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Chapter 34

Leprosy

Leprosy is an ancient and complex disease, once feared and abhorred by all communities, who almost universally regarded it as a punishment from their gods. This is strange, for there are diseases which have caused greater havoc and yet humanity has taken them in its stride. Slowly, as it is becoming known that the disease is curable, this fear is receding.

The earliest records of leprosy come from India, from about 600 B.C. Absolute evidence has been found in a Coptic mummy buried about 500 A.D. In Europe, leprosy was widespread in the Middle Ages; thereafter it declined slowly, until it now exists only in the southern and eastern areas. It has remained endemic in many other parts of the world. The bacillus, Myobacterium leprae was first recognized in Norway by Hansen in 1873, but it is only in the past four decades that leprosy has become truly curable.

Despite its long history, leprosy still poses many unanswered questions. It is the only known bacterial infection with a predilection for nerves: there is no satisfactory way of detecting either past or current subclinical infection. The bacillus cannot be grown in an artificial medium and the mode of infection and transmission remains a mystery. However, it is no longer an untreatable disease and the deformities which for centuries caused such social stigma are no longer inevitable.

A radiologist is seldom likely to make the initial diagnosis, but has a vital part to play in assessing the activity and extent of the disease, and in helping to plan surgery and rehabilitation. There are still about 1 million patients with leprosy in the world and they have a right to humanity's skill and care, not our uneasy withdrawal.

Synonyms

Leprosy. Hansen's disease. Sp: Lepra. Fr: Leper. Ladrerie. Ger: Lepra. Leprageschwür. Aussatz. (The Old Testament name "tsara' ath" may not really refer to the disease we know as leprosy.) The International Leprosy Association does not use the word "leper" but prefers "leprosy patient"; the alternative, Hansen's disease or H. D., is often used in the United States and in Europe, but has not been adopted universally.

Definition

Leprosy is a chronic infection caused by Mycobacterium leprae.

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Copyright: Palmer and Reeder