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68-461: The name Gutleut originates from the "Gutleuthof", once a refuge for lepers hosted by the " fraternity of the good people". The former working class district has spruced up considerably in recent years with the development of a new housing and business district at the former West Harbor. This Hesse location article is a stub . You can help Misplaced Pages by expanding it . Leper Leprosy , also known as Hansen's disease ( HD ),

136-450: A better effect on ulcer healing than clioquinol cream or zinc paste, but the evidence for this is weak. Phenytoin applied to the skin improves skin changes to a greater degree when compared to saline dressings. Although leprosy has been curable since the mid-20th century, left untreated it can cause permanent physical impairments and damage to a person's nerves, skin, eyes, and limbs. Despite leprosy not being very infectious and having

204-636: A commentary on all medical and surgical knowledge and descriptions and remedies to do with leprosy from the Romans, Greeks, and Arabs. Leprosy did not exist in the Americas before colonization by modern Europeans nor did it exist in Polynesia until the middle of the 19th century. The causative agent of leprosy, M. leprae , was discovered by Gerhard Armauer Hansen in Norway in 1873, making it one of

272-834: A different path for the spread of leprosy, meaning it may have originated in Western Eurasia. This study also indicates that there were more strains in Europe at the time than previously determined. Literary attestation of leprosy is unclear because of the ambiguity of many early sources, including the Indian Atharvaveda and Kausika Sutra, the Egyptian Ebers Papyrus , and the Hebrew Bible 's various sections regarding signs of impurity ( tzaraath ). Clearly leprotic symptoms are attested in

340-495: A low pathogenicity, there is still significant stigma and prejudice associated with the disease. Because of this stigma, leprosy can affect a person's participation in social activities and may also affect the lives of their family and friends. People with leprosy are also at a higher risk for problems with their mental well-being. The social stigma may contribute to problems obtaining employment, financial difficulties, and social isolation. Efforts to reduce discrimination and reduce

408-423: A role in susceptibility to an infection. Cases of leprosy often cluster in families and several genetic variants have been identified. In many people who are exposed, the immune system is able to eliminate the leprosy bacteria during the early infection stage before severe symptoms develop. A genetic defect in cell-mediated immunity may cause a person to be susceptible to develop leprosy symptoms after exposure to

476-461: A sensory and a motor division. The visceral motor division is known as the autonomic nervous system. In the somatic nervous system, the cranial nerves are part of the PNS with the exceptions of the olfactory nerve and epithelia and the optic nerve (cranial nerve II) along with the retina , which are considered parts of the central nervous system based on developmental origin. The second cranial nerve

544-639: A tumour mass or injury. Alternatively, if a nerve is in an area with a fixed size it may be trapped if the other components increase in size, such as carpal tunnel syndrome and tarsal tunnel syndrome . Common symptoms of carpal tunnel syndrome include pain and numbness in the thumb, index and middle finger. In peripheral neuropathy, the function one or more nerves are damaged through a variety of means. Toxic damage may occur because of diabetes ( diabetic neuropathy ), alcohol, heavy metals or other toxins; some infections; autoimmune and inflammatory conditions such as amyloidosis and sarcoidosis . Peripheral neuropathy

612-437: Is 24 months because of their lower bactericidal activity. Evidence on the potential benefits and harms of alternative regimens for drug-resistant leprosy is not available. For people with nerve damage, protective footwear may help prevent ulcers and secondary infection. Canvas shoes may be better than PVC boots. There may be no difference between double rocker shoes and below-knee plaster. Topical ketanserin seems to have

680-576: Is a long-term infection by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis . Infection can lead to damage of the nerves , respiratory tract , skin, and eyes. This nerve damage may result in a lack of ability to feel pain, which can lead to the loss of parts of a person's extremities from repeated injuries or infection through unnoticed wounds. An infected person may also experience muscle weakness and poor eyesight. Leprosy symptoms may begin within one year, but, for some people, symptoms may take 20 years or more to occur. Leprosy

748-494: Is a "self-regulating" system which influences the function of organs outside voluntary control, such as the heart rate , or the functions of the digestive system . The somatic nervous system includes the sensory nervous system (ex. the somatosensory system ) and consists of sensory nerves and somatic nerves, and many nerves which hold both functions. In the head and neck , cranial nerves carry somatosensory data. There are twelve cranial nerves, ten of which originate from

