Leprosy is an ancient disease that is widely known and feared. This is shown by its prominence in the Bible. In both the Old and the New Testaments, leprosy was thought to be a punishment sent by God for sin. The sufferer was said to be in a state of tsara'ath or defilement. This Hebrew term was later translated to 'lepros', from which we get the word leprosy. Victims of the disease were shunned and sent to leper colonies that nobody would go near.

What Is Leprosy?

Leprosy (Hansen's Disease), sometimes called Hanseniasis or HD, is a chronic disease caused by Mycobacterium Leprae (M Leprae).

M Leprae is a rod-shaped bacillus¹, which is similar to the bacillus that causes tuberculosis. Norwegian physician Gerhard Henrick Armaur Hansen discovered the leprosy bacillus in 1874.

In some cases it is contagious but not to the great extent believed in ancient times. In fact, leprosy is probably the least contagious of all contagious diseases. Droplets from the nose and mouth of a sufferer spread leprosy, but you can only get it through very close and frequent contact with an untreated patient. In most cultures, leprosy still carries a strong prejudice that sometimes makes more trouble for the sufferer than the disease itself.

Leprosy is an ancient and widespread disease that has, at one time or another, affected all the continents and, still persists today. Anyone can be affected by leprosy, though it is most common in countries where malnutrition is high. However, progress is being made. In 1951, there were approximately 15 million sufferers around the world; today the World Health Organization (WHO) estimates that six million people remain to be treated. An example of the horror of leprosy is that a rat or other animal could chew off a sufferer's toe without them noticing. The most common injury to people with leprosy is burns; since they cannot feel hot or cold they will often touch a heated object without realising.

Leprosy Symptoms

Leprosy primarily affects the peripheral nerves and, secondarily, it affects skin and certain other tissues/organs, in particular the eye, the mucosa of the nasal and upper respiratory tract and the testes. It does not affect the central nervous system. Where the sensory nerves are damaged in varying degrees they cannot register pain. Where the eye is affected it can often lead to blindness.

A myth that still prevails - even in 'educated' societies - is that the disease causes flesh to rot and fingers and toes to drop off. Nothing could be further from the truth. Tragically, limbs that are damaged by accident, because the victim cannot feel pain, sometimes have to be amputated.

The earliest symptom is often anaesthesia (loss of sensation) in a patch of skin. The patch of skin, or skin lesion, is usually less pigmented than the rest of the body or copper-coloured. The skin lesions may also be raised or have nodules.

Due to nerve damage, muscles may become paralysed and sensory loss usually begins at the extremities (toes, fingertips). In many advanced cases, gangrene sets in causing parts of the body to 'die' and become deformed. Where the autonomic nerves are affected it can result in hair loss and/or poor or no function of the sweat and sebaceous glands resulting in drying and cracking of the skin, thus exposing the sufferer to secondary infection.

Types of Leprosy

There are two types of leprosy:

• Paucibacillary Leprosy (PB) results in one to five numb skin patches.

• Multibacillary Leprosy (MB) results in more than five numb skin patches.

Cures for Leprosy (Therapy)

Leprosy is completely curable and chaulmoogra oil was used for many years and is still an established treatment for leprosy. Contemporary therapy includes the use of drugs such as dapsone, rifampin, clofazimine and provisions of adequate nutrition.

The combination of dapsone, rifampin, and clofazimine is called multi drug therapy (MDT). This drug combination kills the pathogen and cures the patient.

MDT

For MB patients, a combination of all three drugs is used and they are cured within 12 months. For PB leprosy patients only rifampicin and dapsone are used and they are cured within six months. Of these three drugs, rifampicin is the most important.

• Rifampicin - This is given once a month and no toxic effects have been reported in cases of monthly administration.

• Clofazimine - This is most active when administered daily. The drug is well tolerated and virtually non-toxic in the dosage used for MDT. The drug causes brownish black discolouration and dryness of skin. This disappears within a few months after stopping treatment.

• Dapsone - This drug is very safe in the dosage used in MDT and side effects are rare. The main side effect is allergic reaction which causes itchy skin, rash and exfoliative dermatitis.

Patients are no longer infectious to others after the first dose of MDT and there are virtually no relapses (recurrences of the disease) after the treatment has been completed.

Resistance of bacillus MDT is relatively cheap. It costs only $15 per month to provide drugs and services to cure one patient of leprosy.