Decoding Leprosy: Stigma, Science, and Godzilla

WEBVTT

00:00:09.730 --> 00:00:17.230
This is a podcast about One Health the idea that the health of humans, animals, plants and the environment that we all share are intrinsically linked.

00:00:17.721 --> 00:00:21.591
Coming to you from the University of Texas Medical Branch and the Galveston National Laboratory.

00:00:21.940 --> 00:00:26.562
This is Infectious Science, where enthusiasm for science is contagious.

00:00:26.562 --> 00:00:41.014
Hey everybody, welcome back to another episode of Infectious Science and, dare I say, another season, a new season, a new season Season two we're born, born anew Season two.

00:00:41.014 --> 00:00:47.526
We have a couple of new faces helping us out here today and I'm going to let them introduce themselves.

00:00:47.526 --> 00:00:48.869
Christina, do you want to introduce yourself?

00:00:49.200 --> 00:00:51.244
Yes, my name is Christina Rios.

00:00:51.244 --> 00:00:58.170
I am a first year medical student here at UTMB and I'm so happy to be working with you guys this season on the podcast.

00:00:58.170 --> 00:01:10.527
I just really wanted to join in because I found our block of infectious disease studies to be incredibly interesting, and I previously worked in veterinary medicine before I came to medical school.

00:01:10.527 --> 00:01:13.007
Actually, I've always wanted to go into human medicine.

00:01:13.007 --> 00:01:26.480
Really funny story how I got into veterinary medicine, but I loved it regardless, and so when I first had a presentation from Dr Benta really resonated with me the interaction between veterinary and human medicine and sciences.

00:01:26.480 --> 00:01:29.748
So, so, so grateful to be helping out this season.

00:01:30.010 --> 00:01:32.763
And Christina, you know well, first of all, welcome right.

00:01:32.763 --> 00:01:35.691
But you know that real doctors study more than one species.

00:01:36.944 --> 00:01:38.129
Yes they do, yes, they do.

00:01:40.968 --> 00:01:44.079
As you were mentioning that, christina, I was thinking about the first Terminator movie.

00:01:44.079 --> 00:01:49.891
When Arnold Schwarzenegger lands, I think he actually gets treatment in the veterinary clinic From a vet.

00:01:50.180 --> 00:01:51.346
I mean, I appreciate that.

00:01:51.719 --> 00:01:52.805
Growing up in a rural area.

00:01:52.805 --> 00:01:55.439
Sometimes the vet clinic was probably a better bet than the local hospital.

00:01:55.900 --> 00:02:01.945
I was going to say probably shouldn't share it, but definitely done some human CTs, Some veterinary CTs.

00:02:03.140 --> 00:02:05.429
But Arnold Schwarzenegger is a robot.

00:02:05.429 --> 00:02:06.905
Why would a robot go to?

00:02:06.905 --> 00:02:07.468
I don't know.

00:02:07.587 --> 00:02:08.110
Isn't he a cyborg?

00:02:08.110 --> 00:02:08.573
Isn't he a cyborg?

00:02:08.573 --> 00:02:10.258
Isn't he like part robot?

00:02:10.258 --> 00:02:13.086
Yeah, so that's you know, a cyborg.

00:02:13.086 --> 00:02:14.389
Another species, technically.

00:02:14.550 --> 00:02:17.266
Well, I'm excited we're going to talk about Godzilla today.

00:02:17.266 --> 00:02:18.645
Yes, we digress.

00:02:27.020 --> 00:02:28.085
We get a veterinarian's opinion on Godzilla Camille.

00:02:28.085 --> 00:02:28.406
I'm Camille Adu.

00:02:28.406 --> 00:02:29.972
I am a third-year PhD candidate here at the University of Texas Medical Branch.

00:02:29.972 --> 00:02:38.293
I grew up on a livestock farm and shadowing a vet and that's how I got interested in infectious disease biology and when I went to college, that was my concentration.

00:02:38.293 --> 00:02:40.206
So I've worked with all kinds of pathogens.

00:02:40.206 --> 00:02:44.021
I've worked with cholera, completely antibiotic-resistant flesh-eating bacteria.

00:02:44.021 --> 00:03:17.951
I've worked with bacteriophages, which are very neat and I hope we do an episode on them and currently I work in a lab that studies viruses that infect the brain in the context of infectious diseases, the social and the economic and the geopolitical things that shift how health changes across the globe, and I think that this is a really cool opportunity to dive more into them and also to talk to some of my favorite people and get their ideas and get their answers to all my questions.

00:03:18.340 --> 00:03:19.663
So I'll be coming with lots of people.

00:03:20.223 --> 00:03:22.590
Definitely definitely Dr Dasha, dr Bente.

00:03:22.590 --> 00:03:29.324
Definitely definitely Dr Dasha, dr Bente.

00:03:29.324 --> 00:03:30.008
My favorite professors, definitely.

00:03:30.008 --> 00:03:32.000
So I'm glad to be here and get to just have a chance to chat and learn more.

00:03:32.520 --> 00:03:32.741
Straight.

00:03:32.820 --> 00:03:33.764
A's, camille, you get it.

00:03:33.843 --> 00:03:34.887
Thank you, there's your PhD.

00:03:36.479 --> 00:03:39.710
So, Matt, tell us real quick what are we supposed to expect from the new season.

00:03:40.219 --> 00:03:44.449
New season, everybody be looking for some new faces, new discussions.