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816-630: Is a single dose of rifampicin (SDR) in adults and children over 2 years old who do not already have leprosy or tuberculosis. Preventive treatment is associated with a 57% reduction in infections within 2 years and a 30% reduction in infections within 6 years. The Bacillus Calmette–Guérin (BCG) vaccine offers a variable amount of protection against leprosy in addition to its closely related target of tuberculosis . It appears to be 26% to 41% effective (based on controlled trials) and about 60% effective based on observational studies with two doses possibly working better than one. The WHO concluded in 2018 that

884-436: Is at high risk of developing or transmitting leprosy such as those with few lesions or an atypical clinical presentation. New approaches propose tools to diagnose leprosy through Artificial Intelligence. Several different approaches for classifying leprosy exist. There are similarities between the classification approaches. Leprosy may also occur with only neural involvement, without skin lesions. Leprosy may cause

952-418: Is called spinal nerve root C8). In the lumbar and sacral region, the spinal nerve roots travel within the dural sac and they travel below the level of L2 as the cauda equina. The first 4 cervical spinal nerves, C1 through C4, split and recombine to produce a variety of nerves that serve the neck and back of head. Spinal nerve C1 is called the suboccipital nerve , which provides motor innervation to muscles at

1020-411: Is confirmed by finding acid-fast bacilli in a biopsy of the skin. Leprosy is curable with multidrug therapy. Treatment of paucibacillary leprosy is with the medications dapsone , rifampicin , and clofazimine for six months. Treatment for multibacillary leprosy uses the same medications for 12 months. A number of other antibiotics may also be used. These treatments are provided free of charge by

1088-471: Is delayed by several months. Damage to nerves may cause loss of muscle function, leading to paralysis. It may also lead to sensation abnormalities or numbness , which may lead to additional infections, ulcerations, and joint deformities. M. leprae and M. lepromatosis are the mycobacteria that cause leprosy. M. lepromatosis is a relatively newly identified mycobacterium isolated from a fatal case of diffuse lepromatous leprosy in 2008. M. lepromatosis

1156-492: Is indistinguishable clinically from M. leprae . M. leprae is an aerobic , rod-shaped, acid-fast bacterium with a waxy cell envelope characteristic of the genus Mycobacterium . M. leprae and M. lepromatosis are obligate intracellular pathogens , and cannot grow or be cultured outside of host tissues. However, they can be grown using research animals such as mice and armadillos . Naturally occurring infection has been reported in nonhuman primates (including

1224-464: Is known as leprology. Common symptoms present in the different types of leprosy include a runny nose; dry scalp ; eye problems; skin lesions ; muscle weakness; reddish skin; smooth, shiny, diffuse thickening of facial skin, ear, and hand; loss of sensation in fingers and toes; thickening of peripheral nerves ; a flat nose from destruction of nasal cartilages ; and changes in phonation and other aspects of speech production. In addition, atrophy of

1292-411: Is not a true peripheral nerve but a tract of the diencephalon . Cranial nerve ganglia , as with all ganglia , are part of the PNS. The autonomic nervous system exerts involuntary control over smooth muscle and glands . The connection between CNS and organs allows the system to be in two different functional states: sympathetic and parasympathetic . The peripheral nervous system is divided into

1360-413: Is not sexually transmitted and is not spread through pregnancy to the unborn child. The majority (95%) of people who are exposed to M. leprae do not develop leprosy; casual contact such as shaking hands and sitting next to someone with leprosy does not lead to transmission. People are considered non-infectious 72 hours after starting appropriate multi-drug therapy. Two exit routes of M. leprae from

1428-413: Is safe and easy to use under field conditions because of it is available in calendar labelled blister packs. Post-treatment relapse rates remain low. Resistance has been reported in several countries, although the number of cases is small. People with rifampicin-resistant leprosy may be treated with second line drugs such as fluoroquinolones , minocycline , or clarithromycin , but the treatment duration

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1496-448: Is spread between people, although extensive contact is necessary. Leprosy has a low pathogenicity and 95% of people who contract or who are exposed to M. leprae do not develop the disease. Spread is thought to occur through a cough or contact with fluid from the nose of a person infected by leprosy. Genetic factors and immune function play a role in how easily a person catches the disease. Leprosy does not spread during pregnancy to

