August 2, 2024 • 33 mins
Curious about how armadillos and ancient diseases intersect? Prepare to be captivated as we unravel the fascinating mysteries surrounding Hansen's disease, more commonly known as leprosy. We start this season with some fresh faces: Christina Rios, a first-year medical student with a veterinary background, and Camille Ledoux, a third-year PhD candidate specializing in infectious disease biology. They join us for a lively discussion that seamlessly transitions from humorous pop culture references to the serious history of leprosy. With expert insights from Dr. Dacso, we uncover the history, clinical presentations, and treatments of this age-old disease.
Ever wondered if Godzilla could be a carrier of leprosy? We tackle this amusing hypothesis head-on, while focusing on the real-life connection between armadillos and Hansen's disease. Discover how armadillos, unlike our reptilian movie monsters, play a pivotal role in scientific research due to their susceptibility to Mycobacterium leprae. Learn about the ways armadillos are used as laboratory models to replicate human symptoms, helping us understand critical aspects of nerve damage and skin lesions in leprosy patients. We'll also discuss the methods of transmission and the historical stigma that has long surrounded this misunderstood disease, plus essential safety precautions for those who might encounter armadillos in the wild.
Stigma has always clouded diseases, like leprosy, TB, and HIV, but can compassion and education pave the way for change? We explore this complex issue by examining the history of Hansen's disease, including possible origins and the evolution of human resistance. Drawing parallels with the stigma surrounding other infectious diseases, we emphasize the importance of empathy and higher-order thinking in overcoming fear and prejudice. Our conversation aims to foster a more inclusive society where health care is accessible and free of stigma, proving that understanding the interconnectedness of global health can lead to a more compassionate world. Join us for an episode rich in science, history, and heartfelt discussion.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 2 (00:09):
This is a podcast about One Health the idea that
the health of humans, animals,plants and the environment that
we all share are intrinsicallylinked.
Speaker 3 (00:17):
Coming to you from the University of Texas Medical
Branch and the GalvestonNational Laboratory.
Speaker 2 (00:21):
This is Infectious Science, where enthusiasm for
science is contagious.
Hey everybody, welcome back toanother episode of Infectious
Science and, dare I say, anotherseason, a new season, a new
season Season two we're born,born anew Season two.
We have a couple of new faceshelping us out here today and
(00:45):
I'm going to let them introducethemselves.
Christina, do you want tointroduce yourself?
Speaker 1 (00:49):
Yes, my name is Christina Rios.
I am a first year medicalstudent here at UTMB and I'm so
happy to be working with youguys this season on the podcast.
I just really wanted to join inbecause I found our block of
infectious disease studies to beincredibly interesting, and I
previously worked in veterinarymedicine before I came to
(01:09):
medical school.
Actually, I've always wanted togo into human medicine.
Really funny story how I gotinto veterinary medicine, but I
loved it regardless, and so whenI first had a presentation from
Dr Benta really resonated withme the interaction between
veterinary and human medicineand sciences.
So, so, so grateful to behelping out this season.
Speaker 4 (01:30):
And Christina, you know well, first of all, welcome
right.
But you know that real doctorsstudy more than one species.
Speaker 5 (01:36):
Yes they do, yes, they do.
Speaker 2 (01:40):
As you were mentioning that, christina, I
was thinking about the firstTerminator movie.
When Arnold Schwarzeneggerlands, I think he actually gets
treatment in the veterinaryclinic From a vet.
Speaker 1 (01:50):
I mean, I appreciate that.
Speaker 5 (01:51):
Growing up in a rural area.
Sometimes the vet clinic wasprobably a better bet than the
local hospital.
Speaker 1 (01:55):
I was going to say probably shouldn't share it, but
definitely done some human CTs,Some veterinary CTs.
Speaker 4 (02:03):
But Arnold Schwarzenegger is a robot.
Why would a robot go to?
I don't know.
Speaker 5 (02:07):
Isn't he a cyborg?
Isn't he a cyborg?
Isn't he like part robot?
Yeah, so that's you know, acyborg.
Another species, technically.
Speaker 4 (02:14):
Well, I'm excited we're going to talk about
Godzilla today.
Yes, we digress.
Speaker 5 (02:27):
We get a veterinarian's opinion on
Godzilla Camille.
I'm Camille Adu.
I am a third-year PhD candidatehere at the University of Texas
Medical Branch.
I grew up on a livestock farmand shadowing a vet and that's
how I got interested ininfectious disease biology and
when I went to college, that wasmy concentration.
So I've worked with all kindsof pathogens.
I've worked with cholera,completely antibiotic-resistant
flesh-eating bacteria.
I've worked with bacteriophages, which are very neat and I hope
(02:47):
we do an episode on them andcurrently I work in a lab that
studies viruses that infect thebrain in the context of
infectious diseases, the socialand the economic and the
geopolitical things that shifthow health changes across the
(03:09):
globe, and I think that this isa really cool opportunity to
dive more into them and also totalk to some of my favorite
people and get their ideas andget their answers to all my
questions.
Speaker 4 (03:18):
So I'll be coming with lots of people.
Speaker 5 (03:20):
Definitely definitely Dr Dasha, dr Bente.
Definitely definitely Dr Dasha,dr Bente.
My favorite professors,definitely.
So I'm glad to be here and getto just have a chance to chat
and learn more.
Speaker 2 (03:32):
Straight.
Speaker 5 (03:32):
A's, camille, you get it.
Speaker 3 (03:33):
Thank you, there's your PhD.
Speaker 4 (03:36):
So, Matt, tell us real quick what are we supposed
to expect from the new season.
Speaker 2 (03:40):
New season, everybody be looking for some new faces,
new discussions.
We're going to have a lot ofreally great guests.
We're going to be trying tocontinue to get people excited
about One Health and aboutscience and all the great things
that are going on around us anddestigmatize the world around
us.
Sounds good.
That's our plan.
Dennis Benta Dr Benta is hereas well, Myself, Matt Dasho and
(04:03):
yeah, today we're going to belaunching into a discussion
about one of the oldest, one ofthe wisest pathogens in human
existence.
Speaker 4 (04:11):
Can pathogens be wise .
I mean, they don't have a brain, you're anthropomorphized Been
around for a while.
Speaker 2 (04:16):
Yes, and that is Anson's disease or mycobacteria
M leprae.
So we'll get into thatdiscussion shortly.
Speaker 5 (04:26):
Excited to be here for our episode of Infectious
Science.
Today we'll be talking aboutHansen's disease, also known as
leprosy.
According to the CDC, the riskof getting Hansen's disease is
quite low for most adults in theworld, and that's because more
than 95% of all people havenatural immunity to the disease.
The only real risk is being inprolonged contact with someone
(04:46):
who has untreated Hansen'sdisease.
It's caused by mycobacteriumleprae, and what's interesting
is that this is a disease that'sbeen with humans for a very
long time.
The earliest skeletal evidenceof leprosy that I found in
literature was actually frommore than 4,000 years ago, and
the earliest written evidence wehave is 2,000 years old.
So this has been with humanityfor a very long time, and so
(05:08):
with us today we have Dr Dasho,who has actually seen a patient
with Hansen's disease.
Dr Dasho, could we hear a bitabout the clinical presentations
of M leprosy that physicianssee and how it's treated?
Speaker 2 (05:20):
Yeah, thanks, camille .
This is Matt Dasho, and welcometo the podcast.
Hello everybody.
Yeah, thanks, camille.
This is Matt Dasho, and welcometo the podcast, hello everybody
.
Yeah, thanks for that, camille.
Obviously, leprosy has beenaround for a very long time.
It's something that it datesback, as you mentioned,
millennia.
I think the earliest documentedcases were from even 4000 BCE.
It was in the Bible, right.
Lepers were people who weresuffering from this condition,
(05:42):
were ostracized, stigmatized andoften separated in very
profound ways from theirfamilies and from their loved
ones.
And I think you mentioned itreally well before.
This is a chronic cutaneousdisease and it's caused by
bacteria.
It's a mycobacterium.
We know mycobacteria are very,very slow growing bacteria and
(06:02):
it's caused by one of twostrains of that bacteria, called
either M leprae ormycobacterium leprae or
mycobacterium lepromatosis, andthey're pretty much clinically
indistinguishable.
I've had two brushes orencounters with leprosy.
I've not myself treated someone.
We're going to be lucky enoughto speak with a clinician who
has spent a lot of her careerstudying leprosy and especially
(06:25):
the pathologic elements ofleprosy, who happens to be my
sister, dr Mara Dasho, and soshe will be on with us a little
later to talk about some of herexperience.
