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Leprosy or Hansen's Disease: Bacteria and Nerve Damage

Updated on August 25, 2017
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Linda Crampton is a teacher with a first class honors degree in biology. She writes about human biology and the scientific basis of disease.

Partial reabsorption of fingers in leprosy
Partial reabsorption of fingers in leprosy | Source

A Potentially Serious Bacterial Infection

Leprosy is a disease that has been feared since ancient times due to its effects on the body. It’s caused by a bacterial infection and can produce debilitating and disfiguring symptoms. A lack of understanding of the disease has resulted in ostracization and sometimes cruel treatment of patients.

Doctors now know that it’s not easy to catch leprosy and that the disease progresses slowly. In addition, they can treat the infection effectively if it does develop. If someone becomes infected and doesn’t get treatment, however, serious nerve damage can result.

Leprosy is also known as Hansen's disease. In 1873, a Norwegian doctor named Gerhard Henrik Armauer Hansen discovered that a bacterium was the cause of the disease. The bacterium was eventually named Mycobacterium leprae. Though leprosy is the more common term for the illness, Hansen's disease is sometimes preferred today because it reduces the stigma attached to the illness. Some interesting discoveries have been made in relation to exactly how M. leprae causes nerve damage.

Mycobacterium leprae is the main cause of leprosy. The bacterium is stained red in this photo.
Mycobacterium leprae is the main cause of leprosy. The bacterium is stained red in this photo. | Source

There are two main types of leprosy. Paucibacillary or tuberculoid leprosy is much milder than the multibacillary or lepromatous form of the disease. Some people have a disorder that is on the borderline between the two forms.

Possible Symptoms of Leprosy

The list below contains some common symptoms of leprosy. A patient may not have all of them. In addition, having one or more of the symptoms doesn't necessarily mean that a person has leprosy. Different diseases often share some of their symptoms. A doctor should be consulted for a diagnosis.

The symptoms of leprosy take an average of five years to appear after the initial infection but may take as long as twenty years. The milder symptoms generally develop first. The disease is rarely fatal but may be so due to a secondary effect such as kidney failure. Symptoms may include:

  • skin lesions (patches with an altered appearance) that are white or red in colour
  • numbness in the lesions due to nerve damage in the skin
  • skin lumps and bumps, especially on the face
  • loss of eyebrows and eyelashes
  • muscle weakness or paralysis
  • enlarged nerves under the skin that can often be seen from outside the body
  • eye and vision problems, including blindness in severe cases
  • nose problems, such as nosebleeds. a stuffy nose, and disfigurement
  • chronic ulcers on the soles of the feet
  • paralysis and clubbing of hands and feet
  • reabsorption of the cartilage in fingers or toes, making them shorter
  • damage to the male reproductive organs
  • kidney damage

Additional problems may develop because the patient may develop injuries in the areas without sensation. The nerve damage may stop them from feeling pain and realizing that their body is being hurt.

It's important to get treatment for leprosy as early as possible in the progression of the disease. The sooner treatment is begun, the less likely that symptoms will be severe or permanent. Early attention is necessary because doctors may be unable to correct some of the effects of the disease even when the bacteria are destroyed.

Leprosy bacteria may be transmitted from person to person in droplets of moisture released when an infected person sneezes or coughs. Most people don't become infected when this happens, however. Long-term exposure to a contagious person is needed. In addition, a genetic susceptibility to the disease seems to be required. A regimen of specific antibiotics known as multidrug therapy is used to treat the illness.

A neuron with its axon surrounded by Schwann cells and a myelin sheath
A neuron with its axon surrounded by Schwann cells and a myelin sheath | Source

Mycobacterium leprae and Myelin

Mycobacterium leprae is a rod-shaped bacterium with rounded ends. It's a difficult organism to study because it's hard to grow to lab equipment and has little effect on lab animals. This means that scientists don't know as much about its biology as might be expected. The bacterium affects the skin and the peripheral nerves (those leaving the brain or spinal cord and travelling to the surface of the body). In severe cases of leprosy, it may also cause damage to some of the internal organs.

Researchers have known for some time that the bacterial infection causes the myelin sheath around neurons to disappear. Myelin is a fatty material that electrically insulates the axon of a neuron, allowing the nerve impulse to travel effectively. A nerve impulse is a type of electrical current, although it consists of a flow of ions instead of the flow of electrons that occurs in a wire.