1564-477: Is to connect the CNS to the limbs and organs , essentially serving as a relay between the brain and spinal cord and the rest of the body. Unlike the CNS, the PNS is not protected by the vertebral column and skull , or by the blood–brain barrier , which leaves it exposed to toxins . The peripheral nervous system can be divided into the somatic nervous system and the visceral nervous system . Each of these have

1632-551: The World Health Organization . Leprosy is not highly contagious. People with leprosy can live with their families and go to school and work. In the 1980s, there were 5.2 million cases globally, but by 2020 this decreased to fewer than 200,000. Most new cases occur in 14 countries, with India accounting for more than half. In the 20 years from 1994 to 2014, 16 million people worldwide were cured of leprosy. About 200 cases per year are reported in

1700-424: The brainstem , and mainly control the functions of the anatomic structures of the head with some exceptions. One unique cranial nerve is the vagus nerve , which receives sensory information from organs in the thorax and abdomen . The other unique cranial nerve is the accessory nerve which is responsible for innervating the sternocleidomastoid and trapezius muscles , neither of which are located exclusively in

1768-440: The central nervous system are connected with organs that have smooth muscle, such as the heart, bladder, and other cardiac, exocrine, and endocrine related organs, by ganglionic neurons. The most notable physiological effects from autonomic activity are pupil constriction and dilation, and salivation of saliva. The autonomic nervous system is always activated, but is either in the sympathetic or parasympathetic state. Depending on

1836-415: The somatic nervous system , and the autonomic nervous system . The somatic nervous system is under voluntary control, and transmits signals from the brain to end organs such as muscles . The sensory nervous system is part of the somatic nervous system and transmits signals from senses such as taste and touch (including fine touch and gross touch) to the spinal cord and brain. The autonomic nervous system

1904-432: The thoracic diaphragm , enabling breathing . If the spinal cord is transected above C3, then spontaneous breathing is not possible. The last four cervical spinal nerves, C5 through C8, and the first thoracic spinal nerve, T1, combine to form the brachial plexus , or plexus brachialis , a tangled array of nerves, splitting, combining and recombining, to form the nerves that subserve the upper-limb and upper back. Although

1972-464: The African chimpanzee , the sooty mangabey , and the cynomolgus macaque), armadillos, and red squirrels . Multilocus sequence typing of the armadillo M. leprae strains suggests that they were of human origin for at most a few hundred years. Thus, it is suspected that armadillos first acquired the organism incidentally from early European explorers of the Americas. This incidental transmission

2040-664: The African origin of the disease". A proven human case was verified by DNA taken from the shrouded remains of a man discovered by researchers from the Hebrew University of Jerusalem in a tomb in Akeldama , next to the Old City of Jerusalem , Israel , dated by radiocarbon methods to the first half of the 1st century. The oldest strains of leprosy known from Europe are from Great Chesterford in southeast England and dating back to AD 415–545. These findings suggest

2108-550: The BCG vaccine at birth reduces leprosy risk and is recommended in countries with high incidence of TB and people who have leprosy. People living in the same home as a person with leprosy are suggested to take a BCG booster which may improve their immunity by 56%. Development of a more effective vaccine is ongoing. A novel vaccine called LepVax entered clinical trials in 2017 with the first encouraging results reported on 24 participants published in 2020. If successful, this would be

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2176-663: The Indian doctor Sushruta 's Compendium , originally dating to c. 600 BC but only surviving in emended texts no earlier than the 5th century. Symptoms consistent with leprosy were possibly described by Hippocrates in 460 BC. However, Hansen's disease probably did not exist in Greece or the Middle East before the Common Era . In 1846, Francis Adams produced The Seven Books of Paulus Aegineta which included

2244-596: The Near East and traveled with humans along their migration routes, including those of trade in goods and slaves. The four strains of M. leprae are based in specific geographic regions where each predominantly occurs: This confirms the spread of the disease along the migration, colonisation, and slave trade routes taken from East Africa to India, West Africa to the New World, and from Africa into Europe and vice versa. Skeletal remains discovered in 2009 represent

