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Leprosy: the ancient disease scientists can't solve

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https://www.bbc.com/future/article/20230...cant-solve

EXCERPT: Leprosy is a chronic infectious disease, attacking the skin, nerves and mucous membranes. [...]  In Brazil, one of three countries that account for most of the 200,000 new leprosy cases every year alongside India and Indonesia, armadillos are hunted for meat.

One study by researchers found 62% of the armadillos killed by hunters were infected with M. leprae (similar surveys in the US – where there are between 150-250 new cases in humans reported each year – have found 20% of the animals there carry the bacterium). In the US, they have been blamed for a rise in cases in Florida...

[...] Why has leprosy remained so mysterious – and proved so hard to solve? Crucially, could this be about to change?

[...] According to Sunkara, there are a number of factors involved. For one, M. leprae replicates extremely slowly, so it can take between two and 20 years before an infected person shows any symptoms of the disease. The average incubation time (the time between exposure to the bacteria and symptoms first appearing) for the disease is five years, and in rare cases, a patient may have no symptoms for two decades.

"This bacteria has a longer incubation time," says Sunkara. "It takes about 14 days for one bacteria to divide into two in the body, as compared to other disease causing bacteria which can double in minutes," says Sunkara. For comparison, in optimal conditions the common gut bacteria Escherichia coli, some strains of which cause cases of food poisoning, can divide once every 20 minutes.

The long incubation time is problematic not just for the patient, but also those around them. During this time, a patient who doesn't know that they've been infected can pass on the infection to others, particularly to close contacts such as family members.

Once a leprosy infection has become established and developed into the multibacillary form, it can take up to two years to treat, even with a combination of antibiotics. Another issue is antibiotic resistance. The original treatment for leprosy was the antibiotic dapsone, which was discovered to be effective against the bacteria in the 1940s – before then, it was incurable. However, by the 1960s, this drug was becoming less effective.

Today there are several more effective options, particularly the antibiotic rifampicin. The modern approach of using several antibiotics together was partly designed to prevent resistance developing again, but this remains an ongoing concern. 

On the other hand, with early diagnosis and treatment, leprosy is an order of magnitude easier to eliminate. Unfortunately, diagnosing leprosy is extremely difficult... (MORE - missing details)
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