national hansen’s disease programs. diagnosis & treatment of hansen’s disease diagnosis...
TRANSCRIPT
NATIONAL HANSEN’S DISEASE
PROGRAMS
NATIONAL HANSEN’S DISEASE
PROGRAMS
DIAGNOSIS & TREATMENTOF HANSEN’S DISEASE
DIAGNOSIS & TREATMENTOF HANSEN’S DISEASE
Hansen’s disease is an infectious disease of man primarily involving:Hansen’s disease is an infectious disease of man primarily involving:
• Skin
• Peripheral Nerves
• Eyes
• Mucous Membranes (Nose and Throat)
• Skin
• Peripheral Nerves
• Eyes
• Mucous Membranes (Nose and Throat)
HANSEN’S DISEASE IN THEUNITED STATES
HANSEN’S DISEASE IN THEUNITED STATES
Average number of new casesReported annually is between150 - 225
Average number of new casesReported annually is between150 - 225
ETIOLOGY - MYCOBACTERIUM LEPRAEETIOLOGY - MYCOBACTERIUM LEPRAE
• Acid Fast Bacteria
• Discovered by Hansen in Norway in 1873
• Never Been Cultured in Laboratory
• Found in Man, Armadillos, and Some Monkeys
• Acid Fast Bacteria
• Discovered by Hansen in Norway in 1873
• Never Been Cultured in Laboratory
• Found in Man, Armadillos, and Some Monkeys
MODE OF TRANSMISSIONMODE OF TRANSMISSION
• Untreated Lepromatous Patients - Respiratory Route
• Armadillos?
• Soil or Vegetation?
• Incubation Period Average 3 - 5 years
• Untreated Lepromatous Patients - Respiratory Route
• Armadillos?
• Soil or Vegetation?
• Incubation Period Average 3 - 5 years
SUSCEPTIBILITYSUSCEPTIBILITYSUSCEPTIBILITYSUSCEPTIBILITY
• Only 3 - 5% of Populations are Susceptible
• Children or Contacts of Treated Patients Rarely Get the Disease
• Attack Rate of Spouses is 2 - 10%
• Genetic Factors
• Immune Factors
• Only 3 - 5% of Populations are Susceptible
• Children or Contacts of Treated Patients Rarely Get the Disease
• Attack Rate of Spouses is 2 - 10%
• Genetic Factors
• Immune Factors
TT BT BB BL LL TT BT BB BL LL
CMICMI
TUBERCULOID
FEWBACTERIA
LOWANTIBODY
LEVELS
HIGH RESISTANCETO M. LEPRAE
TUBERCULOID
FEWBACTERIA
LOWANTIBODY
LEVELS
HIGH RESISTANCETO M. LEPRAE
LEPROMATOUS
MANYBACTERIA
HIGHANTIBODY
LEVELS
LOW RESISTANCETO M.LEPRAE
LEPROMATOUS
MANYBACTERIA
HIGHANTIBODY
LEVELS
LOW RESISTANCETO M.LEPRAE
The Hansen’s Disease SpectrumThe Hansen’s Disease Spectrum
BIBI
ENLENL
ANTIBODY
LEVELANTIB
ODY
LEVEL
Reversal Reaction
Reversal Reaction
CLASSIFICATION FOR TREATMENTCLASSIFICATION FOR TREATMENT
• I - Indeterminate
• TT - Tuberculoid
• BT - Borderline Tuberculoid
• I - Indeterminate
• TT - Tuberculoid
• BT - Borderline Tuberculoid
• BB - Midborderline• BL - Borderline Lepromatous• LL - Lepromatous
• BB - Midborderline• BL - Borderline Lepromatous• LL - Lepromatous
PAUCIBACILLARY (PB)(No Bacilli in Skin Smears)
PAUCIBACILLARY (PB)(No Bacilli in Skin Smears)
MULTIBACILLARY (MB)(Skin Smears: 1+ to 6+ Bacilli)MULTIBACILLARY (MB)
(Skin Smears: 1+ to 6+ Bacilli)
DIAGNOSIS OF HANSEN’S DISEASEDIAGNOSIS OF HANSEN’S DISEASE
• Skin
• Nerves
• Eyes
• Hands & Feet
• Skin
• Nerves
• Eyes
• Hands & Feet
• Slit Skin Smears
• Skin Biopsies
• Slit Skin Smears
• Skin Biopsies
Clinical Exam ProceduresClinical Exam Procedures Lab ProceduresLab Procedures
DIAGNOSTIC CRITERIADIAGNOSTIC CRITERIA
• Anesthetic Skin Lesions
• Enlarged Peripheral Nerves
