Dr. Devraj Dogra and Dr. Mubashar Mir.
Leprosy is one of the ancient diseases known with its origin tracing back to India in 3rd B.C. It is believed to have spread to the rest of the world much later after India was discovered and military invasion and trade became the hiatus of its transmission from India. Around 60 percent of world’s leprosy burden is still contributed by India. Locally famous in India askushtarog, it is yet to fall below the elimination level in Chhattisgarh and the union territory of Dadra and Nagar Haveli.
As a result of substantial progress achieved under national leprosy program, the national prevalence rate which was 57.60/10,000 population before start of MDT in 1983 reduced to 0.66/10,000 by March 2016. The prevalence of leprosy in the state of J&K is at an even lower level i.e. 0.14/10,000. However recent data highlights that over the past few years case detection and prevalence of leprosy has become stagnant and patients of leprosy with deformities have increased. This signifies that people suffering from leprosy are hesitant to approach health care centres for treatment because of lack of knowledge about the disease and also because of the stigma associated. Sparsh campaign launched by govt. of India aims at touching the grass root level to bridge this gap through village level educational campaigns and removing the social stigma associated with the disease.
Leprosy is a chronic disease with a long incubation period (average 5-7 years). The major source of infection in the community is an ignored case i.e., a case of leprosy lying hidden or untreated in the public, who transmits the disease agent to other people of the community. Thus, active detection and treatment of the case will help in reducing the disease burden besides cutting off the disease transmission at an early stage and reducing the progression to deformities.
World Leprosy Day:
World Leprosy Day is celebrated on 30th January to increase public awareness on Leprosy. It is celebrated in remembranceof the death anniversary of Mahatma Gandhi. Mahatma Gandhi was a prominent figure globally in the fight against leprosy. Sabarmati ashram was an abode for many leprosy patients whom Gandhiji personally used to nurse.
Leprosy as a disease
Leprosy is a chronic infectious disease caused by a bacteriumknown as M.leprae. It appears usually as a light-coloured patch on the skin with certain loss of sensations over the lesion. It affects nerves, skin and eyes. Of all the infectious diseases, leprosy is most significant for its potential to cause everlastingdeformities which is responsible for strong social stigma and discord.
Transmission
Leprosy although an infectious disease does not spread readily from on person to the other. Most common source of infection in leprosy is through the respiratory route.Disease causing organism enters the body commonly by means of droplet infections. After its entry it travels into the skin and nerves. Early diagnosis and treatment is the only way to prevent and stop nerve damage and deformities.
Leprosy and environmental factors
Leprosy spreads more readily among people belonging to lower socio-economic strata of the society due to factors like overcrowding, improper hygiene and lack of knowledge about the disease.
Presentation
The symptoms of the disease occur generally after a long incubation period which is highly variable. The average incubation period of the disease is said to be around 5 to 7 years. The initial lesions of leprosy are asymptomatic due to which patient presents usually after the deformities and late sequelae have set in. Thus, the role of early detection and treatment as envisaged in the National leprosy control programmes is a must.
Light coloured patches with partial or complete numbness, persistent nasal stuffiness, hoarseness of voice, numbness or tingling sensations in the hands and feet are the early manifestations of leprosy. Painful nerves, spontaneous blistering of 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 and its cure
The disease is completely treatable. Patients are given Multi Drug Therapy (MDT) for a fixed time interval. MDT is a combination of different drugs used in disease like leprosy and TB. Leprosy should never be treated with any single anti-leprosy drug as it can lead to drug resistant leprosy. 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.It is important to understand that a leprosy patient must complete a full course of MDT. However, there are circumstances where a patient is forced to stop the treatment. 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. Request from the same health care centre 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. Identify and report to the nearest healthcare centre in his/her new place by showing the referral letter; inform the new health care centre about new address in detail including contact no., if appropriate.
Side effects of treatment
MDT is remarkably safe, and severe adverse reactions are rare. Minor adverse drug reactions include nausea, vomiting, reddish urine, anaemia and brown discolouration of skin.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 facilities.
Complications
When a person is left untreated for a longer time the bacterium starts to damage the nerves which leads to sensory and motor impairment. This leads to deformities, non-healing ulcers, swollen limbs andloss of part or sometimes total loss of limbs.Complications and infections can further lead to systemic involvement in the form of blindness, sterility and renal failure. Occurrence of leprosy and tuberculosis together can result in complications which are difficult to treat.
Management
In no other disease the concept of prevention is better than cure is more relevant than leprosy. Once the deformity sets in, there is no treatment modality which can guarantee complete recovery. Cases need to be treated as early as possible, before deformities can set in.Deformities can be corrected to a limited extent only with surgery. It is therefore important to sensitise the village level workers like ASHA and ANMs to recognise signs and symptoms of leprosy early for timely referral and early institution of treatment.
Cohabitation
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 out patient 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.
However, it is important to have people living in the same household and close friends examined regularly for leprosy. At the same time, they should also be educated regarding the signs and symptoms of leprosy.
The fight against leprosy has been a long and constant struggle and results have been fulfilling. However, consolidation of the gains, early detection and treatment and removal of social stigma associated with the disease still hold the key. A determined effort and a logical approach is needed before we give the final push.
(The authors are Head of Department & MD Resident, Department of Dermatology Venereology and Leprosy, GMC Jammu)
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