Leprosy: What EMS should know amid Florida’s possible endemic
Learn how leprosy presents in patients and how providers can protect themselves when treating someone suffering from the condition
The number of leprosy cases seen each year in the U.S. has gradually increased over the last two decades, though not proportionately across the country. The Southeastern states have seen leprosy cases nearly double in the last 10 years, according to the report; central Florida alone accounts for nearly 20% of the country’s cases.
Learn how leprosy presents in patients and how providers can protect themselves when treating someone suffering from the condition.
The history of leprosy
Leprosy, also known as Hansen’s disease, is one of the oldest diseases recorded in human history. References to leprosy have been found in ancient texts from Egypt, India and China dating back to 600 B.C.
The disease was widely misunderstood and often stigmatized, leading to the isolation and mistreatment of those affected.
In the late 19th century, Dr. Gerhard Armauer Hansen discovered the bacterium Mycobacterium leprae, which causes leprosy, marking the first identification of bacteria as a cause for human disease. This breakthrough paved the way for further understanding and treatment of the disease, ultimately leading to its curability today.
Leprosy cases on the rise in Fla., CDC says
A recent report by the agency found that Central Florida accounts for nearly 20% of all cases in the country
Where leprosy persists in the world
Despite being a curable disease, leprosy remains an issue in several parts of the world, particularly in low- to middle-income countries. According to the World Health Organization, more than 200,000 new cases were reported in 2019, primarily in countries like India, Brazil and Indonesia. Factors such as limited access to healthcare, poverty and lack of awareness contribute to the disease’s prevalence.
How leprosy spreads
Leprosy is caused by the bacterium Mycobacterium leprae but, contrary to popular belief, it’s not highly contagious. It’s thought to spread through droplets from the nose and mouth of an infected person during close and frequent contact with untreated cases. It’s important to note that the majority of people – about 95% of the population – have a natural immunity to the bacteria and will not develop the disease even if exposed.
The bacteria thrive in cooler areas of the body, such as the skin and the peripheral nerves. Once infected, the bacteria multiply very slowly, which is why symptoms may only appear 5 to 20 years after exposure. This long incubation period makes it difficult to identify when and where a person was infected, which can hinder prevention efforts.
It’s also worth mentioning that leprosy cannot be contracted through touch, as many ancient stigmas suggest. The disease is also not passed from mother to child during pregnancy, nor is it spread through sexual contact.
Prevention strategies primarily focus on early detection and treatment of the disease. People living in close contact with someone who has untreated leprosy are most at risk and should be examined by a medical professional. Vaccines, such as the BCG vaccine, can also provide a certain level of protection against the disease.
Common symptoms of leprosy
Leprosy primarily affects the skin, nerves and mucous membranes. The disease can manifest in several ways, but common symptoms include:
- Skin lesions that are lighter than the normal skin color
- Numbness or loss of sensation in the hands, arms, feet and legs
- Muscle weakness or paralysis (typically in the hands and feet)
- Eye problems, which may lead to blindness
- Enlarged nerves (especially those around the elbow and knee)
- Nasal congestion, nosebleeds or collapse of the nasal septum
It’s worth noting that these symptoms can take several years to appear after being infected due to the slow-multiplying nature of the bacteria.
Treatment of leprosy
Leprosy is curable with a multidrug therapy (MDT) that combines three antibiotics: dapsone, rifampicin, and clofazimine. This treatment kills the bacteria and stops the progression of the disease. The duration of the treatment depends on the type of leprosy, but it usually lasts between six months to a year or more.
Early detection and treatment can prevent disability. It is important to seek medical help if any of the symptoms of leprosy are noticed, as untreated leprosy can cause permanent damage to the skin, nerves, limbs and eyes.
Post-treatment, patients may require physical therapy to manage disabilities and complications. In some cases, reconstructive surgery may be necessary to improve function and appearance.
Recommended PPE for leprosy
According to an EMS guide to infectious disease published by the Dane County (Wisconsin) EMS Association, providers should wear PPE, including an N95 mask and respiratory isolation equipment, if treating someone potentially suffering from leprosy.
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