00:03:44.449 --> 00:03:46.653
We're going to have a lot of really great guests.

00:03:46.653 --> 00:03:57.050
We're going to be trying to continue to get people excited about One Health and about science and all the great things that are going on around us and destigmatize the world around us.

00:03:57.050 --> 00:03:57.891
Sounds good.

00:03:57.891 --> 00:03:58.794
That's our plan.

00:03:58.794 --> 00:04:11.570
Dennis Benta Dr Benta is here as well, Myself, Matt Dasho and yeah, today we're going to be launching into a discussion about one of the oldest, one of the wisest pathogens in human existence.

00:04:11.911 --> 00:04:13.193
Can pathogens be wise.

00:04:13.193 --> 00:04:16.175
I mean, they don't have a brain, you're anthropomorphized Been around for a while.

00:04:16.396 --> 00:04:20.250
Yes, and that is Anson's disease or mycobacteria M leprae.

00:04:20.250 --> 00:04:22.206
So we'll get into that discussion shortly.

00:04:26.800 --> 00:04:28.242
Excited to be here for our episode of Infectious Science.

00:04:28.242 --> 00:04:32.653
Today we'll be talking about Hansen's disease, also known as leprosy.

00:04:32.653 --> 00:04:43.036
According to the CDC, the risk of getting Hansen's disease is quite low for most adults in the world, and that's because more than 95% of all people have natural immunity to the disease.

00:04:43.036 --> 00:04:49.228
The only real risk is being in prolonged contact with someone who has untreated Hansen's disease.

00:04:49.228 --> 00:04:56.132
It's caused by mycobacterium leprae, and what's interesting is that this is a disease that's been with humans for a very long time.

00:04:56.132 --> 00:05:04.730
The earliest skeletal evidence of leprosy that I found in literature was actually from more than 4,000 years ago, and the earliest written evidence we have is 2,000 years old.

00:05:04.730 --> 00:05:14.189
So this has been with humanity for a very long time, and so with us today we have Dr Dasho, who has actually seen a patient with Hansen's disease.

00:05:14.189 --> 00:05:20.483
Dr Dasho, could we hear a bit about the clinical presentations of M leprosy that physicians see and how it's treated?

00:05:20.764 --> 00:05:21.444
Yeah, thanks, camille.

00:05:21.444 --> 00:05:22.406
This is Matt Dasho, and welcome to the podcast.

00:05:22.406 --> 00:05:23.187
Hello everybody.

00:05:23.187 --> 00:05:23.627
Yeah, thanks, camille.

00:05:23.627 --> 00:05:25.531
This is Matt Dasho, and welcome to the podcast, hello everybody.

00:05:25.531 --> 00:05:26.632
Yeah, thanks for that, camille.

00:05:26.851 --> 00:05:29.235
Obviously, leprosy has been around for a very long time.

00:05:29.235 --> 00:05:36.204
It's something that it dates back, as you mentioned, millennia.

00:05:36.204 --> 00:05:37.990
I think the earliest documented cases were from even 4000 BCE.

00:05:37.990 --> 00:05:39.233
It was in the Bible, right.

00:05:39.233 --> 00:05:50.687
Lepers were people who were suffering from this condition, were ostracized, stigmatized and often separated in very profound ways from their families and from their loved ones.

00:05:50.687 --> 00:05:52.968
And I think you mentioned it really well before.

00:05:53.141 --> 00:05:57.065
This is a chronic cutaneous disease and it's caused by bacteria.

00:05:57.065 --> 00:05:58.209
It's a mycobacterium.

00:05:58.209 --> 00:06:13.283
We know mycobacteria are very, very slow growing bacteria and it's caused by one of two strains of that bacteria, called either M leprae or mycobacterium leprae or mycobacterium lepromatosis, and they're pretty much clinically indistinguishable.

00:06:13.283 --> 00:06:16.156
I've had two brushes or encounters with leprosy.

00:06:16.156 --> 00:06:17.882
I've not myself treated someone.

00:06:17.882 --> 00:06:35.187
We're going to be lucky enough to speak with a clinician who has spent a lot of her career studying leprosy and especially the pathologic elements of leprosy, who happens to be my sister, dr Mara Dasho, and so she will be on with us a little later to talk about some of her experience.

00:06:35.187 --> 00:06:47.714
But most often it presents as a chronic cutaneous condition that mostly affects the digits, the extremities and the parts of the skin that are at the distal ends.

00:06:47.714 --> 00:06:50.509
You'd often see it on the nose, the earlobes, the cheeks.

00:06:50.509 --> 00:07:01.047
The route of infection is actually not cutaneous, it's probably aerosol and, as you mentioned, you can be around people with leprosy many times and not get leprosy So-.

00:07:01.288 --> 00:07:18.005
So, matt, sorry to interrupt you, but what I heard, the reason why they prefer areas like the nose and the cheeks and finger and the digits and so on, as you said, it's because the bacteria really like a lower temperature and that's obviously where the body temperature is a little bit lower, right, yeah?

00:07:18.086 --> 00:07:20.113
I have heard that and that also makes a lot of sense.

00:07:20.113 --> 00:07:25.350
So, as Camille was mentioning, this is a really fascinating condition, hansen's disease.

00:07:25.350 --> 00:07:33.391
It has a very, I think, variable clinical spectrum, but most of the time people are coming in with years of cutaneous infections.

00:07:33.391 --> 00:07:35.127
They have a highly varied appearance.

