Study finds leprosy persists in the United States

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Researchers at Mayo Clinic wanted to understand how common it was in their clinic after diagnosing the disease in a patient in March 2017. In the clinic's electronic medical records, they found nine patients with leprosy over a period of 23 years.

The authors of the study pointed out that, although rare, the disease should always be taken into account when diagnosing patients.

"This is not a disease that worries the average citizen in the United States, but if it develops a rash and frequently moves to a place where it is common, then it should bring it to the attention from his provider ", said study author and dermatologist Dr. Spencer A. Bezalel.

According to the World Health Organization, these locations include the Democratic Republic of Congo, Ethiopia, Madagascar, Mozambique, Nigeria, Tanzania, Bangladesh, India, the United States, and the United States. Indonesia, Myanmar, Nepal, the Philippines, Sri Lanka and Brazil. Each of these countries reported 1,000 new cases of leprosy, also known as Hansen's disease, in the last five years.
According to the US Centers for Disease Control and Prevention, more than 200,000 cases of leprosy are diagnosed each year worldwide. In the United States, there are only 150-250 cases diagnosed each year.

The scarcity of leprosy in the United States is the reason why it is so often missed, the average diagnosis taking more than two years., according to Dr. Abinash Virk, study an infectious disease specialist and the author of the new study. Depending on the type of leprosy and the patient's reaction, the skin lesions may look like vitiligo, psoriasis or even common dermatitis. What is different from leprosy is a loss of sensation.

"The Indian doctor who knows leprosy would see a patch and would quickly do a sensation-loss test, here you would not even test for loss of sensation because it's not common to see," he said. Virk.

She added that once the biopsy was done, it became "very obvious that something was different", even though the pathologist was not specifically looking for the bacterium mycobacterium leprae or mycobacterium lepromatosis that causes leprosy.

The disease can be treated with a regimen involving several months or even years of antibiotics, Virk said. There is almost always success, although patients may have autoimmune reactions because the bacteria responsible for leprosy are broken down.

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If left untreated, the results can be disfiguring, including paralysis of the hands and feet, according to the CDC. "In very advanced cases, the person may have multiple injuries due to lack of sensations, and the body eventually absorbs affected fingers over time, resulting in an apparent loss of toes and fingers", explains the agency. "Corneal ulcers or blindness can also occur if the nerves of the face are affected, because of the loss of sensation of the cornea (on the outside) of the eye." Damage to the septum can cause "saddle nose deformity" and loss of eyebrows.
However, Dr. Ramanuj Lahiri, a microbiologist and senior scientist at the Laboratory Research Branch of Hansen's National Disease Control Program, wants doctors to know that it is highly treatable. He was not involved in the new research.

The mission of the program is to support the education, diagnosis and clinical treatment of leprosy. "A person with leprosy can lead a very normal life and we are here to help them in the diagnosis and treatment of patients."

To develop leprosy, a person must be in contact with an infected person for an extended period of time and, even then, the risk of infection is very low. According to the CDC, 95% of people enjoy natural immunity.

The infection can also be transmitted by armadillos. It is believed that the low body temperature and adipose tissue of these mammals make it an ideal breeding ground for leprosy bacteria. The preference for lower temperatures may also explain why limbs such as the nose, ears and fingers tend to be the most affected by the disease.

Theories abound, but it is not clear how people are infected with leprosy. "Bezalel said.

Experts agree that this is not a concern. "It's so rare," said Virk. "This is not a panic, but our suppliers and our colleagues need to think they see something a little unusual and that it does not improve, with what is it? They do at first

Bezalel added: "In the United States, there are many more common things that can hurt you and you may be afraid of leprosy."

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