In many ways the past few years have seemed biblical. First came a pandemic. Then war, followed by food shortages, fires and floods. Just when it seemed that things could not look more like the end of days, leprosy has joined the list.
Hansen’s disease, better known as leprosy, is a tropical malady that is rare in America. In 2020 (the last year with available data) just 159 cases were reported. Only 5% of people seem to be susceptible to infection. Because it is so rare, Americans seldom think about leprosy, and many clinicians have never seen it outside a textbook. This is starting to change.
Charles Dunn, a dermatologist, and his colleague, Rajiv Nathoo, came across their first leprosy patient last year in a clinic in Orlando, Florida. “It was very classic in terms of what you read in the books,” says Dr Dunn. Yet the 54-year-old patient had been seen by multiple clinicians, and none had properly diagnosed him.
“I am hoping that people take their blinders off,” says Dr Dunn, referring to other clinicians, especially those in central Florida. Nearly 17% of American leprosy cases were in Florida in 2020, and over 80% of those were in central Florida. This year the state has reported 16 cases. Dr Dunn says medics should look out for the disease, so they can diagnose and treat it.
In the past, Americans with leprosy had usually caught it while travelling to countries where it is more common, such as Brazil, India or Indonesia, or had been in close contact with people who had travelled to such places. Armadillo wrestlers (who chase, capture and wrangle with the creatures) are also at risk—the nine-banded armadillo can carry the disease. This latest outbreak is unusual in that the new patients are neither intrepid travellers nor armadillo wrestlers. This suggests that the disease is now endemic in the south-east.
Though few people know what leprosy is, ears prick up at its mention. “There is essentially no population in history…that didn’t have a stigma associated with leprosy,” says Barry Bloom, an immunologist and former dean of Harvard University’s School of Public Health. People have been burned or buried alive for having it, says Dr Bloom. Many were cast out of society, or forced to sound bells or clappers to warn others of their approach. That led to “a mortal fear of the disease”. Many people still shun medical help for fear of the stigma. In some countries leprosy is recognised as grounds for divorce.
It is the symptoms that give the disease its awful reputation, says Dr Bloom. Those with a visible infection develop lesions, usually on their face and extremities, that lack feeling. This is because the bacterium—mycobacterium leprae—affects the skin and the nervous system. In severe cases sufferers may lose fingers, toes and other body parts. When you cannot feel pain in your extremities, it is harder to avoid accidents that may cut them off.
In the Bible leprosy afflicts the sinful; at least until Jesus “cleanses” them. Scientists today are less sure how it spreads. This is partly because the disease can remain dormant for up to 20 years, so contact-tracing is difficult. (Who remembers what they were doing 20 years ago?) Scientists think that people catch the disease through prolonged contact with a contagious person, perhaps when that person coughs or sneezes.
Today there is a cure—a round of several antibiotics does the trick. After a few weeks infected people are no longer contagious. The lesions go away; though they may leave scars. The treatment is free thanks to the World Health Organisation. In the old days, leprosy was seen as a marker of sin. Today it is simply a sign that people should see a doctor. ■
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