2312-607: The United States. Central Florida accounted for 81% of cases in Florida and nearly 1 out of 5 leprosy cases nationwide. Separating people affected by leprosy by placing them in leper colonies still occurs in some areas of India, China, Africa, and Thailand. Leprosy has affected humanity for thousands of years. The disease takes its name from the Greek word λέπρα ( lépra ), from λεπίς ( lepís ; 'scale'), while

2380-550: The area affected. The skin can crack and if the skin injuries are not carefully cared for, there is a risk for a secondary infection that can lead to more severe damage. In countries where people are frequently infected, a person is considered to have leprosy if they have one of the following two signs: Skin lesions can be single or many, and usually hypopigmented , although occasionally reddish or copper-colored. The lesions may be flat ( macules ), raised ( papules ), or solid elevated areas ( nodular ). Experiencing sensory loss at

2448-520: The bacteria. The region of DNA responsible for this variability is also involved in Parkinson's disease , giving rise to current speculation that the two disorders may be linked at the biochemical level. Most leprosy complications are the result of nerve damage. The nerve damage occurs from direct invasion by the M. leprae bacteria and a person's immune response resulting in inflammation. The molecular mechanism underlying how M. leprae produces

2516-475: The base of the skull . C2 and C3 form many of the nerves of the neck, providing both sensory and motor control. These include the greater occipital nerve , which provides sensation to the back of the head, the lesser occipital nerve , which provides sensation to the area behind the ears , the greater auricular nerve and the lesser auricular nerve . The phrenic nerve is a nerve essential for our survival which arises from nerve roots C3, C4 and C5. It supplies

2584-460: The body, while others remain rested. Primarily using the neurotransmitter acetylcholine (ACh) as a mediator, the parasympathetic system allows the body to function in a "rest and digest" state. Consequently, when the parasympathetic system dominates the body, there are increases in salivation and activities in digestion, while heart rate and other sympathetic response decrease. Unlike the sympathetic system, humans have some voluntary controls in

2652-569: The brachial plexus may appear tangled, it is highly organized and predictable, with little variation between people. See brachial plexus injuries . The anterior divisions of the lumbar nerves , sacral nerves , and coccygeal nerve form the lumbosacral plexus , the first lumbar nerve being frequently joined by a branch from the twelfth thoracic . For descriptive purposes this plexus is usually divided into three parts: The autonomic nervous system (ANS) controls involuntary responses to regulate physiological functions. The brain and spinal cord of

2720-452: The diagnosis is typically made without laboratory tests, based on symptoms. If a person has a new leprosy diagnosis and already has a visible disability caused by leprosy, the diagnosis is considered late. In countries or areas where leprosy is uncommon, such as the United States, diagnosis of leprosy is often delayed because healthcare providers are unaware of leprosy and its symptoms. Early diagnosis and treatment prevent nerve involvement,

2788-444: The disease is important, since physical and neurological damage may be irreversible even if cured. Medications can decrease the risk of those living with people who have leprosy from acquiring the disease and likely those with whom people with leprosy come into contact outside the home. The WHO recommends that preventive medicine be given to people who are in close contact with someone who has leprosy. The suggested preventive treatment

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2856-439: The disease, and lack of medical care in affected areas. The registered prevalence of the disease is used to determine disease burden . Registered prevalence is a useful proxy indicator of the disease burden, as it reflects the number of active leprosy cases diagnosed with the disease and receiving treatment with MDT at a given point in time. The prevalence rate is defined as the number of cases registered for MDT treatment among

2924-427: The first leprosy-specific vaccine available. A number of leprostatic agents are available for treatment. A three-drug regimen of rifampicin , dapsone and clofazimine is recommended for all people with leprosy, for six months for paucibacillary leprosy and 12 months for multibacillary leprosy. Multidrug therapy (MDT) remains highly effective, and people are no longer infectious after the first monthly dose. MDT

2992-403: The first species of pathogenic bacteria identified. Peripheral nervous system The peripheral nervous system ( PNS ) is one of two components that make up the nervous system of bilateral animals , with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia , which lie outside the brain and the spinal cord . The main function of the PNS

3060-415: The general population. Leprosy also occurs more commonly among those living in poverty. Not all people who are infected with M. leprae develop symptoms. Conditions that reduce immune function, such as malnutrition, other illnesses, or genetic mutations, may increase the risk of developing leprosy. Infection with HIV does not appear to increase the risk of developing leprosy. Certain genetic factors in

