Hi Julie!
My understanding of leprosy is that it is a disease of the nerves and causes
a lack of sensation in the limbs. The reason some people with this disease
loose limbs is because they cannot feel pain, so when they have an injury or
infection, it does not hurt, and they often do not seek treatment.
From Wikipedia:
Leprosy is primarily a _granulomatous_
(http://en.wikipedia.org/wiki/Granuloma) disease of the _peripheral nerves_
(http://en.wikipedia.org/wiki/Peripheral_nerves) and _mucosa_ (http://en.wikipedia.org/wiki/Mucosa) of the
_upper respiratory tract_ (http://en.wikipedia.org/wiki/Upper_respiratory_tract) ;
skin lesions are the primary external symptom._[2]_
(http://en.wikipedia.org/wiki/Leprosy#_note-Sherris) Left untreated, leprosy can be progressive,
causing permanent damage to the skin, nerves, limbs, and eyes. Contrary to
popular conception, leprosy does not cause body parts to simply fall off, and it
differs from _tzaraath_ (http://en.wikipedia.org/wiki/Tzaraath) , the malady
described in the Hebrew scriptures and previously translated into English as
leprosy._[3]_ (http://en.wikipedia.org/wiki/Leprosy#_note-0)
and
The exact mechanism of transmission of leprosy is not known: prolonged close
contact and transmission by nasal droplet have both been proposed, and,
while the latter fits the pattern of disease, both remain unproved._[10]_
(http://en.wikipedia.org/wiki/Leprosy#_note-1) The only other animals besides
humans to contract leprosy are the _armadillo_
(http://en.wikipedia.org/wiki/Armadillo) , chimpanzees, _sooty mangabeys_
(http://en.wikipedia.org/wiki/Sooty_mangabey) , and _cynomolgus macaques_
(http://en.wikipedia.org/wiki/Crab-eating_Macaque) ._[11]_ (http://en.wikipedia.org/wiki/Leprosy#_note-2) The bacterium
can also be grown in the laboratory by injection into the footpads of
mice._[12]_ (http://en.wikipedia.org/wiki/Leprosy#_note-3) There is evidence that
not all people who are infected with M. leprae develop leprosy, and genetic
factors have long been thought to play a role, due to the observation of
clustering of leprosy around certain families, and the failure to understand why
certain individuals develop lepromatous leprosy while others develop other
types of leprosy._[13]_ (http://en.wikipedia.org/wiki/Leprosy#_note-4) However,
the role of genetic factors is not clear in determining this clinical
expression. In addition, malnutrition and possible prior exposure to other
environmental _mycobacteria_ (http://en.wikipedia.org/wiki/Mycobacteria) may play a
role in development of the overt disease.
The most widely-held belief is that the disease is transmitted by contact
between infected persons and healthy persons._[14]_
(http://en.wikipedia.org/wiki/Leprosy#_note-5) In general, closeness of contact is related to the dose
of infection, which in turn is related to the occurrence of disease. Of the
various situations that promote close contact, contact within the household is
the only one that is easily identified, although the actual incidence among
contacts and the relative risk for them appear to vary considerably in
different studies. In _incidence studies_
(http://en.wikipedia.org/wiki/Incidence_(epidemiology)) , infection rates for contacts of lepromatous leprosy have
varied from 6.2 per 1000 per year in _Cebu_ (http://en.wikipedia.org/wiki/Cebu) ,
_Philippines_ (http://en.wikipedia.org/wiki/Philippines) _[15]_
(http://en.wikipedia.org/wiki/Leprosy#_note-Doull_1942) to 55.8 per 1000 per year in a
part of Southern _India_ (http://en.wikipedia.org/wiki/India) ._[16]_
(http://en.wikipedia.org/wiki/Leprosy#_note-Noordeen_1978)
Two exit routes of M. leprae from the human body often described are the
skin and the nasal mucosa, although their relative importance is not clear. It
is true that lepromatous cases show large numbers of organisms deep down in
the _dermis_ (http://en.wikipedia.org/wiki/Dermis) . However, whether they
reach the skin surface in sufficient numbers is doubtful. Although there are
reports of _acid-fast bacilli_ (http://en.wikipedia.org/wiki/Acid-fast) being
found in the _desquamating_
(http://en.wikipedia.org/w/index.php?title=Desquamating&action=edit) _epithelium_ (http://en.wikipedia.org/wiki/Epithelium) of
the skin, Weddell et al have reported that they could not find any acid-fast
bacilli in the _epidermis_ (http://en.wikipedia.org/wiki/Epidermis) , even
after examining a very large number of specimens from patients and
contacts._[17]_ (http://en.wikipedia.org/wiki/Leprosy#_note-Weddell_1963) In a recent
study, Job et al found fairly large numbers of M. leprae in the superficial
_keratin_ (http://en.wikipedia.org/wiki/Keratin) layer of the skin of
lepromatous leprosy patients, suggesting that the organism could exit along with the
_sebaceous_ (http://en.wikipedia.org/wiki/Sebaceous_gland) secretions._[18]_
(http://en.wikipedia.org/wiki/Leprosy#_note-Job_1999)
So, it would appear to me that the close contact required to feed baby at the
breast may be a concern, and perhaps measures should be taken in that
regard IF THE MOTHER IS NOT BEING TREATED.
This document from WHO reads that it is not necessary to discontinue
breastfeeding nor to separate mother and baby:
_www.who.int/child-adolescent-health/New_Publications/NUTRITION/Breastfeeding/
Trainers_Guide_Part4.pdf_
(http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/Breastfeeding/Trainers_Guide_Part4.pdf)
I hope this is helpful,
Laura Goodwin-Wright
Date: Tue, 30 Oct 2007 06:48:34 -0700
From: julie taylor <[log in to unmask]>
Subject: leprosy
I have just been advised of a patient laboring at this very moment with
leprosy, she intends to breastfeed. What I know about leprosy is, to be frank,
limited. I have discovered that the AAP considers the drug used to treat it,
compatible with breastfeeding. What I am concered about is if she is
unmedicated. Should she breastfeed?
If anyone out there is familiar with this disease I would be grateful for
advice.
Many thanks.
Julie Taylor
RN IBCLC
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