00:07:35.127 --> 00:07:40.071
We'll ask Dr Dasho other Dr Dasho to maybe comment in a more knowledgeable way.

00:07:40.071 --> 00:07:44.468
As a dermatopathologist she can describe those things in much greater detail.

00:07:44.468 --> 00:07:47.831
But yeah, that's the clinical presentation and the epidemiology.

00:07:47.831 --> 00:07:51.365
It's really interesting because it's a disease that's not seen all around the world.

00:07:51.365 --> 00:07:55.603
It's really only in certain countries and in certain clusters of populations.

00:07:55.805 --> 00:07:58.862
I actually found some interesting research on why that is so.

00:07:58.862 --> 00:08:26.627
First and foremost, something that's cool from a One Health perspective is I actually found some research where they were looking at both archaeological data and then data from basically genetic samples from people that are living in urban areas, and what they found is that basically living in urban areas which is something that we've sort of recently started to do as a species has basically allowed us to develop a resistance to things like tuberculosis and leprosy.

00:08:26.627 --> 00:08:31.872
So if your ancestors were in a much more urban environment, they were more likely to be exposed to a lot of different pathogens.

00:08:31.872 --> 00:08:33.801
Ancient cities were not the cleanest.

00:08:33.801 --> 00:08:37.011
That's something really interesting that we're now finding out.

00:08:37.011 --> 00:08:45.038
It's relatively new that we live in cities, and so that has changed how and why people might be resistant to some diseases like leprosy.

00:08:45.578 --> 00:09:14.533
But something else that I found, particularly if we think about a population that does have a really high proportion of leprosy, which is the Marshallese population, and just to give you an idea of how much higher it is, so in the United States it's 0.0083 per 10,000 people, which is a very low prevalence, but for the people from the Marshall Islands it's 12 per 10,000 people, which is a very low prevalence, but for the people from the Marshall Islands it's 12 per 10,000 people, which is incredibly high, and I found that there's a couple different reasons that are speculated for that.

00:09:14.533 --> 00:09:26.130
Some of it is housing, but some of it's also there's a hesitancy to seek medical care, and the longer it's untreated, the more likely you are to have more severe complications from it things like nerve damage and stuff like that.

00:09:26.351 --> 00:09:33.902
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 something that clinicians are looking for.

00:09:33.902 --> 00:09:43.414
We see chronic skin diseases we're thinking allergic problems, malignancies, other cutaneous infections, and Hansen's disease doesn't always jump to the top of the list.

00:09:43.414 --> 00:09:45.278
But, as you mentioned, there are certain populations.

00:09:45.278 --> 00:09:50.543
This is where I think your knowledge of the world and of epidemiology is really important.

00:09:50.543 --> 00:09:52.765
You know we're a globalized society, right?

00:09:52.765 --> 00:10:03.398
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.

00:10:03.398 --> 00:10:05.113
So you mentioned the Marshall Islands.

00:10:05.113 --> 00:10:08.441
I mean, marshall Islands is a very, very interesting particular case.

00:10:08.682 --> 00:10:16.378
Many people don't know much about the Marshall Islands, but they're an archipelago, it's a nation of islands that are run about 70 miles and they're in the South Pacific.

00:10:16.378 --> 00:10:29.716
And if anybody has seen the movie Godzilla, the opening sequence is of a nuclear test and this is actually footage from a nuclear test that was conducted in Bikini Atoll in the Marshall Islands.

00:10:29.716 --> 00:10:34.014
So I can nerd out for hours and hours about the strategic importance of the Marshall Islands.

00:10:34.014 --> 00:10:46.581
But the US found the Marshall Islands to be of strategic interest, especially during and in the aftermath of World War II, when there was active war with Japan, and so having military presence in the South Pacific was seen as quite important.

00:10:46.581 --> 00:10:49.028
We know we have military bases in Hawaii, et cetera.

00:10:49.489 --> 00:11:00.028
Marshall Islands were deemed to be a good place for nuclear testing in the years following World War II, and so obviously this exposed a lot of Marshallese to toxic levels of radiation.

00:11:00.028 --> 00:11:14.162
There were certain parts of the islands that were rendered uninhabitable, and so it pushed populations of people closer and closer together and resulted, through a series of agreements with the US government, that Marshallese could actually come live and work in the United States without visas.

00:11:14.162 --> 00:11:19.291
So they were given sort of a special status through something called the COFA agreement, which we won't go into.

00:11:19.291 --> 00:11:28.013
But the Marshallese also have a much higher incidence, continued incidence, of mycobacterium leprosy or M leprae, and MTB.

00:11:28.013 --> 00:11:31.662
So mycobacterial infections are highly prevalent in that population.

00:11:31.741 --> 00:11:40.440
As well, I guess this brings us back to the topic that we've discussed many times displaced populations and the influence on density and diseases and stuff like that.

00:11:40.440 --> 00:11:47.754
But I think for me the most important question is does Godzilla have leprosy, or is Godzilla a reservoir?

00:11:47.754 --> 00:11:47.813
Is?

00:11:47.955 --> 00:11:48.636
he a reservoir?

00:11:48.636 --> 00:11:49.539
Is Godzilla a reservoir?

00:11:50.390 --> 00:11:54.642
As the veterinarian in the room, could you tell us a little more about reservoirs for?

00:11:55.009 --> 00:11:57.317
I feel like Godzilla could have some armadillo in him.

00:11:57.317 --> 00:12:01.572
Yes, yeah, because it's really armadillos, right, dennis?