But most often it presents as achronic cutaneous condition
that mostly affects the digits,the extremities and the parts of
the skin that are at the distalends.
(06:47):
You'd often see it on the nose,the earlobes, the cheeks.
The route of infection isactually not cutaneous, it's
probably aerosol and, as youmentioned, you can be around
people with leprosy many timesand not get leprosy So-.
Speaker 4 (07:01):
So, matt, sorry to interrupt you, but what I heard,
the reason why they preferareas like the nose and the
cheeks and finger and the digitsand so on, as you said, it's
because the bacteria really likea lower temperature and that's
obviously where the bodytemperature is a little bit
lower, right, yeah?
Speaker 2 (07:18):
I have heard that and that also makes a lot of sense.
So, as Camille was mentioning,this is a really fascinating
condition, hansen's disease.
It has a very, I think,variable clinical spectrum, but
most of the time people arecoming in with years of
cutaneous infections.
They have a highly variedappearance.
We'll ask Dr Dasho other DrDasho to maybe comment in a more
(07:38):
knowledgeable way.
As a dermatopathologist she candescribe those things in much
greater detail.
But yeah, that's the clinicalpresentation and the
epidemiology.
It's really interesting becauseit's a disease that's not seen
all around the world.
It's really only in certaincountries and in certain
clusters of populations.
Speaker 5 (07:55):
I actually found some interesting research on why
that is so.
First and foremost, somethingthat's cool from a One Health
perspective is I actually foundsome research where they were
looking at both archaeologicaldata and then data from
basically genetic samples frompeople that are living in urban
areas, and what they found isthat basically living in urban
areas which is something thatwe've sort of recently started
(08:17):
to do as a species has basicallyallowed us to develop a
resistance to things liketuberculosis and leprosy.
So if your ancestors were in amuch more urban environment,
they were more likely to beexposed to a lot of different
pathogens.
Ancient cities were not thecleanest.
That's something reallyinteresting that we're now
finding out.
It's relatively new that welive in cities, and so that has
(08:40):
changed how and why people mightbe resistant to some diseases
like leprosy.
But something else that I found,particularly if we think about
a population that does have areally high proportion of
leprosy, which is theMarshallese population, and just
to give you an idea of how muchhigher it is, so in the United
States it's 0.0083 per 10,000people, which is a very low
(09:03):
prevalence, but for the peoplefrom the Marshall Islands it's
12 per 10,000 people, which is avery low prevalence, but for
the people from the MarshallIslands it's 12 per 10,000
people, which is incredibly high, and I found that there's a
couple different reasons thatare speculated for that.
Some of it is housing, but someof it's also there's a
hesitancy to seek medical care,and the longer it's untreated,
the more likely you are to havemore severe complications from
(09:23):
it things like nerve damage andstuff like that.
Speaker 2 (09:26):
Yeah, no, and I think one of the things you mentioned
is really important is that,because it's so uncommon in the
US, it's often not somethingthat clinicians are looking for.
We see chronic skin diseaseswe're thinking allergic problems
, malignancies, other cutaneousinfections, and Hansen's disease
doesn't always jump to the topof the list.
But, as you mentioned, thereare certain populations.
This is where I think yourknowledge of the world and of
(09:48):
epidemiology is really important.
You know we're a globalizedsociety, right?
This is the human migration,the migration of people, for all
the reasons that people migrate, has put us in contact, I think
, in the US and around the world, with diseases we may not have
previously thought to look for.
So you mentioned the MarshallIslands.
I mean, marshall Islands is avery, very interesting
particular case.
(10:08):
Many people don't know muchabout the Marshall Islands, but
they're an archipelago, it's anation of islands that are run
about 70 miles and they're inthe South Pacific.
And if anybody has seen themovie Godzilla, the opening
sequence is of a nuclear testand this is actually footage
from a nuclear test that wasconducted in Bikini Atoll in the
(10:28):
Marshall Islands.
So I can nerd out for hours andhours about the strategic
importance of the MarshallIslands.
But the US found the MarshallIslands to be of strategic
interest, especially during andin the aftermath of World War II
, when there was active war withJapan, and so having military
presence in the South Pacificwas seen as quite important.
We know we have military basesin Hawaii, et cetera.
(10:49):
Marshall Islands were deemed tobe a good place for nuclear
testing in the years followingWorld War II, and so obviously
this exposed a lot ofMarshallese to toxic levels of
radiation.
There were certain parts of theislands that were rendered
uninhabitable, and so it pushedpopulations of people closer and
closer together and resulted,through a series of agreements
(11:09):
with the US government, thatMarshallese could actually come
live and work in the UnitedStates without visas.
So they were given sort of aspecial status through something
called the COFA agreement,which we won't go into.
But the Marshallese also have amuch higher incidence,
continued incidence, ofmycobacterium leprosy or M
leprae, and MTB.
So mycobacterial infections arehighly prevalent in that
(11:31):
population.
Speaker 4 (11:31):
As well, I guess this brings us back to the topic
that we've discussed many timesdisplaced populations and the
influence on density anddiseases and stuff like that.
But I think for me the mostimportant question is does
Godzilla have leprosy, or isGodzilla a reservoir?
Is?
Speaker 2 (11:47):
he a reservoir?
Is Godzilla a reservoir?
Speaker 5 (11:50):
As the veterinarian in the room, could you tell us a
little more about reservoirsfor?
Speaker 2 (11:55):
I feel like Godzilla could have some armadillo in him
.
Yes, yeah, because it's reallyarmadillos, right, dennis?
That are some of the morecommon reservoir hosts.
Yeah, you don't have to go nerdout on armadillos yet.
I know we're going to get toyour armadillos.
Speaker 4 (12:08):
No, but I want to nerd out on Godzilla, because I
think Godzilla is a reptile.
That's what I was always toldand I think for me, the
perception was always thatarmadillos, they're actually
mammals and they're actuallyclosely related to anteaters and
sloths.
So they are placental mammalsand they just so happen to be
(12:30):
very susceptible tomycobacterium leprae and that's
why they've been traditionallyused as a laboratory animal to
study the disease.
And the key thing here is thatthe reason why they are being
used as an animal model isbecause they mimic the human
disease very well.
So what you see in a humandisease and I hope Matt will get
into that in a second themyopathy, the nerve damage, the
neuropathologies and so on arevery similar to what's seen in
(12:54):
humans.
So in terms of face value, it'sa very good model that mimics
human disease.
So what are the clinical signs?
Speaker 2 (13:00):
Yeah, so I talked a little about the skin lesions,
which remember that people getexposed and they may not
manifest disease for many, manyyears.
Anywhere from one up to 30years have been described, but
usually four to eight years fromexposure people will start to
manifest skin lesions.
But really the reason all thatcomes about is, as you mentioned
, dennis, because the diseaseaffects Schwann cells and
(13:21):
histiocytes and things like that.
There's nerve damage,especially peripheral nerves,
and so it's often said thatpeople with Hansen's disease
just don't feel pain in thoseextremities and so they're
constantly injuring them,bumping them into things,
they're getting burned, and sothose get secondarily infected
and there are erosive damagesthat happen.
There's all kinds of stuff thatyou do, unconsciously, your
(13:42):
brain does to keep yourextremities intact and to keep
your skin intact and keep yourbones from getting hurt.
You will feel pain, you willfeel discomfort, you will say
I'm going to sit down or I'mgoing to put on shoes.
People with Hansen's disease donot have those natural
responses and so they start todevelop a lot of erosive changes
of both the skin and then ofthe nerves and then ultimately
of the bones as well.
(14:03):
So you'll see digits missing,you'll see neural digits, you'll
see often pretty erosivechanges of those extremities and
then on the skin you'll seethese ulcerative lesions that
pop up on the ears, on the nose,on the cheeks and then
obviously on the surface of theskin.
Speaker 4 (14:19):
So you're saying and I'm stealing a lot of Camille's
questions here it's ulcerative,but it's not contagious though.
Right, so we don't have to beafraid if we see somebody with
leprosy and they touch us orgive us the hand.
That's not a way oftransmission.
Right, that's correct.
Speaker 2 (14:33):
That's correct.
I think that was one of thethings is, prior to the
elaboration of this pathogen asa respiratory pathogen mostly
respiratory there was a hugeamount of stigma.
I remember germ theory is arelatively new innovation for
our species, so people thoughtit was miasmas, they thought it
was genetic and it wasn't untilNorwegian scientist Gerard Armer
Hansen, who lived from 1841 to1912, checks notes.
