Ecuador
The Damien House
Leprosy: Biblical Curse or modern reality?
The Damien House continues to offer hope for those afflicted by this ancient malady.
By Elizabeth A. Szalay M.D.
People express surprise that leprosy, now known as Hansen’s disease, exists in the world today. Isn’t it a biblical myth, such as prophetic dreams, manna from heaven, and seas that part to permit passage? My medical school barely mentioned leprosy, so my association with the Damien House in Guayaquil, Ecuador, led me to investigate on my own to learn about this ancient and frightening malady. Mycobacterium leprae is a bacterium that is transmitted from human to human, possibly through inhalation of the bacteria, but it generally requires prolonged personal contact for infection to take place. It has never been grown in laboratory culture, making research on the disease challenging.
The bacterium has an affinity for skin, mucous membranes, and nerve cells, and produces a sticky substance that induces the nerve lining cell to ingest the bacterium. The bacterium thrives in body regions with cooler temperatures: the skin, mucous membranes such as the nose, and certain nerves. Nerves with more superficial courses, such as facial nerves and peripheral nerves of the limbs, are most severely infected deep nerves being protected by the
higher core body temperatures. An intense inflammation within the nerve occurs, often resulting in gross enlargement of the nerve. Profound nerve compression injury may occur where the nerve passes through tight canals such as the carpal tunnel or certain nerve tunnels in the skull. Intense pain may ultimately give way to numbness and inability to perceive injury. The constricted nerve causes muscle weakness. When one cannot feel pain and the limb is weak, injury follows, leading to infection, gangrene, and loss of limb. A systemic “crisis” can occur when treatment kills many bacilli. The dying bacilli cause a severe painful systemic reaction and a rash called “erythema nodosum.” These symptoms can be alleviated by either high dose steroid treatment or by the use of the drug thalidomide, history’s most infamous drug in the 50’s for causing birth defects in newborns. Thalidomide has been approved by the FDA for the treatment of severe crisis in Hansen’s disease. Antibiotic treatment, which is usually 2 or 3 drug therapy for 6 months, is rapidly effective in eliminating the infection –one is no longer contagious almost immediately upon beginning treatment–but despite “cure,” the ravages of the nerve damage continue and may worsen for years. It is perhaps ironic that one of the side effects of Dapsone, a mainstay drug of treatment, can be characteristic changes in facial pigmentation that mark one forever as having been “a leper.” These individuals, although cured of the disease and no longer infectious, may be, because of the telltale marks, denied reentry into society and may remain outcasts like their biblical predecessors. St. Anthony’s Alliance partners with Sr. Annie Credidio in her remarkable 19 year mission to individuals with Hansen’s disease in Guayaquil, Ecuador. She and they have created a loving home and haven as well as an inpatient and outpatient treatment facility and outreach programs. If you would like to visit the Damien House in Guayaquil, learn more about this facility and ways you can help, or to earmark a donation for the Damien House, contact any of the Board of Directors.