00:12:01.572 --> 00:12:04.475
That are some of the more common reservoir hosts.

00:12:04.475 --> 00:12:07.158
Yeah, you don't have to go nerd out on armadillos yet.

00:12:07.158 --> 00:12:08.100
I know we're going to get to your armadillos.

00:12:08.120 --> 00:12:10.984
No, but I want to nerd out on Godzilla, because I think Godzilla is a reptile.

00:12:10.984 --> 00:12:23.590
That's what I was always told and I think for me, the perception was always that armadillos, they're actually mammals and they're actually closely related to anteaters and sloths.

00:12:23.590 --> 00:12:35.004
So they are placental mammals and they just so happen to be very susceptible to mycobacterium leprae and that's why they've been traditionally used as a laboratory animal to study the disease.

00:12:35.004 --> 00:12:42.403
And the key thing here is that the reason why they are being used as an animal model is because they mimic the human disease very well.

00:12:42.403 --> 00:12:54.552
So what you see in a human disease and I hope Matt will get into that in a second the myopathy, the nerve damage, the neuropathologies and so on are very similar to what's seen in humans.

00:12:54.552 --> 00:12:58.361
So in terms of face value, it's a very good model that mimics human disease.

00:12:58.361 --> 00:12:59.855
So what are the clinical signs?

00:13:00.035 --> 00:13:07.041
Yeah, so I talked a little about the skin lesions, which remember that people get exposed and they may not manifest disease for many, many years.

00:13:07.041 --> 00:13:15.482
Anywhere from one up to 30 years have been described, but usually four to eight years from exposure people will start to manifest skin lesions.

00:13:15.482 --> 00:13:22.639
But really the reason all that comes about is, as you mentioned, dennis, because the disease affects Schwann cells and histiocytes and things like that.

00:13:22.639 --> 00:13:40.370
There's nerve damage, especially peripheral nerves, and so it's often said that people with Hansen's disease just don't feel pain in those extremities and so they're constantly injuring them, bumping them into things, they're getting burned, and so those get secondarily infected and there are erosive damages that happen.

00:13:40.571 --> 00:13:48.278
There's all kinds of stuff that you do, unconsciously, your brain does to keep your extremities intact and to keep your skin intact and keep your bones from getting hurt.

00:13:48.278 --> 00:13:52.639
You will feel pain, you will feel discomfort, you will say I'm going to sit down or I'm going to put on shoes.

00:13:52.639 --> 00:14:03.115
People with Hansen's disease do not have those natural responses and so they start to develop a lot of erosive changes of both the skin and then of the nerves and then ultimately of the bones as well.

00:14:03.115 --> 00:14:19.441
So you'll see digits missing, you'll see neural digits, you'll see often pretty erosive changes of those extremities and then on the skin you'll see these ulcerative lesions that pop up on the ears, on the nose, on the cheeks and then obviously on the surface of the skin.

00:14:19.701 --> 00:14:25.756
So you're saying and I'm stealing a lot of Camille's questions here it's ulcerative, but it's not contagious though.

00:14:25.756 --> 00:14:31.232
Right, so we don't have to be afraid if we see somebody with leprosy and they touch us or give us the hand.

00:14:31.232 --> 00:14:32.658
That's not a way of transmission.

00:14:32.658 --> 00:14:33.722
Right, that's correct.

00:14:33.984 --> 00:14:34.424
That's correct.

00:14:34.424 --> 00:14:42.611
I think that was one of the things is, prior to the elaboration of this pathogen as a respiratory pathogen mostly respiratory there was a huge amount of stigma.

00:14:42.611 --> 00:14:59.461
I remember germ theory is a relatively new innovation for our species, so people thought it was miasmas, they thought it was genetic and it wasn't until Norwegian scientist Gerard Armer Hansen, who lived from 1841 to 1912, checks notes.

00:14:59.461 --> 00:15:11.408
In the late 1800s he characterized the infectious Asian as a mycobacterium and that let them make the name of what was previously called leprosy, which was a very stigmatizing name.

00:15:11.408 --> 00:15:12.427
They called it Hansen's disease.

00:15:12.809 --> 00:15:19.116
And, if I can just jump in, something you mentioned was that this particular bacteria has a bit of a tropism for a certain type of cells.

00:15:19.116 --> 00:15:30.894
So Schwann cells and for those listening who might not be familiar with these, I had to look them up myself and I work in a neuroscience lab they're glial cells and they form the myelin sheath on axons outside the brain, which is really important.

00:15:30.894 --> 00:15:48.336
But what's really interesting is that the bacterium actually promotes a nuclear reprogramming and de-differentiation of these host Schwann cells and they become progenitor stem-like cells that are more vulnerable to infection, which I think is a really fascinating mechanism by which it's infecting.

00:15:48.336 --> 00:15:51.854
And, dr Pente, I also had a clarifying question for you on what you said about armadillos.

00:15:51.854 --> 00:16:00.230
So if, as Dr Daschow has mentioned we've talked about, it's primarily a respiratory pathogen, are there any precautions the public should take when dealing with armadillos?

00:16:00.230 --> 00:16:02.072
We certainly have them here in Texas.

00:16:02.072 --> 00:16:07.520
Should people avoid contact with armadillos and how many armadillos are really carrying amblaprae?

00:16:07.861 --> 00:16:10.754
Yeah, before I answer your question, I want to go back to what I said previously.

