Genetic disorder behind tree man disease

The ‘tree man’ disease occurs due to genetic defects and has no curative or preventive therapy, experts have said. No cure for it has been found yet, but various treatment methods are being tried out. Education of the patient, early detection and removal of the tumoural lesions are being emphasised to prevent the development of cutaneous growths, the experts said. They added genetic predisposition was the main reason for the illness that formed wart-like lesions on parts of the body, while their recurrence after removal posed a challenge. They termed the disease, colloquially known as tree man illness, as a rare inherited skin disorder associated with a high risk of carcinoma of the skin. “There is no means to prevent the tree man disease. We will be able to find out the reason and whether there is any preventive measure only after receiving the test reports on samples of blood, saliva, and tumour tissue taken from Abul Bajandar, the first man to have been diagnosed with the rare disease in Bangladesh,” said Prof. Dr Samanta Lal Sen, national chief coordinator of the Burn and Plastic Surgery Units in the country.
Talking to The Independent, he said the test reports from the USA were expected within
a month. Prof. Sen said they had learnt of two more cases, from Thakurgaon and Netrakona districts, since Abul Bajandar’s ailment. They were likely to come to the DMCH within a day or two. Prof. Dr Md Abul Kalam, head of the Department of Plastic and Reconstructive Surgery of Dhaka Medical College and Hospital, said: “Tree man disease is a skin condition, which is called Epidermodysplasia Verruciformis (EV) in English.”
“Tree man disease is not a scientific name. The disease has come to be known as such because the growths looks like sprouting branches of a tree,” He told this correspondent at his office at the DMCH.  Prof. Kalam said genetic predisposition was one of the main reasons behind the illness. This suggests a genetic defect triggers the illness, as has been found in some cases.
He said the EV was not virus-induced but had an association with it. It is seen that when different types of virus, particularly the human papilloma virus, comes in contact, they cause changes that ultimately lead to cancer.
Kalam said there were several treatment options for this rare disorder, but the method applied to Abul Bajandar, 26, appeared to the best so far.
He said the detection of the tree-man illness in Bangladesh was the third case in the world. The first had been identified in Indonesia and the second in Romania. “It is the first case in Bangladesh and the third in the world. No fourth case has been found here as yet,” he said. He said the disease posed a challenge because of the chances of its recurrence due to predisposition.
However, Dr Kalam expects Bajandar’s test reports to provide an insight into the nature of the disease once they arrived from the US. The patient’s blood, saliva, and tumour tissue samples have sent there for DNA and genetic analysis.
If there is a serious defect, a major treatment may be needed to prevent recurrence. “But if the defect is found to be small, the treatment we are providing would be enough,” he added.
He said EV was not a contagious disease, citing the patient’s family example. His parents, wife and a child live with him, but have not contracted the disease.
He ruled out that anyone with a particular genetic disorder would necessarily develop the ailment. “It is not that all will be affected by the disease due to the genetic defect. If a case is diagnosed after 10 generations, another might be detected 20 generations later.” Dr Kalam said the treatment cost of the disease was very high, as it needed several surgeries.
In this connection, he said Abul Bajandar had so far undergone nine operations and needed a few more on his limbs. The government was bearing the entire cost of his treatment, including accommodation and food expenses.Similar treatment in a private hospital could run up a bill of millions of taka, he said. Nine surgeries would cost about Tk. 9 lakh, excluding the cost of medicines and other expenses.
Replying to a question, he said, Abul Bajandar had been kept under observation in a cabin in the hospital. It would take months for his treatment to be over, with several more operations on his hands and legs lined up.  Bajandar was beaming with happiness when this correspondent met him at his cabin. He was grateful to the doctors for his treatment and said that he dreams of bringing up his daughter Tahira as a doctor so that she would be able to help others in need in future. For this, he sought help and blessings from all.
After Bajandar’s successful operation on February 20, three patients of a family were admitted to the DMCH on March 10 with what seemed like an initial stage of the tree-man illness, but less severe. They were Tajul Islam, 48, his brother Based, 55, and his son Ruhul Amin, 7. They came from Rangpur, where they begged for a living. But all three ran away from the hospital without informing the doctors or attending nurses before any proper diagnosis.
Meanwhile, at least two more new cases were detected in Thakurgaon and Netrakona with symptom like Abul Bajandar’s. They are Shahana, a student of Class II of the Baluchara Government Primary School (BGPS), Kalkamakanda in Netrokona and Ripon Roy, 7, son of Mohendra Roy of Ketgaon village, and a Class II student of the Ketgaon Government Primary School in Thakurgaon. Both the patients are likely to be sent to the DMCH for diagnosis, according to DMCH sources.

