Download - Hansen’s Disease “The Other Mycobacterium”
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Hansen’s Disease “The Other Hansen’s Disease “The Other Mycobacterium”Mycobacterium”
Diane Rimple, MD FACEPUNM Marine and Tropical Medicine April, 2005
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Basic Facts
Leprosy is caused by Mycobacterium leprae.
Bacteria infection of skin eyes, testicles and peripheral nerves.
Method of spread is unknown
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Classification of Disease
Localized disease: high host immunity (tuberculoid leprosy).
Disseminated disease: low host immunity (lepromatous leprosy).
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Worldwide Epidemiology
10-15 million people afflicted, half of whom live in Africa and India.
Approximately 6000 cases in the US, 150-200 new cases reported annually.
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Leprosy in Hawaii
First reported case in Hawaii in 1835 Large epidemic followed soon thereafter 1865: "Act to Prevent the Spread of Leprosy". King Kamehameha V ordered incurable leprosy
victims removed from the general population. Permanent quarantine area on the island of
Molokai.
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Clinical Syndrome
Symptoms of leprosy include: Skin lesion without sensation Epistaxis Nose congestion Hair loss (eyebrows, eyelashes, body
hair)
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Clinical Features to Evaluate
Number of skin lesions Size and morphology of lesions Presence of neuropathy Presence of reactional states (immune
reaction)
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Clinical Features: Tuberculoid
Usually a single skin lesion Lesions are large, flat plaques Well demarcated, irregular Erythematous with raised borders and
atrophic center Hypopigmented Located on face and extremities
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Clinical Features: Tuberculoid
Nerve involvement is confined to area of skin lesions.
Testicular and eye infiltration does not occur
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Clinical Features: Lepromatous
Unrestrained proliferation of bacilli in skin, peripheral nerves, anterior eye and testes.
Innumerable small erythematous, symmetric hyperpigmented macules, papules and nodules.
Diffuse infiltration of face: leotine facies and loss of eyebrows (madarosis)
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Clinical Features: Lepromatous
Peripheral nerves less likely to be infiltrated. Anesthesia occurs later in disease. May be
subtle. Stocking glove distribution. Testicle involvement: impotence, sterility Eye involvement: keratitis, corneal denervation Erythema nodosum leprosum: can cause iritis
and secondary glaucoma
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Diagnostics
Clinical diagnosis Skin biopsy: Acid fast staining (Fite
stain) Skin smears: assess bacillary load Nerve biopsy: looking for organisms and
typical granulomas Serologic assays (ELISA or PCR)
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Transmissability
Estimated risk of infection of 2-4% among close household contacts.
Tuberculoid leprosy patients do not shed the bacteria and are considered noncontagious.
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Transmisability
Lepromatous patients shed bacteria in Nasal secretions Sweat Blood Breast milk Wound exudate
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Treatment
Treatment is antibiotics from 6 months to several years.
Must be multidrug therapy (usually two) Rifampin and dapsone are mainstays
– Clofazimine is used for cases of dapsone resistance.
Steroid for ENL
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Additional Treatments
Physical therapy: – Prevention of injury due to neuropathies.– Wound care
Psychosocial therapy:– Issues regarding societal reaction to the
disease.– Fears regarding transmissability.– Issues regarding dealing with a chronic
disease.
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Prophylaxis
Vaccine is not effective Dapsone prophylaxis promotes
resistance. May delay but not prevent onset of disease
Currently, household contacts are examined regularly and any suspicious lesion is biopsied.
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The Leper Colony: Kalaupapa
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