Leprosy etiology and pathology: eradication challenges

¶ … leprosy has all but been eradicated in the developed world, a recent report from the World Health Organization (WHO) (2007) demonstrates that leprosy still represents a considerable threat to the health and well being of developing nations. In terms of the total number of global cases, the WHO reports that as of the beginning of 2007, there were 224,717 cases of leprosy reported in the international community. New cases reported in 2006 totaled 259,017 which represented a decline of more than 13% when compared with 2005. The WTO argues that even though the data indicates that stability in the total number of leprosy cases may have been achieved, the goal is eradication of the condition by 2010. Early identification of the disease and aggressive drug therapy are viewed as the most salient means for combating this condition.

With the realization that leprosy represents such a significant world health problem and further that the WHO seeks to eradicate the disease before 2010, there is a direct impetus to consider the disease and its overall impact on the patient. Using this as a basis for investigation, this research considers a review of the etiology and pathology of leprosy. Through a careful review of what has been noted about this condition, it will be possible to elucidate the challenges posed for eradicating this disease and improving the outcomes of world health. Further, a review of this condition will provide a more integral understanding of the burden the leprosy poses for the patient.

Literature Review

Leprosy: Definition and Scope

In order to begin this investigation, it is first helpful to consider what has been noted about the definition and scope of this disease. Koch, Kostler, Zieger, et al., (2006) provide a review of the disease noting that leprosy is an infectious disease that is caused by the bacteria Mycobacterium leprae. According to these authors, the bacteria infiltrates on two levels including cutaneous and neurological. Infiltration on the cutaneous level creates open sores and nodes on the skin that can be significantly disfiguring. Over the course of time, neurological infiltration occurs which results in permanent nerve damage. "Bacterial infiltration of peripheral nerve Schwann cells leads to nerve damage, disfigurement and physical incapacity" (p. 1321). Koch and coworkers further report that presently, 70% of all leprosy cases are found in India, Brazil and Africa.

Diagnosis

Diagnosis of leprosy can be a significant challenge for medical professionals. What is perhaps most challenging about leprosy is that contraction of the bacteria will not always result in the development of the disease. As reported by Jacobson and Krahenbuhl (1999) when the Mycobacterium leprae bacterium is transmitted, the body is often able to mount a natural immune response that will prevent systemic infection. In many instances, this response is successful, resulting in no long-term health implications for the affected individual. However, in some instances, the body's natural defenses will fail. However, when this occurs it may take several years for the bacteria to build up enough potency to manifest. Further, the initial manifestation of leprosy may be a single lesion that heals. Thus, for medical professionals, diagnosis of leprosy in the early stages can be a notable challenge. Further, once a diagnosis has been made, it can be difficult, if not impossible, to trace the origins of the bacteria. This is due to the fact that leprosy can take several years to manifest. As such, developing effective preventive public health interventions to stop the spread of the diseases remains a notable challenge (Jacobson & Krahenbuhl, 1999).

Treatment review of the literature with regard to the treatment of leprosy indicates that with aggressive treatment, leprosy can be cured. Further, research indicates that with early intervention, the disease can be cured before disability occurs. Unfortunately, once significant nerve damage has occurred as a result of the disease, this damage cannot be repaired. Among the most effective treatments for leprosy is MDT or multidrug therapy. Research on the development of MDT indicates that the three drugs used for MDT treatment have been developed over the course of the twentieth century. Dapsone was first developed in 1940 however, resistance to the drug prompted further research which produced Rifampicin and clofazimine in the 1960s. In 1981, the WHO discovered that treatment with a combination of these three drugs provided the most effective means to eliminate the disease (WHO, 2005, Leprosy). A critical review of the research clearly suggests that MDT is the gold standard for the treatment of leprosy providing a complete cure for the patient within 6 to 12 months.

Conclusion

Synthesizing all of the data provided in this investigation, it becomes evident that while leprosy represents a treatable and curable health condition, eradicating the disease remains a notable challenge for public health officials. Because the incubation time for the bacteria can be several years, preventing the further spread of leprosy is a notable challenge. Further, because most cases of leprosy occur in developing nations, access to multidrug therapy may be markedly limited. Individuals affected with this condition may not have access to healthcare services that would allow for early detection and treatment of the condition. Thus, while the WTO continues to work toward eradication of the disease by 2010, the organization will face considerable challenges in achieving this goal.