Why is the incidence of leprosy on the rise worldwide?

do you remember the movie papillon, starring Steve McQueen and Dustin Hoffman, released in 1973? This is a true classic based on the autobiographical novel of the same name by the French writer and former prisoner Henri Charrière.

In the film, Henri Charrière (played by Steve McQueen) is sentenced to life in prison for a crime he did not commit and sent to a leper colony in French Guiana. In the film’s immortal scene, a leper offers his cigar to the protagonist, who agrees to smoke. The patient asks how he knew that his leprosy is not contagious, to which he replies: “I don’t know.”

Leprosy may seem like a 19th century disease, but it’s not. This far from extinct disease is considered a neglected tropical disease that is still present in more than 120 countries and causes more than 200,000 new cases each year.

The severity of the scenario is so worrisome that the WHO has developed a strategy called Towards Zero Leprosy, which proposes zero infections and diseases, zero disabilities, zero stigma and discrimination, and elimination of leprosy as a goal by 2030.

Prolonged contact is necessary for infection.

Leprosy, which was called St. Lazarus’ disease in medieval Europe and is still known in some places as Hansen’s disease, is an infection caused by bacteria. Mycobacterium leprosy D Mycobacterium lepromatosis. The last one was discovered in 2008. The infection affects the skin and peripheral nerves and can lead to severe functional limitations.

Leprosy can be spread from person to person when droplets from the nose and mouth of an infected person are inhaled or touched by an uninfected person. The exact mechanism of transmission is unknown, but evidence suggests the need for long-term contact with an infected person.

In some cases, transmission has been observed from armadillos, which act as a reservoir for the bacteria.

The disease can be classified into three types based on cellular response and clinical evaluation:

1. In the so-called tuberculoid leprosy a few skin lesions appear in the form of hypoesthetic spots with central hypopigmentation and raised sharp edges.

2. In the second category, called lepromatous leprosyperipheral neuropathy is more severe and there are many numb areas and even some compromised areas such as the kidneys, nose and testicles.

3. The third type combines the features of the two previous ones, and it is called borderline leprosy.

It increased by ten percent: why?

Unfortunately, in recent years there has been a significant increase in the incidence of leprosy. According to data from 143 countries compiled by the World Health Organization (WHO) and published by the Fonteille Foundation on the occasion of World Leprosy Day, the number of cases increased by 10% in just one year, from 128,405 cases in 2020 to 140,594 new cases reported. in the world in 2021

In Spain, 10 new cases of leprosy were registered in the National Leprosy Registry of the Carlos III Institute of Health in 2022 alone, compared to 4 new cases in 2021). Southeast Asia remains the worst affected area, with India the country with the highest number of reported cases.

World Leprosy Day was established in 1954 at the initiative of the French journalist Raoul Follereau and is celebrated on January 30 of each year or the next Sunday, in memory of the death of Mahatma Gandhi, who understood the importance of stopping this disease.

Covered by covid-19

This unusual surge may be due to the increase in the number of undiagnosed cases as a result of the quarantine imposed to combat the covid-19 pandemic. After all, the SARS-CoV-2 coronavirus pandemic has severely impacted global health, causing the suspension of many regular medical services and making it difficult to diagnose other infections such as leprosy.

The figures show that 385 new cases of leprosy continue to be detected every day in the world, 23 of them with visible disorders.

Before the advent of antibiotics and sulfonamides, there were no effective treatments. Infected patients often suffered from visible and obvious disfigurements, often accompanied by disability. This caused fear and rejection, stigmatizing patients who, in addition to what had already been done to them, were subjected to strong psychological influence.

Today, the World Health Organization offers leprosy patients free treatment with conventional drugs. It consists of taking rifampicin 600 mg and clofazimine 300 mg orally once a month for twelve months under medical supervision. To this is added dapsone 100 mg with clofazimine 50 mg orally once a day, without supervision. Dapsone has the advantage of being relatively inexpensive and generally safe.

Antibiotic treatment can stop the progression of leprosy, but it cannot reverse nerve damage or deformity. For this reason, early detection and treatment are vital.

Unfortunately, this is still a long way off. The four strategic directions for global leprosy elimination include implementing comprehensive and proprietary roadmaps to eliminate leprosy in all endemic countries, scaling up leprosy prevention along with integrated active case finding, managing leprosy and its complications, and leprosy stigmatization. fight disease while guaranteeing respect for human rights.

Let’s not forget that prejudice and discrimination against people with leprosy is a violation of human rights. As Mother Teresa of Calcutta, one of those who did the most for lepers, clearly put it, “The biggest disease today is not leprosy or tuberculosis, but the feeling of being unloved.”

Raul Rivas Gonzalez, professor of microbiology, University of Salamanca

This article was originally published on The Conversation. Read the original.