The myelin around the neurons in peripheral nerves is made by Schwann cells. These cells spiral around the axon of a neuron, wrapping it in layers of cell membrane containing myelin. Some evidence suggests that the leprosy bacteria enter the Schwann cells and interfere with their production of myelin.

Mycobacterium lepromatosis also causes leprosy, although it appears to be a less common cause than M. leprae.

Facts About Leprosy

Genetic Reprogramming of Schwann Cells

In 2013, a group of researchers at the University of Edinburgh took Schwann cells from mice and added M. leprae to them. They found that the bacteria reprogrammed the cells by turning off genes used in mature Schwann cells and turning on ones used in immature ones. This reprogramming caused the cells to revert to an unspecialized form resembling that of a stem cell.

Stem cells are normally very useful because they can produce the specialized cells that we need when they are stimulated correctly. In the mouse experiment, however, the reprogrammed Schwann cells weren't useful because they were unable to make myelin.

The researchers placed the altered Schwann cells inside living mice. Some of the cells migrated to the muscles, carrying and distributing the bacteria as they travelled. This could be one way in which the bacteria spread through our body.

In 2017, a different team of researchers found evidence suggesting that leprosy bacteria may cause myelin destruction by altering the action of the patient's immune system.

Mycobacterium leprae and Macrophages

An international team of researchers has recently discovered that the bacteria that cause leprosy enter white blood cells known as macrophages and hijack their activity. The scientists say that this leads to the injury to the nerves. Macrophages are part of our immune system. This system protects us from disease by destroying microbes that can make us sick and by removing and destroying damaged material.

Macrophages are large cells that engulf and digest particles in a process called phagocytosis. The particles that are "eaten" include bacteria such as M. leprae as well as unwanted material. Normally, bacteria that enter the macrophages are destroyed, but this may not happen in the case of the leprosy bacterium.

Four-day-old zebrafish; the lower one has been genetically modified to eliminate its dark pigment
Four-day-old zebrafish; the lower one has been genetically modified to eliminate its dark pigment | Source

Zebrafish Research

The researchers inserted leprosy bacteria into zebrafish larvae, which were transparent. The scientists had previously genetically modified the fish so that their myelin glowed a fluorescent green colour. This enabled the scientists to more clearly see what was happening to the myelin. They then injected leprosy bacteria close to the myelin.

The researchers found that the bacteria appeared to settle on the nerve and that bubbles of myelin were released from the sheath. When the scientists examined their discovery in more detail, they found that the bacteria were located inside macrophages and that they were still intact.

The scientists say that it was actually the macrophages that damaged the myelin, not the bacteria. They confirmed this by destroying the macrophages in the zebrafish. The researchers found that the bacteria alone couldn't destroy the myelin. They also found that a molecule on the surface of the bacterium named PGL-1 altered the behaviour of the macrophages, causing them to make an excessive amount of nitric oxide. This chemical damaged the mitochondria of the nerve cells. Mitochondria produce energy for a cell. If a cell contains an insufficient number of mitochondria, it can't survive.

The researchers say that the altered macrophage damages neurons in two ways: it stops "patrolling" the neuron to protect it from damage and also damages nerve cells directly.

The Potential Importance of the Research

Both the 2013 and the 2017 reports about M. leprae are very interesting, but as far as I know each study has been performed by only one group of researchers. This doesn't mean that the results are incorrect, but results from another team could add evidence supporting the original study. One or both of the discoveries might be medically useful if they are correct.

A problem with the first study is that the bacterium's behaviour in mouse cells and living mice may not be the same as its behaviour inside our body. A problem with the second study is that discoveries in zebrafish larvae may not apply to humans. It's interesting to note that the fish have been useful in the study of an M. lepae relative called Mycobacterium tuberculosis, however. As its name suggests, this bacterium causes tuberculosis. In addition, the biology of zebrafish larvae has important similarities to that of mammals, including humans.

Both sets of researchers hope that that their discovery will help treat leprosy in some way. The 2013 researchers hope that leprosy can be diagnosed at an earlier stage. The 2017 researchers hope that nerve damage caused by the bacterium can be reversed. Both sets of researchers suspect that their research will lead to a better understanding and perhaps a better treatment for other demyelination disorders, including multiple sclerosis, or MS. In MS, the immune system is believed to destroy the myelin around nerves.

