Leprosy: Alive and Well in the U.S.

Recently, I heard MSNBC’s Keith Olbermann mention Lou Dobbs and leprosy in the same sentence. That caught my attention, but I missed the full story. Curious, I pecked around the Web and found a New York Times article that shed some light on Mr. Dobbs and the disease that still sends atavistic chills down people’s spine. Apparently, Mr. Dobbs—a kind of one-man border patrol—was concerned that illegal aliens infected with leprosy were coming into the U.S. Well, maybe they are, but they are not likely to add greatly to the number of U.S. citizens already infected with leprosy. In addition, leprosy is not very contagious, and contrary to myths, movies and cartoons, body parts do not fall off leprosy patients. Leprosy is an ancient disease; references to it date back to 600 B.C.E. The infection is caused by Mycobacterium leprae, a cousin of the bacterium that causes tuberculosis. A Norwegian doctor named Hansen discovered M. leprae in the 1870’s, and today leprosy usually is referred to as Hansen’s disease. M. leprae is a slow-growing bacterium that likes cool temperatures. That peculiar temperature sensitivity may explain its preference for the cooler parts of us: the skin and dermal nerves, the nose and nasal passages, ear lobes, fingers and toes, and the testicles. It may also explain why regular and close contact is required to spread the infection from person to person. Fortunately, almost ninety-five percent of us appear to be naturally immune. Prior TB exposure and widespread use of the TB vaccine (BCG) in many countries also may have contributed to a decline in new cases of leprosy by providing some immunological cross protection. Despite a global effort to eliminate the disease, there are still many patients throughout

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the world. Countries with the greatest disease burden today include Brazil, India, China and numerous areas of Africa. Last year, the Reuters news agency reported that China still has hundreds of “leper colonies” housing mostly people who have recovered from leprosy, but who have nowhere else to go because of the ancient stigma of the disease. Two years ago, the Indian government estimated there were still 107,000 leprosy patients nationally. Tourists may sometimes see the injured and disfigured victims of leprosy around fashionable Connaught Place in downtown New Delhi. (Ironically, my first visit to Connaught Place was in the company of one of world’s leading experts on leprosy treatments.) A posting on the Internet infectious disease site, ProMED, reported that the Centers for Disease Control diagnoses about 200 cases in the U.S. each year. Of these, 160 are from immigrants or Americans returning from overseas. The remaining cases are from Louisiana (6-8 cases) and Texas (32-34). So how and where are local Gulf Coast residents getting leprosy? Maybe they get it from another local resident: the 9-banded armadillo. This strange creature—it resembles a small dinosaur with pointed ears—is unique among animals in that it too contracts leprosy. Before the discovery of this shared affliction, it was impossible to grown M. leprae in the lab, study the molecular biology of the disease, or test anti-leprosy drugs and vaccines. Treatment today usually consists of multiple antibiotics (dapsone, rifampicin, fluoroquinolones) taken over the course of six months to two years. M. leprae grows slowly so antibiotic treatment takes an equally long time. Inflammatory skin lesions associated with leprosy are often treated with thalidomide, a drug once made infamous by causing horrible birth defects in the 1950’s. Surgery also may sometimes be required to repair damaged tissues and

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appendages. Modern research and effective therapies have turned yesterday’s “lepers” into just another class of patients with a treatable infection. That is a profound change from the days of public fear and forced quarantine. America’s last colony for leprosy patients was in Carville, Louisiana. The beds are empty now, the site has been placed on the National Register of Historic Places, and the small Hansen’s Disease Center Laboratory Research Branch has moved to Louisiana State University’s veterinary school in Baton Rouge. It’s odd that the last chapters of this ancient and horrible affliction would be written in Louisiana. According to recent genetic research, leprosy first appeared in East Africa and then spread to Asia and Europe. It was carried into West Africa and the Americas by explorers. But its low-level persistence in Louisiana today may depend on armadillos, which are recent immigrant to the state. Apparently they used U.S. bridges and highways built in the 1950s to move from northeast Mexico. But don’t tell Lou Dobbs. Happy New Year.

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