3128-447: The hallmark of leprosy, and the disability it causes. There is no recommended test to diagnose latent leprosy in people without symptoms. Few people with latent leprosy test positive for anti PGL-1. The presence of M. leprae bacterial DNA can be identified using a polymerase chain reaction (PCR)-based technique. This molecular test alone is not sufficient to diagnose a person, but this approach may be used to identify someone who

3196-472: The hands or feet. Secondary infections (additional bacterial or viral infections) can result in tissue loss, causing fingers and toes to become shortened and deformed, as cartilage is absorbed into the body. A person's immune response differs depending on the form of leprosy. Approximately 30% of people affected with leprosy experience nerve damage. The nerve damage sustained is reversible when treated early, but becomes permanent when appropriate treatment

3264-454: The head. For the rest of the body, spinal nerves are responsible for somatosensory information. These arise from the spinal cord . Usually these arise as a web ("plexus") of interconnected nerves roots that arrange to form single nerves. These nerves control the functions of the rest of the body. In humans, there are 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. These nerve roots are named according to

3332-493: The human body often described are the skin and the nasal mucosa, although their relative importance is not clear. Lepromatous cases show large numbers of organisms deep in the dermis , but whether they reach the skin surface in sufficient numbers is doubtful. Leprosy may also be transmitted to humans by armadillos , although the mechanism is not fully understood. Not all people who are infected or exposed to M. leprae develop leprosy, and genetic factors are suspected to play

3400-513: The human immune response, white blood cell -derived macrophages may engulf M. leprae by phagocytosis . In the initial stages, small sensory and autonomic nerve fibers in the skin of a person with leprosy are damaged. This damage usually results in hair loss to the area, a loss of the ability to sweat, and numbness (decreased ability to detect sensations such as temperature and touch). Further peripheral nerve damage may result in skin dryness, more numbness, and muscle weaknesses or paralysis in

3468-528: The leprosy epidemic in medieval Europe. A pre- Norman era skull excavated in Hoxne, Suffolk , in 2017 was found to carry DNA from a strain of Mycobacterium leprae, which closely matched the strain carried by modern red squirrels on Brownsea Island , UK. The greatest risk factor for developing leprosy is contact with another person infected by leprosy. People who are exposed to a person who has leprosy are 5–8 times more likely to develop leprosy than members of

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3536-571: The oldest documented evidence for leprosy, dating to the 2nd millennium BC . Located at Balathal , Rajasthan, in northwest India, the discoverers suggest that, if the disease did migrate from Africa to India during the 3rd millennium BC "at a time when there was substantial interaction among the Indus Civilization, Mesopotamia, and Egypt, there needs to be additional skeletal and molecular evidence of leprosy in India and Africa to confirm

3604-411: The parasympathetic system. The most prominent examples of this control are urination and defecation. There is a lesser known division of the autonomic nervous system known as the enteric nervous system . Located only around the digestive tract, this system allows for local control without input from the sympathetic or the parasympathetic branches, though it can still receive and respond to signals from

3672-471: The person exposed have been associated with developing lepromatous or tuberculoid leprosy. Transmission of leprosy occurs during close contact with those who are infected. Transmission of leprosy is through the upper respiratory tract . Older research suggested the skin as the main route of transmission, but research has increasingly favored the respiratory route. Transmission occurs through inhalation of bacilli present in upper airway secretion. Leprosy

3740-464: The population in which the cases have occurred, again at a given point in time. Using comparative genomics , in 2005, geneticists traced the origins and worldwide distribution of leprosy from East Africa or the Near East along human migration routes. They found four strains of M. leprae with specific regional locations: Monot et al. (2005) determined that leprosy originated in East Africa or

3808-422: The rest of the body. The enteric system is responsible for various functions related to gastrointestinal system. Diseases of the peripheral nervous system can be specific to one or more nerves, or affect the system as a whole. Any peripheral nerve or nerve root can be damaged, called a mononeuropathy . Such injuries can be because of injury or trauma, or compression . Compression of nerves can occur because of

3876-589: The situation, one state can overshadow the other, resulting in a release of different kinds of neurotransmitters . The sympathetic system is activated during a "fight or flight" situation in which mental stress or physical danger is encountered. Neurotransmitters such as norepinephrine , and epinephrine are released, which increases heart rate and blood flow in certain areas like muscle, while simultaneously decreasing activities of non-critical functions for survival, like digestion. The systems are independent to each other, which allows activation of certain parts of

