Certain diseases are not as insufferable as the myths and stigma surrounding them. One such disease is Leprosy. It has been regarded by the community as a contagious, mutilating and incurable disease. Leprosy has struck fear into human beings for thousands of years, and was well recognized in the oldest civilizations of China, Egypt and India.There are many countries in Asia, Africa and Latin America with a significant number of leprosy cases.

Leprosy is not a curse from the gods or divine punishment for some sins committed in the past. Leprosy is a disease like any other disease and it is TOTALLY CURABLE. It was believed that leprosy is a highly contagious disease. The new school of thought, many a research papers later, is that it is not as contagious as it was made to be. Several health care workers have known to be in close contact with leprosy patients for years, without getting the disease themselves. Another myth that still prevails, even in "educated" societies, is that the disease causes flesh to rot and fingers and toes to "drop off". Nothing could be further from the truth. Tragically, limbs that are damaged, because the victim cannot feel pain, sometimes have to be amputated but we can now detect the disease before the patient is conscious of any loss of sensation. Even if the patient has experienced some measure of deformity, we are able, through chemotherapy, physiotherapy, and reconstructive surgery, to correct many of the disabilities.

Even though many patients are being cured, thousands still suffer because of deformity and stigma. They may have become bacteriologically "negative" but a prejudiced, uneducated, and ill-informed society may still reject them because of these disabilities that they had absolutely no control over.

However, there is good news on Leprosy front. Progress is being made. Today, the World Health Organization estimates that 6 million people remain to be treated, either through chemotherapy, or physiotherapy/surgery, or both. As with almost all serious afflictions, an early diagnosis along with early treatment and health education, are of vital importance here, too.

What is Leprosy?

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. The disease mainly affects the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes, apart from some other structures. Leprosy has afflicted humanity since time immemorial. It once affected every continent and it has left behind a terrifying image in history and human memory - of mutilation, rejection and exclusion from society.

When M.leprae was discovered by G.A. Hansen in 1873, it was the first bacterium to be identified as causing disease in man. However, treatment for leprosy only appeared in the late 1940s with the introduction of dapsone, and its derivatives.

Symptoms and Diagnosis

In an endemic country or area, an individual should be regarded as having leprosy if he or she shows ONE of the following cardinal signs: Skin lesion consistent with leprosy and with definite sensory loss, with or without thickened nerves or positive skin smears. The skin lesion can be single or multiple, usually less pigmented than the surrounding normal skin. Sometimes the lesion is reddish or copper-coloured. A variety of skin lesions may be seen but macules (flat), papules (raised), or nodules are common. Sensory loss is a typical feature of leprosy. The skin lesion may show loss of sensation to pin prick and/or light touch. Thickened nerves, mainly peripheral nerve trunks constitute another feature of leprosy. A thickened nerve is often accompanied by other signs as a result of damage to the nerve. These may be loss of sensation in the skin and weakness of muscles supplied by the affected nerve. In the absence of these signs, nerve thickening by itself, without sensory loss and/or muscle weakness is often not a reliable sign of leprosy.

Treatment

Multidrug therapy (MDT) is a key element of the elimination strategy. The drugs used in WHO-MDT are a combination of rifampicin, clofazimine and dapsone for MB leprosy patients and rifampicin and dapsone for PB leprosy patients. Among these rifampicin is the most important antileprosy drug and therefore is included in the treatment of both types of leprosy. Treatment of leprosy with only one antileprosy drug will always result in development of drug resistance to that drug.

MDT is the best combination available today, as proved by its successful application in leprosy control under varying conditions since 1982. The combination not only cures leprosy but is also highly cost-effective. The recommended standard regimen for multibacillary (MB) leprosy is: Rifampicin: 600 mg once a month Dapsone: 100 mg daily Clofazimine: 300 mg once a month, and 50 mg daily Duration: 12 months. The recommended standard regimen for paucibacillary (PB) leprosy is: Rifampicin: 600 mg once a month Dapsone: 100 mg daily Duration: 6 months. Children should receive appropriately reduced doses of the above drugs.

Access to information, diagnosis and treatment with multidrug therapy is essential. Several agencies including government health departments and non-governmental organizations are involved in the task of creating awareness about leprosy. Information campaigns about leprosy in high-risk areas are crucial so that patients and their families, who were historically ostracized from their communities, are encouraged to come forward and receive treatment. Today, diagnosis and treatment of leprosy is easy. Essential work is being carried out to integrate leprosy services into existing, general health services. This is especially important for communities at risk for leprosy, which are often the poorest of the poor and under-served.