World leprosy day is celebrated on the 30th of January in India and it is undoubtedly one of the oldest diseases known to mankind. Caused by a microbe called Mycobacterium Leprae, this disease is considered deadly as it can bring about severe deformities to the body. The first recorded case of leprosy dates back to 600 BC which is proof that the disease has been plaguing mankind since time immemorial.
In 2005, the world health organization declared that leprosy has been eliminated as a public health hazard in from the global population. Yet, there are several pockets mostly in the developing nations where the prevalence of the condition is still high. The higher efficiency of the treatment methods has made the treatment of leprosy to become easier contributing to the widespread eradication of the disease. Today there is close to 22,0000 reported cases of leprosy worldwide, 60% of which comes from India.
What is Leprosy?
Leprosy is basically a condition caused due to the infection caused by Mycobacterium Leprae which grows slowly and colonises different parts of the skin, eyes, peripheral nerves and the upper part of the respiratory tract. There is no particular age or gender that this disease can affect, instead, any person is equally susceptible to this disease. Leprosy is identified with thickened nerves and very recognizable skin lesions with sensory loss.
Sensory loss is one of the most identifiable symptoms of leprosy and is checked by pricking with a pin at the site of infection. The lack of sensory response is caused due to the infection that affects the peripheral nerves of the individual. The majority of the cases reported under leprosy are from India, Brazil and Indonesia. In many parts of the world, leprosy is also called Hansen’s disease.
The ability of leprosy to spread is fairly low and the disease is only contagious due to repeated contact with the infected person over long periods of time. If leprosy is recognized and cured in the early stages you can get away with infection without having significant disfigurement. There are various medications that are effective in the treatment of leprosy about which we will be talking in the below sections.
Symptoms of Leprosy:
Leprosy is a very distinct disease to diagnose because of its unique symptoms. The bacteria which causes leprosy attacks your nerve endings located in your limbs rendering them to be insensitive to touch and feel. The main symptoms of leprosy are listed below.
1. Muscle Weakness:
As the onset of leprosy starts you will start feeling that your muscles are losing power and they are becoming weak. The ability of the bacterium to affect your peripheral nerves is the major cause behind it. If not treated at the right time, this symptom can manifest in long term muscle loss.
2. Numbness In Limbs:
This is one of the most classic symptoms of leprosy. This is the symptom that most doctors use to suspect leprosy. The effect the bacterium have on your nerves is the cause for this symptom. This numbness can occur in your hands, legs, arms or feet at the same time or at multiple sites at the same time.
3. Skin Lesions:
Skin lesions are very visible when the disease starts to onset. The condition worsens as the disease start to progress. The effect of skin lesions in leprosy is the most dangerous ones. These lesions can be very prone to infections and the numbness in the limbs can lead the patient to be completely unaware of it leading to serious ramifications caused due to the skin being infected and also limb loss due to necrosis. It can also come in a format where the skin just becomes a little discoloured and can become inflated with redness all over.
Types of Leprosy:
There are various kinds of leprosy that plague the humankind. The distinctions in the type of leprosy are mainly decided based on the immune response of your body, type and number of sites infected and the severity of the systems. These classifications are done base on 3 different classification systems as mentioned below.
1. Tuberculoid Vs Lepromatous Vs Borderline:
This classification system is solely based on your immune response to the infection. Tuberculoid, lepromatous and borderline infections are the three distinct types of classifications under this system.
- Tuberculoid Leprosy: Tuberculoid leprosy is defined when the immune response to the infection is on the higher side, the patient only exhibits mild symptoms and the transmission possibility is also very low.
- Lepromatous Leprosy: In lepromatous leprosy is defined when the immune response to the infection is very poor. Lepromatous leprosy is very dangerous as this condition will lead to the serious ill effects on the skin lesions often accompanied by large and visually displeasing bumps and lumps that can cause other issues too. Lepromatous leprosy also affects the internal organs putting the patient at grave risk. The contagiousness is also very high for this form of leprosy.
- Borderline Leprosy: This form of leprosy is when both the symptoms of the above classification is visible. This form is considered to be in between both the above forms of leprosy.
2. WHO Classification:
This method of classification is implemented by the world health organization and is dependant on the type and instances of infection in the body. There are two categories of classification:
- Paucibacillary: Paucibacillary leprosy id defines as when the number of skin lesions is below five and there are no traces of the bacterium in the skin samples when cultured and tested.
- Multibacillary: Multibacillary leprosy is defined when the number of infected sites in the skin is above five and there are visible traces of the bacteria in both the skin samples and the smears.
3. Ridley Jopling Classification:
In most clinical studies the Ridley-Jopling classification system is used which is based solely on the severity of the symptoms of leprosy. There are five categories under this classification system:
- Tuberculoid Leprosy: In this classification tuberculoid leprosy is defined with skin lesions that are inconsistent, where some of them are large and numb and then there is little or no nerve involvement present.
- Borderline Tuberculoid Leprosy: Borderline tuberculoid leprosy is when the skin lesions are higher than that of tuberculoid leprosy and the nerve involvement is on the higher side.
