Leprosy: Still present, but can be diagnosed and treated early

In a 2011 interview, Heng Bak Nang, then 75, who was diagnosed with tuberculoid leprosy at the age of three, shared that when she accepted her fate, she learnt not to be angry at anyone or anything in life. — Photos: Filepic

I read that there was recently a leprosy outbreak in Negri Sembilan, where there was even one death. I was driving to buy plants in Sungai Buloh, Selangor, recently and I noticed that there is still a leprosy centre there. Is leprosy still common in Malaysia?

In Malaysia, the number of leprosy cases actually fluctuates.

In 2020, there were 181 cases.

Then in 2021, there were 142 cases.

This went up slightly to 183 cases in 2022.

In 2023, there was a marked increase to 256 cases.

This was attributed to better detection methods, especially as the Covid-19 pandemic was just over.

With the Negri Sembilan outbreak this year, we are not sure what numbers 2025 will see.

Leprosy is also called Hansen’s disease.

Is leprosy still common around the world?

There are apparently 200,000 new cases reported globally every year.

It still has not been completely eliminated, although it is no longer considered a public health problem.

It is estimated that there are 5.5 million cases around the world.

When a disease achieves a worldwide prevalence of less than one case per 10,000 people, it is no longer considered a ­public health issue.

However, there are some countries that are still experien-cing a fairly high number of cases.

In fact, 80% of all leprosy cases are mostly found in five countries around the world: India, Indonesia, Myanmar, Brazil and Nigeria.

Is leprosy an infectious disease?

It is caused by a bacteria called Mycobacterium leprae.

This bacteria is related to the mycobacterium that causes tuberculosis.

It can affect anyone, but the two ages it is mostly seen in is between 10 to 14 years of age, and 35 to 44 years of age.

It is considered infectious in how it spreads from infected people to other people.

But it is not like Covid-19 or the flu where the spread is rapid.

The mycobacterium is believed to spread through respiratory droplets from infected patients when they cough or sneeze.

But fret not, it doesn’t mean that if you inhale this, you will definitely get leprosy.

Most people will not develop any symptoms.

In fact, you have to have certain genes in order to develop leprosy if you are exposed to the bacteria.

This is called being “genetically susceptible”.

Also important to note is that this mycobacterium incubates for a long, long time – we are talking about around five years.

So you may notice symptoms only years after you have been exposed.

In some religious books, they mention leper colonies. Does this mean that leprosy is a very old disease?

The word “leprosy” in religious books may not really mean the disease as we know it today, meaning Hansen’s disease.

The word was translated from old Hebrew, which referred to a broad range of skin diseases, including fungal infections.

It is usually mentioned to denote people who have disfiguring skin disease.

But yes, it may include leprosy.

A view of the Valley of Hope in Sungai Buloh, Selangor, formerly a leprosarium, which still houses a few old leprosy patients who have now recovered.

How will I know if I have ­leprosy?

You have to remember that leprosy symptoms usually take a long time to develop.

But the first symptom people notice is numbness.

You may notice it in your hands.

First, you will be unable to distinguish between hot and cold.

Then you will not be able to feel light touches and pain.

After a while, you won’t even be able to feel deep pressure.

This can go on for years before you actually see any skin lesions.

The first skin lesions will appear as pale patches, and may be single or multiple.

They can evolve into two major types of skin lesions, as well as several in-between ­versions.

The two main types are:

> Tuberculoid leprosy

These are a few red, clearly-defined patches with raised borders, or a single pale patch of less than 10cm.

You may experience loss of sensation and lack of sweating in those patches.

Your nerves around that area can be thickened and tender.

It is considered “better” to have tuberculoid leprosy than leprematous leprosy as it is less disfiguring.

> Leprematous leprosy

This type has more symptoms.

Early on, you may experience a stuffy nose, nasal discharge and bleeding.

You can have swelling of your limbs, such as your ankles and legs.

Ulcers can develop.

Then the skin lesions start to appear.

They are widespread, and can be pale or red in colour.

These have normal sensation.

They will progress to form nodules and plaques.

In the advanced stages, your forehead can thicken to resemble that of a lion’s (leonine facies).

Your eyebrows and eyelashes are lost.

Your nose thickens and distorts, as do your earlobes.

This is the “disfiguring” sort of leprosy that we have come to know as the so-called “hallmark” of the disease.

Other organs like your eyes, liver, bones and kidneys may also be involved and become inflamed, giving rise to health issues stemming from these organs.

Naturally, there are many types of skin lesions in between.

If diagnosed early, leprosy need not progress to these advanced stages.

Unfortunately, in many poor and remote communities, they do not have access to medical care, and so, leprosy may run its full course.

Can leprosy cause death?

If not treated, one of your major organs may become affected and lead to a slow death.

But nowadays, leprosy can be detected early on, as well as treated early, so that you do not have to progress to the disfiguring stages.

The disease is treated with a cocktail of antibiotics for up to six months to a year.

If you believe you have been exposed to someone with leprosy, you can also be treated with a prophylactic (preventive) antibiotic.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email [e-mail]. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.