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April 28, 2009

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Forgotten but not gone: leprosy lives on in America

Nov. 9, 2008
Courtesy American Society of 
Tropical Medicine and Hygiene
and World Science staff

Long seen as a dis­ease of bib­li­cal times, lep­ro­sy still ap­pears and may be spread­ing in the Un­ited States, re­search­ers say. But it’s often mis­diag­nosed, they warn, with dis­as­trous re­sults.

Al­so known as Hansen’s dis­ease, lep­ro­sy is a slow, chron­ic ill­ness that of­ten leads to dis­abil­ity and dis­fig­ure­ment by at­tack­ing the per­iph­er­al nerv­ous sys­tem and by de­grad­ing mo­tor skills. Sci­en­tists don’t clearly un­der­stand how it’s trans­mit­ted.

Father Damien, a Catholic priest who know­ingly ex­posed him­self to le­prosy and suc­cumbed to it in 1889 after years of help­ing lep­rosy pa­tients in Ha­waii.

Long seen as a disease of biblical times, leprosy continues to appear in the United States, researchers say. Also known as Hansen’s disease, leprosy is a slow, chronic illness that often leads to disability and disfigurement by attacking the peripheral nervous system and by degrading motor skills. Scientists don’t clearly understand how it’s transmitted. “We believe there are more cases of leprosy not identified due to the lack of awareness about the disease among physicians in the U.S.,” said James Krahenbuhl, director of the Health Resources Service Administration’s National Hansen’s Disease Program in Baton Rouge, La. This leads to “misdiagnosis and wrong treatments,” he added. About 150 leprosy cases are diagnosed yearly; 3,000 people in the U.S. are being treated for leprosy, he said. Leprosy, whose patients have historically been quarantined in isolated “leper colonies” throughout many countries and time periods, is caused by a rod-shaped bacterium, Mycobacterium leprae. The onset of infection and symptoms can take three to 10 years, making it difficult for researchers to pinpoint where or how people acquire the disease, according to Hansen’s Disease program. As leprosy progresses, patients lose their sense of touch in fingers and toes, leaving them open to repeated burns and cuts which get infected. The repeated damage leads to bone absorption and motor nerve deterioration causing fingers to shorten and curve, resulting in a claw-like appearance. Leprosy is fully treatable with medicine in early stages. But nerve damage that occurs in later stages can’t be reversed. Because many U.S. leprosy patients are poor immigrants who seek treatment in free clinics or emergency rooms, the program said many of the doctors involved aren’t familiar with the disease. They often mistake the skin lesions for a fungus or ringworm and prescribe a topical cream. Because leprosy progresses slowly, it can take months or longer before it becomes clear the treatment is failing—giving the disease a sizeable head start. Leprosy prevails most in the tropics and poor countries. Due to changes in immigrant relocation, leprosy is now being diagnosed throughout the United States, Krahenbuhl said. The program sees about 30 cases each year among residents in southern Louisiana and the Gulf Coast of Texas who were born in the U.S. and who have never visited an endemic country. “As we see leprosy move toward internal regions of the States, it becomes more urgent to reach those physicians to let them know about the symptoms of this disease,” said Krahenbuhl, who plans to lead a symposium at the American Society of Tropical Medicine and Hygiene meeting to raise awareness among physicians.