• Acid Fast Bacilli in Skin Smears
• Biopsy Evidence of Nerve Damage or Acid Fast Bacilli
• Anesthetic Skin Lesions
• Enlarged Peripheral Nerves
• Acid Fast Bacilli in Skin Smears
• Biopsy Evidence of Nerve Damage or Acid Fast Bacilli
Posterior TibialNerve
Posterior TibialNerve
Peroneal NervePeroneal Nerve
Radial CutaneousNerve
Radial CutaneousNerve
UlnarNerveUlnarNerve
Great AuricularNerve
Great AuricularNerve
PERIPHERAL NERVESPERIPHERAL NERVES
BACTERIAL INDEX (BI)BACTERIAL INDEX (BI)
0 = None found in 100 OIF
1+ = 1 - 10 Per 100 OIF
2+ = 1 - 10 Per 10 OIF
3+ = 1 - 10 Per OIF
4+ = 10 - 100 Per OIF
5+ = 100 - 1000 Per OIF
6+ = 1000+ Per OIF
0 = None found in 100 OIF
1+ = 1 - 10 Per 100 OIF
2+ = 1 - 10 Per 10 OIF
3+ = 1 - 10 Per OIF
4+ = 10 - 100 Per OIF
5+ = 100 - 1000 Per OIF
6+ = 1000+ Per OIF
(OIF = Oil Immersion Field)(OIF = Oil Immersion Field)
BIOPSIESBIOPSIES
• Punch Biopsy : 4 - 6mm (in Face, 2 - 3mm)
• Deep Enough to Include Subcutaneous Tissue and Fat
• Fix Promptly in at Least 10 Volumes of 10% Formalin
• Punch Biopsy : 4 - 6mm (in Face, 2 - 3mm)
• Deep Enough to Include Subcutaneous Tissue and Fat
• Fix Promptly in at Least 10 Volumes of 10% Formalin
DRUGS FOR CHEMOTHERAPYDRUGS FOR CHEMOTHERAPY
• DAPSONE (DDS)
• RIFAMPIN
• CLOFAZIMINE (B663 - LAMPRENE)
• DAPSONE (DDS)
• RIFAMPIN
• CLOFAZIMINE (B663 - LAMPRENE)
CHEMOTHERAPY OF HANSEN’S DISEASECHEMOTHERAPY OF HANSEN’S DISEASE
• U.S. Short Term
• World Health Organization
• U.S. Short Term
• World Health Organization
U. S. SHORT TERM THERAPYU. S. SHORT TERM THERAPY
PAUCIBACILLARY - 1 Year TreatmentPAUCIBACILLARY - 1 Year Treatment
• Dapsone 100 mg Daily• Rifampin 600 mg Daily• Dapsone 100 mg Daily• Rifampin 600 mg Daily
MULTIBACILLARY - 2 Year TreatmentMULTIBACILLARY - 2 Year Treatment
• Dapsone 100 mg Daily• Rifampin 600 mg Daily• Clofazimine 50 mg Daily
• Dapsone 100 mg Daily• Rifampin 600 mg Daily• Clofazimine 50 mg Daily
LABORATORY MONITORINGLABORATORY MONITORING
Baseline Studies - CBC, Platelets, Liver Functions, and G-6-PD
Rifampin - CBC and Liver FunctionStudies Every 2 to 3 Months
Dapsone - CBC Every 6 Months
Clofazimine - No Specific Studies Required
Baseline Studies - CBC, Platelets, Liver Functions, and G-6-PD
Rifampin - CBC and Liver FunctionStudies Every 2 to 3 Months
Dapsone - CBC Every 6 Months
Clofazimine - No Specific Studies Required
SIDE EFFECTSSIDE EFFECTS
• DAPSONE - Mild Anemia
• RIFAMPIN - Liver ToxicityThrombocytopenia
• CLOFAZIMINE- Skin Pigmentation GI Disturbances
• DAPSONE - Mild Anemia
• RIFAMPIN - Liver ToxicityThrombocytopenia
• CLOFAZIMINE- Skin Pigmentation GI Disturbances
MONITORING RESPONSE TO TREATMENTMONITORING RESPONSE TO TREATMENT
• Regular Examination of Eyes, Hands and Feet
• Examination of Skin Lesions
• Repeat Skin Smears Annually
• Repeat Biopsies
• Regular Examination of Eyes, Hands and Feet
• Examination of Skin Lesions
• Repeat Skin Smears Annually
• Repeat Biopsies
NATIONAL HANSEN’S DISEASE PROGRAMS1770 Physicians Park Drive
Baton Rouge, Louisiana 70816Phone: 1-800-642-2477
Fax: (225) 756-3760
NATIONAL HANSEN’S DISEASE PROGRAMS1770 Physicians Park Drive
Baton Rouge, Louisiana 70816Phone: 1-800-642-2477
Fax: (225) 756-3760