Today's contribution deals with a topic that is particularly close to my heart. It is easy to avoid certain topics if the patients concerned are absent from our daily professional routines and in other latitudes. And yet the issue of leprosy is as real as it was in the Europe of the Middle Ages.
Leprosy is a disease which, stigmatized like no other, leads to disabilities and chronic suffering. It poses a sad vicious circle of a disfiguring disease: Out of fear of infectivity, the sick are shunned, stigmatized and cannot even come close to an otherwise healing therapy. Children, in particular, are affected because they are dependent on adults. This blog entry will address the current state of leprosy, their social consequences, and possible solutions in a succinct way.
For thousands of years, leprosy has been a source of sorrow and concern for mankind. The initiation and continuity of treatments are difficult due to social stigmatization. And so undertreatment and the development of resistance are becoming more and more frequent. If we focus on the origin, we have to look for the reasons behind infection in small children with leprosy. As is so often the case, suffering brings suffering. Leprosy is particularly prevalent among the poorer sections of the world's population, with a particularly terrible incidence amongst children. And by looking away and stigmatizing, the gap that separates patients from any healing therapy is getting deeper and deeper.
According to current WHO data, more than 200,000 new cases of leprosy occur every year worldwide. The disease, which can manifest itself in the form of lepromatous, tuberculoid and borderline leprosy, is caused by the obligate intracellular bacteria Mycobacterium leprae. It is a persistent microorganism characterized by its acid resistance.
The Mycobacterium leprae surrounds itself with a wall of wax. And it wants to do the same to its victims. The limbs of those affected feel as if they possess a waxy coating after the microorganism has killed the limbs’ nerves. It protects itself against external environmental influences through its lipid-containing layer, while its victims remain defenseless. It is a slowly acting bacterium that creeps into the host body and only after years of incubation, which can last from 3 to 10 years, spreads into the body and begins its destructive process there. It multiplies in macrophages and in Schwann cells.
It is a stubborn bacteria, that no scientist has yet succeeded in cultivating in a culture medium or cell culture. Mycobacterium leprae is a rough, ancient, destructive, invisible and lurking force. This fact, as well as the disfiguring and paralyzing consequences of the disease, have always scared mankind (sources 1, 2).
Perhaps that is also the reason why the WHO only published the first official guidelines for leprosy therapy last year. Three years have now passed since the introduction of the Global Leprosy Strategy 2016-2020 (see source 1). There have been successes, but not enough. It is the minds of millions of people around the world that first need to change in order to build the capacity to eliminate the disease. Leprosy is curable! If the disease is diagnosed early enough, disabilities can be avoided. Since the mid-1990s, the Nippon Foundation and Novartis have made antibiotic combination therapy available worldwide. So why haven't we managed to rid the world of this disease yet? More on this in my follow-up blog entry on leprosy.
Sources:
1. https://www.who.int/neglected_diseases/news/WHO-to-publish-first-guidelines-on-leprosy-diagnosis/en/
2. Fischer M. (2017). Lepra - Ein Überblick über Klinik, Diagnose und Therapie. J Dtsch Dermatol Ges. 2017 Aug;15(8):801-829.