Genetic disorder behind tree man disease

The tree man disease occurs due to genetic defects and has no curative or preventive therapy, experts have said. No cure for it has been found yet, but various treatment methods are being tried out. Education of the patient, early detection and removal of the tumoural lesions are being emphasised to prevent the development of cutaneous growths, the experts said. They added genetic predisposition was the main reason for the illness that formed wart-like lesions on parts of the body, while their recurrence after removal posed a challenge. They termed the disease, colloquially known as tree man illness, as a rare inherited skin disorder associated with a high risk of carcinoma of the skin. There is no means to prevent the tree man disease. We will be able to find out the reason and whether there is any preventive measure only after receiving the test reports on samples of blood, saliva, and tumour tissue taken from Abul Bajandar, the first man to have been diagnosed with the rare disease in Bangladesh, said Prof. Dr Samanta Lal Sen, national chief coordinator of the Burn and Plastic Surgery Units in the country. Talking to The Independent, he said the test reports from the USA were expected within a month. Prof. Sen said they had learnt of two more cases, from Thakurgaon and Netrakona districts, since Abul Bajandars ailment. They were likely to come to the DMCH within a day or two. Prof. Dr Md Abul Kalam, head of the Department of Plastic and Reconstructive Surgery of Dhaka Medical College and Hospital, said: Tree man disease is a skin condition, which is called Epidermodysplasia Verruciformis (EV) in English. Tree man disease is not a scientific name. The disease has come to be known as such because the growths looks like sprouting branches of a tree, He told this correspondent at his office at the DMCH. Prof. Kalam said genetic predisposition was one of the main reasons behind the illness. This suggests a genetic defect triggers the illness, as has been found in some cases. He said the EV was not virus-induced but had an association with it. It is seen that when different types of virus, particularly the human papilloma virus, comes in contact, they cause changes that ultimately lead to cancer. Kalam said there were several treatment options for this rare disorder, but the method applied to Abul Bajandar, 26, appeared to the best so far. He said the detection of the tree-man illness in Bangladesh was the third case in the world. The first had been identified in Indonesia and the second in Romania. It is the first case in Bangladesh and the third in the world. No fourth case has been found here as yet, he said. He said the disease posed a challenge because of the chances of its recurrence due to predisposition. However, Dr Kalam expects Bajandars test reports to provide an insight into the nature of the disease once they arrived from the US. The patients blood, saliva, and tumour tissue samples have sent there for DNA and genetic analysis. If there is a serious defect, a major treatment may be needed to prevent recurrence. But if the defect is found to be small, the treatment we are providing would be enough, he added. He said EV was not a contagious disease, citing the patients family example. His parents, wife and a child live with him, but have not contracted the disease. He ruled out that anyone with a particular genetic disorder would necessarily develop the ailment. It is not that all will be affected by the disease due to the genetic defect. If a case is diagnosed after 10 generations, another might be detected 20 generations later. Dr Kalam said the treatment cost of the disease was very high, as it needed several surgeries. In this connection, he said Abul Bajandar had so far undergone nine operations and needed a few more on his limbs. The government was bearing the entire cost of his treatment, including accommodation and food expenses.Similar treatment in a private hospital could run up a bill of millions of taka, he said. Nine surgeries would cost about Tk. 9 lakh, excluding the cost of medicines and other expenses. Replying to a question, he said, Abul Bajandar had been kept under observation in a cabin in the hospital. It would take months for his treatment to be over, with several more operations on his hands and legs lined up. Bajandar was beaming with happiness when this correspondent met him at his cabin. He was grateful to the doctors for his treatment and said that he dreams of bringing up his daughter Tahira as a doctor so that she would be able to help others in need in future. For this, he sought help and blessings from all. After Bajandars successful operation on February 20, three patients of a family were admitted to the DMCH on March 10 with what seemed like an initial stage of the tree-man illness, but less severe. They were Tajul Islam, 48, his brother Based, 55, and his son Ruhul Amin, 7. They came from Rangpur, where they begged for a living. But all three ran away from the hospital without informing the doctors or attending nurses before any proper diagnosis. Meanwhile, at least two more new cases were detected in Thakurgaon and Netrakona with symptom like Abul Bajandars. They are Shahana, a student of Class II of the Baluchara Government Primary School (BGPS), Kalkamakanda in Netrokona and Ripon Roy, 7, son of Mohendra Roy of Ketgaon village, and a Class II student of the Ketgaon Government Primary School in Thakurgaon. Both the patients are likely to be sent to the DMCH for diagnosis, according to DMCH sources.