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Medical [Medical] New Test For Leprosy
2013.02.19 17:43
By DONALD G. McNEIL Jr. Published: February 19, 2013 A simple, fast and inexpensive new test for leprosy offers hope that, even in the poorest countries, victims can be found and cured before they become permanently disabled or disfigured like the shunned lepers of yore. American researchers developed the test, and Brazil’s drug-regulatory agency registered it last month. A Brazilian diagnostics company, OrangeLife, will manufacture it on the understanding that the price will be $1 or less. “This will bring leprosy management out of the Dark Ages,” said Dr. William Levis, who has treated leprosy patients at a Bellevue Hospital outpatient clinic for 30 years. Many consider leprosy, formally called Hansen’s disease, a relic of the past, but annually about 250,000 people worldwide get it; Brazil is among the hardest-hit countries, as are India, the Philippines, Indonesia and the Democratic Republic of Congo. The United States has 150 to 250 new diagnoses each year, mostly in immigrants. Leprosy is curable, so better detection may mean that someday it could join the short list of ailments, like polio and Guinea worm disease, on the brink of eradication, experts say. The new test gives results in under 10 minutes and is far simpler than the current diagnostic method of cutting open nodules, often in the earlobe, and looking for the bacteria under a microscope. “It works like a pregnancy test and requires just one drop of blood,” said Malcolm S. Duthie, who led the test’s development at the Infectious Disease Research Institute in Seattle. “I can teach anyone to use it.” Even more important, he said, it is expected to detect infections as much as a year before symptoms appear. And the earlier treatment begins, the better the outcome. Leprosy is caused by a bacterium, Mycobacterium leprae, related to the one that causes tuberculosis, but reproducing so slowly that symptoms often take seven years to appear. “We’re definitely excited about this,” said Bill Simmons, president of the American Leprosy Missions, a Christian medical aid group that has been fighting the disease since 1906. Dr. Levis said that if the test eventually became available in this country he would use it to test the families of his Bellevue patients. M. leprae is transmitted only after prolonged, close contact. The bacteria spread under the skin in the coolest parts of the body: the hands, feet, cheeks and earlobes. The first visible signs are usually numb, off-color patches of skin, which are often misdiagnosed as fungus, psoriasis or lupus. The victim may get repeated cooking burns or cuts. Feet develop sores from something as simple as a stone they cannot feel in a shoe. “Finally, when it gets bad enough,” Mr. Simmons said, “they go to a big city. And that’s where they get the bad news: ‘Yes, you have leprosy — and we wish you’d come here six months ago.’ ” After about six months, the nerve damage is permanent. So even if a patient is cured — and a cure normally requires taking three kinds of antibiotics for six to 12 months — there is still a lifelong risk of developing ulcers that can become infected. The standard antibiotics are provided free through the World Health Organization. The disease has historically been hard to diagnose, despite the popular, but inaccurate, image of fingers and toes dropping off victims. As the bacteria kill nerves, muscles atrophy and those digits curl into claws. After disuse and repeated injuries, the body reacts protectively by absorbing the bone calcium in the bones, shrinking the digits. For centuries, some observant doctors have noticed early signs: the numb skin patches, missing eyebrows, drooping earlobes, bulging neck nerves, the flat “lion face” caused by nasal cartilage dissolving. Since nothing could be done for them before the age of antibiotics, victims lost the use of their hands and had to beg. Some also went blind as the blinking muscles degenerated and their eyes dried out. In the Middle Ages, some towns banned lepers, while others required them to ring bells to warn of their approach. Religious charities created “leper colonies.” And they still exist, even in the United States. A few elderly residents have chosen to stay on in Carville, La., and Kalaupapa, Hawaii, despite having been cured. Several thousand live at one in northeast Brazil, said John S. Spencer, a leprosy researcher at Colorado State University who has worked there. “People say things like ‘People outside won’t understand what’s wrong with my face,’ ” he said. Nowadays, he said, most patients are cured before their faces are severely disfigured. Still, he said, he had read a survey in which health experts asked Brazilians whether they would rather have the human immunodeficiency virus or leprosy. Most chose H.I.V. — even though leprosy does not kill, can be cured, and does not make a victim risky to have sex with. “The stigma is that strong,” he said. A new test was crucial because trained microscope diagnosticians are rare in the rural areas where the disease persists. It is simple: one drop of blood goes into a well on a plastic test strip followed by three drops of solution. It took a long time to develop, Dr. Spencer said, because researchers needed a steady supply of the bacterium, and no way to grow it in a laboratory has ever been found. It grows vigorously in one animal: the armadillo, a fact discovered only in the 1970s at a federal laboratory in Baton Rouge, La. But armadillos come with their own complications. After a year of harboring the slow-growing bacteria, they must be killed for their livers and spleens — and armadillos do not breed in captivity. “Luckily,” Dr Duthie said, in Louisiana and Texas, “they’re everywhere, and they’re easy to catch.” However, armadillo hunting is not risk-free. Some Southerners hunt them for food and their armored skins, and some wild armadillos harbor strains of leprosy bacteria. Two years ago, federal researchers estimated that about a third of the human cases discovered in the United States each year are caught from armadillos — which have the honor of being one of the state mammals of Texas. ■ PUBLISHED FEBRUARY 19, 2013 http://www.nytimes.com/2013/02/20/health/fast-new-test-could-help-nip-leprosy-in-the-bud.html |
Comment 3
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이한중*65
2013.02.21 08:50
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운영자
2013.02.21 16:35
Nowadays, there are so few religious practitioners like Father Damien.