(14:59):
In the late 1800s hecharacterized the infectious
Asian as a mycobacterium andthat let them make the name of
what was previously calledleprosy, which was a very
stigmatizing name.
They called it Hansen's disease.
Speaker 5 (15:12):
And, if I can just jump in, something you mentioned
was that this particularbacteria has a bit of a tropism
for a certain type of cells.
So Schwann cells and for thoselistening who might not be
familiar with these, I had tolook them up myself and I work
in a neuroscience lab they'reglial cells and they form the
myelin sheath on axons outsidethe brain, which is really
important.
But what's really interestingis that the bacterium actually
(15:34):
promotes a nuclear reprogrammingand de-differentiation of these
host Schwann cells and theybecome progenitor stem-like
cells that are more vulnerableto infection, which I think is a
really fascinating mechanism bywhich it's infecting.
And, dr Pente, I also had aclarifying question for you on
what you said about armadillos.
So if, as Dr Daschow hasmentioned we've talked about,
(15:55):
it's primarily a respiratorypathogen, are there any
precautions the public shouldtake when dealing with
armadillos?
We certainly have them here inTexas.
Should people avoid contactwith armadillos and how many
armadillos are really carryingamblaprae?
Speaker 4 (16:07):
Yeah, before I answer your question, I want to go
back to what I said previously.
I think we talked about thestigma of humans and I think
that's the stigma witharmadillos.
The bacterium can be carried bya range of different animals,
so it can be wild rodents, itcan be a range of different
mammals, non-human primates Incertain areas we have different
species, even chimpanzees ormanga bees, that can carry the
(16:30):
disease.
But I think the reason whyarmadillos are always so in the
focus is because they showdisease and so they have an
active, ongoing infection, andthat obviously makes them more
relevant to transmit the diseaseto humans.
And I'm not a hunter, but I wasalways told that these
armadillos are considered a pestand so if you shoot them
(16:51):
because they are digging holesand they're destroying your
crops and your agriculturalcomponents, you shoot them
because they're a pest.
And I don't know what the meattastes like, but I could assume
that certain people will alsotry to harvest the meat and eat
the meat and in this process ofbutchering the animal or
handling the animal, I thinkthat's where some of the
transmission is happening.
(17:11):
And if you think about that,maybe one in six armadillos in
Texas or in Louisiana arepositive or carry the infection.
That's quite a high risk.
Speaker 1 (17:21):
I just wanted to interject here, dr Benta.
Does leprosy or Hansen'sdisease manifest in armadillos
the same way that it manifestsin humans?
Could you tell that anarmadillo has leprosy or
Hansen's disease?
Speaker 4 (17:34):
When I was doing my literature research and I was
looking into these animal modelsand how good armadillos are to
mimic human disease, I had thesame question and I didn't
really find the answer.
If the Amadillo comes down withsome sort of a muscle disease,
some sort of a neuropathy ofsome sorts, they might be
impaired in their locomotion orin some sort of stuff.
(17:57):
And if an animal is sick, thequestion is always is it easier
prey and is it easier to huntthe animal?
To be honest with you, I'm notsure if they show any sign of
ulcerative cutaneous lesions ornot.
I don't know.
Do you know?
Speaker 5 (18:12):
I do not know, but I wonder if part of the problem is
studying them is that they're,from my understanding, mainly
nocturnal animals.
So if you're trying to get asample in the wild, that might
be difficult for researchers.
But going off of that, thinkingabout ulcerative lesions,
things like that, dr Tasho, Iwanted to ask when I was looking
in clinical literature why aredermatologists the ones who
often diagnose Hansen's disease?
It's not really infectiousdisease docs, from my
(18:34):
understanding.
Is it just that skin checks arenot like a normal part of
seeing a patient?
Speaker 2 (18:39):
That's a good question.
I mean, I think there isobviously the part of it that,
in order to make the diagnosis,you often need a sample, and
it's often dermatologists thatare taking the biopsies or
taking the samples.
Many times, when there arethese chronic lesions, we will
push for a biopsy or push forsome kind of tissue diagnosis,
in which case dermatologists canbe involved.
(18:59):
Some people, when they havechronic skin issues, will
primarily go to a dermatologist,so I think that'll be a good
thing for us to also review withMara, because, as you mentioned
, yeah, dermatologists are goingto be the ones that may
actually pick these things upfirst, but those of us who are
out in the world, I think I'malways curious as to why we
don't have more of it in Texas.
If we have so many armadillos,so many armadillos, we should
(19:20):
all be on the lookout for it.
Speaker 4 (19:23):
Yeah, that's a good question.
I can only speculate.
I guess Probably like 100 or200 years ago, I think, there's
more need for the meat ofarmadillos and nowadays they're
just being shot and then justleft to die and decay.
I don't know how the armadillopopulation has changed over time
, but I think it's also theexposure, the density of the
(19:44):
animals in the area and theexposure to humans.
Speaker 5 (19:48):
I do wonder how armadillos originally became
infected.
Is this something that humansgave armadillos?
Which way did the zoonosis go?
Speaker 4 (19:56):
The chicken and the egg question.
I don't think that anybody willever find out.
Speaker 2 (20:01):
With so many species potentially susceptible to it, I
don't think that you can everfind out what the origins and I
think you mentioned Camille atthe beginning but 95% of the
human population is immune to it.
So when you have thesepathogens that have been around
for literally thousands of years, with generations of people
exposed, and it's a slow-growingbacterium I don't know much
(20:23):
about the genetics but it seemsall very conserved, so probably
the strains and the evolution ofthe bacterial pathogen is not
very fast, so it gives us anopportunity to develop immunity
for it.
Speaker 4 (20:36):
I actually have a quick question for you, camille.
You said that there'sresistance has built in humans.
Over time, you said, from theagricultural development into
the urbanization of things andhumans being exposed over and
over again, they became lesssusceptible to the disease.
Do you know anything about that?
What makes humans now moreresistant to it?
Speaker 5 (20:55):
Oh, that's a really good question.
They were talking abouttuberculosis and leprosy.
They do have loci in the paperbut I don't have them written
down.
But yeah, I'm not a geneticistso unfortunately I can't answer
that now, but I can send it toyou this will be the next
episode.
Speaker 2 (21:07):
Stay tuned, everybody yeah.
Speaker 4 (21:09):
Deep dive on the genetics of the embassy.
Go to the show notes.
Speaker 5 (21:14):
But what is interesting about thinking about
Hansen's disease is that I didfind a paper talking about when
was it introduced to Pacificislands.
So if you're thinking about,like the Marshallese population,
things like that, it was reallyinteresting.
I would have assumed it waswith colonialism, whether that
was Japanese imperialism orEuropean colonialism.
(21:35):
It was not.
Actually, they refute that.
They analyzed basically ninedifferent samples and they found
that it was with the firstmigration of people there.
So this has been with uspotentially even longer than we
have 4,000-old skeleton evidence, but much longer than that.
If it has gone everywhere inthe world, it might have been
reintroduced at different timesand they talk about that a bit
in the paper, but thatsubsequent migrations can move
(21:56):
it around, but that it wasalready there and I think that
that's a really fascinatingthing to think about,
particularly if we're thinkingabout animal reservoirs.
Was this just sort of on allcontinents?
Speaker 4 (22:05):
if it was in the islands.
And I think if there'ssomething we can learn from
Mycobacterium tuberculosis,which is also worldwide and it's
in so many different speciesand it's probably also found in
the soil it's very tenacious inthe soil and you have again the
range of mammals that areinvolved.
So I don't think this is reallyjust a very easy zoonotic
transmission one-to-one, butmaybe there's certain reservoirs
(22:31):
in the soil.
I know, for example, formycobacterium tuberculosis in
Europe, badgers are a big issue.
They can transmit that and theydig and root around and all
kinds of things.
Cows get infected withmycobacterium and so on.
So I don't think it's easy topinpoint the source of something
like that.
It's been probably around for amuch longer time than what?
4,000 years.
Speaker 5 (22:50):
Yeah, that's a really good point and I would say the
stigma surrounding it has alsobeen around for an exceptionally
long time and I would reallylike us to talk about that,
because I think there's always adanger, as someone who works in
the field of infectiousdiseases, in suggesting that
it's a very us-versus-themrhetoric to say, oh, most cases
are acquired outside of theUnited States, because the
reality is our health is soglobally interconnected and if
(23:13):
anyone thought that wasn't thecase, covid-19 proved us wrong.
Every individual's health onthis planet, whether they're
animal or human, is sointerconnected and anything that
happens in one place caneventually kind of shift around,
and it's something we've chosento be so globalized.
But could we talk about more onwhy does this always pop up,
particularly in regards toleprosy?
