by Godfrey George,
In this interview with GODFREY GEORGE, a senior registrar in the Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Dr Chinyere Atansi, speaks about the prevention and management of leprosy
What is leprosy?
Hansen’s disease or leprosy is an infectious disease caused by a slow-growing bacterium called Mycobacterium leprae. Leprosy has a love for the skin and the nerve. But it can affect the eyes and the lining of the nose (nasal mucosa) as well.
What are some of the things that predispose a person to leprosy?
The major risk factor is poverty and overcrowding. Other risk factors include age. Leprosy exists majorly in the extremes of age (i.e. the very young and very old or elderly – from age 65). There is also some genetic explanation to it, in the sense that if one person in the family has had leprosy before, their offspring are more likely to contract the disease. The level of immunity of the host is also an important factor. Any form of disease or conditions, such as HIV/AIDS, malnutrition, diabetes, certain medications or therapy, that can reduce a person’s immunity can increase the risk of risk of contracting leprosy where there is an existing patient.
How can one differentiate between leprosy and other skin-related diseases?
There are so many diseases that affect the hands and the feet but the mode of contracting them are different. Leprosy is infectious. If you are in contact with someone who has leprosy and all these other factors come to play, you might come down with leprosy. Leprosy tends to eat up the nerve around the affected area. If it is in the face, it would begin to eat up the area and the person may not have eyebrows anymore; the ears and nose may become flattened and so on. As I said earlier, it is not just about the hands and the feet; leprosy affects all parts of the body.
Where exactly can leprosy be contracted?
Medically, for now, it is only by man to man transmission. But there is also a rat called armadillos that may be a vector. Cockroaches and rats cannot transmit leprosy. That is a myth. It is mainly a human thing, and because we are becoming more industrialised, we may not come in contact with these kinds of animals that can transmit it. Although there are some reports suggesting other primates outside humans can also transmit the disease, that is still very rare. When humans come in contact with the nasal secretion – any form of droplet from the nose – either through sneezing or coughing, the person can contract it. It can also be passed down from the skin if the person has ulcers or lesions in the skin and one comes in contact with those lesions. However, if the skin is intact, it may be difficult to contract it. But once there is a bruise, you are more likely to get this disease.
What are some of the clinical signs to look out for?
Depending on the type of leprosy, one of the signs may be some whitish patches. Sometimes, these patches may be mistaken for a fungal infection if one doesn’t look at it closely. But the number or extent of the patches can be an indicator or a distinguishing factor. When the patches are more than six, that may be something to worry about. One has to go get tested once they see this. Some people may not have those white patches at all; there may be red patches and itches. Some of them might notice that they cannot feel sensations in their hands and feet. Once this happens, one must go to the hospital and check. It may not be leprosy; it may be something else but it is it is better to present in the hospital for proper diagnosis because early diagnosis and treatment are important. Some persons may notice that all of a sudden their nose, which used to be very straight and pointed, has become flat and looking very rough; the earlobe may begin to be eaten up. Such people should present themselves in the hospital.
What are the different types of leprosy and how do they present in their hosts?
There are different classifications. The World Health Organisation has made it very simple. There is tuberculoid leprosy and there is lepromatous leprosy. For tuberculoid leprosy, it is milder and seen more in people who have some form of immunity whereas the latter is seen in the persons who do not have as much immunity. The loss of sensation in affected areas of the body is faster in the latter. The disabilities as well as the patches are also more pronounced in the latter than in the lepromatous type where the patches may be less than five. If you test the lepromatous, you would find the causal organism inside but it is not so for the tuberculoid type where nothing may be seen.
In between these two types, however, there are some types that are known as the borderlines tuberculoid and the borderline lepromatous. They do not have all the features of the names they take up. For the bother lines, some already have deformities of the hands and feet, but it is not so for the tuberculoid. Without treatment, the person may have ulcers and may require amputation. Their skin may be very thick and rough and they may not be able to go due to discrimination or stigmatisation. In all my years of practice, I have found out that it is not as common because of the proliferation of drugs for treatment and the likes.
What should be one’s response when one is diagnosed with leprosy?
Leprosy is not life-threatening. The only problem with leprosy is the disability that comes with it. Once we find a person with leprosy, experts in community health and the state epidemiologists get involved. They may begin contact tracing to see the level of contact the patient has had. The patient would have to be isolated and then treated. This treatment depends on the type. If it is tuberculoid, the treatment is just for six months whereas, for the lepromatous, the treatment is for 12 months. That does not mean the person has to be isolated for that long. By the time the person starts treatment and the investigations are done and the bacterium is no longer there, the person can go back to the community. They would have to work with other specialists like physiotherapist, dermatologist and infectious disease experts to help curtail the spread.
How bad can it get if one does not present to the hospital on time?
If one fails to present at a health facility, it can get really bad, because it might be the strain that progresses very fast. Treatment is already available. There are centres where these things are handled, so I don’t see the reason why one would not want to get treated.
There is a belief that people who have leprosy can never be completely whole. How true is this?
That is not true. It is just a myth. If the person presents for treatment, the person can come out clear in no time. Even when the person has some resistance, the person can come out clean. The only problem is the disability that the person already has, and because of the stigma, being able to mix with the society with all the complications that have come, maybe a problem. It doesn’t mean that the patient cannot be whole. Before now when it was just one drug, it was difficult to clear the bacterium, but not now when there are many drugs used to treat the infection.
Would you say that Nigeria has beaten this disease?
Well, there are still cases in Nigeria as of 2020. There were about 4,000 cases per annum even though that number may be seen as negligible or less worrisome. Some of these factors that predispose one to this disease are no longer as prevalent as before. There is also the availability of drugs to manage the condition. So, I wouldn’t say it has been as problematic as it was in the past. I think everyone is trying to join the fight to make sure it is eradicated from the country and worldwide. So, yes, I would say Nigeria has done well.
What would be your reaction to self-medication which is prevalent amongst Nigerians?
I don’t know how else we as health professionals would handle this issue rather than continuing to enlighten the public. Self-medication is a huge problem in the country; it is really bad. The drugs used in treating leprosy are not got over the counter and even if they are found there, they are expensive. However, if you present at a medical facility, treatment for leprosy is free. So, if you see these patches on someone’s body, it may not be a fungal infection that needs anti-fungal creams. It is better you see a doctor and complain, especially if the rashes are coming with numbness or tingling sensation on one’s hands. You may even be feeling feverish; it is better you see a health practitioner and get proper health care. If it is just a fungal infection, the healthcare professional knows what to do. I am completely against self-medication for any reason.
Is it true that men are more likely to contract leprosy than women? Is there an explanation for this?
Well, men being more likely to get leprosy may be assumed because men are more out there in the streets trying to fend for their families, and maybe in overcrowded spaces than women. There are more men in prisons and slums. They may have other things in their bodies that may threaten their immunity.
What do you think society’s response should be to people who have fought and won the battle against leprosy?
That someone has had leprosy before and has been treated shows that the person needs as much love as the person can get because it is already difficult for the person as they have already been disfigured. The way the person was is not how the person is again, and this is really hard for the person. Give as much love as you can give to them because that is all they need at this time. This will encourage more people to go and get tested and start treatment soon enough. If the person gets treated, the likelihood of passing it down to the next person is much more reduced.
Can leprosy be sexually transmitted?
If it is skin-to-skin, anything can happen. Like scabies, it may be sexually transmitted.
PUNCH
