Prof. Dr. Shyam P Lohani

The World Health Organisation (WHO) estimated that more than 200,000 people worldwide were infected with leprosy in 2018. Most of them live in Africa and Asia. Leprosy is found in more than 100 countries today. The disease affects the poorest sections of the communities denying them of mutual benefits traditionally being exchanged. Globally, more than 3 million people are living with irreversible disabilities, including blindness, due to late treatment of leprosy.
Leprosy is a chronic, progressive bacterial infection caused by Mycobacterium Leprae. It primarily affects the peripheral nerves, the skin, the lining of the nose and upper respiratory tract. Leprosy causes nerve damage, skin ulcers, and muscle weakness if it is not treated. It produces severe disfigurement and disability. The disease has been around since ancient times, often surrounded by terrifying and negative stigmas and tales. The oldest civilisations of Egypt, China and India feared leprosy as an incurable, mutilating and contagious disease. For thousands of years of civilisation, leprosy was thought to be a curse of the gods, a punishment for the sins and a hereditary condition.

Nepal’s scenario
In Nepal, every day around 10 people are diagnosed with leprosy making the country 7th position worldwide in terms of new case detection. The detection rate has been on the rise since Nepal declared leprosy eradicated in 2009 (case detection less than 1 per 10,000 is considered eradicated). Leprosy is spread between people but needs extensive contact. About 95 per cent people who contract M. Laprae do not develop the disease. The spread is thought to occur with a cough or fluid from the nose of a person with the disease. The genetic factor and immunity may play a role in how easily a person catches the disease. It usually takes between three to five years for symptoms to appear after coming in repeated contact with an infected person, however, it may take as long as 20 years for some people to develop symptoms. The disease isn’t highly contagious. However, close, repeated contact with an untreated person for an extended period of time can lead to contracting leprosy. The bacterium responsible for leprosy multiplies very slowly. The long incubation period often places the physician in difficulty to find out when a person with leprosy got infected.
The delayed diagnosis and treatment can lead to serious complications that may include disfigurement, hair loss particularly on the eyebrows and eyelashes, muscle weakness, permanent nerve damage in the arms and legs, inability to use hands and feet, chronic nasal congestion, nosebleeds, and collapse of the nasal septum, iritis, which is an inflammation of the iris of the eye, glaucoma, an eye disease that causes damage to the optic nerve, blindness, erectile dysfunction (ED), infertility and kidney failure. Nerve damage can lead to a dangerous loss of feeling. A person with leprosy-related nerve damage may not feel pain when the hands, legs, or feet are cut, burned, or otherwise injured.
The type of leprosy is based on the number of skin sores. They are tuberculoid which is a mild, less severe form of leprosy. People with this type have only one or a few patches of flat, pale-coloured skin (paucibacillary leprosy). The affected area of skin may feel numb because of nerve damage underneath. Tuberculoid leprosy is less contagious than other forms. Lepromatous is a more severe form of the disease. It has widespread skin bumps and rashes (multibacillary leprosy), numbness, and muscle weakness. The nose, kidneys, and male reproductive organs may also be affected. It is more contagious than tuberculoid leprosy. And borderline in which people with this type of leprosy have symptoms of both the tuberculoid and lepromatous forms.
Leprosy can be cured. The duration of treatment depends on the type of leprosy and it ranges from six months to one year of multidrug therapy with antibiotics. About 16 million people with leprosy have been cured over the last two decades. The WHO provides free treatment for all people with leprosy. There are three specialised leprosy hospitals in Nepal, one at Ananadaban in Lele, another at Green Pastures in Pokhara, and third at Lalgadh in Dhanusha.

Stigma
The traditional attitude towards the disease is still problematic making people with leprosy deny the disease in the early stage that may lead to irreversible nerve impairments. The fear associated with the disease may cause a delay in seeking treatment, thus contributing adversely to physical, social as well as individual consequences. The traditional belief of incurability of the disease may exacerbate the stigma associated with it. The caste and gender-based prejudices contribute immensely to the treatment-seeking behavior of people in low and middle-income countries in Asia and Africa.
The targets of global leprosy strategies (2016-2020) which include zero disabilities among new pediatric patients, a grade-2 disability rate of less than 1 case per 1 million people and zero countries with legislation allowing discrimination on basis of leprosy are possible with active case finding, increasing awareness among most endemic areas of the countries and integrating leprosy patients in the communities so that they can contribute to the economy. For eradicating leprosy, it is important to break the chain of transmission of the disease and it is hoped that the pilot prophylaxis programme among people who are long term contacts of newly diagnosed with the leprosy of the Government of Nepal in few selected districts is successful and can be extended throughout the country.

(Prof. Lohani is the Founder and Academic Director of Nobel College. He can be reached at lohanis@gmail.com)