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Paging Dr. Frischer - Hansen's Disease
WRITTEN BY :   Dr. Alan Frischer

This disease is so ancient and impactful that it appears throughout the Bible. Evidence of it dates back to 4,000 BCE in ancient Egypt, and it was addressed by Hippocrates. The earliest proven human case, verified by DNA, is that of a man discovered in a 2,000 year old tomb near Jerusalem. It was recognized in the ancient civilizations of China and India. While this is not likely to be a disease that you or anyone you know will ever suffer from, it does make for a fascinating topic for this column.
It is Hansen’s Disease…far better known as leprosy. The more modern name comes from the Norwegian physician Gerhard Armauer Hansen, who in 1873 identified the bacterium that causes it. Leprosy is a chronic infection, is progressive, and without treatment can result in permanent damage to the nerves, mucosa, and upper respiratory tract. It leads to disfiguring skin changes, but contrary to folklore, it does not cause body parts to fall off! Still, fingers and toes can become deformed or shortened, and because they may lose sensation due to nerve damage, can be badly damaged. Common symptoms include skin lesions that are numb in the center, numbness in fingers and toes, runny nose, dry scalp, eye problems, muscle weakness, and a flattening of the nose due to loss of cartilage. Antibiotic treatment is now quite effective, but wasn’t developed until the 1940’s.
The number of cases worldwide has decreased significantly, to about 250,000 new cases each year. India has the greatest number; over half of the world’s total. Brazil falls in second place, and there are 91 countries where a significant number of cases is found.
Is leprosy a danger here in the United States? There are approximately 6,500 cases of leprosy in the country, with about 150 to 250 new ones reported each year. The majority are in California, Hawaii, Florida, and New York. Note that most of those affected are either immigrants, or those who have worked in countries where leprosy is widespread. Therefore, it’s not considered “endemic” to the United States, and the numbers are considered to be quite low.
Part of the colorful history of leprosy involves the tragic forced quarantine or segregation of patients. Leper colonies still exist today in India, which is home to over 1,000 colonies, and in other countries as well. Where treatment is available, quarantine is not necessary. There is still a major social stigma toward leprosy for several reasons: It has been thought of as highly contagious; the skin lesions can be extremely conspicuous; and there was at one time confusion between the symptoms of leprosy and syphillis – at one time, both were treated with mercury.
In reality, 95% of people are naturally immune to leprosy! Those at highest risk are people living in endemic areas with poor conditions. Scientists are still studying the ways in which leprosy can be contracted. It appears to be transmitted by prolonged exposure, or from person to person via nasal droplets. You may find it interesting that leprosy is known to thrive in only two animals: humans, of course, and…armadillos! Apparently, a number of domestic leprosy cases were contracted by people who ate or handled armadillo flesh.
In our busy and often stressful lives, this is one disease that we don’t need to lose sleep over. I have never seen it in my medical practice. Good health to you all, and stay away from those armadillos.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

Published: Nov. 28, 2013 – Volume 12 – Issue 33

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