Friday, March 22, 2013

Health Care and Leprosy

Back in Biblical times, thousands of years ago, when someone shouted “Unclean, unclean,” that usually meant the person was suffering from a dreaded disease, typically leprosy. In that time it was commonly believed that you could catch that horribly disabling and fatal illness simply by being near someone or breathing the same air near the affected individual. Plus, it was a legal requirement for the victim to announce the fact they were in the area by shouting out those words. That way, everyone within ear shot could run the other way. Leprosy was seen as a plague on those who had it and a direct result of sin against their god.

A lot of knowledge about leprosy has been gained since then, as in most all medicine. According to the World Health Organization (WHO), leprosy was recognized in the ancient civilizations of China, Egypt and India. The first known written mention of leprosy is dated 600 BC. Throughout history, the afflicted have often been ostracized by their communities and families. Although leprosy was treated differently in the past, the first breakthrough occurred in the 1940s with the development of the drug Dapsone, which arrested the disease. But the duration of the treatment was many years, even a lifetime, making it difficult for patients to follow.

The WHO reports that leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes. Leprosy is curable and treatment provided in the early stages averts disability. Here are some key facts about this disease:

• Official figures show that almost 182,000 people, mainly in Asia and Africa, were affected at the beginning of 2012, with approximately 219,000 new cases reported during 2011.

• M. leprae multiplies very slowly and the incubation period of the disease is about five years. Symptoms can take as long as 20 years to appear.

• Leprosy is not highly infectious. It is transmitted via droplets, from the nose and mouth, during close and frequent contacts with untreated cases.

• Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes.

• Early diagnosis and treatment with multidrug therapy (MDT) remain the key elements in eliminating the disease as a public health concern. Here is more detail about leprosy found on the WHO website: http://www.who.int/mediacentre/factsheets/fs101/en/index.html.

The medical name for leprosy is Hansen's disease, according to American Leprosy Missions (ALM). Norwegian doctor Armauer Hansen was the first to view the bacillus under a microscope in 1873. The bacteria attack nerve endings and destroy the body's ability to feel pain and injury. Without feeling pain, people injure themselves and the injuries can become infected, resulting in tissue loss. Fingers and toes become shortened and deformed as the cartilage is absorbed into the body. Repeated injury and infection of numb areas in the fingers or toes can cause the bones to shorten. The tissues around them shrink, making them short.

Early signs include spots on the skin that may be slightly red, darker or lighter than normal skin. The spots may also become numb and have lost hair. Often they appear on the arms, legs or back. Sometimes the only sign may be numbness in a finger or toe. If left untreated, hands can become numb and small muscles are paralyzed, leading to curling of the fingers and thumb. When leprosy attacks nerves in the legs, it interrupts communication of sensation in the feet. The feet can then be damaged by untended wounds and infection. If the facial nerve is affected, a person loses the blinking reflex of the eye, which can eventually lead to dryness, ulceration and blindness. Bacteria entering the mucous lining of the nose can lead to internal damage and scarring which in time causes the nose to collapse. Untreated, leprosy can cause deformity, crippling and blindness, according to ALM.

Leprosy is transmitted primarily through coughing and sneezing. In most cases, it is spread through long-term contact with a person who has the disease but has not been treated. Scientists don't fully understand how leprosy is spread. Most people will never develop the disease even if they are exposed to the bacteria. Approximately 95% of the world population has a natural immunity to leprosy. Approximately 5,000 people in the U.S. are cured but suffer from the effects of leprosy and continue to receive care through outpatient clinics and private physicians. Approximately 150 people are diagnosed with leprosy each year in the U.S, per American Leprosy Missions. More info can be found on their website: http://www.leprosy.org/ .

According to the National Institutes for Health (NIH), most cases are in the South, California, Hawaii, and U.S. islands. Effective medications exist. Isolating people with this disease in "leper colonies" is not needed. People with long-term leprosy may lose the use of their hands or feet due to repeated injury because they lack feeling in those areas. Prevention consists of avoiding close physical contact with untreated people. People on long-term medication become noninfectious (they do not transmit the organism that causes the disease). Call your health care provider if you have symptoms of leprosy, especially if you've had contact with someone who has the disease. Cases of leprosy in the United States need to be reported to the Centers for Disease Control and Prevention. Much more info can be found at this website: http://www.nlm.nih.gov/medlineplus/ency/article/001347.htm .

Leprosy is a disease that largely has been contained in most places in the world, especially in the US, even though there are new cases every year that are diagnosed. However, most people who contract this disease are located in more impoverished third world nations where sanitary living conditions are not readily available, or that have limited access to health care, or who live in a population largely ignorant of disease prevention. As with any health care need, always talk with a medical professional for proper diagnosis and treatment.

Until next time.

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