hansen’s disease “the other mycobacterium”
DESCRIPTION
Hansen’s Disease “The Other Mycobacterium”. Diane Rimple, MD FACEP UNM Marine and Tropical Medicine April, 2005. Basic Facts. Leprosy is caused by Mycobacterium leprae. Bacteria infection of skin eyes, testicles and peripheral nerves. Method of spread is unknown. Classification of Disease. - PowerPoint PPT PresentationTRANSCRIPT
Hansen’s Disease “The Other Hansen’s Disease “The Other Mycobacterium”Mycobacterium”
Diane Rimple, MD FACEPUNM Marine and Tropical Medicine April, 2005
Basic Facts
Leprosy is caused by Mycobacterium leprae.
Bacteria infection of skin eyes, testicles and peripheral nerves.
Method of spread is unknown
Classification of Disease
Localized disease: high host immunity (tuberculoid leprosy).
Disseminated disease: low host immunity (lepromatous leprosy).
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.
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.
Clinical Syndrome
Symptoms of leprosy include: Skin lesion without sensation Epistaxis Nose congestion Hair loss (eyebrows, eyelashes, body
hair)
Clinical Features to Evaluate
Number of skin lesions Size and morphology of lesions Presence of neuropathy Presence of reactional states (immune
reaction)
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
Clinical Features: Tuberculoid
Nerve involvement is confined to area of skin lesions.
Testicular and eye infiltration does not occur
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)
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
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)
Transmissability
Estimated risk of infection of 2-4% among close household contacts.
Tuberculoid leprosy patients do not shed the bacteria and are considered noncontagious.
Transmisability
Lepromatous patients shed bacteria in Nasal secretions Sweat Blood Breast milk Wound exudate
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
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.
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.
The Leper Colony: Kalaupapa