Dr. Devraj Dogra, Dr. Mubashar Mir.
Leprosy caused by mycobacterium leprae,referred to as kusht rog in ancient Indian scriptures, originated as an ancient malady during 600 BC in India itself. It was later during the invasion of Indian peninsula by Alexander when it spread to the rest of the world through military and mercenaries. Over the time with better understanding of the disease and better treatment armamentarium, leprosy has been on decline. However, India still is the biggest contributor to the global leprosy burden and more than half of the leprosy patients belong to India.
The prevalence rate of leprosy in India is 0.66/10,000. The prevalence of leprosy in J&K is at an even lower level of 0.14/10,000. The decline from being a public health problem to crossing the elimination mark of 1/10,000 has been an exceptional success however critical analysis of recent trends signifies that the declining trend has almost hit a plateau in the recent years and there has been an increase in the cases with deformities. This highlights the delayed reporting of cases in late stages of the disease when deformities have already set in.
Leprosy is a chronic disease; the infection is usually contacted during childhood but due to a long incubation period (average 5-7 years) the disease usually manifests during second and third decade. The major source of infection in the community is an open case who has not been treated yet i.e., a case of leprosy lying hidden or untreated in the public, who transmits the disease agent to other people of the community.
World Leprosy Day is celebrated every year on the day of martyrdom of Mahatma Gandhi Ji i.e. 30th January to increasepublic awareness onthe disease. It is celebrated in remembranceof the father of the nation who was a prominent figure globally in the fight against leprosy.
Causation:
Leprosy is a chronic infectious disease caused by a mycobacterium known as M. Leprae discovered by GA Hansen. It is an acid-fast bacillus like tuberculosis causing mycobacterium. It is a slowly dividing bacillus which is responsible for the insidious nature of the disease.
Mode of Spread:
Leprosy is most commonly spread as a droplet infection through the respiratory route. Spread from one person to the other through direct contact is not a major route. Isolation in leprosaria which was practiced in the past is not required as the patients are rendered virtually non-infectious once the treatment is started.
Environmental factors:
Overcrowding, poor socioeconomic status, lack of personal hygiene and lack of education about the disease are known predisposing factors. Better hygiene, urbanisation, nuclear families and improvement in socioeconomic status has helped in fighting the disease.
Presentation
The manifestations of the disease set in late years after the infection. Patients may notice light coloured patches with partial or complete numbness or may complain of persistent nasal stuffiness, hoarseness of voice, numbness or tingling sensations in the hands and feet. Painful nerves, spontaneous blistering over hands and feet and visible non-healing ulcers and deformities are the features which occur later in the course of the disease. In case of presence of signs and symptoms of leprosy, patients should be advised to contact ASHA or ANM of your area or visit the nearest dispensary. Leprosy centres are also available at tertiary care institutes where patients with doubtful presentations are managed by specialist doctors.
Treatment:
Early detection and treatment remain the cornerstones of treatment. The disease is completelytreatable. Combination of multiple drugs known as Multi Drug Therapy (MDT)is given to the patients for a fixed time interval based on the patients’ age. Leprosy should never be treated with any single anti-leprosy drug as it can lead to drug resistance. One should complete the full course of MDT as prescribed by a trained health worker according to the type of leprosy. MDT is highly effective in treating leprosy and relapse after adequate treatment with MDT is a rarity. Treatment of leprosy is available free of cost at all government dispensaries. In case, the patient has to move out from the place where he/she lives, the patient should request for a referral letter from the health care centre where he/she is currently taking the treatment. The letter should contain reports pertinent to his/her diagnosis and treatment. The same health care centre should be requested for sufficient MDT stock to ensure continuous treatment before he/she reports to the nearest healthcare centre in his/her new place. All health care centres can provide leprosy treatment and care. The nearest healthcare centre should be identified and reported to, in his/her new place by showing the referral letter and informing the new health care centre about new address in detail including contact no., if appropriate.
Once treated with full course of MDT, the patient is declared cured and needs to report regularly to the concerned centre for few years to observe for sequalae.
Side effects of MDT:
MDT is remarkably safe.Minor adverse drug reactions like nausea, vomiting, reddish urine, anaemia and brown discolouration of skin can be seen. MDT is safe during pregnancy and lactation for the mother and the baby. Any adverse event to MDT should be reported to the nearest health centre.
Cohabitation with leprosy patients
The practice of isolation of leprosy patients in separate leprosaria is now obsolete as the rate of transmission of leprosy is almost nil, once the treatment is initiated. Almost all patients of leprosy can be managed on outpatient basis from the nearest government dispensary or health worker. A person affected by leprosy can lead a normal married life and have children. There is no risk in staying with a patient of leprosy as the disease is not highly infectious and treatment reduces the risk of transmission even further. All contacts of the patient should be screened and symptoms regarding the disease should be enquired uponin all the family members.
Vision for the future:
The biggest impediment in the fight against leprosy continues to be the stigma which is associated with the disease. This stigma itself is a major reason of late reporting of such cases. WHO leprosy strategy 2016-2020 envisages in itself policies which encourage inclusion of leprosy sufferers into the mainstream and to remove social discord and discrimination against leprosy patients.
The struggle against this ancient and pervasive disease has been a tiring but a rewarding journey. International and national organisations like World Health Organisation, World Bank, Indian federation of anti-leprosy associations, Novartis, DANLEP etc have been instrumental in this endeavourand the fight still is far from being over. Since the national leprosy eradication program has achieved remarkable success in bringing down the disease prevalence, it has been integrated with the national health mission.It needs to be impressed upon that,this stage concrete efforts towards promoting public awareness about the disease and an efficient health machinery at the grass root level would be instrumental for the final push. (The Authors are Head of Department & MD Resident, Department of Dermatology Venereology &Leprosy, GMC Jammu)
(The authors are Professor & Head Department of Dermatology, Venereology & Leprosy. GMC Jammu.)
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