There's this idea of the stigmaof being morally unclean, and
(23:36):
that's something that has poppedup with other diseases as well.
I think of things like HIV andeven people just making
judgments about particularly anyinfectious disease.
So could we talk about why thatis in the context of leprosy or
other diseases?
Speaker 4 (23:49):
Yeah, I think that leprosy is kind of the poster
child for this.
The stigma, right.
How many colonies and they'retypically isolated islands or
some sanitarium or some hospitalon some remote islands, right,
I think that's really the posterchild for stigma in disease.
Matt, do you have any thoughtson that?
Oh, man.
Speaker 2 (24:08):
Why does it keep happening, camille?
I mean first of all theinterconnectedness of
human-animal environmentalhealth migration.
Someone should really make apodcast about that.
Speaker 4 (24:18):
It's going to be the spinoff.
Speaker 2 (24:20):
Someone should just really, really do that.
I wish I had a good answer forwhy that is.
It's the other, isn't it?
For a long time, I think it waslack of knowledge, lack of
understanding, lack ofcompassion.
Most of the people who weresuffering from Hansen's disease
that were uprooted from theircommunities and put into leper
colonies.
(24:40):
It was done against their will,but the people who cared for
them were often faith-basedcommunities.
These were largely missiongroups that took care of these
populations because they werestigmatized and nobody else
would, and they were in manyways out of the system.
People didn't want to deal withthem and this is a problem of
marginalized groups around theworld and you can look at it as
(25:02):
a stigma of disease, a stigma ofethnicity, of cultural
background, of race, whatever.
The examples of otherizing arerife within society throughout
human history.
So tough one to answer, justspecifically on infectious
diseases.
Speaker 4 (25:17):
And I think the reason why it's probably so
stigmatizing is because theclinical presentation is so
visible, right, and we see thiswith leishmania, for example,
where you have the cutaneousthings that everybody can see.
Keep in mind the driver of whenwe go back to pox, for example,
to the smallpox vaccinations,the initial idea.
(25:38):
When the vaccination was doneby the Chinese, they
purposefully inoculated a lessvirulent version of smallpox in
a part of the body that's notvisible your arm or something
like that, not your face, sothat you don't have the blisters
and the postules and stuff likethat in your face later on.
So I think the appearanceaspect of leprosy is why it's so
(26:01):
.
Ostracizing is the word.
I think it's the right word.
Speaker 5 (26:04):
Yeah, I think that that's an excellent point and I
wonder too if part of that'sjust the psychological aspect of
if you can see something, youcan imagine it happening to
yourself, and that is somethingI think that makes people kind
of resist, like an aversion tolike I don't want that to happen
to me.
So there becomes thisdisconnect between seeing
someone as another person whoalso is deserving of care and
things like that.
And speaking of care, up untilfairly recently there were still
(26:28):
leper colonies.
Does anyone know if there'sstill any in existence?
I know there's remnants.
Speaker 2 (26:34):
Yeah, I think there's remnants.
I don't know that there'sactive places where people with
leprosy have lived.
It's interesting because I knowin some countries people who
are long-term sufferers of thedisease.
They've continued to live inthe same communities because
they're actually quitecomfortable there.
So I think some of it has beenstructural and some of it is
just historic.
But I don't think there's anactive program right now that
(26:56):
says okay, if you have leprosyyou must go to this place
because, as you mentioned before, it's really quite difficult to
acquire.
Speaker 5 (27:02):
Yeah, and then something that I had found that
I just also wanted to mention.
I actually found an interviewfrom a nurse who works in the
Marshall Islands, particularlyin a clinic that deals with
Hansen's disease, and the titleof the article was actually
Please Don't Tell my Husband Ihave Leprosy, and she actually
details how.
That wasn't on BuzzFeed no, itwas not but it was fascinating
(27:30):
because she's giving basicallyall of these examples of
patients who don't even want tobe seen going into a clinic
that's associated with treatingHansen's disease and so
healthcare workers sometimeslike have to meet patients
outside of the clinic, thingslike that, and it becomes a very
difficult thing to end uptreating because there ends up
not being necessarily continuityof care, which can then put
that person in more danger ofdeveloping the nerve damage and
things like that.
So what I guess I wanted to getat with this is what can we do
(27:51):
as people who are working in themedical and science fields to
help continue reducing stigma?
Is it just language?
Is it using Hansen's diseaseand not leprosy?
Speaker 2 (28:00):
I mean, I think it's becoming more familiar with it
and, I think, becoming verycomfortable with the idea that
infectious pathogens are part ofour ecosystem.
And I think part of our job ascommunicators, as clinicians, as
scientists, as people who areinterested in this pushing the
idea of One Health is that we doshare this planet with all
(28:22):
kinds of different species andwhat we want to do is we want to
meet conditions and people andother animals with compassion.
So that's kind of a cop-outtheory question, camille, which
is what do we do about it?
I think education is maybe oneof the most important things
that we can do, communicatingwith people, answering questions
(28:42):
.
I think people have legitimatefears and worries.
I didn't mean to imply earlierthat people were wrong to fear
leprosy.
There was a time where wedidn't know how it was
transmitted and we didn't knowthat it was caused by who knows.
But what we saw, even in thosemoments where we didn't know
what it was, we saw compassion.
And I think if we lead withcompassion and we lead with the
idea that there's always more tolearn and understand, I think
(29:04):
we can help with stigma, becauseyou brought it up really well
that it's not just Hansen'sdisease they surround the world.
People don't want to go to TBclinics to get treated.
They used to have to go tospecial HIV clinics to get HIV
medicines.
It's very stigmatizing.
So part of it is that oursystem can adapt to be a bit
more inclusive and make it sothat even getting people the
treatment that they need wherethey need it, instead of having
(29:26):
to go to specific places.
So those are just some thoughtsabout how we can all work to
decent.
But there are people who workin the stigma area that have
written entire books aboutapproaches, which I could say
more about.
Speaker 4 (29:36):
So, camille and Christina, since you guys are
new here, I'm known for alwaysasking one philosophical
question.
So my question for you I thinkthat some of the stigmas and the
otherization and so on is alsosomething that we probably carry
as instincts inside of us.
Like an infected animal willalways separate itself from the
group to avoid transmission.
(29:57):
Or we have these mechanisms inplace where, if you eat
something that you think istoxic, your tongue will tell you
it's bitter.
We have these mechanisms inplace to warn us about potential
danger.
It's bitter.
We have these mechanisms inplace to warn us about potential
danger.
Can we, as a human race,overcome this with our brain and
then kick in empathy andoverrule our instincts?
Speaker 1 (30:15):
I feel like we can and I'm only going to say this
because isn't that supposed tobe what sets us apart from other
species and other animals, asis our higher order thinking and
our ability to understandthings and then act on that
understanding.
And I really liked what DrDasho said about education,
because I really do think thateducation is the key to so much,
(30:37):
to unlocking so much.
And I think one important thingto know and please correct me
if I'm wrong is to realize thatso many of these diseases have
treatments.
There is treatment availablefor these things.
If you probably ask someone onthe street, hey, if you develop
leprosy, what do you think yourprognosis is?
And I think that if you catchleprosy early on, of course
(30:58):
that's really important.
It's so important to know thatthere is actually treatment for
these diseases and I thinkunderstanding that there is
treatment kind of takes the fearof that disease process away.
Of course, we still have lightyears to go to make sure that
treatment is available foreveryone.
Of course we still need toovercome that stigmatization so
that we can make sure that a lotof people have access to the
(31:21):
treatment that they need.
And also we need to overcome somany other social factors that
we can go into for hours, but Ido think just understanding that
can strip away a lot of thefear of these infectious
diseases.
Speaker 5 (31:34):
Yeah, I think we can overcome it, but perhaps not
unilaterally, because in orderto have the bandwidth to do that
, you have to have a lot ofsecurity in other areas of your
life.
In order to be able to haveempathy for others, you need to
have your needs met in so manyways, whether that's something
like Maslow's hierarchy, orwhether that's even just like
having your mental and emotionalhealth your needs met for that
(31:55):
in order to in any way supportsomeone else.
And so I think that that, to me, would probably be the barrier
to overcoming stigmatization isthat in the world as it is now,
I think so many people are verystressed and are very insecure
on what's happening, whether intheir local area or on a global
scale, and I think that we kindof run into this empathy fatigue
where it becomes very difficultto just constantly keep caring.
(32:16):
So that, to me, is the onlybarrier we have to actually
being able to overcome that.
That would be my answer to this.
But this has been reallyfascinating Migration, godzilla
philosophy, leprosy Very cool,very cool.