3944-470: The skin lesion is a feature that can help determine if the lesion is caused by leprosy or by another disorder such as tinea versicolor . Thickened nerves are associated with leprosy and can be accompanied by loss of sensation or muscle weakness, but muscle weakness without the characteristic skin lesion and sensory loss is not considered a reliable sign of leprosy. In some cases, acid-fast leprosy bacilli in skin smears are considered diagnostic; however,

4012-440: The spinal vertebrata which they are adjacent to. In the cervical region, the spinal nerve roots come out above the corresponding vertebrae (i.e., nerve root between the skull and 1st cervical vertebrae is called spinal nerve C1). From the thoracic region to the coccygeal region, the spinal nerve roots come out below the corresponding vertebrae. This method creates a problem when naming the spinal nerve root between C7 and T1 (so it

4080-441: The stigma surrounding leprosy may help improve outcomes for people with leprosy. In 2018, there were 208,619 new cases of leprosy recorded, a slight decrease from 2017. In 2015, 94% of the new leprosy cases were confined to 14 countries. India reported the greatest number of new cases (60% of reported cases), followed by Brazil (13%) and Indonesia (8%). Although the number of cases worldwide continues to fall, there are parts of

4148-485: The symptoms of leprosy is not clear, but M. leprae has been shown to bind to Schwann cells , which may lead to nerve injury including demyelination and a loss of nerve function (specifically a loss of axonal conductance). Numerous molecular mechanisms have been associated with this nerve damage including the presence of a laminin -binding protein and the glycoconjugate (PGL-1) on the surface of M. leprae that can bind to laminin on peripheral nerves . As part of

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4216-472: The term "Hansen's disease" is named after the Norwegian physician Gerhard Armauer Hansen . Leprosy has historically been associated with social stigma , which continues to be a barrier to self-reporting and early treatment. Leprosy is classified as a neglected tropical disease . World Leprosy Day was started in 1954 to draw awareness to those affected by leprosy. The study of leprosy and its treatment

4284-499: The testes and impotence may occur. Leprosy can affect people in different ways. The average incubation period is five years. People may begin to notice symptoms within the first year or up to 20 years after infection. The first noticeable sign of leprosy is often the development of pale or pink coloured patches of skin that may be insensitive to temperature or pain. Patches of discolored skin are sometimes accompanied or preceded by nerve problems including numbness or tenderness in

4352-548: The time. International (e.g., the WHO 's "Global Strategy for Reducing Disease Burden Due to Leprosy") and national (e.g., the International Federation of Anti-Leprosy Associations) initiatives have reduced the total number and the number of new cases of the disease. The number of new leprosy cases is difficult to measure and monitor because of leprosy's long incubation period, delays in diagnosis after onset of

4420-417: The unborn child or through sexual contact. Leprosy occurs more commonly among people living in poverty. There are two main types of the disease – paucibacillary and multibacillary, which differ in the number of bacteria present. A person with paucibacillary disease has five or fewer poorly pigmented , numb skin patches, while a person with multibacillary disease has more than five skin patches. The diagnosis

4488-403: The victim to lose limbs and digits but not directly. M. leprae attacks nerve endings and destroys the body's ability to feel pain and injury. Without feeling pain, people with leprosy have an increased risk of injuring themselves. Injuries become infected and result in tissue loss. Fingers, toes, and limbs become shortened and deformed as the tissue is absorbed into the body. Early detection of

4556-413: The world where leprosy is more common, including Brazil, South Asia (India, Nepal, Bhutan), some parts of Africa (Tanzania, Madagascar, Mozambique), and the western Pacific. About 150 to 250 cases are diagnosed in the United States each year. In the 1960s, there were tens of millions of leprosy cases recorded when the bacteria started to develop resistance to dapsone , the most common treatment option at

4624-552: Was sustained in the armadillo population, and it may be transmitted back to humans, making leprosy a zoonotic disease (spread between humans and animals). Red squirrels ( Sciurus vulgaris ) , a threatened species in Great Britain, were found to carry leprosy in November 2016. It has been suggested that the trade in red squirrel fur, highly prized in the medieval period and intensively traded, may have been responsible for

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