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Chapter 14 : Leprosy, the Striking Hand of God

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Abstract:

The pandemic of leprosy reached epidemic proportions in the 12th century and had its peak in Europe in the 13th and 14th centuries; records showing the construction of 19,000 lazarets document this increase in leprosy in Europe. The disease involves cell-mediated immunity with T-helper cells and interleukin-2 secretion in tuberculoid leprosy, but since the bacteria multiply within the Schwann cells that insulate the nerve, there is damage to the nerves, and anesthesia results. In lepromatous leprosy, the T-helper cells do not respond to the bacilli—gamma interferon is not produced, macrophages are not activated, and as a consequence the bacteria multiply within the macrophages and the disease spreads with multiple organ involvement, leading to facial deformity and blindness. Mycobacterium bovis BCG vaccination for tuberculosis has had a positive effect on leprosy by reducing the incidence by 20 to 80%. The vaccine stimulates the immune system of leprosy patients by disrupting immune tolerance and provoking an immune response that kills and clears M. leprae from the body. Leprosy has been a dreaded and disfiguring disease since time immemorial. Although today we know that for transmission to occur there must be prolonged contact with the infected individual, and that the disease is curable, one still does not know the precise mode of transmission or how nerves are destroyed. But, most important, as with AIDS, one still does not know how to completely remove its stigma from the consciousness so that discrimination of those afflicted is abandoned.

Citation: Sherman I. 2006. Leprosy, the Striking Hand of God, p 302-311. In The Power of Plagues. ASM Press, Washington, DC. doi: 10.1128/9781555816483.ch14
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Figures

Image of Figure 14.1
Figure 14.1

Job stricken with a plague, as depicted in a 17th century woodcut. Job lies on a pile of dung dressed in a loincloth and covered with boils. (Courtesy of the Wellcome Library of Medicine.)

Citation: Sherman I. 2006. Leprosy, the Striking Hand of God, p 302-311. In The Power of Plagues. ASM Press, Washington, DC. doi: 10.1128/9781555816483.ch14
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Image of Figure 14.2
Figure 14.2

The clinical appearance of infections with Mycobacterium leprae, the cause of leprosy. (A) Drawing of a leprosy patient in On Leprosy by Danielsen and Boeck (1847). (B and C) Facial and hand deformities associated with leprosy. (Panel A is courtesy of the Wellcome Library of Medicine and panels B and C are courtesy of Wallace Peters.)

Citation: Sherman I. 2006. Leprosy, the Striking Hand of God, p 302-311. In The Power of Plagues. ASM Press, Washington, DC. doi: 10.1128/9781555816483.ch14
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Image of Figure 14.3
Figure 14.3

Leper announcing his arrival in the city with the ringing of a bell. Water color by R. Cooper. (Courtesy Wellcome Library of Medicine.)

Citation: Sherman I. 2006. Leprosy, the Striking Hand of God, p 302-311. In The Power of Plagues. ASM Press, Washington, DC. doi: 10.1128/9781555816483.ch14
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References

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