For Rajesh, life took a painful turn after his leprosy diagnosis. Once a boy who lived a carefree life, he found himself cast into loneliness due to the stigma surrounding the disease.
“When I had no leprosy I used to swim in the river with my friends. I used to share bathing soap. Without hesitation, I used to visit my relatives and friends. After I contracted leprosy, everything changed for me. I became lonely.” he recounted.
Across the world, the lack of awareness about leprosy continues to fuel fear and discrimination. As we celebrate World Leprosy Day on the 26th of January every year, let us take the chance to understand this disease better.
What is Leprosy?
Leprosy, caused by the bacterium Mycobacterium leprae, is actually chronic infectious disease. It primarily affects the skin, eyes, peripheral nerves, and respiratory tract.
The disease spreads through airborne droplets during close, prolonged contact with untreated patients. However, once treatment begins, the risk of transmission ends. Most individuals have a natural immunity to Mycobacterium leprae and will not develop the disease even after exposure.
You might think of leprosy as an ancient disease – something you hear about in Bible stories or history books. Yet, it persists.
In 2023, the World Health Organization (WHO) reported approximately 183,000 global cases, primarily concentrated in Africa and South-East Asia. The top five countries with the highest prevalence include India, Brazil, Indonesia, the Republic of Congo, and Bangladesh.
While cases have significantly declined over the years, the disease has not been eradicated and continues to affect thousands.
Signs and Symptoms
Leprosy progresses slowly, with symptoms often taking years, or even decades, to appear. This long incubation period can delay diagnosis and treatment. Social stigma may also deter infected individuals from seeking medical treatment.
The symptoms of leprosy mainly affect the skin and nerves.
Skin symptoms
- Lightened or discolored skin patches
- Nodules on the skin
- Painless lumps on the face and earlobes
- Painless ulcers or wounds on the limbs
- Thick and dry skin
Nerve symptoms
- Loss of sensation, tingling or numbness at affected areas
- Muscle weakness, especially in the limbs
- Enlarged nerves around the elbows, knees, and side of the neck
- Vision problems
Nasal symptoms
- Nosebleeds
- Nasal congestion
Left untreated, leprosy can cause severe complications, including deformities, blindness, and debilitating nerve damage.
Diagnosing Leprosy
Apart from the presence of the cardinal features of leprosy, it is diagnosed through clinical signs and confirmed by a skin biopsy, which detects the presence of Mycobacterium leprae.
Leprosy is classified into two types based on the immune response and severity of symptoms.
Paucibacillary (PB) leprosy
PB leprosy is a mild, less severe form of leprosy. People with this type have only one or a few patches of flat, pale-coloured skin. This type of leprosy is less contagious than other forms.
Multibacillary (MB) leprosy
This type of leprosy causes widespread lesions affecting the skin and nerves. The bacterial load is higher, and it is more contagious.
Is Leprosy Curable?
Leprosy is curable with a combination of antibiotics called multi-drug therapy (MDT). The treatment regimen may consist of two or three antibiotics, including dapsone, rifampicin and clofazimine, to kill the bacteria.
The combination of drugs used in the MDT depends on the classification of the disease.
- Rifampicin is the most important anti-leprosy medicine and required in the treatment of both types of leprosy.
- For PB leprosy, dapsone is added on to rifampicin for a 6-month treatment regimen.
- For MB leprosy, a combination of all three drugs, rifampicin, clofazimine and dapsone, is recommended for 12 months of treatment.
- Sometimes, steroids may be prescribed to manage nerve pain and inflammation.
Strict compliance to the antibiotic regimen can cure the disease and prevent complications.
Can We Prevent Leprosy?
The best possible way to prevent the spread of the condition is to avoid close contact with individuals at risk of infection (e.g. travellers who have returned from countries with leprosy prevalence).
Other preventive measures may include:
- Post-exposure prophylaxis: The administration of a single dose of rifampicin (a type of antibiotic) for individuals with recent history of contact with infected persons.
- Vaccination
- The BCG (bacillus Calmette-Guérin) vaccine that protects against tuberculosis (TB), may also have protective effects against leprosy.
- The Mycobacterium indicus pranii vaccine has been introduced in India to prevent the spread among close contacts of infected individuals.
Beyond Medicine
Leprosy is more than just a medical condition. Historical interpretations of the condition often perpetuated a sense of fear and separation. These depictions have influenced perceptions of the disease over centuries, contributing to the stigma that still exists today.
While it is now curable with modern medicine, discrimination remains a reality in some parts of the world. For those diagnosed, the social challenges, such as isolation and rejection, can sometimes feel as significant as the physical symptoms.
Addressing this disease requires a multifaceted approach, especially in regions where the condition remains prevalent. A deeper understanding of leprosy can pave the way for both medical advances and a more accepting society.