00:16:10.754 --> 00:16:15.251
I think we talked about the stigma of humans and I think that's the stigma with armadillos.

00:16:15.251 --> 00:16:30.446
The bacterium can be carried by a range of different animals, so it can be wild rodents, it can be a range of different mammals, non-human primates In certain areas we have different species, even chimpanzees or manga bees, that can carry the disease.

00:16:30.446 --> 00:16:44.663
But I think the reason why armadillos are always so in the focus is because they show disease and so they have an active, ongoing infection, and that obviously makes them more relevant to transmit the disease to humans.

00:16:44.769 --> 00:16:57.241
And I'm not a hunter, but I was always told that these armadillos are considered a pest and so if you shoot them because they are digging holes and they're destroying your crops and your agricultural components, you shoot them because they're a pest.

00:16:57.241 --> 00:17:11.422
And I don't know what the meat tastes like, but I could assume that certain people will also try to harvest the meat and eat the meat and in this process of butchering the animal or handling the animal, I think that's where some of the transmission is happening.

00:17:11.422 --> 00:17:18.993
And if you think about that, maybe one in six armadillos in Texas or in Louisiana are positive or carry the infection.

00:17:18.993 --> 00:17:20.978
That's quite a high risk.

00:17:21.318 --> 00:17:23.063
I just wanted to interject here, dr Benta.

00:17:23.063 --> 00:17:29.864
Does leprosy or Hansen's disease manifest in armadillos the same way that it manifests in humans?

00:17:29.864 --> 00:17:33.780
Could you tell that an armadillo has leprosy or Hansen's disease?

00:17:34.329 --> 00:17:46.721
When I was doing my literature research and I was looking into these animal models and how good armadillos are to mimic human disease, I had the same question and I didn't really find the answer.

00:17:46.721 --> 00:17:57.380
If the Amadillo comes down with some sort of a muscle disease, some sort of a neuropathy of some sorts, they might be impaired in their locomotion or in some sort of stuff.

00:17:57.380 --> 00:18:04.695
And if an animal is sick, the question is always is it easier prey and is it easier to hunt the animal?

00:18:04.695 --> 00:18:10.824
To be honest with you, I'm not sure if they show any sign of ulcerative cutaneous lesions or not.

00:18:10.824 --> 00:18:11.325
I don't know.

00:18:11.325 --> 00:18:11.884
Do you know?

00:18:12.205 --> 00:18:17.521
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.

00:18:17.521 --> 00:18:20.673
So if you're trying to get a sample in the wild, that might be difficult for researchers.

00:18:20.673 --> 00:18:31.707
But going off of that, thinking about ulcerative lesions, things like that, dr Tasho, I wanted to ask when I was looking in clinical literature why are dermatologists the ones who often diagnose Hansen's disease?

00:18:31.707 --> 00:18:35.060
It's not really infectious disease docs, from my understanding.

00:18:35.060 --> 00:18:39.026
Is it just that skin checks are not like a normal part of seeing a patient?

00:18:39.366 --> 00:18:40.009
That's a good question.

00:18:40.009 --> 00:18:51.029
I mean, I think there is obviously the part of it that, in order to make the diagnosis, you often need a sample, and it's often dermatologists that are taking the biopsies or taking the samples.

00:18:51.029 --> 00:18:59.924
Many times, when there are these chronic lesions, we will push for a biopsy or push for some kind of tissue diagnosis, in which case dermatologists can be involved.

00:18:59.924 --> 00:19:17.699
Some people, when they have chronic skin issues, will primarily go to a dermatologist, so I think that'll be a good thing for us to also review with Mara, because, as you mentioned, yeah, dermatologists are going to be the ones that may actually pick these things up first, but those of us who are out in the world, I think I'm always curious as to why we don't have more of it in Texas.

00:19:17.699 --> 00:19:21.873
If we have so many armadillos, so many armadillos, we should all be on the lookout for it.

00:19:23.615 --> 00:19:24.597
Yeah, that's a good question.

00:19:24.597 --> 00:19:26.040
I can only speculate.

00:19:26.040 --> 00:19:37.521
I guess Probably like 100 or 200 years ago, I think, there's more need for the meat of armadillos and nowadays they're just being shot and then just left to die and decay.

00:19:37.521 --> 00:19:48.176
I don't know how the armadillo population has changed over time, but I think it's also the exposure, the density of the animals in the area and the exposure to humans.

00:19:48.757 --> 00:19:51.920
I do wonder how armadillos originally became infected.

00:19:51.920 --> 00:19:54.803
Is this something that humans gave armadillos?

00:19:54.803 --> 00:19:56.825
Which way did the zoonosis go?

00:19:56.845 --> 00:19:58.605
The chicken and the egg question.

00:19:58.605 --> 00:20:01.229
I don't think that anybody will ever find out.

00:20:01.729 --> 00:20:14.159
With so many species potentially susceptible to it, I don't think that you can ever find out what the origins and I think you mentioned Camille at the beginning but 95% of the human population is immune to it.

00:20:14.159 --> 00:20:35.877
So when you have these pathogens that have been around for literally thousands of years, with generations of people exposed, and it's a slow-growing bacterium I don't know much about the genetics but it seems all very conserved, so probably the strains and the evolution of the bacterial pathogen is not very fast, so it gives us an opportunity to develop immunity for it.

00:20:36.240 --> 00:20:38.067
I actually have a quick question for you, camille.

00:20:38.067 --> 00:20:41.099
You said that there's resistance has built in humans.