An Effort to Eliminate Leprosy

Leprosy is uncommon in the United States, but it does occur in the country.

Leprosy in the Present and the Future

The World Health Organization (WHO) reports that the incidence of leprosy is decreasing. Some health experts believe that certain countries are becoming complacent with respect to the disease and that far more cases exist than are being reported. This is very troubling because the illness can be treated and the worst of the permanent effects avoided. If people aren't identified as having leprosy, they won't be given the appropriate antibiotics and may develop life-altering symptoms that could have been prevented.

People with leprosy were treated badly in the past. Unfortunately, they still are in some countries. Education of the public is important. Better treatment for the effects of the illness would be wonderful. It's good that we can destroy the bacteria in patients. Depending on when the treatment is started, however, the bacterial infection may cause disabling and irreversible effects. I hope that the latest research eventually prevents this from happening.

References

  • "Hansen's Disease (Leprosy)." Centers for Disease Control and Prevention. https://www.cdc.gov/leprosy/ (accessed August 24, 2017).
  • "Leprosy Overview." WebMD. http://www.webmd.com/skin-problems-and-treatments/guide/leprosy-symptoms-treatments-history#1 (accessed August 24, 2017).
  • "Leprosy." Merck Manual. http://www.merckmanuals.com/en-ca/home/infections/tuberculosis-and-leprosy/leprosy (accessed August 24, 2017).
  • Telis, Gisela. "Leprosy Reprograms Body's Cells." American Association for the Advancement of Science. http://www.sciencemag.org/news/2013/01/leprosy-reprograms-bodys-cells (accessed August 25, 2017).
  • "Leprosy turns the immune system against itself, study finds." Medical Xpress. https://medicalxpress.com/news/2017-08-leprosy-immune.html (accessed August 24, 2017).
  • "Leprosy Elimination." World Health Organization. http://www.who.int/lep/disease/en/ ((accessed August 25, 2017).
  • Lyons, Kate. "Shadow of leprosy falls again as experts claim millions of cases go undiagnosed." The Guardian. https://www.theguardian.com/global-development/2017/aug/03/leprosy-experts-claim-millions-of-cases-go-undiagnosed (accessed August 25, 2017).

© 2017 Linda Crampton

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    • AliciaC profile image
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      Linda Crampton 10 days ago from British Columbia, Canada

      Thank you for the comment, Dianna. I appreciate your visit.

    • teaches12345 profile image

      Dianna Mendez 10 days ago

      I did not realize this disease was throughout the world. As always, your posts are interesting and give readers much to consider.

    • AliciaC profile image
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      Linda Crampton 2 weeks ago from British Columbia, Canada

      Thanks for the kind comment, DDE.

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      DDE 2 weeks ago

      Informative and so much to learn from the interesting topic. You certainly researched in detail.

    • AliciaC profile image
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      Linda Crampton 3 weeks ago from British Columbia, Canada

      Thank you very much, Nadine. I've never heard of the film that you mention. I'll have to look for it.

    • Nadine May profile image

      Nadine May 3 weeks ago from Cape Town, Western Cape, South Africa

      Wow, Linda, you must have done a lot of research to write this informative article. People with leprosy were totally isolated in the film City of Joy. Glad that today it can be controlled or even cured.

    • AliciaC profile image
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      Linda Crampton 3 weeks ago from British Columbia, Canada

      Hi, Martie. Yes, the advances and discoveries in medicine are exciting. I hope they lead to better treatments for disease as soon as possible.

    • MartieCoetser profile image

      Martie Coetser 3 weeks ago from South Africa

      Oh, leprosy was such a traumatic and devastating disease for ages before medical science discovered a treatment. We are living in a wonderful time.

      Thanks for this informative and useful hub, Linda!

    • AliciaC profile image
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      Linda Crampton 3 weeks ago from British Columbia, Canada

      Thanks, Louise. I appreciate your visit.

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      Louise Powles 3 weeks ago from Norfolk, England

      Yes I agree with Larry, this was very educational to read. Although I've heard of Leprosy, I knew very little about it.

    • AliciaC profile image
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      Linda Crampton 3 weeks ago from British Columbia, Canada

      Hi, Sonia. Yes, there has been a lot of dread attached to the disease. There does seem to be more understanding of the disease and of the people who have it, although this isn't the case everywhere. I hope the illness is eradicated soon.

