Leprosy

Staff bus at Karigiri.

Patient cured from leprosy, lives and works at Karigiri producing ceramics. He is deaf and mute with minimal vision. I bought two of his "magic pots".

The feet are numb due to nerve damage from leprosy. The feet are disfigured because they were numb and underwent repeated damage.

Dr. Brand was a pioneer in leprosy research and used his own ingenuity to help unravel this disease that destroyed lives and harbored a stigma like no other. He is now one of my personal heroes. His wife, Margaret, worked as an opthalmologist and also conducted work that led to the discovery of how leprosy causes blindness.

Leprosy is diagnosed by a skin scraping, they are the little red dots. I am very proud of this picture because it is hard to take pictures through the lens of a microscope. My mother in law will be so proud!

I am finally prepared to share my experiences at Karigiri, a nearby Leprosy hospital. As part of my class participation in discussing a tropical disease, I will also discuss some history and medical points with my own narration from this trip. I apologize if it is a little disorganized.

Leprosy (or Hansen's Diseas) has been around for a while, noted many times in the Bible - those afflicted with this disease have a horrid history of being shunned by society. In medieval times lepers (now called people cured from leprosy) were brought to church for the last time, made to "die" to their human life, and sent outside with ten foot pole attached to a bucket which they could use to beg for food or money. Thus, "I wouldn't touch that with a ten foot pole".

The disease itself is quite interesting. It starts with an infection with mycobacterium leprae. Only about one in 200 people are even susceptible to this infection, and of those infected even fewer become symptomatic. It can be spread by droplet, but again you have to be in the group susceptible to be infected. I haven't found a great explanation as to its origins and predilection for tropical areas, but some sources think it is in the soil and armadillos (don't eat roadkill). This mycobacterium replicates in the nerve cells in the body, preferring the colder areas of the body such as the nose, earlobes, and nerves closer to the skin surface. This replication causes inflammation, edema and ischemia killing the nerve slowly over time. Eventually, the patient loses sensation in the areas serviced by the dying nerves. Symptoms include hypopigmented lesions (tuberculoid leprosy) or rhinorrhea with nodules (lepromatous leprosy). An inbetween varient called borderline leprosy also exists.

This loss of sensation proves to be horrendously problematic. When you and I step on a sharp object, we recoil in pain and nurse our wounds until they heal, treating them with tender care. If a person who is without sensation steps off a curb the wrong way, he may break his ankle yet continue walking because the brain never receives the red flags of pain. Eventually this process will lead to open and infected wounds, leading to chronic inflammation and bone resorption. In this way the disease becomes disfiguring. Before the etiology of the disease was appreciated, thanks much to Dr. Paul Brand, it was commonly assumed that these sores and disfigurements were the disease itself attacking the skin. But, as proven by Dr. Paul Brand, paying careful attention to the skin can actually halt the destruction and there are surgeries available to reverse some of the debilitating changes. It appears as if fingers and toes are falling off the patient, but the bone is just being resorbed by the body due to the chronic, local inflammatory response. In the Vellore hospital, Dr. Brand discovered that in some cases the appendages were gnawed off by mice or other rodents - the patient slept soundly because they could not feel a thing but would wake to find their fingers had "fallen off".

An effective treatment for leprosy, the sulfone drugs, has been around for decades. But, as you might guess, once the nerve damage is done clearing the infection will not reverse the consequences. There are people "cured" from leprosy, but still dealing with the insensate portions of their body that are blinded to the very important signals of pain. There are still about 100 new cases of leprosy per year in the USA and many more around the world. With prompt treatment, the patients tend to do very well, but this is not widely available in the developing world.

So why would American medicine still care about leprosy? Isn't it treatable and a historical novelty? Well, many of the research done in leprosy also applies to diabetics and all of us know the prevalence of that disease is dramatically rising. Though diabetics lose their sensation through high sugars and ischemic nerve damage, the end result is the same. They cannot feel their feet. One relative of mine feel asleep with his feet near a space heater and his wife woke him when she realized they had sustained significant burns. He just could not feel it, just like a leprosy patient.

About 4,000 patients in the United States are infected, estimates as high as one million worldwide. According to a physician I met at Karigiri, research has dramatically dropped off since the AIDS epidemic as philanthropists shifted their gifts for research to the effort against HIV.

I will share more soon, but time is up for me. Thanks for reading.