00:20:41.099 --> 00:20:50.785
Over time, you said, from the agricultural development into the urbanization of things and humans being exposed over and over again, they became less susceptible to the disease.

00:20:50.785 --> 00:20:52.268
Do you know anything about that?

00:20:52.268 --> 00:20:55.281
What makes humans now more resistant to it?

00:20:55.643 --> 00:20:56.846
Oh, that's a really good question.

00:20:56.846 --> 00:20:58.807
They were talking about tuberculosis and leprosy.

00:20:58.807 --> 00:21:01.318
They do have loci in the paper but I don't have them written down.

00:21:01.318 --> 00:21:07.944
But yeah, I'm not a geneticist so unfortunately I can't answer that now, but I can send it to you this will be the next episode.

00:21:07.964 --> 00:21:09.387
Stay tuned, everybody yeah.

00:21:09.775 --> 00:21:11.583
Deep dive on the genetics of the embassy.

00:21:11.583 --> 00:21:13.221
Go to the show notes.

00:21:14.615 --> 00:21:24.226
But what is interesting about thinking about Hansen's disease is that I did find a paper talking about when was it introduced to Pacific islands.

00:21:24.226 --> 00:21:28.145
So if you're thinking about, like the Marshallese population, things like that, it was really interesting.

00:21:28.145 --> 00:21:35.486
I would have assumed it was with colonialism, whether that was Japanese imperialism or European colonialism.

00:21:35.486 --> 00:21:35.727
It was not.

00:21:35.727 --> 00:21:36.829
Actually, they refute that.

00:21:36.829 --> 00:21:42.465
They analyzed basically nine different samples and they found that it was with the first migration of people there.

00:21:42.465 --> 00:21:48.587
So this has been with us potentially even longer than we have 4,000-old skeleton evidence, but much longer than that.

00:21:48.587 --> 00:22:02.958
If it has gone everywhere in the world, it might have been reintroduced at different times and they talk about that a bit in the paper, but that subsequent migrations can move it around, but that it was already there and I think that that's a really fascinating thing to think about, particularly if we're thinking about animal reservoirs.

00:22:02.958 --> 00:22:05.481
Was this just sort of on all continents?

00:22:05.821 --> 00:22:06.824
if it was in the islands.

00:22:06.824 --> 00:22:21.815
And I think if there's something we can learn from Mycobacterium tuberculosis, which is also worldwide and it's in so many different species and it's probably also found in the soil it's very tenacious in the soil and you have again the range of mammals that are involved.

00:22:21.815 --> 00:22:31.438
So I don't think this is really just a very easy zoonotic transmission one-to-one, but maybe there's certain reservoirs in the soil.

00:22:31.438 --> 00:22:35.816
I know, for example, for mycobacterium tuberculosis in Europe, badgers are a big issue.

00:22:35.816 --> 00:22:40.165
They can transmit that and they dig and root around and all kinds of things.

00:22:40.165 --> 00:22:42.781
Cows get infected with mycobacterium and so on.

00:22:42.781 --> 00:22:46.395
So I don't think it's easy to pinpoint the source of something like that.

00:22:46.395 --> 00:22:49.243
It's been probably around for a much longer time than what?

00:22:49.243 --> 00:22:50.066
4,000 years.

00:22:50.996 --> 00:23:15.603
Yeah, that's a really good point and I would say the stigma surrounding it has also been around for an exceptionally long time and I would really like us to talk about that, because I think there's always a danger, as someone who works in the field of infectious diseases, in suggesting that it's a very us-versus-them rhetoric to say, oh, most cases are acquired outside of the United States, because the reality is our health is so globally interconnected and if anyone thought that wasn't the case, covid-19 proved us wrong.

00:23:15.904 --> 00:23:27.125
Every individual's health on this planet, whether they're animal or human, is so interconnected and anything that happens in one place can eventually kind of shift around, and it's something we've chosen to be so globalized.

00:23:27.125 --> 00:23:32.887
But could we talk about more on why does this always pop up, particularly in regards to leprosy?

00:23:32.887 --> 00:23:38.698
There's this idea of the stigma of being morally unclean, and that's something that has popped up with other diseases as well.

00:23:38.698 --> 00:23:44.278
I think of things like HIV and even people just making judgments about particularly any infectious disease.

00:23:44.278 --> 00:23:48.428
So could we talk about why that is in the context of leprosy or other diseases?

00:23:49.015 --> 00:23:51.501
Yeah, I think that leprosy is kind of the poster child for this.

00:23:51.501 --> 00:23:52.464
The stigma, right.

00:23:52.464 --> 00:24:05.287
How many colonies and they're typically isolated islands or some sanitarium or some hospital on some remote islands, right, I think that's really the poster child for stigma in disease.

00:24:05.287 --> 00:24:07.458
Matt, do you have any thoughts on that?

00:24:07.458 --> 00:24:08.078
Oh, man.

00:24:08.140 --> 00:24:10.003
Why does it keep happening, camille?

00:24:10.003 --> 00:24:15.362
I mean first of all the interconnectedness of human-animal environmental health migration.

00:24:15.362 --> 00:24:17.446
Someone should really make a podcast about that.

00:24:18.654 --> 00:24:19.741
It's going to be the spinoff.

00:24:20.335 --> 00:24:22.259
Someone should just really, really do that.

00:24:22.259 --> 00:24:25.385
I wish I had a good answer for why that is.

