Mycobacterium leprae

Seeing as I was reading about leprosy and this was Paul Brand’s particular interest I wanted to read a bit more about it and use the topic as my paper for my final requirement of this elective.
Leprosy, a.k.a. Hansen’s disease, is caused by the bacteria Mycobacterium leprae, an acid-fast, rod-shaped organism that affects the skin, mucous membranes, eyes and peripheral nerves. There are two main types of leprosy: turberculoid and leprematous. We saw mostly leprematous form in the hospital so that is what I will focus my paper. The leprematous form is the more severe version, invading multiple organ systems along with the areas mentioned previously. The exact mechanism of transmission remains unknown although it is believed to involve respiratory secretions from infected individuals, human-to-human contact and vertical transmission (from mother to child). The incubation period is about five years, making it more difficult to pinpoint an exact source.

Leprematous leprosy presents with the pathognomonic sign of multiple hypo-pigmented skin lesions lacking sensation. Severe cases can involve the eyes or nasal septum and hand contractures. Multiple methods for testing for leprosy have been tried but the only reliable and standardized method is a skin biopsy, a simple procedure that is easy to do even in India! In leprematous leprosy one can see giant cells accompanied with epithelioid-lymphocyte granulomas along with bacilli surrounding blood vessels and within nerves. The disease begins first affecting thermal sensation followed by pain and touch while proprioception and vibratory senses are often preserved. In addition, deep tendon reflexes remain intact due to bacilli sparing muscle spindles and large nerve fibers. This denervation eventually leads to compression ulcers of the feet or damage to the fingers, often times becoming infected.

From the time of diagnosis patients are then treated with a multiple drug regimen, in the clinic they largely used rifampin, dapsone, clofazamine and sulfa medications. All these meds were tested in the laboratories housed in the center. These meds were determined to be the most effective and required a shorter duration of use, increasing compliance and improving outcomes.
Knowing the treatment for leprosy the medication regimen is simple. What remains difficult is the education of patients to prevent further damage. Education involves significant effort on the part of doctors, nurses, physical therapists and many others. One thing that Ms. Koshi (the public relations woman) pointed out that was interesting, and something to take home, was the effectiveness of patients teaching patients. The clinic organized sessions of previously diagnosed leprosy patients to come and talk to newly diagnosed patients to educate each other on what works and what does not. Patients do not want to hear orders from another doctor or nurse who has never experienced the disease first hand and does not know about the day to day struggles.
In addition, India has the large task of finding those yet to be diagnosed as 70% of leprosy cases are found in India, Myanmar, and Nepal. With 12 million diagnosed worldwide it remains quite prevalent and with it endemic to Florida, Louisiana, and Texas (one reservoir being our very own nine-banded armadillo) it is something we may see at home.


We are asked to research a topic for our elective on a “tropical disease” but the bottom line is the leading cause of death in India, just as in the US, is cardiovascular disease. This along with cancer, traffic accidents and diabetes, amongst many others, are what plague our patients and stress India’s and our healthcare system. What is the solution? I’m not sure yet Going into Ob/Gyn I have a pipe dream of improving the world and quality of life by making women more healthy and thereby their children, even if it is just one person at a time.

I had the pleasure of reading Atul Gawande’s Better: A surgeons notes on performance which definitely got me thinking about what I as an individual and in turn as an individual adding to the medical community can do to make the system “work.” One thing that he stresses and I must remember is to be open to change. Each person has something they can teach someone else and we all have a lot more to learn, no matter who you are. Being humble and putting aside ones ego could dramatically improve how we deliver care. Because of this we have discovered new methods for delivering babies, laparoscopic surgery, vaccines, new medications, etc. and have turned this information into common practice.

After being in India I have learned that we have excellent healthcare in the US (especially after being a patient myself in an Indian hospital), if one has access to it. However, where India falls short of resources and supplies they excel at physical diagnosis and ingenuity, skills that are somewhat fleeting in the American healthcare system.

You may disagree with me and that is ok as long as this makes you start thinking about how you can improve the world around you. Yes, you might be one person but one person can make a huge difference, especially when working with others.

Going to other countries has always inspired me to continue to make a difference, in my local community and abroad. I have traveled and worked in hospitals in other countries before but never with the knowledge and expectations of the medical system that I now have. India was unforgettable, challenging and inspiring, something completely unique and magnificent all at once. So, thank you to the donors who contributed to the scholarship fund that sent me here, nothing compares to this opportunity and for that I am forever grateful.