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Gizmodo
3 days ago
- General
- Gizmodo
Leprosy's Origins Are Even Weirder Than We Thought
New research complicates the narrative of how leprosy reached the Americas. One of the world's oldest diseases has an even more complex history than expected. Research out today reveals that a form of leprosy was stalking people in the Americas long before Europeans arrived. A large international team of scientists conducted the study, published Thursday in Science. The researchers found DNA evidence of Mycobacterium lepromatosis—a recently discovered species of leprosy-causing bacteria—infecting people in North and South America over 1,000 years ago, predating European colonization. The findings upturn the prevailing belief that Europeans were responsible for leprosy's introduction to the New World. Leprosy's reputation for human destruction is so notorious that it's repeatedly referenced in the Bible (some of these references might have been about other conditions, though). These bacteria can cause a chronic infection of our skin and nerve cells, though it may take years for symptoms like lesions and sores to appear. If not treated with antibiotics, the infection can progressively and permanently damage these cells, leading to lifelong disabilities and other serious complications. Leprosy, also called Hansen's disease, is primarily caused by Mycobacterium leprae bacteria. But in 2008, scientists discovered that a similar species, M. lepromatosis, can cause it, too. Leprosy from M. lepromatosis appears to be rarer than the former, with cases predominantly found in North and South America. And we know very little about it, partly because both species aren't easy to culture in the lab (much like viruses, leprosy-causing bacteria can only replicate by hijacking our cells from the inside). Study author Nicolas Rascovan, who specializes in the evolution of human diseases, and his team decided to take a closer look at the bacteria after making a discovery of their own. 'Our interest began when we unexpectedly detected M. lepromatosis DNA in the remains of an ancient individual in North America,' Rascovan, a researcher at the Pasteur Institute in Paris, France, told Gizmodo. 'That prompted us to ask how long this pathogen had been circulating in the continent, how much spread there was before European contact, and what diversity it might still hold today.' The team analyzed hundreds of samples collected from modern-day people (mostly recent leprosy patients), as well as ancient DNA samples recovered from people in the Americas before European contact. Three of these ancient samples tested positive for the bacteria, the researchers found, from people living in what's now Canada and Argentina. 'Leprosy has long been considered a disease brought to the Americas by Europeans, which is true for the case of M. leprae. But our study shows that at least one of the two species that causes it—M. lepromatosis—was already here centuries earlier, and probably evolved locally for thousands of years,' Rascovan explained. 'This essentially changes how we understand the disease's history in the Americas.' Thanks to antibiotics and improved sanitation, leprosy is rare in much of the world (only about 200 cases are documented in the U.S. every year). But it remains a public health issue in some countries, with more than 200,000 cases reported annually globally. And the researchers' findings may complicate both the past and future of leprosy. While most modern cases of M. lepromatosis were linked to one specific lineage, or clade, of the bacteria that has recently expanded, the team also identified older clades that have likely been evolving independently in the Americas for over 9,000 years. That suggests these bacteria have been hiding out in still mysterious animal hosts (in the U.S. the classic form of leprosy has sometimes been linked to armadillo exposure). And though M. leprae still causes the majority of leprosy cases worldwide, its less famous cousin certainly has the potential to become a bigger threat. 'Given its diversity and spread, M. lepromatosis could be an emerging pathogen with dynamics different from M. leprae,' Rascovan said. As is often the case in science, the team's work has raised even more questions for them to answer. They're hoping to unearth the animal reservoirs where the bacteria have potentially been circulating all this time, for instance, and to trace its journey from the Americas to other parts of the world. They now believe that a strain of M. lepromatosis was brought over to the British Isles sometime in the 19th century, where it still infects red squirrels today. But we're still in the dark about how it reached Asia, where cases have been documented. 'All of this suggests that this is not just a neglected disease, but a neglected pathogen—one whose history and spread are only now beginning to be understood,' Rascovan said.
Boston Globe
20-04-2025
- Health
- Boston Globe
Public health's reckoning started with COVID. It was too late.