I believe Father Damien had found a true heaven in his death bed in Molokai.
What he showed us is what I can say the true faith and religion.
Most of the contemporary practitioners are worse than the snakes in the garden of Eden.
I just returned from Houston last night, attending the funeral of one of my close friend, Dr. Sam Ryu (Ph.D.).
Sam used say that he would not want to have a Christian funeral for himself but his wife did it anyway.
Sam had been a famous community leader but didn't attend any Korean churches.
I guess his wife couldn't resist the threat from her Korean church.
It was sickening to see the whole bullshits of it.
It wasn't the first sickening so-called-Christian funeral I saw though.
I saw many of them. I was sickened everytime. -
이한중*65
2013.02.21 16:49
Thank you, WM, for your honest comment out of your heart as always. Let's try, as you always do, to accept the fact that one must do, as always happens, what he or she must, whether they appear to be nothing but hypocrites(and there are too many including myself), or not.
문둥병하면 한국사람들은 소록도를 생각하게되는데
미국에서는 하와이의 몰로카이 섬을 생각하게되고 카토릭신자들과
많은 미국사람들은 신부 데미엔을 생각 하게됩니다.
몇천년동안 인간들을 겁나게하고 성경에도 자주 나오는 그병이 이지구상에서
없어질 가능성이 농후하다는 사실은 의학도의 하나로서 큰 역사적 이벤트임을
새삼 느끼게 합니다.
다음의 신부 데미엔에 관한 이야기를 소개드립니다.
"I make myself a leper with the lepers to gain all for Christ."
Damien de Veuster(1840-1889)
In 1873, Belgian priest Damien de Veuster volunteered to serve the lepers
at Molokai. Shortly after the young missionary had arrived in Hawaii 8 years before,
a leprosy epidemic struck the islands, and victims were herded into isolation. ...
He undertook his assignment with excitement. "I want to go there!" he had told his bishop.
"I know many of these unfortunate souls and I ask only to share their lot and
their prison."
And Damien found that Molokai was indeed a prison - of degradation, suffering, and death.
Although engulfed by hopelessness, he refused to submit to it.
Immediately, Damien set out to restore the dignity of the lepers. He treated them not as victims,
but as ordinary human beings. He organized them into work groups that constructed roads,
cottages, and clinics. He established a cemetery and built coffins for them, improving their lives
by making their deaths respectable.
For the sports-loving Hawaiians he organized footraces, even though some competitors had lost
their feet. He cheered the island by forming a choir and a band. Two organists who had ten fingers
between them played at funeral masses.
Damien took no personal precautions in caring for his people.
Though often sickened by the overwhelming stench of their rotting flesh,
daily he touched, hugged, and bathed them.
"I have seen him," said a visitor, "dress the most loathsome sores as if he were arranging flowers."
Father Damien never rested. When he was not tending to the needs of his beloved lepers,
he was pressuring the government for more money and medical resources for the colony.
He finally contracted the dreaded disease and died at Molokai on April 15, 1889.
... from the book, "Voices of the Saints" by Bert Ghezzi, 2000
"