“the biggest disease of our time is not leprosy or tuberculosis, but the feeling of being unwanted...

“the biggest disease of our time is not leprosy or tuberculosis, but the feeling of

being unwanted”- Mother Teresa

April 6, 2010

Photo from the German Federal Archive, Bild 105-DOA0199

Leprosy

A Disease of the Forgotten

April 6, 2010 Meagan Davis

Leprosy = Hansen’s Disease

April 6, 2010

One of the world’s oldest infectious diseasesPhotos from http://www.bevscountrycottage.com/images/leper.jpg and

http://symptomsofleprosy.com/treatment-for-leprosy.php

-Skin-Peripheral nerves-Eyes -Extremities-Respiratory mucosa

April 6, 2010

Hansen’s Disease is a chronic disease affecting

Leprosy is identified by skin lesions and progressive debilitation

April 6, 2010

Photos from http://symptomsofleprosy.com/leprosy.php and http://www.asnom.org/image/421_lepre/IB071_lepre.jpg

Forms of Leprosy

• Tuberculoid (75%)– Partial T-cell immunity– Paucibacillary

• Lepromatous– Little to no T-cell immunity– Multibacillary

April 6, 2010 Photo from http://pathmicro.med.sc.edu/Infectious%20Disease/MYCOBACTERIAL%20DISEASES.htm

April 6, 2010

1873: Dr. Amauer Hansen of Norway

Microphotograph from CDC, US Government public domain, 1979) Public Health Image Library (PHIL) #2123 and photo from http://en.wikipedia.org/wiki/File:Gerhard_Armauer_Hansen.jpg

Mycobacterium leprae

April 6, 2010

http://bioweb.uwlax.edu/bio203/s2008/jaedike_alic/scientificclassification.htm

Identical in appearance to M. tuberculosis

April 6, 2010April 6, 2010

Mycobacterium leprae

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1471987/figure/f2/:

We can’t grow Mycobacteria leprae in the lab! We need

living cells…

April 6, 2010

The Solution?

Armadillos, of course!April 6, 2010

Mycobacterium leprae has affinity for

April 6, 2010

1. Schwann cells

2. Macrophageshttp://www.mc.vanderbilt.edu/histology/slide.php?image_name=myelin&slide_file=images/histology/nervous_tissue/display/schwann3.jpg&image_id=1058

http://www.hhmi.org/biointeractive/disease/leprosy/leprosy1.html

April 6, 2010 How does Mycobacterium leprae target the peripheral nervous system?

Interaction with Schwann Cell

April 6, 2010

Interaction with Macrophage

No phagocytosis!

Janeway, C., Travers, P., Walport, M., Shlomchik M. Immuno Biology: the immune system in health and disease. 6th Ed. 2005. New York: Garland Science Publishing.

http://newscenter.lbl.gov/wp-content/uploads/phagocytosis.jpg

Genome

• Reductive evolution: pseudogenes

• Sequenced in 2001• Unique proteins• PARK2/PACRG

April 6, 2010

Image from http://www.nature.com/nature/journal/v409/n6823/full/4091007a0.html

How infectious?

April 6, 2010

Treatment• Completely CURABLE!• MDT (Multi-drug Treatment)

– Dapsone– Rifampicin– Clofazimine

April 6, 2010 http://www.searo.who.int/en/Section10/Section20/Section57_9882.htm

History of Leprosy

http://www.nytimes.com/2009/05/27/science/27leprosy.html?_r=1&pagewanted=print

April 6, 2010

Middle Ages

April 6, 2010 Photo from http://www.associatedcontent.com/image/625316/index.html?cat=70

Leper Colonies

April 6, 2010

http://irrevocable.wordpress.com/2009/02/

http://www.historycooperative.org/journals/jah/92.3/images/lechtreck_fig01b.jpg

April 6, 2010

Curse!

Sexually Transmitted!

Hereditary!

a highly misunderstood disease

April 6, 2010 WHO’s Leprosy Elimination ProjectWorld Health Organization

A disease of poverty

April 6, 2010

Why?

Photo from http://www.flickr.com/photos/medapt/408552571/

April 6, 2010

“The biggest disease of our time is not

leprosy or tuberculosis, but the

feeling of being

unwanted”

- Mother TeresaPhoto from http://baba.niya.org/index.php?mact=Album,cntnt01,default,0&cntnt01albumid=1&cntnt01pictureid=10&cntnt01returnid=64

Quote from http://quotationsbook.com/quote/11148/

Sources

Comment in:Am J Clin Pathol. 2008 Dec;130(6):849-52.

Brophy, Peter J. "Microbiology: Subversion of Schwann Cells and the Leper's Bell." Science 296.5569 (2002): 862-863. Print.

Abulafia, Jorge. “Leprosy: pathogenesis updated.” International Journal of Dermatology 38 (1999): 321-334.

Chacha, JJ. “Peripheral nervous system and grounds for the neural insult in leprosy.” An Bras Dermatol 84.5 (2009): 495-500.

Suzuki, Koichi. “Localization of CORO1A in the Macrophages Containing Mycobacterium leprae.” Acta Histochem Cytochem 39.4 (2006): 107-112.

Cole, S . T. “Massive gene decay in the leprosy bacillus.” Nature 409 (2001): 1007-1011

Baillie, Rebecca A. “Biblical Leprosy as Compared to Present-Day Leprosy.” Southern Medical Journal 75.7 (1982): 855-857.

Vissa, Varalakshmi D. “The genome of Mycobacterium leprae: a minimal mycobacterial gene set.” Genoma Biology 2:reviews1023.1-1023.8 (2001).

Rambukkana, Anura .“How does Mycobacterium leprae target the peripheral nervous system? “ Trends in Microbiology 8.1 (2000): 23-28.

Han, X. Y. “A new Mycobacterium species causing diffuse lepromatous leprosy.” Am J Clin Pathol. 2008 Dec;130(6):849-52.

Scollard, D. M. “The Continuing Challenges of Leprosy.” Clinical Microbiology Review. 19.2 ( 2006) 338-381.

Miller, Timothy S. “Medieval Leprosy Reconsidered.” International Social Sciene Review, Spring-Summer 2006. http://findarticles.com/p/articles/mi_m0IMR/is_1-2_81/ai_n16701818/pg_2/?tag=content;col1

Nester, Eugene, W. Microbiology. Mcgraw Hill, 6th edition (2009).

April 6, 2010

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new-insights-into-an-ancient-disease/http://www.hhmi.org/biointeractive/disease/leprosy/leprosy1.htmlhttp://www.thaindian.com/newsportal/lifestyle/scientists-measure-mercury-level-in-humanbones-from-medieval-times_10055550.htmlhttp://www3.niaid.nih.gov/topics/leprosy/Understanding/history.htmhttp://emedicine.medscape.com/article/1104977-overviewhttp://www.informaworld.com/smpp/section?content=a777379128&fulltext=713240928http://www.europaworld.org/week113/50worldleprosyday24103.htmhttp://www.who.int/mediacentre/factsheets/fs101/en/http://www.searo.who.int/EN/Section10/Section20/Section57_8963.htm WHOhttp://www.ghananewsagency.org/s_health/r_13273/http://pathmicro.med.sc.edu/fox/mycobacteria.htmhttp://www.mdconsult.com/das/book/body/193191995-2/0/1492/1203.htmlhttp://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=mmed&part=A1833