Weak immune system could be a cause

Weak immune system linked to severe malnutrition could be a cause of “tree man” disease, doctors believe.

In about the last one year, four Bangladeshis showed symptoms of the rare skin disorder, raising concerns among physicians.

They have suggested a prompt investigation for finding out the exact causes of the disease and developing the remedies.

“Malnutrition is a problem in our socio-economic context. This is one of the factors that lead to a weak immune system,” Kabir Chowdhury, a skin specialist at the Dhaka Medical College Hospital, said.

“Viruses attack the body quite easily, if the immune system is weak.”

The immune system is a “network” of cells, tissues, and organs that work together to protect the body against attacks by “foreign invaders”. These invaders are infection-causing primarily microbes such as bacteria, parasite, fungus and virus.

The issue comes to the fore after three more people have showed the disease symptoms after “tree man” Abul Bajandar.

The man from Khulna has been suffering from epidermodysplasia verruciformis, a rare skin disorder commonly known as the tree man illness, which covers limbs with warts, making them look like tree branches. He is believed to be the fourth man in the world with tree man illness.

The 27-year-old had at least 18 surgeries at the hospital to remove the bark-like warts from his limbs. He is doing much better now and doctors are hoping for his recovery.

Ten-year-old Shahana Khatun, who is believed to be the first female suffering from the disease, is undergoing treatment at the burn unit of the DMCH. The girl from Netrokona was admitted to the hospital late last month.

Tajul Islam, 48, and his son Ruhul Amin, 10, of Pirganj in Rangpur, were also admitted to the DMCH burn unit early last year. They, however, left the hospital without informing anyone when doctors were preparing to operate on them.

Talking to this newspaper, Tajul had claimed that his father had died of the same disease. Tajul's elder brother Baset Ali too had the warts on his legs. Later, doctors in Rangpur cut them off.

Dr Samanta Lal Sen, national coordinator of the burn services, told The Daily Star that he received a phone call on Friday and was told that another person in Khulna was showing the “tree man” symptoms.

“As the news about the disease and its treatment at this hospital is spreading, many are reporting their cases here. I think we will get more of these in the upcoming days,” he said, expressing concerns over the situations.

Expressing concerns over the situation, the physician said he was working to meet health ministry officials to conduct a research on the disease.

“Tree man” illness is usually a genetic disease, which is mainly characterised by persistent “human papilloma virus” (HPV) infection, according to an article published by the International Journal of Allied Medical Sciences and Clinical Research of India.

“These diseases carry higher risk of skin cancer [squamous cell carcinoma] when exposed to the sun,” it said.

There is no treatment to prevent new lesions from occurring. But it is important to reduce the risk of skin cancer by strictly avoiding the sun, the journal said in its April-June issue last year.

Kabir Chowdhury, visiting professor at the DMCH, said “tree man” syndrome can be inherited or acquired. However, the one carrying the virus will not essentially be affected, if his or her immune system is strong.

Skin specialist Prof ASM Zakaria of the Bangabandhu Sheikh Mujib Medical University echoed Dr Kabir's views.

However, he said it is a matter of scientific research to find the relation between weak immune system caused by malnutrition and the “tree man” syndrome.

According to health experts, immune system can be weak for poor diet, stress, taking excessive alcohol, lack of sleep, obesity, lack of exercise, medications, lack of hygiene, radiation exposure, smoking and dehydration.