00:24:25.385 --> 00:24:26.816
It's the other, isn't it?

00:24:26.816 --> 00:24:31.480
For a long time, I think it was lack of knowledge, lack of understanding, lack of compassion.

00:24:31.480 --> 00:24:40.729
Most of the people who were suffering from Hansen's disease that were uprooted from their communities and put into leper colonies.

00:24:40.729 --> 00:24:46.557
It was done against their will, but the people who cared for them were often faith-based communities.

00:24:46.557 --> 00:24:56.180
These were largely mission groups that took care of these populations because they were stigmatized and nobody else would, and they were in many ways out of the system.

00:24:56.180 --> 00:25:08.022
People didn't want to deal with them and this is a problem of marginalized groups around the world and you can look at it as a stigma of disease, a stigma of ethnicity, of cultural background, of race, whatever.

00:25:08.022 --> 00:25:13.064
The examples of otherizing are rife within society throughout human history.

00:25:13.064 --> 00:25:16.598
So tough one to answer, just specifically on infectious diseases.

00:25:17.039 --> 00:25:31.178
And I think the reason why it's probably so stigmatizing is because the clinical presentation is so visible, right, and we see this with leishmania, for example, where you have the cutaneous things that everybody can see.

00:25:31.178 --> 00:25:38.861
Keep in mind the driver of when we go back to pox, for example, to the smallpox vaccinations, the initial idea.

00:25:38.861 --> 00:25:57.218
When the vaccination was done by the Chinese, they purposefully inoculated a less virulent version of smallpox in a part of the body that's not visible your arm or something like that, not your face, so that you don't have the blisters and the postules and stuff like that in your face later on.

00:25:57.218 --> 00:26:01.327
So I think the appearance aspect of leprosy is why it's so.

00:26:01.327 --> 00:26:02.858
Ostracizing is the word.

00:26:02.858 --> 00:26:04.323
I think it's the right word.

00:26:04.563 --> 00:26:17.400
Yeah, I think that that's an excellent point and I wonder too if part of that's just the psychological aspect of if you can see something, you can imagine it happening to yourself, and that is something I think that makes people kind of resist, like an aversion to like I don't want that to happen to me.

00:26:17.400 --> 00:26:23.496
So there becomes this disconnect between seeing someone as another person who also is deserving of care and things like that.

00:26:23.496 --> 00:26:28.922
And speaking of care, up until fairly recently there were still leper colonies.

00:26:28.922 --> 00:26:32.184
Does anyone know if there's still any in existence?

00:26:32.184 --> 00:26:33.526
I know there's remnants.

00:26:34.067 --> 00:26:35.127
Yeah, I think there's remnants.

00:26:35.127 --> 00:26:39.412
I don't know that there's active places where people with leprosy have lived.

00:26:39.412 --> 00:26:44.298
It's interesting because I know in some countries people who are long-term sufferers of the disease.

00:26:44.298 --> 00:26:49.525
They've continued to live in the same communities because they're actually quite comfortable there.

00:26:49.525 --> 00:26:53.611
So I think some of it has been structural and some of it is just historic.

00:26:53.611 --> 00:27:02.406
But I don't think there's an active program right now that says okay, if you have leprosy you must go to this place because, as you mentioned before, it's really quite difficult to acquire.

00:27:02.914 --> 00:27:06.221
Yeah, and then something that I had found that I just also wanted to mention.

00:27:06.221 --> 00:27:17.880
I actually found an interview from a nurse who works in the Marshall Islands, particularly in a clinic that deals with Hansen's disease, and the title of the article was actually Please Don't Tell my Husband I have Leprosy, and she actually details how.

00:27:17.880 --> 00:27:46.522
That wasn't on BuzzFeed no, it was not but it was fascinating because she's giving basically all of these examples of patients who don't even want to be seen going into a clinic that's associated with treating Hansen's disease and so healthcare workers sometimes like have to meet patients outside of the clinic, things like that, and it becomes a very difficult thing to end up treating because there ends up not being necessarily continuity of care, which can then put that person in more danger of developing the nerve damage and things like that.

00:27:46.522 --> 00:27:56.299
So what I guess I wanted to get at with this is what can we do as people who are working in the medical and science fields to help continue reducing stigma?

00:27:56.299 --> 00:27:57.142
Is it just language?

00:27:57.142 --> 00:27:59.386
Is it using Hansen's disease and not leprosy?

00:28:00.055 --> 00:28:09.526
I mean, I think it's becoming more familiar with it and, I think, becoming very comfortable with the idea that infectious pathogens are part of our ecosystem.

00:28:09.526 --> 00:28:29.808
And I think part of our job as communicators, as clinicians, as scientists, as people who are interested in this pushing the idea of One Health is that we do share this planet with all kinds of different species and what we want to do is we want to meet conditions and people and other animals with compassion.

00:28:29.808 --> 00:28:35.407
So that's kind of a cop-out theory question, camille, which is what do we do about it?

00:28:35.407 --> 00:28:42.703
I think education is maybe one of the most important things that we can do, communicating with people, answering questions.

00:28:42.703 --> 00:28:45.104
I think people have legitimate fears and worries.

00:28:45.375 --> 00:28:48.141
I didn't mean to imply earlier that people were wrong to fear leprosy.

00:28:48.141 --> 00:28:53.662
There was a time where we didn't know how it was transmitted and we didn't know that it was caused by who knows.