Speaker 2 (32:29):
Yeah, I think, guys, we're going to fix it One
podcast episode at a time.
Speaker 3 (32:35):
Thanks for listening to the Infectious Science
Podcast.
Be sure to hit subscribe andvisit infectiousscienceorg to
join the conversation, accessthe show notes and to sign up
for our newsletter and receiveour free materials.
Speaker 2 (32:46):
If you enjoyed this new episode of Infectious
Science, please leave us areview on Apple Podcasts and
Spotify, and go ahead and sharethis episode with some of your
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Speaker 3 (32:55):
Also, don't hesitate to ask questions and tell us
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To get in touch, drop a line inthe comments section or send us
a message on social media.
Speaker 2 (33:04):
So we'll see you next time for a new episode, and in
the meantime, stay happy stayhealthy, stay interested.
This is a podcast about One Health the idea that
the health of humans, animals,plants and the environment that
we all share are intrinsicallylinked.
Speaker 3 (00:17):
Coming to you from the University of Texas Medical
Branch and the GalvestonNational Laboratory.
Speaker 2 (00:21):
This is Infectious Science, where enthusiasm for
science is contagious.
Hey everybody, welcome back toanother episode of Infectious
Science and, dare I say, anotherseason, a new season, a new
season Season two we're born,born anew Season two.
We have a couple of new faceshelping us out here today and
(00:45):
I'm going to let them introducethemselves.
Christina, do you want tointroduce yourself?
Speaker 1 (00:49):
Yes, my name is Christina Rios.
I am a first year medicalstudent here at UTMB and I'm so
happy to be working with youguys this season on the podcast.
I just really wanted to join inbecause I found our block of
infectious disease studies to beincredibly interesting, and I
previously worked in veterinarymedicine before I came to
(01:09):
medical school.
Actually, I've always wanted togo into human medicine.
Really funny story how I gotinto veterinary medicine, but I
loved it regardless, and so whenI first had a presentation from
Dr Benta really resonated withme the interaction between
veterinary and human medicineand sciences.
So, so, so grateful to behelping out this season.
Speaker 4 (01:30):
And Christina, you know well, first of all, welcome
right.
But you know that real doctorsstudy more than one species.
Speaker 5 (01:36):
Yes they do, yes, they do.
Speaker 2 (01:40):
As you were mentioning that, christina, I
was thinking about the firstTerminator movie.
When Arnold Schwarzeneggerlands, I think he actually gets
treatment in the veterinaryclinic From a vet.
Speaker 1 (01:50):
I mean, I appreciate that.
Speaker 5 (01:51):
Growing up in a rural area.
Sometimes the vet clinic wasprobably a better bet than the
local hospital.
Speaker 1 (01:55):
I was going to say probably shouldn't share it, but
definitely done some human CTs,Some veterinary CTs.
Speaker 4 (02:03):
But Arnold Schwarzenegger is a robot.
Why would a robot go to?
I don't know.
Speaker 5 (02:07):
Isn't he a cyborg?
Isn't he a cyborg?
Isn't he like part robot?
Yeah, so that's you know, acyborg.
Another species, technically.
Speaker 4 (02:14):
Well, I'm excited we're going to talk about
Godzilla today.
Yes, we digress.
Speaker 5 (02:27):
We get a veterinarian's opinion on
Godzilla Camille.
I'm Camille Adu.
I am a third-year PhD candidatehere at the University of Texas
Medical Branch.
I grew up on a livestock farmand shadowing a vet and that's
how I got interested ininfectious disease biology and
when I went to college, that wasmy concentration.
So I've worked with all kindsof pathogens.
I've worked with cholera,completely antibiotic-resistant
flesh-eating bacteria.
I've worked with bacteriophages, which are very neat and I hope
(02:47):
we do an episode on them andcurrently I work in a lab that
studies viruses that infect thebrain in the context of
infectious diseases, the socialand the economic and the
geopolitical things that shifthow health changes across the
(03:09):
globe, and I think that this isa really cool opportunity to
dive more into them and also totalk to some of my favorite
people and get their ideas andget their answers to all my
questions.
Speaker 4 (03:18):
So I'll be coming with lots of people.
Speaker 5 (03:20):
Definitely definitely Dr Dasha, dr Bente.
Definitely definitely Dr Dasha,dr Bente.
My favorite professors,definitely.
So I'm glad to be here and getto just have a chance to chat
and learn more.
Speaker 2 (03:32):
Straight.
Speaker 5 (03:32):
A's, camille, you get it.
Speaker 3 (03:33):
Thank you, there's your PhD.
Speaker 4 (03:36):
So, Matt, tell us real quick what are we supposed
to expect from the new season.
Speaker 2 (03:40):
New season, everybody be looking for some new faces,
new discussions.
We're going to have a lot ofreally great guests.
We're going to be trying tocontinue to get people excited
about One Health and aboutscience and all the great things
that are going on around us anddestigmatize the world around
us.
Sounds good.
That's our plan.
Dennis Benta Dr Benta is hereas well, Myself, Matt Dasho and
(04:03):
yeah, today we're going to belaunching into a discussion
about one of the oldest, one ofthe wisest pathogens in human
existence.
Speaker 4 (04:11):
Can pathogens be wise .
I mean, they don't have a brain, you're anthropomorphized Been
around for a while.
Speaker 2 (04:16):
Yes, and that is Anson's disease or mycobacteria
M leprae.
So we'll get into thatdiscussion shortly.
Speaker 5 (04:26):
Excited to be here for our episode of Infectious
Science.
Today we'll be talking aboutHansen's disease, also known as
leprosy.
According to the CDC, the riskof getting Hansen's disease is
quite low for most adults in theworld, and that's because more
than 95% of all people havenatural immunity to the disease.
The only real risk is being inprolonged contact with someone
(04:46):
who has untreated Hansen'sdisease.
It's caused by mycobacteriumleprae, and what's interesting
is that this is a disease that'sbeen with humans for a very
long time.
The earliest skeletal evidenceof leprosy that I found in
literature was actually frommore than 4,000 years ago, and
the earliest written evidence wehave is 2,000 years old.
So this has been with humanityfor a very long time, and so
(05:08):
with us today we have Dr Dasho,who has actually seen a patient
with Hansen's disease.
Dr Dasho, could we hear a bitabout the clinical presentations
of M leprosy that physicianssee and how it's treated?
Speaker 2 (05:20):
Yeah, thanks, camille .
This is Matt Dasho, and welcometo the podcast.
Hello everybody.
Yeah, thanks, camille.
This is Matt Dasho, and welcometo the podcast, hello everybody
.
Yeah, thanks for that, camille.
Obviously, leprosy has beenaround for a very long time.
It's something that it datesback, as you mentioned,
millennia.
I think the earliest documentedcases were from even 4000 BCE.
It was in the Bible, right.
Lepers were people who weresuffering from this condition,
(05:42):
were ostracized, stigmatized andoften separated in very
profound ways from theirfamilies and from their loved
ones.
And I think you mentioned itreally well before.
This is a chronic cutaneousdisease and it's caused by
bacteria.
It's a mycobacterium.
We know mycobacteria are very,very slow growing bacteria and
(06:02):
it's caused by one of twostrains of that bacteria, called
either M leprae ormycobacterium leprae or
mycobacterium lepromatosis, andthey're pretty much clinically
indistinguishable.
I've had two brushes orencounters with leprosy.
I've not myself treated someone.
We're going to be lucky enoughto speak with a clinician who
has spent a lot of her careerstudying leprosy and especially
(06:25):
the pathologic elements ofleprosy, who happens to be my
sister, dr Mara Dasho, and soshe will be on with us a little
later to talk about some of herexperience.
But most often it presents as achronic cutaneous condition
that mostly affects the digits,the extremities and the parts of
the skin that are at the distalends.
(06:47):
You'd often see it on the nose,the earlobes, the cheeks.
The route of infection isactually not cutaneous, it's
probably aerosol and, as youmentioned, you can be around
people with leprosy many timesand not get leprosy So-.
Speaker 4 (07:01):
So, matt, sorry to interrupt you, but what I heard,
the reason why they preferareas like the nose and the
cheeks and finger and the digitsand so on, as you said, it's
because the bacteria really likea lower temperature and that's
obviously where the bodytemperature is a little bit
lower, right, yeah?
Speaker 2 (07:18):
I have heard that and that also makes a lot of sense.
So, as Camille was mentioning,this is a really fascinating
condition, hansen's disease.
It has a very, I think,variable clinical spectrum, but
most of the time people arecoming in with years of
cutaneous infections.
