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Leprosy, a disease that has been present for 4 thousand years
Hansen's disease better known as leprosy is an infectious disease caused by a bacilliferous bacterium called Mycobacterium leprae.
Hansen's disease better known as leprosy is an infectious disease caused by a bacilliferous bacterium called Mycobacterium leprae. It is a disease that mainly affects the peripheral nervous system, the skin, the respiratory tract and the ocular system. Today it is a disease that has a cure as long as it is detected in the early stages in order to avoid death and disability, although in ancient times it was one of the causes of mortality.
On a historical level, leprosy has been a very old disease in which the sick were held in leprosarium and were often repudiated by society for fear of contagion. A turning point in the management of this pathology was in the 1940s when a drug called "dapsone" was developed.
It was a chronic treatment or for many years making it difficult to adhere to the treatment. The problem appeared around 1960 when the Mycobacterium Leprae developed a resistance drug, so new drugs had to be redeveloped. It was then that rifampicin and clofazimine were discovered that allowed this disease to be effectively treated again.
The World Health Organization in 1981 recommended multimedicamentous treatment with dapsone, clofazimine and rifampin with a duration between 6 and 12 months depending on the type of bacillus. This treatment allows the patient to be cured and the Mycobacterym Leprae exterminated.
Although since 2000 leprosy is not considered a public health problem, currently the World Health Organization offers free treatment to all patients with leprosy.
Transmission, clinical, diagnosis and treatment
The bacillus Mycobacterium Leprae reproduces very slowly, hence the incubation period can reach up to five years, causing the symptomatology to take up to a year and even twenty in the slowest cases. This can make it difficult where and when the disease could be contracted.
A high percentage of people who come into contact with the bacillus do not develop the disease because the immune system is able to cope with the infection.
The way of transmission of Hansen's disease is through the droplets of Flügge (the droplets that spread by coughing or talking) when a person is infected or by contact with body fluids of an infected person.
The clinical picture involves skin lesions that show a change in skin color, decreased sensitivity and / or pain to the touch or heat in the affected areas. These injuries can take up to months to heal.
At the musculoskeletal level, the patient usually presents with muscle weakness or decreased sensation in the extremities.
For the diagnosis of the disease, a sample of the skin lesion is usually taken either by the biopsy technique or by scraping. There is a test called lepromin that is indicated to differentiate the type of leprosy (if it is a tuberculoid or lepromatous type).
The typology of the disease will give us different symptoms and course of the disease. So in the tuberculoid it is characterized because there are large skin lesions and at a cellular level they have a large lymphocyte load but little bacterial load. In the lepromatous type, large nodules originate in the skin that will cause deformations and subsequent destruction of tissues such as cartilage in ears and nose. A nervous level involvement occurs that can cause sensory losses.
The management of this disease as indicated above consists of antibiotic therapy being the most used drugs, the three described above, although other types of antibiotics such as fluoroquinolones or macrolides can also be used. Other drugs for the control of inflation that the disease causes such as acetylsalicylic acid, or some corticosteroid such as prednisone can be associated.
Early treatment is essential to avoid not so much death but long-term complications that can cause dependence. These complications could be chronic muscle weakness, and neurological damage to limbs that lead to a loss of sensation as well as permanent skin and eye effects.
In the latest data, it is reflected that in 2017 211.009 cases of leprosy were registered worldwide according to figures from the World Health Organization.
who.int World Health Organization [Internet] Press center, descriptive notes. [updated Sep 10, 2019, cited Jan 9, 2020]. Available at: https://www.who.int/es/news- room / fact-sheets / detail / leprosy
Medlineplus.gov. National Library of Medicine of the USA. [Internet] Medical Encyclopedia. [updated Sep 27, 2017, cited Jan 9, 2020]. Available at: https://medlineplus.gov/spanish/ency/article/001347.htm