00:28:53.662 --> 00:28:57.826
But what we saw, even in those moments where we didn't know what it was, we saw compassion.

00:28:57.826 --> 00:29:09.788
And I think if we lead with compassion and we lead with the idea that there's always more to learn and understand, I think we can help with stigma, because you brought it up really well that it's not just Hansen's disease they surround the world.

00:29:09.894 --> 00:29:11.942
People don't want to go to TB clinics to get treated.

00:29:11.942 --> 00:29:15.344
They used to have to go to special HIV clinics to get HIV medicines.

00:29:15.344 --> 00:29:16.286
It's very stigmatizing.

00:29:16.286 --> 00:29:27.471
So part of it is that our system can adapt to be a bit more inclusive and make it so that even getting people the treatment that they need where they need it, instead of having to go to specific places.

00:29:27.471 --> 00:29:30.138
So those are just some thoughts about how we can all work to decent.

00:29:30.138 --> 00:29:36.342
But there are people who work in the stigma area that have written entire books about approaches, which I could say more about.

00:29:36.555 --> 00:29:41.845
So, camille and Christina, since you guys are new here, I'm known for always asking one philosophical question.

00:29:41.845 --> 00:29:51.327
So my question for you I think that some of the stigmas and the otherization and so on is also something that we probably carry as instincts inside of us.

00:29:51.327 --> 00:29:57.749
Like an infected animal will always separate itself from the group to avoid transmission.

00:29:57.749 --> 00:30:03.968
Or we have these mechanisms in place where, if you eat something that you think is toxic, your tongue will tell you it's bitter.

00:30:03.968 --> 00:30:08.381
We have these mechanisms in place to warn us about potential danger.

00:30:08.381 --> 00:30:09.061
It's bitter.

00:30:09.061 --> 00:30:10.984
We have these mechanisms in place to warn us about potential danger.

00:30:10.984 --> 00:30:15.451
Can we, as a human race, overcome this with our brain and then kick in empathy and overrule our instincts?

00:30:15.875 --> 00:30:30.636
I feel like we can and I'm only going to say this because isn't that supposed to be what sets us apart from other species and other animals, as is our higher order thinking and our ability to understand things and then act on that understanding.

00:30:30.636 --> 00:30:38.402
And I really liked what Dr Dasho said about education, because I really do think that education is the key to so much, to unlocking so much.

00:30:38.402 --> 00:30:46.087
And I think one important thing to know and please correct me if I'm wrong is to realize that so many of these diseases have treatments.

00:30:46.087 --> 00:30:48.784
There is treatment available for these things.

00:30:49.055 --> 00:30:54.919
If you probably ask someone on the street, hey, if you develop leprosy, what do you think your prognosis is?

00:30:54.919 --> 00:30:59.336
And I think that if you catch leprosy early on, of course that's really important.

00:30:59.336 --> 00:31:09.928
It's so important to know that there is actually treatment for these diseases and I think understanding that there is treatment kind of takes the fear of that disease process away.

00:31:09.928 --> 00:31:15.367
Of course, we still have light years to go to make sure that treatment is available for everyone.

00:31:15.367 --> 00:31:22.288
Of course we still need to overcome that stigmatization so that we can make sure that a lot of people have access to the treatment that they need.

00:31:22.288 --> 00:31:33.888
And also we need to overcome so many other social factors that we can go into for hours, but I do think just understanding that can strip away a lot of the fear of these infectious diseases.

00:31:34.329 --> 00:31:44.059
Yeah, I think we can overcome it, but perhaps not unilaterally, because in order to have the bandwidth to do that, you have to have a lot of security in other areas of your life.

00:31:44.059 --> 00:31:57.895
In order to be able to have empathy for others, you need to have your needs met in so many ways, whether that's something like Maslow's hierarchy, or whether that's even just like having your mental and emotional health your needs met for that in order to in any way support someone else.

00:31:57.895 --> 00:32:16.684
And so I think that that, to me, would probably be the barrier to overcoming stigmatization is that in the world as it is now, I think so many people are very stressed and are very insecure on what's happening, whether in their local area or on a global scale, and I think that we kind of run into this empathy fatigue where it becomes very difficult to just constantly keep caring.

00:32:16.684 --> 00:32:22.665
So that, to me, is the only barrier we have to actually being able to overcome that.

00:32:22.665 --> 00:32:23.976
That would be my answer to this.

00:32:23.976 --> 00:32:29.961
But this has been really fascinating Migration, godzilla philosophy, leprosy Very cool, very cool.

00:32:29.981 --> 00:32:32.755
Yeah, I think, guys, we're going to fix it One podcast episode at a time.

00:32:35.420 --> 00:32:37.785
Thanks for listening to the Infectious Science Podcast.

00:32:37.785 --> 00:32:45.778
Be sure to hit subscribe and visit infectiousscienceorg to join the conversation, access the show notes and to sign up for our newsletter and receive our free materials.

00:32:46.320 --> 00:32:54.523
If you enjoyed this new episode of Infectious Science, please leave us a review on Apple Podcasts and Spotify, and go ahead and share this episode with some of your friends.

00:32:55.095 --> 00:32:59.646
Also, don't hesitate to ask questions and tell us what topics you'd like us to cover for future episodes.

00:32:59.646 --> 00:33:03.986
To get in touch, drop a line in the comments section or send us a message on social media.

00:33:04.335 --> 00:33:09.968
So we'll see you next time for a new episode, and in the meantime, stay happy stay healthy, stay interested.