Photo: Courtesy of emedicine.medscape.com
When we think of leprosy we think of biblical scourges and colonies for the ‘unclean’. The fact is leprosy never went away. Upwards of 200,000 cases are diagnosed each year and almost 200,000 people around the globe are undergoing treatment for the condition.
Scores of children failed to turn up at school today amid a leprosy scare. Two children at Indian Hills Elementary School in Riverside, California, are awaiting confirmation after undergoing tests for the disease.
According to the county’s disease control director Barbara Cole, neither are hospitalized; both are at home near school in west Riverside County. The Jurupa Unified School District informed families at Indian Hills Elementary School about the unconfirmed cases in a letter sent on Friday.
They insisted the diagnoses cannot be confirmed for a few weeks, but the district is doing everything possible to monitor and control the risk. Parents were also issued with fact sheets explaining the disease, how it is transmitted, and how it is treated. (source)
If these kids are diagnosed with leprosy it will be a very, very unusual event. Leprosy is also known as Hansen’s disease and is usually associated with The Middle East and Asia.
The bacteria that causes Hansen’s, Mycobacterium leprae multiples very slowly and this is why sufferers often have the disease for many years, sometimes decade a before showing symptoms. It is spread by respiratory droplets but usually requires regular and prolonged contact to pass from person to person. The is some evidence that the bacterium can enter the body through cuts and grazes. It is known to favor lower temperatures and this is why peripheral nerve damage is so common, the nerves close to the surface of the skin operate at lower temperatures than nerves buried deeper inside the body. The upper respiratory track, nasal mucosa, eyes and skin are also profoundly affected in those with a long-standing history of the disease. Skin lesions with slight pigmentation differences in relation to the patients normal skin tone are often a sign of Hansen’s and diagnosis also looks at the amount of M.leprae on the skin, which is massively raised in those suffering from the disease.
The CDC lists the following as symptoms of the disease:
The bacteria that cause Hansen’s disease grow very slowly. It may take 2-10 years before signs and symptoms appear.
Symptoms mainly affect the skin, nerves, and mucous membranes (the soft, moist areas just inside the body’s openings).
The disease can cause:
Skin lesions that may be faded/discolored
Growths on the skin
Thick, stiff or dry skin
Numbness on affected areas of the skin
Muscle weakness or paralysis (especially in the hands and feet)
Eye problems that may lead to blindness
Enlarged nerves (especially those around the elbow and knee)
A stuffy nose
Ulcers on the soles of feet
Since Hansen’s disease affects the nerves, loss of feeling or sensation can occur.
When loss of sensation occurs, injuries (such as burns or fractures) may go unnoticed. You should always try to avoid injuries. But, if you experience loss of sensation due to Hansen’s disease (or another cause), you may not feel pain that can warn you of harm to your body. So, take extra caution to ensure your body is not injured.
Many doctors in The West have never seen Hansen’s and may struggle with the diagnosis, though between 100-200 new cases a year are diagnosed in the United States. Most cases occur in theGulf Coast, Hawaii, Massachusetts, and New York or among people who have lived in areas of the world where the disease is more widespread (source)
The World Health Organisation recommends multi-drug therapy, it states:
Leprosy can be easily treated with a 6–12-month course of multidrug therapy. The treatment is highly effective, and has few side-effects and low relapse rates; there is no known drug resistance.
If the suspected cases in California do turn out to be leprosy it will be interesting to hear how such young children contracted a disease that usually requires regular and prolonged contact and why the disease has shown itself after a relatively short time.