They have a highly variedappearance.
We'll ask Dr Dasho other DrDasho to maybe comment in a more
(07:38):
knowledgeable way.
As a dermatopathologist she candescribe those things in much
greater detail.
But yeah, that's the clinicalpresentation and the
epidemiology.
It's really interesting becauseit's a disease that's not seen
all around the world.
It's really only in certaincountries and in certain
clusters of populations.
Speaker 5 (07:55):
I actually found some interesting research on why
that is so.
First and foremost, somethingthat's cool from a One Health
perspective is I actually foundsome research where they were
looking at both archaeologicaldata and then data from
basically genetic samples frompeople that are living in urban
areas, and what they found isthat basically living in urban
areas which is something thatwe've sort of recently started
(08:17):
to do as a species has basicallyallowed us to develop a
resistance to things liketuberculosis and leprosy.
So if your ancestors were in amuch more urban environment,
they were more likely to beexposed to a lot of different
pathogens.
Ancient cities were not thecleanest.
That's something reallyinteresting that we're now
finding out.
It's relatively new that welive in cities, and so that has
(08:40):
changed how and why people mightbe resistant to some diseases
like leprosy.
But something else that I found,particularly if we think about
a population that does have areally high proportion of
leprosy, which is theMarshallese population, and just
to give you an idea of how muchhigher it is, so in the United
States it's 0.0083 per 10,000people, which is a very low
(09:03):
prevalence, but for the peoplefrom the Marshall Islands it's
12 per 10,000 people, which is avery low prevalence, but for
the people from the MarshallIslands it's 12 per 10,000
people, which is incredibly high, and I found that there's a
couple different reasons thatare speculated for that.
Some of it is housing, but someof it's also there's a
hesitancy to seek medical care,and the longer it's untreated,
the more likely you are to havemore severe complications from
(09:23):
it things like nerve damage andstuff like that.
Speaker 2 (09:26):
Yeah, no, and I think one of the things you mentioned
is really important is that,because it's so uncommon in the
US, it's often not somethingthat clinicians are looking for.
We see chronic skin diseaseswe're thinking allergic problems
, malignancies, other cutaneousinfections, and Hansen's disease
doesn't always jump to the topof the list.
But, as you mentioned, thereare certain populations.
This is where I think yourknowledge of the world and of
(09:48):
epidemiology is really important.
You know we're a globalizedsociety, right?
This is the human migration,the migration of people, for all
the reasons that people migrate, has put us in contact, I think
, in the US and around the world, with diseases we may not have
previously thought to look for.
So you mentioned the MarshallIslands.
I mean, marshall Islands is avery, very interesting
particular case.
(10:08):
Many people don't know muchabout the Marshall Islands, but
they're an archipelago, it's anation of islands that are run
about 70 miles and they're inthe South Pacific.
And if anybody has seen themovie Godzilla, the opening
sequence is of a nuclear testand this is actually footage
from a nuclear test that wasconducted in Bikini Atoll in the
(10:28):
Marshall Islands.
So I can nerd out for hours andhours about the strategic
importance of the MarshallIslands.
But the US found the MarshallIslands to be of strategic
interest, especially during andin the aftermath of World War II
, when there was active war withJapan, and so having military
presence in the South Pacificwas seen as quite important.
We know we have military basesin Hawaii, et cetera.
(10:49):
Marshall Islands were deemed tobe a good place for nuclear
testing in the years followingWorld War II, and so obviously
this exposed a lot ofMarshallese to toxic levels of
radiation.
There were certain parts of theislands that were rendered
uninhabitable, and so it pushedpopulations of people closer and
closer together and resulted,through a series of agreements
(11:09):
with the US government, thatMarshallese could actually come
live and work in the UnitedStates without visas.
So they were given sort of aspecial status through something
called the COFA agreement,which we won't go into.
But the Marshallese also have amuch higher incidence,
continued incidence, ofmycobacterium leprosy or M
leprae, and MTB.
So mycobacterial infections arehighly prevalent in that
(11:31):
population.
Speaker 4 (11:31):
As well, I guess this brings us back to the topic
that we've discussed many timesdisplaced populations and the
influence on density anddiseases and stuff like that.
But I think for me the mostimportant question is does
Godzilla have leprosy, or isGodzilla a reservoir?
Is?
Speaker 2 (11:47):
he a reservoir?
Is Godzilla a reservoir?
Speaker 5 (11:50):
As the veterinarian in the room, could you tell us a
little more about reservoirsfor?
Speaker 2 (11:55):
I feel like Godzilla could have some armadillo in him
.
Yes, yeah, because it's reallyarmadillos, right, dennis?
That are some of the morecommon reservoir hosts.
Yeah, you don't have to go nerdout on armadillos yet.
I know we're going to get toyour armadillos.
Speaker 4 (12:08):
No, but I want to nerd out on Godzilla, because I
think Godzilla is a reptile.
That's what I was always toldand I think for me, the
perception was always thatarmadillos, they're actually
mammals and they're actuallyclosely related to anteaters and
sloths.
So they are placental mammalsand they just so happen to be
(12:30):
very susceptible tomycobacterium leprae and that's
why they've been traditionallyused as a laboratory animal to
study the disease.
And the key thing here is thatthe reason why they are being
used as an animal model isbecause they mimic the human
disease very well.
So what you see in a humandisease and I hope Matt will get
into that in a second themyopathy, the nerve damage, the
neuropathologies and so on arevery similar to what's seen in
(12:54):
humans.
So in terms of face value, it'sa very good model that mimics
human disease.
So what are the clinical signs?
Speaker 2 (13:00):
Yeah, so I talked a little about the skin lesions,
which remember that people getexposed and they may not
manifest disease for many, manyyears.
Anywhere from one up to 30years have been described, but
usually four to eight years fromexposure people will start to
manifest skin lesions.
But really the reason all thatcomes about is, as you mentioned
, dennis, because the diseaseaffects Schwann cells and
(13:21):
histiocytes and things like that.
There's nerve damage,especially peripheral nerves,
and so it's often said thatpeople with Hansen's disease
just don't feel pain in thoseextremities and so they're
constantly injuring them,bumping them into things,
they're getting burned, and sothose get secondarily infected
and there are erosive damagesthat happen.
There's all kinds of stuff thatyou do, unconsciously, your
(13:42):
brain does to keep yourextremities intact and to keep
your skin intact and keep yourbones from getting hurt.
You will feel pain, you willfeel discomfort, you will say
I'm going to sit down or I'mgoing to put on shoes.
People with Hansen's disease donot have those natural
responses and so they start todevelop a lot of erosive changes
of both the skin and then ofthe nerves and then ultimately
of the bones as well.
(14:03):
So you'll see digits missing,you'll see neural digits, you'll
see often pretty erosivechanges of those extremities and
then on the skin you'll seethese ulcerative lesions that
pop up on the ears, on the nose,on the cheeks and then
obviously on the surface of theskin.
Speaker 4 (14:19):
So you're saying and I'm stealing a lot of Camille's
questions here it's ulcerative,but it's not contagious though.
Right, so we don't have to beafraid if we see somebody with
leprosy and they touch us orgive us the hand.
That's not a way oftransmission.
Right, that's correct.
Speaker 2 (14:33):
That's correct.
I think that was one of thethings is, prior to the
elaboration of this pathogen asa respiratory pathogen mostly
respiratory there was a hugeamount of stigma.
I remember germ theory is arelatively new innovation for
our species, so people thoughtit was miasmas, they thought it
was genetic and it wasn't untilNorwegian scientist Gerard Armer
Hansen, who lived from 1841 to1912, checks notes.
(14:59):
In the late 1800s hecharacterized the infectious
Asian as a mycobacterium andthat let them make the name of
what was previously calledleprosy, which was a very
stigmatizing name.
They called it Hansen's disease.
Speaker 5 (15:12):
And, if I can just jump in, something you mentioned
was that this particularbacteria has a bit of a tropism
for a certain type of cells.
So Schwann cells and for thoselistening who might not be
familiar with these, I had tolook them up myself and I work
in a neuroscience lab they'reglial cells and they form the
myelin sheath on axons outsidethe brain, which is really
important.
But what's really interestingis that the bacterium actually
(15:34):
promotes a nuclear reprogrammingand de-differentiation of these
host Schwann cells and theybecome progenitor stem-like
cells that are more vulnerableto infection, which I think is a
really fascinating mechanism bywhich it's infecting.
And, dr Pente, I also had aclarifying question for you on
what you said about armadillos.
