Leprosy Mailing List – February 19, 2020
Ref.: (LML) The importance of undiagnosed LL patients in spreading HD
From: Ben Naafs, Munnekeburen, the Netherlands
Dear Pieter,
I read the extensive message of Joel Almeida and the article in the newspaper he just sent (https://www.theweek.in/health/more/2020/02/10/a-deformed-system.html - note editor: very interesting article indeed – please read!).
It is clear that only a subpopulation (in a not inbred society) can develop leprosy and thus spread it. That this is genetic is clear. Already Roger and Muir in 1946 saw only 8 % of the exposed develop leprosy. Most researchers cited a similar figure. Only Lara, Palafox and Nolasco (1956) on Cullion reported 36.2% in children living with their affected parents (that was what I cited from memory in my recent letter as 40%). Here exposure and genetics working together is very likely.
It is most important to look at the total pool of infective M. leprae and the possibility of surviving in the environment. In the article it is clear that more or less polar lepromatous patients have contributed to that pool. That is why leprosy as Joel states "in some societies behaves like a non-infectious disease as no carriers are known".
Leprosy seems not to survive for long on clean non-soil surfaces (though their antigens may be present for a longer time). I think that when one is exposed mostly through the nose (as in affluent societies) that may explain the more multi bacillary leprosy in these "affluent societies"; in places when you are exposed mostly through the skin, more paucibacillary leprosy will be found. Increasing concrete floors may contribute to nasal direct exposure and thus lepromatous leprosy too (adaptive immune system).
How do people in the village bath? Are there regular meetings where people sit close together? Is that on soil or wood or concrete.
I feel that it is not only important to define the carriers, but also to look at the route of infection. Do not fall for the Covid-19 approach!
Regards
Ben
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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