- Mid-Borderline Leprosy: Mid-Borderline leprosy as the name suggests lies between borderline leprosy based on the severity of the symptoms. This type of leprosy can be defined with skin lesions with reddish plaques and the nerve will be affected more than borderline leprosy. This category will also have swollen lymph nodes.
- Borderline Lepromatous Leprosy: Borderline lepromatous leprosy is when the skin lesions are many and also includes bumps, flats and noticeable nodules at the site of infection. The numbness will fairly high in this form of leprosy, showing that nerve involvement is on the higher side.
- Lepromatous Leprosy: This is the most severe form of leprosy according to this classification. The number of skin lesions will be high and there will be a heavy presence of nodules and also thickened nerves. In this form of leprosy, you will also find hair loss, weakness in limbs and visible disfigurement.
Yet another form of leprosy is called as intermediate leprosy which does not belong to any of the above classification systems. It is basically an early stage of leprosy which will have only one skin lesion which will be slightly numb to touch and pricks.
Treatment for Leprosy:
Leprosy was very dangerous in the old times because of the difficulty of treating it. The contagious aspect of the disease made even the medical practitioners of that time stay away from it. The only treatment that existed in the very early stages was to cover the lesions in ash and quarantine the patients where most of the symptoms became severe and eventual death occurred.
In modern times, however, the treatment of leprosy has grown to a very effective status. Dapsone was the most used antibiotic for the treatment of leprosy until the resistance of the bacterium grown towards the drug. Today WHO has encouraged the use of MDT (Multi Drug Therapy) for the treatment of leprosy and it’s been very effective till now. In the below table we will show some of the drugs used to cure leprosy.
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The multidrug therapy helps to bring the bacterium causing leprosy under control by cutting of its vital functions. The drug therapy is usually administered with a combination of three drugs aimed at minimizing the effects and damages posed by the bacterium. The world health organization has made blister pack medical kits which are aimed at treating multibacillary leprosy. The effectiveness of the drug can be enhanced with the right diet and patient co-operation. It’s safe to say that early diagnosis of leprosy is the best way to minimize the damages that can be caused by the same.
World Leprosy Day in India:
World leprosy day in India is commemorated on 30th of January every year as a token to the father of the nation, Mahatma Gandhi. Leprosy is still highly prevalent in India despite it being declared as an eradicated public health hazard by the WHO. Almost sixty per cent of the overall cases of leprosy reported worldwide from India.
In India, the eradication and management of any contagious disease is the responsibility of the Ministry of Health and Family Welfare. The ministry to spearhead its efforts in eradicating leprosy from India has devoted a special department called as NLEP (National Leprosy Eradication Programme). The rising average of leprosy cases in India, when compared to the global status, is mainly said by NLEP to be caused due to the lack of infrastructural resources.
In order to make the detection of the disease stronger the programme suggested a three-step plan:
- Leprosy Case Detection Campaign: This refers to the efforts from the department to set up testing centres in remote endemic pockets of the disease to detect the disease early and eradicate it.
- Awareness Campaigns with more focus: This initiative aims to use ASHA and other local communal bodies to create more awareness about the disease and its symptoms which will aid in early detection of the same.
- Area Specific Plans: This initiative aims to focus the efforts of the NLEP to the areas where the prevalence of the disease is very high, it will also help the patients in remote and hard to access areas of the country.
With these new initiatives, the NLEP hopes to resolve the cases of leprosy sooner and the eradication of the same can be done with ease. However, one of the major problems they face is the lack of resources and infrastructure that can match the prevalence of the disease to aid in early detection.
Most patients in the remote locations of India still feel reluctant to reveal the symptoms of leprosy due to the existent stigma about the condition in the society. Undiscovered cases, therefore, cause a huge obstacle in the efforts to eradicate the same and end up spreading the disease, causing an epidemic. In 2017 to curb the issues related to the stigma associated with the disease the government established the Sparsh Leprosy Awareness Campaign. The strategy aims to remove the stigma associated with the condition so that more undiscovered cases will report for self-diagnosis.
The ministry’s continuous efforts have led to the reduction of the prevalence rate of the disease from 57.8/10,000 in 1983 to 0.66/10,000 by the year 2016. The proper administration of MDT is the main factor behind this success. The global eradication of leprosy is the main agenda for the CDC (Centre for disease control) and the WHO and they provide all the support required for India to curb the issue of leprosy.
Now that you have understood the dangerous effects of leprosy and the methods in which you can prevent it, there might be some unanswered questions that must be bothering you. In the below section we will try and answer some of the frequently asked questions about leprosy.
1. Can leprosy cause death?
Yes. like any other disease if leprosy is untreated for a long duration it can lead to eventual death. Leprosy has the ability to affect your nervous system and internal organs that can lead to a slow and painful death.
2. Is leprosy eradicated?
In 2015, the world health organization, declared leprosy to be eradicated as a public health hazard in the global scenario. This does not mean the disease is completely eradicated. Today 87 per cent of all reported cases of leprosy comes from the countries of Indonesia, India and Brazil.
3. Can leprosy be cured?
Yes, leprosy can be easily cured using multidrug therapy. The course of treatment may range from six months to one year based on the severity of the disease and the effects of the symptom.