So if, as Dr Daschow hasmentioned we've talked about,
(15:55):
it's primarily a respiratorypathogen, are there any
precautions the public shouldtake when dealing with
armadillos?
We certainly have them here inTexas.
Should people avoid contactwith armadillos and how many
armadillos are really carryingamblaprae?
Speaker 4 (16:07):
Yeah, before I answer your question, I want to go
back to what I said previously.
I think we talked about thestigma of humans and I think
that's the stigma witharmadillos.
The bacterium can be carried bya range of different animals,
so it can be wild rodents, itcan be a range of different
mammals, non-human primates Incertain areas we have different
species, even chimpanzees ormanga bees, that can carry the
(16:30):
disease.
But I think the reason whyarmadillos are always so in the
focus is because they showdisease and so they have an
active, ongoing infection, andthat obviously makes them more
relevant to transmit the diseaseto humans.
And I'm not a hunter, but I wasalways told that these
armadillos are considered a pestand so if you shoot them
(16:51):
because they are digging holesand they're destroying your
crops and your agriculturalcomponents, you shoot them
because they're a pest.
And I don't know what the meattastes like, but I could assume
that certain people will alsotry to harvest the meat and eat
the meat and in this process ofbutchering the animal or
handling the animal, I thinkthat's where some of the
transmission is happening.
(17:11):
And if you think about that,maybe one in six armadillos in
Texas or in Louisiana arepositive or carry the infection.
That's quite a high risk.
Speaker 1 (17:21):
I just wanted to interject here, dr Benta.
Does leprosy or Hansen'sdisease manifest in armadillos
the same way that it manifestsin humans?
Could you tell that anarmadillo has leprosy or
Hansen's disease?
Speaker 4 (17:34):
When I was doing my literature research and I was
looking into these animal modelsand how good armadillos are to
mimic human disease, I had thesame question and I didn't
really find the answer.
If the Amadillo comes down withsome sort of a muscle disease,
some sort of a neuropathy ofsome sorts, they might be
impaired in their locomotion orin some sort of stuff.
(17:57):
And if an animal is sick, thequestion is always is it easier
prey and is it easier to huntthe animal?
To be honest with you, I'm notsure if they show any sign of
ulcerative cutaneous lesions ornot.
I don't know.
Do you know?
Speaker 5 (18:12):
I do not know, but I wonder if part of the problem is
studying them is that they're,from my understanding, mainly
nocturnal animals.
So if you're trying to get asample in the wild, that might
be difficult for researchers.
But going off of that, thinkingabout ulcerative lesions,
things like that, dr Tasho, Iwanted to ask when I was looking
in clinical literature why aredermatologists the ones who
often diagnose Hansen's disease?
It's not really infectiousdisease docs, from my
(18:34):
understanding.
Is it just that skin checks arenot like a normal part of
seeing a patient?
Speaker 2 (18:39):
That's a good question.
I mean, I think there isobviously the part of it that,
in order to make the diagnosis,you often need a sample, and
it's often dermatologists thatare taking the biopsies or
taking the samples.
Many times, when there arethese chronic lesions, we will
push for a biopsy or push forsome kind of tissue diagnosis,
in which case dermatologists canbe involved.
(18:59):
Some people, when they havechronic skin issues, will
primarily go to a dermatologist,so I think that'll be a good
thing for us to also review withMara, because, as you mentioned
, yeah, dermatologists are goingto be the ones that may
actually pick these things upfirst, but those of us who are
out in the world, I think I'malways curious as to why we
don't have more of it in Texas.
If we have so many armadillos,so many armadillos, we should
(19:20):
all be on the lookout for it.
Speaker 4 (19:23):
Yeah, that's a good question.
I can only speculate.
I guess Probably like 100 or200 years ago, I think, there's
more need for the meat ofarmadillos and nowadays they're
just being shot and then justleft to die and decay.
I don't know how the armadillopopulation has changed over time
, but I think it's also theexposure, the density of the
(19:44):
animals in the area and theexposure to humans.
Speaker 5 (19:48):
I do wonder how armadillos originally became
infected.
Is this something that humansgave armadillos?
Which way did the zoonosis go?
Speaker 4 (19:56):
The chicken and the egg question.
I don't think that anybody willever find out.
Speaker 2 (20:01):
With so many species potentially susceptible to it, I
don't think that you can everfind out what the origins and I
think you mentioned Camille atthe beginning but 95% of the
human population is immune to it.
So when you have thesepathogens that have been around
for literally thousands of years, with generations of people
exposed, and it's a slow-growingbacterium I don't know much
(20:23):
about the genetics but it seemsall very conserved, so probably
the strains and the evolution ofthe bacterial pathogen is not
very fast, so it gives us anopportunity to develop immunity
for it.
Speaker 4 (20:36):
I actually have a quick question for you, camille.
You said that there'sresistance has built in humans.
Over time, you said, from theagricultural development into
the urbanization of things andhumans being exposed over and
over again, they became lesssusceptible to the disease.
Do you know anything about that?
What makes humans now moreresistant to it?
Speaker 5 (20:55):
Oh, that's a really good question.
They were talking abouttuberculosis and leprosy.
They do have loci in the paperbut I don't have them written
down.
But yeah, I'm not a geneticistso unfortunately I can't answer
that now, but I can send it toyou this will be the next
episode.
Speaker 2 (21:07):
Stay tuned, everybody yeah.
Speaker 4 (21:09):
Deep dive on the genetics of the embassy.
Go to the show notes.
Speaker 5 (21:14):
But what is interesting about thinking about
Hansen's disease is that I didfind a paper talking about when
was it introduced to Pacificislands.
So if you're thinking about,like the Marshallese population,
things like that, it was reallyinteresting.
I would have assumed it waswith colonialism, whether that
was Japanese imperialism orEuropean colonialism.
(21:35):
It was not.
Actually, they refute that.
They analyzed basically ninedifferent samples and they found
that it was with the firstmigration of people there.
So this has been with uspotentially even longer than we
have 4,000-old skeleton evidence, but much longer than that.
If it has gone everywhere inthe world, it might have been
reintroduced at different timesand they talk about that a bit
in the paper, but thatsubsequent migrations can move
(21:56):
it around, but that it wasalready there and I think that
that's a really fascinatingthing to think about,
particularly if we're thinkingabout animal reservoirs.
Was this just sort of on allcontinents?
Speaker 4 (22:05):
if it was in the islands.
And I think if there'ssomething we can learn from
Mycobacterium tuberculosis,which is also worldwide and it's
in so many different speciesand it's probably also found in
the soil it's very tenacious inthe soil and you have again the
range of mammals that areinvolved.
So I don't think this is reallyjust a very easy zoonotic
transmission one-to-one, butmaybe there's certain reservoirs
(22:31):
in the soil.
I know, for example, formycobacterium tuberculosis in
Europe, badgers are a big issue.
They can transmit that and theydig and root around and all
kinds of things.
Cows get infected withmycobacterium and so on.
So I don't think it's easy topinpoint the source of something
like that.
It's been probably around for amuch longer time than what?
4,000 years.
Speaker 5 (22:50):
Yeah, that's a really good point and I would say the
stigma surrounding it has alsobeen around for an exceptionally
long time and I would reallylike us to talk about that,
because I think there's always adanger, as someone who works in
the field of infectiousdiseases, in suggesting that
it's a very us-versus-themrhetoric to say, oh, most cases
are acquired outside of theUnited States, because the
reality is our health is soglobally interconnected and if
(23:13):
anyone thought that wasn't thecase, covid-19 proved us wrong.
Every individual's health onthis planet, whether they're
animal or human, is sointerconnected and anything that
happens in one place caneventually kind of shift around,
and it's something we've chosento be so globalized.
But could we talk about more onwhy does this always pop up,
particularly in regards toleprosy?
There's this idea of the stigmaof being morally unclean, and
(23:36):
that's something that has poppedup with other diseases as well.
I think of things like HIV andeven people just making
judgments about particularly anyinfectious disease.
So could we talk about why thatis in the context of leprosy or
other diseases?
Speaker 4 (23:49):
Yeah, I think that leprosy is kind of the poster
child for this.
The stigma, right.
How many colonies and they'retypically isolated islands or
some sanitarium or some hospitalon some remote islands, right,
I think that's really the posterchild for stigma in disease.
Matt, do you have any thoughtson that?
Oh, man.
Speaker 2 (24:08):
Why does it keep happening, camille?
I mean first of all theinterconnectedness of
human-animal environmentalhealth migration.
Someone should really make apodcast about that.
Speaker 4 (24:18):
It's going to be the spinoff.
Speaker 2 (24:20):
Someone should just really, really do that.
