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As the world marks Leprosy Day today, medical experts
have advocated more focus on the disease. They
advised that government and health workers embark on
intense public health awareness to reduce ignorance
about the disease and knowledge of clinical
management of active cases, including management of
contacts. The teaching should also focus on educating
patients confirmed to have leprosy and encouraging
close contacts on the importance of seeing a doctor for
a thorough physical examination and regular follow up
visits.
Describing leprosy as a chronic infectious disease
caused by an acid-fast, rod shaped bacillus
mycobacterium leprae, the experts explained that it is
an age old disease that has been present since biblical
times, and patients have a reduced quality of life due to
the stigma attached to the disease, as well as the
physical symptoms.
Dr. Erere Otrofanowei, a Consultant Physician,
Dermatologist and Genitourinary Specialist with the
Lagos University Teaching Hospital (LUTH), urged
everyone to get well informed about the disease via
different media, where the information is in the public
domain. She said: “Information and the right
application of knowledge garnered is power. The
vaccination with the Bacille Calmette-Guerin (BCG),
given at birth as part of our National Programme on
Immunisation is partially protective against Leprosy.
“This year’s theme: Ending discrimination, stigma and
prejudice against people living with Leprosy, is a call
on people to stop discrimination against patients. New
cases of leprosy are still being recorded in our
hospitals today, and it is unfortunate that most patients
present at the late stages of the disease. This is
largely, due to ignorance and stigma attached to the
disease, which prevents patients from coming forward
and failure to detect the disease early. It is important
that the public know that both male and female can
contract leprosy and it can occur at any age though rare
in infants.
“Contrary to some myths, it is not a result of “home
trouble” or “juju.” The organism that causes the
disease divides slowly and it takes a long time for
anyone who has contracted the mycobacterium to
actually come down with the disease. This is referred to
as the incubation period and it ranges from a few
months to almost 40 years with an average of about 10
years.
“If possible, leprosy should be separated from
tuberculosis in the NTBLCP, as it is cast aside in favour
of its bigger competitor for resources. All hands must
be on deck to ensure that Nigeria achieves and
sustains the World Health Organisation (WHO) leprosy
elimination target. A healthy nation is a wealthy
one.”She explained that this would lead to increased
awareness of the disease, as well as early presentation
and effective management, with the added measure of
reduced stigmatisation.
“The Leprosy Elimination Programmes across the
country would do well to ensure harmonisation of all
stakeholders’ efforts in the industry at all levels of
healthcare delivery.
“Mycobacterium leprae primarily targets the skin and
peripheral nerves of the body. The earliest symptom of
Hansen’s disease is a well-demarcated, discoloured
skin patch or blemish with reduced or no sensation.
Thus, an individual with few innocuous pale or light
coloured skin patches one to five in number, who
cannot feel cold or hot sensation, or touch at those
specific spots needs to have it checked out further by a
doctor.”
A Neurologist and former President, Association of
Resident Doctors at the Lagos University Teaching
Hospital (LUTH), Dr. Olubunmi Omojowolo said: “The
absence of sweating at those specific light coloured
patches is a sign to investigate further. The above
suggests paucibacillary leprosy, where there are five or
fewer skin lesions with undetectable bacteria in skin
smears and this type or stage of the disease is where
treatment is most effective. Sadly, this is the disease
that is mostly missed or overlooked by both individuals
and even some healthcare professionals, allowing a
progression to the multibacillary leprosy, with more
than five skin lesions and bacteria easily detected in
skin smears, where the more recognisable features
occur.
“These signs and symptoms include multiple swellings
or lumps along the earlobes, nose, face, paraesthesia
tingling or numbness in the hands or feet, enlarged or
thickened painful peripheral nerves, at the elbow,
behind the ears, behind the knees, painless wounds or
burns. The later signs include loss of digits fingers and
toes, blindness, loss of eyebrows and eyelashes,
weakness of the hands and claw fingers and collapsed
bridge of the nose to name a few. These are seen in
advanced stages of the disease and are indeed the
result of a failed healthcare system.”
Omojowolo noted that leprosy certainly constitutes
public health hazard as enumerated above with respect
to the mode of transmission and the resulting clinical
features.He said: “Hansen’s disease is still considered
one of the neglected tropical diseases (NTD), as its
impact on the patient, care givers and country, is grave.
In some parts of the world, the stigma of the disease is
isolating the patient; promote mental health disease
and even suicidal ideation.
“In suspected case of Hansen’s disease, the next step
is to present oneself to a healthcare professional at
primary, secondary or tertiary centres. A detailed
clinical history and physical examination will be carried
out and some investigations ordered, including some
blood tests, skin slit and smears to detect the acid-fast
bacilli or a skin biopsy.
“Early detection and proper management can,
however, prevent lasting debilitating sequelae and
reduce the impact of disease on the patient and the
country. The disease is not limited to any particular
race, though is seen more in the tropics. Nigeria is one
of five countries where leprosy is still considered
endemic alongside India, Brazil, Indonesia and
Bangladesh. This status fluctuates from year to year,
probably because the health records are not well
updated. Despite achieving the elimination target of
less than one case detection per 10,000 population, as
stated by WHO in 2000, there are still pockets or
clusters of leprosy with high endemic rates in different
parts of the country.
“The disease is most likely transmitted via the
respiratory system, through nasal droppings from
untreated persons with disease. It may also enter the
blood stream through broken skin. Whether or not a
newly infected person goes on to develop the disease
depends on a number of factors, including the person’s
immune status, the type of leprosy contracted, whether
paucibacillary or multibacillary, the person’s age and
some genetic factors, among others.
“Generally, most people do not develop the disease
following exposure to the organism. Paucibacillary and
Multibacillary leprosy, are WHO’s classification of the
disease, which employs simple measures as the
presence of skin lesions and detection of bacilli in skin
smears to determine what arm of treatment a patient
should have. It is mostly used to stratify patients in
developing countries, where there may be dearth of
specialists.”
Dr. Chukwuma Ogunbor, a Consultant Family
Physician said treatment of leprosy is effective with a
combination of medicines for a specified period.He
said: “Drugs for Hansen’s disease may be two drugs of
rifampicin and dapsone at weight-based doses for
paucibacillary leprosy or three drugs with clofazimine
added to the above two. Some of the drugs are to be
taken daily, while some are taken monthly. After taking
only a few doses of the medication, patients become
non-infectious, hence there is no need to isolate them
from family and friends.
“There are a few sophisticated tests like polymerase
chain reaction and serology, which may be employed in
doubtful cases. Some hospitals may not be well
equipped to do a few of the above and the patient may
need referral to any of the teaching hospitals in the
country for further management by a specialist.
“The duration of treatment is determined by the disease
classification, but the drugs are usually taken for about
12 months or more. It is laudable that patients with
Hansen’s disease can get drugs for free at designated
National Leprosy Control Centres in all 36 states of the
country, as well as the Federal Capital Territory (FCT).
“This is a result of the National Tuberculosis and
Leprosy Control Programme (NTBLCP) of the Federal
Ministry of Health, which became operational in
1991.“It is important to complete medications for as
long as prescribed because poor drug adherence can
contribute to drug resistance, causing a need to move
patients from the above first line therapy to a second
line or alternative therapy. Sometimes, patients may
develop some immunologic Leprae reactions during
leprosy treatment that may require additional drugs,
such as corticosteroids.”
Source:
guardian.ng/features/health/public-health-
awareness-immunisation-curb-leprosy-experts/