    • SoniaSylart profile image

      Sonia Sylart 3 weeks ago from UK

      Leprosy is a word/disease I have not heard about in a long time and from what I had heard of this disorder, the words alienation, fear and dread come to mind. It is good to learn from this thoughtful article that things are changing for the better for those who unfortunately have this condition, and that there is more understanding generally.

    • AliciaC profile image
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      Linda Crampton 4 weeks ago from British Columbia, Canada

      Thank you, Larry. As always, I appreciate your visit.

    • Larry Rankin profile image

      Larry Rankin 4 weeks ago from Oklahoma

      Always educational.

    • AliciaC profile image
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      Linda Crampton 4 weeks ago from British Columbia, Canada

      Thanks for sharing the interesting information, Jackie. I hope scientists investigate the composition and effects of bee venom. It sounds like it might be a useful substance.

    • Jackie Lynnley profile image

      Jackie Lynnley 4 weeks ago from The Beautiful South

      This is a great article Linda with so much information. My best friend from high school died from MS and if I had know about her disease before she died I would have encouraged her to use bee serum to help her. I think they over look this treatment that many live by and claim to be cured from that could help in all this maybe. It certainly worth investigation and it really makes me mad how so many of them poo poo it, especially since I had arthritis in my ankles so bad in my thirties I could barely walk but got accidentally got stung multiple times not by the recommended bees but hornets and it cured me.

      I know it is somewhat changing the subject but since this may be linked to MS the cure may be too and I have waited so many years to see them look into this with no luck. It really is so disappointing.

    • AliciaC profile image
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      Linda Crampton 4 weeks ago from British Columbia, Canada

      Hi, Dora. Unfortunately, the disease still exists. I hope there isn't a resurgence of leprosy. I'm glad that the bacterium that causes the disease might help us learn about other illnesses, though.

    • MsDora profile image

      Dora Isaac Weithers 4 weeks ago from The Caribbean

      Really, I had almost forgotten about the disease. I am told that there used to be a leprosy ward in the hospital on this island many, many years ago, then it closed because there were no more patients. Thanks for the up to date information.

    • AliciaC profile image
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      Linda Crampton 4 weeks ago from British Columbia, Canada

      Thanks for the comment and for sharing the information, Besarien. The case of animal cruelty sounds horrible. I'm glad it was discovered.

    • Besarien profile image

      Besarien 4 weeks ago

      Fascinating hub! You did an excellent job of making a complex topic easier to grasp. I was especially interested in what leprosy might teach us about reprogramming Schwann cells or other cells for that matter to act like stem cells, and also how better to combat other demyelination disorders.

      Also, there was a case in Florida, about a year ago, where a farm was shut down for animal cruelty. It was suspected amongst a litany of other evils, that they were selling armadillo meat as something else entirely, possibly to restaurants.

    • AliciaC profile image
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      Linda Crampton 4 weeks ago from British Columbia, Canada

      Thank you very much, Chitrangada Sharan. I hope we win the battle against leprosy. It can sometimes be a horrible illness if it's not treated.

    • ChitrangadaSharan profile image

      Chitrangada Sharan 4 weeks ago from New Delhi, India

      This is an excellent article about Leprosy ! Such a scary disease ! You have provided almost all the information about it to creat awareness among people. It's heartening to know that the occurrence of this disease is decreasing in general.

      Thanks for sharing another of your well researched and educative article!

    • AliciaC profile image
      Author

      Linda Crampton 4 weeks ago from British Columbia, Canada

      Thanks, Bill. I'm hoping that the research will help us to understand MS and other diseases involving loss of myelin. We need a breakthrough in this area.

    • billybuc profile image

      Bill Holland 4 weeks ago from Olympia, WA

      Absolutely fascinating information, Linda! I have several friends with MS, so hopefully understanding of that disease and a cure will follow soon.

    • AliciaC profile image
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      Linda Crampton 4 weeks ago from British Columbia, Canada

      Hi, Flourish. I hope the full details of how MS develops are discovered soon and that this leads to a cure or at least better treatments. Thank you for the visit.

    • FlourishAnyway profile image

      FlourishAnyway 4 weeks ago from USA

      Fascinating, especially the analogous connections to MS which I hav a sneaking suspicion is at least in part bacterial but we just don't know enough. Hansen's disease is so devastating.