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James Hamilton, M. D.
Medical History Quiz #4
As I recall - please correct me if I am in error - in our English classes at BWHS among our assignments each year we were given one Catholic/religious novel to read. The one that stands out in my memory was about St. Damien De Veuster of Molokai - Damien the Leper. I'm sure you all know his story of ministering to the sick in the leper colony on the Hawaiian Island of Molokai, where he, himself, became infected and died of the disease in 1889.
I think most people think of leprosy (Hansen Disease) as something of the past, a disease of biblical times. Actually, it is a not uncommon problem in some countries throughout the world, including the Americas, and infects about 150 or so people in the USA yearly.
The causative bacterial agent(s) is (are) Mycobacterium leprae (and the genetically different but related M. lepromatosis,which causes the same clinical disease). You may recognize the genus, Mycobacterium, as the same one that produced the species that causes tuberculosis.
These leprosy-causing bacteria are obligate intracellular bacteria, which means they cannot grow or reproduce outside of a host cell. Thus, one cannot grow them on agar plates like strep and most other germs. That makes it difficult to test them to different antibiotics and develop specific vaccines to immunize those at risk of infection.
Outside of man, the only known host/reservoir creature whose cells carry these microbes is the Nine Banded Armadillo, a common resident of the Southwest and South. In 2015 three armadillo-related cases were reported in one county in Florida. It is very difficult to track down sources of leprosy infection from these critters (or human sources also) since the incubation period for leprosy can be up to ten years.
Leprosy is not easy to get. It is believed to be respiratorily spread but not casually. Handling or eating armadillos is also a source. The disease affects skin and peripheral nerves as well as eyes. There are six various stages of infection, but that is beyond what I want to discuss.
Treatment is multi drug (antibiotics which includes some that are used to treat TB along with a medicine called Dapsone) for up to 24 months or longer. Why so long? These buggers have a VERY slow growth rate and antibiotics work when they are in a growth phase. If treated in the early stages there can be up to a 99% "cure" rate, BUT late recurrences - up to 20 years later - can occur.
A vaccine that has been used to help prevent TB, Bacillus of Calmette-Guerin (BCG vaccine), is only about 50% effective for leprosy prophylaxis.
So, here are the Quiz Questions:
1. Leprosy causes nerve damage and pain is not always felt. How did Father Damien realize he had contracted the disease (in the book)?
A. When his hand brushed over a candle flame he felt no pain
B. He dropped an iron pot on his bare foot and felt no pain
C. He splashed boiling water on his hand and felt no pain
D. He noticed a characteristic lesion on the bottom of his foot
E. He noticed a characteristic lesion on his chest
2. The leper colony on Molokai has long since closed. The last one in the USA , which is now a museum, was located where?
A. Las Vegas, New Mexico
B. Carville, Louisiana
C. Lufkin, Texas
D. Mossyrock, Washington
E. Newton, Georgia
Jim
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