • The so-called masked face (facies antonina) occurs if the facial nerve fails.
  • In addition, the eyes are often affected (keratomalacia), which can lead to blindness if left untreated.

 

Lepromatous leprosy

Leprosy occurs when the immune system is weakened and leads to the well-known clinical picture of leprosy with the following symptoms:

  • Skin knots (the so-called lepromas)
  • the so-called lion face, in which the facial features change due to the formation of lepromas on the face
  • hair loss
  • Mutilation of the extremities (due to unnoticed injuries)
  • chronic eyelid inflammation (madarosis) with loss of eyelashes
  • Loss of the lateral part of the eyebrows (Lucio phenomenon)
  • Misalignment of the incisors (Möller-Christensen phenomenon)
  • Malformation of the nose (saddle nose)
  • a rough voice from larynx involvement
  • decreased sweat secretion
  • Inflammation of the kidney corpuscles (glomerulonephritis)
  • Amyloidosis

The course of the disease is very rapid, and there is usually no spontaneous remission of symptoms (spontaneous remission). This form is much more infectious than tuberculoid leprosy and can affect any organ if left untreated.

How do you get leprosy?

You can get leprosy either through contact with sick people or with the nine-banded armadillo (Dasypus novemcinctus). This armadillo is native to South America and is believed to have contracted the bacterium from humans.

How is leprosy transmitted, and where is it found?

The pathogen exists all over the world – so leprosy is not extinct. Regions that were brutally hit are Brazil, India, and Indonesia. The infection is very unlikely for vacationers since the transmission of the pathogens requires long and close contact with those affected, and this is usually not the case with tourists.

The fact that around 200,000 people are still infected with this disease every year is because the standard of living in the affected areas – and therefore also the hygiene and nutrition – is inferior. Those affected usually have a weakened immune system due to malnutrition and no access to medication to treat the disease.

 

How is leprosy treated?

Leprosy is treated with a combination of antibiotics, which is taken for six months and two years, depending on the form of the disease. Nowadays, leprosy patients are no longer isolated and even treated in shared rooms with other patients as long as they do not have open wounds. Inpatient admission is usually only necessary in severe cases or makes sense in the case of symptomatic therapy (e.g. wound care).

Is leprosy curable?

Leprosy is curable if detected and treated early, so further disease progression is halted. However, sensitivity is impaired by affecting the nervous system, which can lead to muscle paralysis and mutilation, including insufficient awareness of injuries. Unfortunately, these changes cannot be undone.

Is leprosy hereditary?

Leprosy is not hereditary. While it is possible to transmit the bacterium to the unborn child, the likelihood of this happening is minimal. However, the placenta detachment during pregnancy poses a greater risk to the unborn child. It can lead to a miscarriage.

In addition, the side effects of the drugs used to treat maternal leprosy can severely damage the development of the fetus. These drugs include thalidomide, also known as Contergan®, used in the United States and South America to treat skin ulcers associated with leprosy, and the antibiotics clofazimine, ethionamide, and protionamide.

 

Leprosy in Germany

According to statistics, the rate of new infections fluctuates between zero and two every year. All infections took place abroad. The risk of contracting leprosy in Germany is, therefore, negligible. In Germany, the detection of the pathogen is notifiable.

What does that mean for my next vacation?

It is advisable to be aware of this disease, but as a holidaymaker, you are hardly exposed to an increased risk of infection due to the short contact times.

Affected areas are South America, Africa and Southeast Asia. Leprosy can still be found today, especially in Brazil, Angola, Madagascar, India and Nepal. It is best to inform yourself individually about the holiday destination before each holiday. There is no vaccine to prevent leprosy.

history of leprosy

The origin of leprosy is believed to be in East Africa or India. It has already been found in biblical writings, Egyptian papyri, and writings from Indian and Chinese cultures. At that time, the disease still spread a lot of fear and terror, as it mutilated those affected, made them unable to work and ultimately fatal. For this reason, the sick were socially excluded and eventually even sent to ghetto-like leper colonies.

One of the best-known of these leper colonies is Spinalonga, northeast of the island of Crete in Greece. At the beginning of the 20th century, Spinalonga served as a quarantine for lepers, which they were not allowed to leave until they died. After the introduction of dapsone, a drug against leprosy, in 1948, the first Spinalonga residents were allowed to give up their exile and reintegrate into society. A short time later, the active ingredients clofazimine and rifampicin were used for the first time in 1962 and 1971 for leprosy therapy and have since led to a substantial limitation of the disease.

This treatment of lepers was not unusual at the time. Japan was one of the countries that stuck to this segregation policy until 1996. In 2019, the Japanese government compensated relatives of lepers without appeal against a court decision involving 541 plaintiffs.

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