Get The Gavel A weekly SCOTUS explainer newsletter by columnist Kimberly Atkins Stohr. Enter Email Sign Up Yet the field's illiberalism did not suddenly emerge during the COVID pandemic. A reckoning was long overdue: The pandemic merely revealed weaknesses in public health's approach to human beings living with disease. I experienced this firsthand. Advertisement What it's like to get tuberculosis Most of us won't interact directly with our public health department during our lifetime. Unless, that is, we contract what is considered a 'reportable disease,' which happens to a small fraction of the population each year (COVID was only reportable for a short time). In 2020, I was one of those people — but I didn't have the novel coronavirus. I had somehow contracted the oldest-known and still deadliest infectious disease: tuberculosis. Advertisement I went to the doctor after a couple of months of coughing, which progressed to intermittent fevers, night sweats, and extreme fatigue. The nurse practitioner first thought the coughing was my childhood asthma rearing its head. Then she thought maybe it was a mild case of pneumonia. A week of antibiotics cleared up the fever and night sweats, for a while at least. But the cough never went away. Finally, as the pandemic lockdown descended around us in late March, I went to get an X-ray. In some ways, I'm in the pandemic's debt — I would have never bothered to get a cough checked out if COVID's respiratory nature hadn't put my husband on high alert. 'What if it's COVID?' he said, worried. I got the call two days into what would become our months-long stay-at-home adventure. My X-ray showed granulomas in my lungs — little nests of calcified tissue protecting the billions of teeming Mycobacterium tuberculosis that had begun to eat away at my lungs. Here's what happens when the health care system suspects a reportable disease: First, your medical provider hands your case over to the local public health department. The health department becomes responsible for coordinating all aspects of your diagnosis and treatment, as well as carrying out contact tracing — tracking down and notifying anyone you might have infected. In my case, which happened in New York State, they also put me under state-ordered quarantine. I was not allowed to leave my house. This and contact tracing are tools that are now familiar to most Americans, as many public health departments Advertisement The State of New York became responsible for my care from that point on. The day after the X-ray news, I got a call from the tuberculosis control nurse at my local health department — I'll call her Joan. She would become my caseworker through the duration of my treatment, although I eventually came to think of her as my warden. Under New York state law, a person diagnosed with tuberculosis is mandated to complete a full course of antibiotics — often under the daily supervision of a trained health care professional. That means a state public health official has to watch you take your pills every day. In my case, that was six months of antibiotics: eight pills daily for the first two months and then three pills every day for the rest of the time. If a patient refuses to comply, the health department can order them to remain under quarantine for an indefinite period or in extreme cases have them committed to a state-run facility. I was initially grateful for Joan. For the first few days the pills made me debilitatingly nauseous. After my first night of vomiting, Joan got me a prescription for an antiemetic and dropped it off at my house. In order to contain the public health threat tuberculosis poses, the government takes care of coordinating all aspects of treatment — down to billing insurance. If you don't have insurance, the state often pays for testing and treatment directly. I had unwittingly walked into an American's vision of a Scandinavian health care utopia. Advertisement I didn't have to call the doctor, make an appointment, go in for an exam, get the prescription, fight with the pharmacy over whether my insurance was up-to-date — instead, the medication just showed up at my door. And it was all free. As the days passed, I slowly felt better. My state-ordered quarantine was lifted (not that it mattered, since we were on COVID lockdown) as I became noninfectious, and I started to go outside for long walks in the woods behind my house. My visits with Joan had turned into video calls as lockdown continued. (In nonpandemic times, the state would have required Joan to meet with me in person to supervise my daily dose of antibiotics.) As I got the hang of my treatment, the daily video calls with Joan started to feel unnecessary. I asked her if I could move to checking in weekly or monthly — I was already required to meet monthly with an infectious disease doctor and have monthly blood work to make sure the antibiotics weren't frying my liver (a fairly serious potential side effect of long-term high-dose antibiotic use). But Joan's answer was an unequivocal no. Some form of daily observed therapy is the recommended standard of care for tuberculosis in every state, and Joan sent me a PowerPoint presentation explaining why having daily supervision from a nurse was necessary to make sure patients don't slack on their treatment. I pushed harder. I would take the drugs, as prescribed, no skipping doses. I had already seen what tuberculosis can do to people. I worked in a network of health clinics in Delhi, India, right after college, and the images of people unable to get out of bed, their emaciated bodies racked with fevers and coughs, have stayed with me. I was well aware of the risks and complications that came with not finishing treatment or skipping doses: drug-resistant tuberculosis — a scary diagnosis with no guaranteed cure. Advertisement And I had the state's Joan was unpersuaded. 'The TB control office told us to take you to court if you don't comply,' she told me during a video call. Well, that seemed a little heavy-handed. To some extent, I understood Joan's perspective. Her job was to make sure I didn't infect anyone else with tuberculosis. Full stop. If I skipped doses, I put not only myself but potentially others at risk. But a question weighed on me, fueling the anger I felt at being treated like a child: How big a risk was that really? Did that risk justify keeping me under Joan's thumb and even taking me to court if I resisted? Wasn't there a better use of Joan's time than chasing after me? Paternalism and public health There are deep contradictions between public health and an individual's rights to consent, privacy, and dignity. Most Americans didn't have to grapple with these trade-offs until COVID forced the issue. But COVID was far from the first time the public health system has been tested — and has failed — to weigh the trade-offs it asks of people who contract infectious diseases. Advertisement Often, the trade-offs are framed