Leprosy Has All but Been

¶ … 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.

Symptoms

Britton and Lockwood (2004) go on to note the clinical features of the disease reporting that various systems can be involved once the bacterium infiltrates the skin. As reported by these authors, "Leprosy affects skin, nerves, and eyes, and causes systemic features in lepromatous disease. Patients commonly present with skin lesions, weakness or numbness caused by a peripheral-nerve lesion, or a burn or ulcer in an anaesthetic hand or foot" (p. 1213). In an effort to further elucidate the symptoms created by the disease Britton and Lockwood go on to provide a review of the specific area and the particular symptoms that will result. These authors make the following observations:

Skin: Lesions caused by the bacteria will result in macules or plagues. In some instances, papules or nodules will be present. Although the skin lesions are one of the hallmarks of the disease, Britton and Lockwood do note that lesions can be transparent and difficult to see in some cases. Close examination in full light is needed to see lesions in some cases.

Nerve Damage: Britton and Lockwood report that nerve damage can occur in two domains: "peripheral nerve trunks and small dermal nerves" (p. 1213). Dermal nerve damage causes damage at the surface of the skin, making it difficult for the individual to sense pain. Peripheral nerve damage can cause deficits in motor coordination, although this damage is often painless for the patient.

Eye Involvement: Blindness occurs in 2.8% of all patients affected by leprosy. "Eye damage results from both nerve damage and direct bacillary invasion" (p. 1213).

Systemic Involvement: Other systems that are impacted by leprosy include: nasal passages, bones, testes and kidneys. Leprosy results increases of testosterone in the body. This can lead to both testicular atrophy and kidney dysfunction.

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).