Leprosy

Sana magka-ketong sila.“ These words came from my kind and mild-mannered father. I have never heard him speak ill of anyone, so it came as a surprise. The topic on the table was corruption in government, and my parents, being socially aware, made sure that we grew up in that kind of environment.

Leprosy? Is it still a problem?

As a pediatric infectious disease specialist, my exposure and experience are very limited. This was also the same sentiment shared by my colleagues. A recent encounter was the trigger for us to reeducate ourselves. Admittedly, while most of the cases are being attended to by dermatologists who most likely are the first ones to be referred to because of the skin manifestations, as general physicians, we should make the effort not to miss out on the diagnosis. Furthermore, we should do our part in raising awareness of leprosy. While it has been eliminated as a public health problem in the country in 1998, cases still exist and transmission continues. From the 2024 report by the World Health Organization on global burden, a majority of cases were from Southeast Asia. In the Philippines, in an article by Fatunmbi et al., data from the Department of Health Field Health Services Information System from 2020 to 2024 showed that most of the newly detected cases were in adults (20-59 years old) and were more prevalent in males. The continued identification of cases in children in the 0-14 range was suggestive of ongoing transmission in areas where the disease was endemic.

Leprosy, more commonly known as Hansen’s disease, is a chronic infectious condition and is one of the 21 neglected tropical diseases. The causative agent is Mycobacterium leprae, which is a bacterium that can be transmitted via respiratory droplets, from the nose and mouth of an individual with untreated leprosy. Other routes that have been mentioned in the literature are contact with broken skin and vertical transmission. It requires close and prolonged contact and predominantly affects the skin and peripheral nerves, and can also involve the eyes, which may result in permanent physical deformities. The incubation period may vary from two to five years, and contrary to popular belief, it is not as highly contagious as measles and influenza. Closely associated with poverty, the disease is curable and early recognition can prevent disabilities.

People who are at risk include those who are genetically susceptible, undernourished, and living in poor sanitary environments, and those living closely with someone who has the disease. With regard to age, though the disease is seen to be more prevalent in adults, as previously mentioned, children can also be affected. On the aspect of prevention, in several studies, receipt of the Bacille Calmette-Guérin vaccine was found to have a protective effect that ranged from 20 to 80 percent against leprosy. Rifampicin, which is used as part of the multiple drug treatment and as prophylaxis, has a bearing on its infective capacity. A single dose of rifampicin as prophylaxis reduces contact risk by approximately 57 to 60 percent, and treatment kills around 99 percent of viable bacteria. The affected individual is rendered noncontagious within one to two weeks of therapy.

For the manifestations, patients may present with changes that involve the face and the ears, and with advanced disease, have a lion-like appearance, with thickened features, loss of eyebrows and eyelashes, and nodular lesions and a flattened nasal bridge. In our case, the patient, the mother, and the sibling didn’t have a clue that it was leprosy, assuming that they shared the same features because they were blood relatives.

Leprosy can also involve the feet and the hands, which can result in what is termed as a claw hand deformity, or present with hypopigmented lesions, scaly plaques, or ulcers, and be mistaken initially as a common dermatologic skin condition. The red flag, according to our speaker, when encountering such lesions, is the presence of hypoesthesia. It took eight years for them to seek a consult, which was not only hindered by a lack of knowledge but further aggravated by financial constraints.

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Diagnosis is mostly clinical but may require further tests, such as a skin-slit smear and a skin punch biopsy. Management involves a three-drug therapy, which is available for free in health centers, and treatment may be for six to 12 months, depending on the type of leprosy, the age, and weight of the patient. Close follow-up is needed to monitor for cure and detect adverse reactions to the drug.

For our case, aside from leprosy, upon further workup, the child was unfortunately suffering from tuberculosis. It was a grave reminder that with both in existence, we need to step up our efforts in supporting the national programs that are in place if we ever hope to attain control or attain the impossible dream of elimination.

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