as insignificant — small steps we are told we should be happy to take to protect our neighbors. Wearing a mask is easy — those who refuse are selfish. Staying at home isn't such a big ask — how important is it really to go out to a restaurant or a friend's party? In my case: It shouldn't be a big deal to have someone watch me take pills every day. What's the harm? There is logic to this. But it ignores much bigger realities. Why should we be compelled to take steps that haven't been shown to work? Daily observed therapy can be more or less coercive than what I experienced and has come under fire as being unnecessarily restrictive, resource-intensive, and ineffective. A 2015 Cochrane So why was I, a fully capable adult, under state supervision and threatened with legal action when I had done nothing wrong? Getting sick is not a crime. Yet public health officials sometimes treat illness as though it is. This is not a new phenomenon. Some of the earliest American public health pioneers were deeply moralistic about the nature of illness. In the mid-19th century, health-minded urban reformers were taking aim at the lack of sanitation in European and American cities as a contributor to poor health. Here in Massachusetts, a statistician named Lemuel Shattuck produced a Report of the Massachusetts Sanitary Commission in which As cities — including Boston — grew, Shattuck and his peers became concerned that the poor could infect the wealthy, necessitating the state to intervene. He recommended the state establish health boards to enforce sanitary regulations and to study specific diseases that disproportionately afflicted the poor, like alcoholism and tuberculosis (which killed 300 per 100,000 Massachusetts residents in 1850 — today, tuberculosis kills 0.2 per 100,000 nationwide). But the key point is that he did not trust the masses. He wanted state regulations in place not only to protect the common good but to police the least virtuous and keep them from infecting the rest. This sort of attitude has been pervasive throughout public health history. Gay men were stigmatized and imprisoned all over the world during the early years of the AIDS crisis: Cuba quarantined people living with HIV, many of whom were gay, in medical facilities from 1986 until 1994. In the United States, public health campaigners targeted gay men and told them to simply stop having sex. Alcoholism and substance use disorders are still treated as crimes in most parts of the world. Compulsory drug treatment Public health's excesses are the downside of something positive: There is little doubt that public health workers are motivated by a desire to protect people's health and lives. But too often, public health has failed to trust those people or respect their rights to question, debate, or even refuse. Some of that is due to an excessively narrow measure of success, as political scientists Frances Lee and Stephen Macedo write in the In July 2023, the former National Institutes of Health director Francis Collins As the long-time global health reporter Donald J. McNeil writes in his recent book 'Wisdom of Plagues , ' 'I think it's imperative to save lives. To the exclusion of every other goal.' In some ways, a field that closely resembles public health is the military — where we expect collateral damage in order to achieve victory. But that mind-set is a problem. It has eroded trust between public health and the people it purports to serve. Very few people outside the field are willing to suffer collateral damage to their lives and livelihoods for tenuous reasons. Taking public health back As the COVID pandemic unfolded, I saw my small example, my dynamic with Joan and New York state's health department, playing out on a larger scale all around me. Americans across the country tried to make sense of what public health officials were telling them, often with increasing confusion and resentment. Much of the populist backlash against public health can be attributed to disinformation campaigns and conspiracy theories — but not all of it. Some in the public health field have acknowledged, and are bravely grappling with, the fact that public anger over the pandemic response is justified. No one wants or deserves to be treated as though they are the unwashed masses, to hark back to Shattuck's attitude. So why has it taken me five years to write this essay? Because I have always been uninterested in piling on an already beleaguered sector — especially now, as the federal government But I write this now because we will experience another pandemic, and we are in danger of failing worse than we did last time. It is critical we understand all contributing factors to that failure and attempt to root out the paternalism that proved to be a part of public health's fall from grace. Now the challenge is not to simply regain public trust. It is to retake the field from the forces like Robert F. Kennedy Jr. and his allies who threaten to destroy it from within. To do so, public health leaders will have to demonstrate their fidelity not only to saving lives but to the dignity and messy complexity of those lives. Christine Mehta can be reached at
Express Tribune
22-02-2025
- Health
- Express Tribune
Safari Park elephants diagnosed with TB
A Four Paws team sounds the alarm on the health of Madhubala and Malka. PHOTO: EXPRESS A preliminary medical examination of two elephants at Safari Park Zoo by a veterinary team of Four Paws, an international animal welfare organisation, has revealed protein deficiency and traces of tuberculosis (TB) bacteria, raising concerns about their health. Subsequently, the Four Paws team, led by Dr Ameer Khalil, urged the Karachi Metropolitan Corporation (KMC) to take immediate protective measures to ensure the safety of the two tuskers named Madhubala and Malka and the park's staff. Treatment for these conditions is expected to take 12 to 18 months. The Four Paws team, along with local vets, conducted a thorough health check on both elephants in early February. The mammoths were given medication and observed while standing. The results revealed two major health issues: both elephants had low protein levels, and tests detected traces of Mycobacterium complex, a potential indicator of TB. TB is a zoonotic disease, meaning it can be transmitted between animals and humans. Given this, Four Paws advised the KMC to implement strict cleaning, sanitisation, and disinfection protocols to minimise the risk of transmission. The team also recommended an improvement in the elephants' diet to address their protein deficiency, along with daily monitoring of their food intake and overall body condition. While neither elephant has shown overt signs of illness, the presence of TB bacteria requires special attention. If TB is confirmed, a lengthy treatment process will be required, lasting anywhere from 12 to 18 months. This treatment would also require specialised training for the caregivers involved.
