Leprosy rages still

October 10, 2012 - 06:16

Leprosy is almost extinct in many countries but in others the disease lives on. In Ethiopia there are thousands of new cases every year.

Weaving without hands: The leprosy bacterium can destroy limbs. This woman lives in a home for lepers in Ethiopia, and is able to weave even though the disease has “eaten up” her hands. (Photo: Signe Ringertz)

A young mother sits on a bead, with a healthy child on her lap. An idyllic picture, you may think, but wait. What if you find out that the mother is a leper, is highly infectious and has therefore been abandoned by her husband.

Unfortunately, this is no fictional situation, but real. The year is 2012, and leprosy rampages still.

“The so-called old diseases are of interest to me, because they always come back,” says Ørjan Olsvik, a professor of microbiology at the University of Tromsø’s Faculty of Health Sciences.

Newly infected

Olsvik recently visited Ethiopia to study leprosy, and encountered many cases.

“I met many. Several had completely new infections,” says Olsvik, whose responsibilities include teaching medical students at the University of Tromsø about these “old” diseases.

“It is important that tomorrow’s doctors are familiar with leprosy, because diseases that we think have died out are coming back. Just look at cholera, syphilis, and polio. We think we are rid of them, but these diseases can sneak up on us if we are not actively fighting them,” he says.

A feared disease
Leprosy still rages among the poorest. Ørjan Olsvik visited a leper centre in Ethiopia. Photo: (Signe Ringertz)

You may know leprosy best from Bible stories, but you may also have heard about it from the best seller, “The Island,” by Victoria Hislop, who wrote a moving story about the lepers of Crete who were forcibly sent to the island of Spinalonga.

Leprosy has always been feared. Even today, the word “leper” is used as an insult, but many people in the western world don't realize that this grotesque disease still affects people.

“There are 3000-5000 new cases in Ethiopia alone, and the worst part is that the disease is easily treated. I have also seen a case here in Norway,” says Olsvik.

According to the Norwegian Institute of Public Health, 19 cases of leprosy were reported in Norway from 1977-2009. There are 150 new cases reported in the United States each year.

In 2008, the World Health Organization reported about 249 000 new cases of leprosy. Ten percent of cases are in children. Leprosy is a significant public health problem in many countries in Southeast Asia, tropical Africa and parts of South America.

Approximately 70 percent of leprosy cases in the world are reported from India.

Destroys nerve cells
The leprosy bacterium destroys nerve cells, which means that patients may develop large ugly wounds without feeling pain. This man has developed this kind of secondary wound under his foot. (Photo: Signe Ringertz)

While people in the West live without fear of leprosy, the disease still rages among the world’s poorest.

“It’s difficult to look at these pictures. Even if you are not affected by the disease, you get a sense of the terrible suffering it causes,” says  Olsvik, as he shares images of new leprosy cases in Ethiopia.

Some of the patients he met on his trip there had been so severely attacked by leprosy that they had lost both arms and legs. One characteristic of the leprosy bacterium is that it destroys the skin, bones and flesh.

It sounds terribly painful, but many of patients actually do not feel pain. The leprosy bacterium first attacks the peripheral nervous system. The infection paralyzes the nerves in the skin so the patient develops numbness. The typical leprosy patient can burn his or her hands while cooking, and a stone in the shoe can quickly cause ugly wounds, called secondary sores. These wounds often get infected, and eventually the bacterium completely destroys tissues, especially fingers and toes.

Gnawed on by rats

When the leprosy bacterium ravaged Norway in the 1800s, a separate leper hospital was established in Bergen to treat patients.

According to the Bergen City Museum, St. Jørgen’s Hospital for lepers was plagued with rats. Rats are not themselves hosts for leprosy, but both mice and rats still managed to inflict a great deal of damage on leprosy patients.

Ørjan Olsvik, a professor of microbiology at the University of Tromsø, went to Ethiopia to study leprosy. Here Olsvik is standing next to a statue of the “father” of the leprosy bacterium, Gerhard Armauer Hansen, a Bergen doctor who discovered the bacterium in the 1800s. (Photo: Tore Lier)

Rats and mice were able to gnaw undisturbed on sleeping patients, because the patients had open wounds they no longer felt.

Shunned and stigmatized

In Ethiopia, Olsvik observed the severe and serious secondary wounds that are often found in leprosy patients.

“I saw a lot of damage, especially on the feet, since many go barefoot,” he said.

Leprosy can cause circulatory failure and can also attack internal organs. If the disease is not treated with antibiotics, it can be fatal. Medical treatment stops the disease and removes the infection, but it does not repair the damage. Patients will be marked for life.

“We thus have the problem of stigmatization. Patients who have been successfully treated and are free of the disease will never be rid of stigma of leprosy, and are forever feared and shunned by the community,” Olsvik says.

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Did you know that the leprosy bacterium was discovered by a Norwegian?

Leprosy, sometimes called Hansen’s disease, has disfigured and crippled millions of people for more than 3000 years. It was Gerhard Armauer Hansen (1841 - 1912) from Bergen who first discovered the leprosy bacillus and proved that it actually caused leprosy, and that the disease is contagious, not hereditary. This discovery was ground-breaking and has been crucial to the fight against leprosy.

Thus, Hansen was and is a shining star, especially in the international medical world. In Norway, on the other hand, he is hardly known. The reason is that he was convicted of an ethical offense after having called one of the female leprosy patients into his office, and stabbed her in the eye without warning with a needle that had just been stuck into another leper patient’s lesions.

Armauer Hansen discovered microscopic rod-shaped bodies in the skin lesions of lepers. He became convinced that this rod-shaped organism was the cause of the disease. He tried to cultivate the bacterium in the laboratory so he could transfer it to animals, but was unable to cause the animals to develop leprosy. Other researchers had previously tried to cause leprosy in themselves without developing signs of disease.

There was an uproar in the Leprosy Hospital because of the incident in the office. Several witnesses were present when Armauer Hansen put the needle in the eye of the woman, and they were also prosecuted in court. The court found Armauer Hansen guilty of a violation of criminal law, and he was removed from his position at the Leprosy Hospital in Bergen in 1880.

Source: Fagbladet forskningsetikk (Research Ethics Journal)

University of Tromsø – The Arctic University of Norway is the northernmost university of the world. Read more

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