I wish I had a good answer forwhy that is.
It's the other, isn't it?
For a long time, I think it waslack of knowledge, lack of
understanding, lack ofcompassion.
Most of the people who weresuffering from Hansen's disease
that were uprooted from theircommunities and put into leper
colonies.
(24:40):
It was done against their will,but the people who cared for
them were often faith-basedcommunities.
These were largely missiongroups that took care of these
populations because they werestigmatized and nobody else
would, and they were in manyways out of the system.
People didn't want to deal withthem and this is a problem of
marginalized groups around theworld and you can look at it as
(25:02):
a stigma of disease, a stigma ofethnicity, of cultural
background, of race, whatever.
The examples of otherizing arerife within society throughout
human history.
So tough one to answer, justspecifically on infectious
diseases.
Speaker 4 (25:17):
And I think the reason why it's probably so
stigmatizing is because theclinical presentation is so
visible, right, and we see thiswith leishmania, for example,
where you have the cutaneousthings that everybody can see.
Keep in mind the driver of whenwe go back to pox, for example,
to the smallpox vaccinations,the initial idea.
(25:38):
When the vaccination was doneby the Chinese, they
purposefully inoculated a lessvirulent version of smallpox in
a part of the body that's notvisible your arm or something
like that, not your face, sothat you don't have the blisters
and the postules and stuff likethat in your face later on.
So I think the appearanceaspect of leprosy is why it's so
(26:01):
.
Ostracizing is the word.
I think it's the right word.
Speaker 5 (26:04):
Yeah, I think that that's an excellent point and I
wonder too if part of that'sjust the psychological aspect of
if you can see something, youcan imagine it happening to
yourself, and that is somethingI think that makes people kind
of resist, like an aversion tolike I don't want that to happen
to me.
So there becomes thisdisconnect between seeing
someone as another person whoalso is deserving of care and
things like that.
And speaking of care, up untilfairly recently there were still
(26:28):
leper colonies.
Does anyone know if there'sstill any in existence?
I know there's remnants.
Speaker 2 (26:34):
Yeah, I think there's remnants.
I don't know that there'sactive places where people with
leprosy have lived.
It's interesting because I knowin some countries people who
are long-term sufferers of thedisease.
They've continued to live inthe same communities because
they're actually quitecomfortable there.
So I think some of it has beenstructural and some of it is
just historic.
But I don't think there's anactive program right now that
(26:56):
says okay, if you have leprosyyou must go to this place
because, as you mentioned before, it's really quite difficult to
acquire.
Speaker 5 (27:02):
Yeah, and then something that I had found that
I just also wanted to mention.
I actually found an interviewfrom a nurse who works in the
Marshall Islands, particularlyin a clinic that deals with
Hansen's disease, and the titleof the article was actually
Please Don't Tell my Husband Ihave Leprosy, and she actually
details how.
That wasn't on BuzzFeed no, itwas not but it was fascinating
(27:30):
because she's giving basicallyall of these examples of
patients who don't even want tobe seen going into a clinic
that's associated with treatingHansen's disease and so
healthcare workers sometimeslike have to meet patients
outside of the clinic, thingslike that, and it becomes a very
difficult thing to end uptreating because there ends up
not being necessarily continuityof care, which can then put
that person in more danger ofdeveloping the nerve damage and
things like that.
So what I guess I wanted to getat with this is what can we do
(27:51):
as people who are working in themedical and science fields to
help continue reducing stigma?
Is it just language?
Is it using Hansen's diseaseand not leprosy?
Speaker 2 (28:00):
I mean, I think it's becoming more familiar with it
and, I think, becoming verycomfortable with the idea that
infectious pathogens are part ofour ecosystem.
And I think part of our job ascommunicators, as clinicians, as
scientists, as people who areinterested in this pushing the
idea of One Health is that we doshare this planet with all
(28:22):
kinds of different species andwhat we want to do is we want to
meet conditions and people andother animals with compassion.
So that's kind of a cop-outtheory question, camille, which
is what do we do about it?
I think education is maybe oneof the most important things
that we can do, communicatingwith people, answering questions
(28:42):
.
I think people have legitimatefears and worries.
I didn't mean to imply earlierthat people were wrong to fear
leprosy.
There was a time where wedidn't know how it was
transmitted and we didn't knowthat it was caused by who knows.
But what we saw, even in thosemoments where we didn't know
what it was, we saw compassion.
And I think if we lead withcompassion and we lead with the
idea that there's always more tolearn and understand, I think
(29:04):
we can help with stigma, becauseyou brought it up really well
that it's not just Hansen'sdisease they surround the world.
People don't want to go to TBclinics to get treated.
They used to have to go tospecial HIV clinics to get HIV
medicines.
It's very stigmatizing.
So part of it is that oursystem can adapt to be a bit
more inclusive and make it sothat even getting people the
treatment that they need wherethey need it, instead of having
(29:26):
to go to specific places.
So those are just some thoughtsabout how we can all work to
decent.
But there are people who workin the stigma area that have
written entire books aboutapproaches, which I could say
more about.
Speaker 4 (29:36):
So, camille and Christina, since you guys are
new here, I'm known for alwaysasking one philosophical
question.
So my question for you I thinkthat some of the stigmas and the
otherization and so on is alsosomething that we probably carry
as instincts inside of us.
Like an infected animal willalways separate itself from the
group to avoid transmission.
(29:57):
Or we have these mechanisms inplace where, if you eat
something that you think istoxic, your tongue will tell you
it's bitter.
We have these mechanisms inplace to warn us about potential
danger.
It's bitter.
We have these mechanisms inplace to warn us about potential
danger.
Can we, as a human race,overcome this with our brain and
then kick in empathy andoverrule our instincts?
Speaker 1 (30:15):
I feel like we can and I'm only going to say this
because isn't that supposed tobe what sets us apart from other
species and other animals, asis our higher order thinking and
our ability to understandthings and then act on that
understanding.
And I really liked what DrDasho said about education,
because I really do think thateducation is the key to so much,
(30:37):
to unlocking so much.
And I think one important thingto know and please correct me
if I'm wrong is to realize thatso many of these diseases have
treatments.
There is treatment availablefor these things.
If you probably ask someone onthe street, hey, if you develop
leprosy, what do you think yourprognosis is?
And I think that if you catchleprosy early on, of course
(30:58):
that's really important.
It's so important to know thatthere is actually treatment for
these diseases and I thinkunderstanding that there is
treatment kind of takes the fearof that disease process away.
Of course, we still have lightyears to go to make sure that
treatment is available foreveryone.
Of course we still need toovercome that stigmatization so
that we can make sure that a lotof people have access to the
(31:21):
treatment that they need.
And also we need to overcome somany other social factors that
we can go into for hours, but Ido think just understanding that
can strip away a lot of thefear of these infectious
diseases.
Speaker 5 (31:34):
Yeah, I think we can overcome it, but perhaps not
unilaterally, because in orderto have the bandwidth to do that
, you have to have a lot ofsecurity in other areas of your
life.
In order to be able to haveempathy for others, you need to
have your needs met in so manyways, whether that's something
like Maslow's hierarchy, orwhether that's even just like
having your mental and emotionalhealth your needs met for that
(31:55):
in order to in any way supportsomeone else.
And so I think that that, to me, would probably be the barrier
to overcoming stigmatization isthat in the world as it is now,
I think so many people are verystressed and are very insecure
on what's happening, whether intheir local area or on a global
scale, and I think that we kindof run into this empathy fatigue
where it becomes very difficultto just constantly keep caring.
(32:16):
So that, to me, is the onlybarrier we have to actually
being able to overcome that.
That would be my answer to this.
But this has been reallyfascinating Migration, godzilla
philosophy, leprosy Very cool,very cool.
Speaker 2 (32:29):
Yeah, I think, guys, we're going to fix it One
podcast episode at a time.
Speaker 3 (32:35):
Thanks for listening to the Infectious Science
Podcast.
Be sure to hit subscribe andvisit infectiousscienceorg to
join the conversation, accessthe show notes and to sign up
for our newsletter and receiveour free materials.
Speaker 2 (32:46):
If you enjoyed this new episode of Infectious
Science, please leave us areview on Apple Podcasts and
Spotify, and go ahead and sharethis episode with some of your
friends.
Speaker 3 (32:55):
Also, don't hesitate to ask questions and tell us
what topics you'd like us tocover for future episodes.
To get in touch, drop a line inthe comments section or send us
a message on social media.
Speaker 2 (33:04):
So we'll see you next time for a new episode, and in
the meantime, stay happy stayhealthy, stay interested.
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