Leprosy Awareness

Leprosy is also known as Hansen’s Disease. Given below are a few points to help you understand the disease.

  1. CAUSE: The leprosy Bacillus(germ) is a rod shaped organism similar to the TB bacillus. It is said to be ACIDFAST(AFB) because it stains red with carbol fuscion solution which does not disappear in an acid wash.
  2. MODE OF SPREADING: Through mucous secretions of the nose or from discharge from ulcerated nodules. It is not spread through deformed hands or ulcers caused by injury.
  3. Immunity:Most people have in their blood the Leprosy Immunity Factor. This means that even if the body is invaded by the leprosy bacillus it will not mature to disease  because the body will overcome it by the L.I.F. Those people who do not have the L.I.F. will have varying degrees of resistance. This decides what type of leprosy occurs if it is contracted.
  4. INOCULATION/VACCINATION: There is no specific vaccine against leprosy, though it is thought that the B.C.G. vaccine is effective to some extent.
  5. PROBLEMS IN PREVENTING AND LIMITING LEPROSY:
  1. It is difficult to culture(grow) the bacillus outside the human body. It cannot be artificially grown on plates. It only grows on mice/rats and the armadillo. Mice rats do not have long enough life span to be effective in long term research.
  2. The bacillus(germ) takes a long time to incubate maybe 5-10 years. Therefore, it is difficult to know the source of the infection.

There is a reluctance of people to admit to having leprosy and therefore going for the treatment. This is due to the fears created by the superstitions and misconceptions concerning leprosy.

  1. SUPERSTITIONS & MISCONCEPTIONS:
  • Leprosy is a punishment for sin.
  • Leprosy is incurable.
  • Leprosy is hereditary.
  • Deformities are infectious.
  • Fingers and toes drop off because of leprosy.
  • Possessions such as bags, pens etc are infectious.

2.PSYCHOLOGICAL & SOCIAL PROBLEMS OF LEPROSY SUFFERERS:

    1. Fear because of superstitions.
    2. Rejection experienced from:-
  • Family- often lose home.
  • Friends.
  • Neighbours.
  • Colleagues- often lose job.
  • Refused water from public places.
  • Refused housing.
  • Not allowed in autorickshaws.
  • Thrown off trains and buses.

3. PSYCHOLOGICAL EFFECTS:

  • Fear of rejection.
  • Unwillingness to admit to having the disease.
  • Neglect of disease and treatment.
  • The above all leading to spread of the disease and increased possibility of deformity.
  • Depression.
  • Withdrawal from society.
  • Suspicious of offers of friendship.

PROGRESS OF THE DISEASE.

The Leprosy bacillus attacks nerves and / or skin and is present in different ways according to how much resistance there is in the body.

1. MASCULAR LEPROSY

    One or more whitish patches usually on the hidden parts of the body, though occasionally on the hands/face.

    These patches:

    • Do not itch.
    • Do not sweat.
    • Do not have hair growing.
    • Have partial or toss loss of sensation, both to touch and heat/cold.

    2. POLYNEURITIC LEPROSY

      The bacillus often attacks nerves, most often the

      • Ulnar Nerve-running from elbow to hand.
      • Popliteal Nerve- running from behind knee to foot.
      • Facial Nerve.

      The damage of the nerve causes loss of sensation to the area supplied by the nerve and progressive weakness and paralysis of the part. It is this which causes the characteristic clawed hand, dropped foot or facial paralysis.  In these cases the germs(bacillae) are hidden in the nerves and there is no fear of passing on the infection.

      3. LAPROMATOUS LEPROSY

        There is extensive spread of the disease in the skin. The patient has little or no resistance. Often bacillae come together in groups and cause a local swelling which we call a “nodule”. The skin especially on the face is thickened giving a “Leo-look”. Nasal secretions are heavy with infection. These are the people whose disease is infectious and may have to live separately from the family for some time. However it should be stressed that even these heavily positive patients quickly become non-infectious once adequate treatment is commenced i.e.  within one to one and a half months.

        CAUSES OF DEFORMITY

        1. PARALYSIS OF NERVES

        Example

          • Claw hand
          • Dropped foot
          • Facial paralysis

        These deformities look unsightly but there is no danger of infection. If treated early they are reversible or maybe corrected by exercise and surgery.

        2.  SHORTENING OF DIGITS

        Most often these are caused by injury rather than disease because:-

        • Sensation is diminished in hands/feet and therefore has no pain.
        • The injury is consequently neglected.
        • Secondary infection occurs and progresses to destruction of the bone.
        • The destroyed bone fall out or has to be removed to the next joint and then spontaneously heals, leaving a shortened digit.

        There may be foul smelling suppurating wounds but these will be staple infections and are a side-effect of leprosy rather than a first cause.

        3.  RARELY there is ABSORPTION OF DIGITS.

        In this case the finger(s) (or toes) will be short, but have no wound and the nail is intact. This is very rare and is certainly not infectious.

        DEFORMITY CAN BE PREVENTED

        LEPROSY CAN BE CURED

        Like all other infections and diseases the earlier treatment is commenced the better the result.

        1. For Paucibacillary Leprosy (i.e. minimal disease)

        Treatment is for 6 months with:

        • Dapsone 600 mgs per week
        • Rifampicin 450mgs once per month

        2.  For Multibacillary Leprosy( i.e. heavy infection)

        Treatment is for 2 years or until negative skin smear achieved.

        • Dapsone 600mgs per week
        • Rifampicin 300 mgs per week
        • Lamprene 300 mgs per week + monthly booster.

        DISADVANTAGES OF THE TREATMENT.

        1. Long term duration- By and large leprosy is not painful except in some acute phases, so it is easy to forget/neglect the treatment.
        2. Lamprene stains th skin red, so in dark or brown skinned people it looks much darker. This is not socially acceptable so adds to the rejection.
        3. Rifampicin also stains urine red and can cause liver complications.
        4. many of those suffering from leprosy are also habitual drinkers. Because of the possibility of the liver complications they should abstain from alcohol. Many are not prepared for this.