Leprosy, also called Hansen’s disease, is an illness known to humankind from pre-historic times. It is a chronic disease caused by the bacterium Mycobacterium leprae. It can affect various organs, predominantly the skin and the peripheral nerves. Left untreated, leprosy can lead to severe disfigurement and disability.
The bacteria causing leprosy is not highly contagious, contrary to popular belief and folklore. It is transmitted through the respiratory route. Initiation of proper treatment further reduces the risk of transmission of leprosy from an infected patient to others.
As mentioned, leprosy predominantly affects the skin and the peripheral nerves. In the skin, it appears commonly as hypopigmented lesions (having a lighter colour than the surrounding skin) or red-coloured lesions. Peculiarly, these lesions will have reduced sensations: meaning that the patient may be unable to feel touch or appreciate the sensation of heat or cold. Lumps or swellings in the face and earlobes may be seen in some patients. The peripheral nerves may be thickened and the patient may feel tingling or numbness in the hands or feet.
Due to the involvement of the peripheral nerves, these patients can also develop disabilities like foot drop and claw fingers. Poor appreciation of sensation may lead to the development of ulcers in hands and feet. In later stages, some patients can develop features like facial weakness, loss of eyelashes and eyebrows and collapsed nose. While these may be frightening to know, one should understand that with effective treatment that is available to us in modern medicine very few patients develop these complications.
Our understanding of the leprosy bacteria has helped to develop an effective treatment for leprosy. Based on the severity and type of the disease the usual duration of treatment is six to 12 months. Effective treatment prevents the complications of leprosy and minimises the risk of transmission.
India has come a long way in controlling the menace of leprosy. The National Leprosy Eradication Programme has made significant progress in controlling the number of leprosy cases. However, the scourge of leprosy is far from over. It is estimated that the prevalence of leprosy in the country is 0.4 per 10,000 population of the country.
The prevalence in Kerala is estimated to be 0.13 per 10,000 population. We need to intensify the case finding and proper treatment of all diagnosed cases so that the goal of leprosy elimination is achievable. The Aswamedham campaign rolled out by the Government of Kerala plays a major role in leprosy control in the state. This year the programme is observed from January 18 to 31st. Under the campaign, specially trained voluntary workers will be conducting house visits to actively find leprosy cases and link patients to treatment centres. A multi-pronged approach is required for leprosy elimination and participation of the private sector, non-governmental organisations and the community at large should be made stakeholders in the programme.
Despite significant advancement in our knowledge about this infectious disease, leprosy remains a disease associated with significant stigma. Myths and misconceptions about the disease remain even among educated persons. A coordinated effort from the government and civil society is needed to dispel these myths.
World Leprosy Day is observed every year on the last Sunday of January. In India, it is observed on January 30 every year, coinciding with the death anniversary of Mahatma Gandhi. The aim of observing leprosy day is to create awareness about the disease and dispel myths and stigma about the disease. On this World Leprosy Day, we must recommit ourselves to ending this ancient disease and dispelling the stigma and discrimination that surrounds it.
The author is Associate Consultant, Infectious Diseases, KIMSHEALTH, Thiruvananthapuram
