Knowing Leprosy: A socially misunderstood disease

FOR more than 50 years, the last Sunday of January is traditionally dubbed as the “World Leprosy Day” to draw awareness about the disease and among its sufferers.

For this year, the theme is “Fullness of Life” for us to look at how we can uphold and support people within our localities and around the globe affected by leprosy to experience life to the fullest.

Leprosy, also known as Hansen’s diseases in honor of its discoverer Gerhard Armauer Hansen, has been dreaded and misunderstood for several centuries.

For the unfortunate part, majority had associated this disease with the stereotype of some supernatural or divine punishment as depicted in biblical literatures.

The fact is, “Leprosy is a chronic infection, caused by the bacterium Mycobacterium Leprae, that results in damage primarily to the peripheral nerves (nerves outside the brain and spinal cord), skin, mucous membrane of the nose, testes and eyes,” explains The Merck Manual of Medical Information.

Being a communicable disease, ideally the mode of transmission is known. Unfortunately, this does not seem to hold true for leprosy as the mode of transmission remains a mystery among most medical scientists.

However, “When an untreated, severely ill person [of leprosy] sneezes, the Mycobacterium Leprae bacteria are dispersed in the air,” The Merck Manual informs. “About 95 percent of people who are exposed to Mycobacterium leprae don’t develop leprosy because their immune system fights off the infection.”

On the contrary, the Public Health Nursing in the Philippines, a manual published by the National League of Philippine Government Nurses Incorporated, points that the mode of leprosy transmission is either airborne or prolonged skin-to-skin contact.

The World Health Organization (WHO) classifies Leprosy as Mild (Paucibacillary); Borderline form (multibacillary); and severe form (mutibacillary).

“The bacteria that cause leprosy multiply very slow. Symptoms usually do not begin until at least one year after a person has been infected,” The Merck Manual states. “On an average, manifestations start appearing five to seven years subsequently and often many years later.”

The Public Health Nursing in the Philippines classifies the clinical manifestations of leprosy into two major categories: Early and Late.

In the early manifestations, the manifestations include (1) Change in color of the skin (either reddish or white); (2) loss of sensation on the skin lesion; (3) decrease or loss of sweating and hair growth over the lesion; (4) muscle weakness or paralysis of extremities; (5) pain and redness of eyes; (6) nasal obstruction or bleeding; and (7) ulcers that do not heal.

The late manifestations include (1) loss of eyebrows; (2) inability to close eyelids; (3) clawing of fingers and toes; (4) contractures; (5) sinking of nose bridge; enlargement of breasts in males; and chronic ulcers.

“The symptoms such as distinctive skin rashes that don’t disappear, a loss of sense of touch and particular deformities that result from muscle weakness provide strong clues to the diagnosis of leprosy” explains The Merck Manual.

The Public Health Nursing in the Philippines maintains that the diagnosis of leprosy is based on clinical signs and symptoms especially if there is a history of contact with people with leprosy.

“Only in rare instances is there really a need to use laboratory and other investigations to confirm a diagnosis,” it said.

However, in doubtful clinical diagnosis, the manual of Public Health Nursing suggests that the patient undergoes a “Slit Skin Smear” exam to prevent misclassification and wrong treatment.

Treatment for leprosy necessitates the use of multi-drug treatment (MDT) -- two or more antibiotics -- that can arrest the progression and possibly curing the disease.

The WHO classification of leprosy forms the basis for the management of leprosy. For mild (Paucibacillary) types, the duration of treatment ranges between six to nine months. For the borderline and severe (Multibacillary) types, the duration of treatment is between 24 to 30 months.

For the Public Health Nursing in the Philippines, the standard mode of MDT for leprosy in the Philippines include (1) Paucibacillary cases are prescribed with Rifampicin and Dapsone; (2) Multibacillary cases are prescribed with Rifampicin, Clofazimine and Dapsone.

“Other antibiotics that may be given by the physician to people with leprosy include ethionamide, minocycline, clarithromycin and ofloxacin,” states The Merck Manual. “Antibiotic therapy must be continued for a long time because the bacteria [Mycobacterium Leprae] are difficult to eradicate.”

Meanwhile, the Philippine National Drug Formulary 2008 edition writes that clofazimine is only available under the DOH program: “Clofazimine, Dapsone and Rifampicin are administered to patients via oral [mouth] route.”

As of 2007, the Manual of Public Health Nursing maintains that leprosy remains a public health concern in eight cities (Laoag, Candon, Vigan, San Jose, Cagayan de Oro, Oroquite, Iligan and Isabela) and five provinces (Ilocos Norte, Ilocos Sur, Basilan, Sulu and Tawi-Tawi).

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