Peripheral Neuropathies: Modern-Day Leprosy

Once a social stigma that caused patients to be ostracized and banished to their own communities, leprosy is now a treatable condition with a good chance of recovery.

Leprosy is a neuropathic disease that is caused by the bacteria Mycobacterium Leprae. The skin is usually riddled with lesions and bumps, and swelling can occur in the extremities. It also affects the neuropathic nervous system, causing tingling and numbness in various areas of the body, and sometimes, paralysis. Leprosy has existed for thousands of years, but no cure has been discovered yet. There are many effective treatments available, however, to reduce the swelling and to treat the bacteria itself. It is not highly contagious and is quite rare, especially in the United States. Domestic cases are currently at around 6,000 patients, with 95% of them contracting the illness in developing countries. It is most common in countries where medical care is not as amply provided, particularly certain regions of Africa and Southern Asia.

Depicted above is a remnant of the Terrace of the Leper King, located in Angkor Thom, Cambodia. It was built possibly in homage to Angkorian king Yasovarman I, also known as Dharmaraja. He was rumored to have been afflicted with leprosy, though he lived a long life and achieved many things in his time.

The incubation period of leprosy is not yet fully understood, but it is believed to take from 6-40 months before any symptoms show at all, sometimes as long as 10 years. There is also risk for contracting the disease through insect bites and contaminated soil. Of course, being within close contact of a leper increases the risk of contraction, as well. While airborne contraction risks are low, the most common form of contraction is fluid and mucous exchange. There are also studies that suggest it is possible to be genetically susceptible to catch the disease more easily. A connection has even been observed between leprosy and armadillos. Many people suffering from the disease had been in close contact with the animals shortly before suspected contraction, but this is not sufficient enough evidence to conclude that armadillo exposure causes the disease.

If left untreated, leprosy can cause permanent deformity, nerve damage, and in rare cases, even death. Patients usually notice a drop in temperature first, being insensitive to hot and cold in the affected extremities. They will slowly lose the feeling of touch, progressing to deep pain and pressure. It is common that even the eyes will be affected, and many sufferers of leprosy start to lose proper function of sight. Each of these symptoms is caused by an increased damage to the various nerves throughout the body. The longer the disease remains untreated, the greater the risk that more areas in the body will become affected.

Multi-drug therapy treatments can help to eradicate the illness, stop the infection, and ward off complications that lead to disability and relapse. Using the medications available for treatment, most patients should begin to see some immediate relief and can be considered non-infectious in as little as 1-2 weeks. The most effective drugs available today are antimicrobials, corticosteroids, and immunomodulators. In rare instances, surgical care is necessary to treat abscesses which cause inflammation around the nerves, bone repair, and deformity altering reconstruction. For patients who suffer from non-mobility, physical therapy will likely be a treatment. Follow-up appointments to physical therapy and surgery will be required: to check for relapse, strength of the limbs, sores and medication management.

While the vaccine is still in development, scientists are working on a fully-functional leprosy vaccine and incorporating it into an effective vaccine schedule. Anyone in close contact with someone who has the disease should be monitored for up to 5 years to insure that contraction can be ruled out.

For more information about the disease and specialty treatment clinics, visit National Hansen’s Disease Program.