Transcript Leprosy - Penn State York

Nadine Chase & Priyanka Patel
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Genus: Mycobacterium
Family: Mycobacteriaceae
Mycobacterium Leprae
 Acid-fast Bacillus
 Gram Positive
 Bacillus shape
 Single arrangement
 Aerobic
 Optimum growth
temperature is 30°
Trivia
 Can not be grown in
culture
http://asylumeclectica.com/asylum/malady/archives/leprosy/leprosy4.jpg
Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.
Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.
 Tuberculoid
Leprosy
 Pauci-bacillary (PB) Leprosy
 Well defined skin lesions that are
numb
 1-5 skin lesions
 Lepromatous Leprosy
 Multi-bacillary (MB) Leprosy
 Chronically stuffy nose
 Many skin lesions and nodules
 >5 skin lesions
 Skin
tissue
 Peripheral nerves
 Mucus membranes
 Bacteria prefers outer cooler parts of the
body
Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.
Widespread
organism
living in water and food
sources
Obligate Parasites (cannot
live independently)
Fish
Insects
 Not
very contagious
 Air born disease
 Droplets discharged from the
respiratory tract
 Nasal secretions
 Prolonged contact with excretions
from lesions
 Slow replication time
 Long incubation period
Affinity for macrophages
and Schwann cells
 In Schwann cell
 Mycobacterium binds to
the G domain of alpha
chain of laminin 2 in
the basal lamina
 Stimulates cell
mediated immune
response which causes
swelling, chronic
inflammatory response
 Ultimately leads to
axonal (nerve) death
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http://www.med.nyu.edu/news_and_views/images/leprosy.jpg
Normal Nerve Cell
Nerve Cell enlargement
Arnold, Harry. Modern Concepts of Leprosy. Springfield, IL, 1953.
Avoid
contact
with infected
persons
99% of the
population
have natural
immunity
http://www.ruggedelegantliving.com/journal/images/2003/05/01/sars.mask.jpg
Long incubation
period
 Skin lesions with
decreased sensitivity
 Numbness
 Muscle weakness
 Cosmetic
Disfiguration
 Death is usually
caused by a
secondary
opportunistic disease
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http://www.wrongdiagnosis.com/l/leprosy/deaths.htm
 Leprosy
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Skin Test
Inactive Leprosycausing bacteria
injected into skin
Body will react to the
Leprosy antigens
Check injection 3
days and 28 days later
Positive skin reaction
is seen in Tuberculoid
Leprosy only
Normal result: little
to no skin irritation
around injection site
http://www.nlm.nih.gov/medlineplus/ency/article/003383.htm
 Shave
Biopsy
 Least invasive
 Superficial layers
of lesion scraped
off
 No stitches
required
 Bacteria can be
identified on a
slide
http://www.nlm.nih.gov/medlineplus/ency/article/003383.htm
 Punch
Biopsy
 Small cylinder
of skin
removed
 Sizes vary
depending on
size of lesion
 May require
stitches
http://www.nlm.nih.gov/medlineplus/ency/article/003383.htm
 Excisional
Biopsy
 Local
anesthetic
applied
 Entire lesion is
removed
 Stitches are
usually needed
http://www.nlm.nih.gov/medlineplus/ency/article/003383.htm
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Methacholine sweat testing
 An intradermal injection of methacholine
demonstrates the absence of sweating in
leprous lesions.
 Helpful to identify diagnosis when lesions are
not visible on dark skin individuals
Arnold, Harry. Modern Concepts of Leprosy. Springfield, IL, 1953.
 Multi-drug
therapy
 PB
Leprosy
 Two Drugs:
Rifampicin and
Dapsone for 6
months
 MB Leprosy
 Three Drugs:
Rifampicin,
Dapsone,
Clofazimine for
12 months
http://www.nlm.nih.gov/medlineplus/ency/article/003383.htm
Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.
 Special
Footwear to prevent foot ulcers
Grunberg, E., Babger, LF, et al. Leprosy. New York, 1951.
 Age
 Children
are more susceptible
 Bimodal age distribution with peaks
at ages 10-14 and 35-44 with higher
susceptibilities in younger years
 Sex
 Higher infection rate in males
compare to females
 Ratio of infection is 2:1
 Race
 African
blacks are highly
susceptible to the tuberculoid form
of leprosy
 Caucasians and Chinese are more
susceptible to the lepromatous
type of Leprosy
 Its more rural than urban disease in
Asia and Pacific Basin
http://tmcr.usuhs.mil/tmcr/chapter34/large34/34-01.jpg
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2002 Data
 1,000 deaths in North and South America
 96 cases in the U.S
 3,000 deaths in South East Asia
 1,000 death in Eastern Mediterranean
 1,000 deaths Western Pacific
2005 Data
 166 new cases were reported in U.S.
 60% of these cases occurred in:
 California
 Louisiana
 Massachusetts
 New York
 Texas
HANSEN DISEASE (LEPROSY)
Number of reported cases, by year
United States, 1973-2003
www.cdc.gov/epo/dphsi/annsum/2003/slides/hansgraf.ppt
 Attempt
to identify new drugs that can
stop the neural damage caused by the
bacteria
 Bacteria needs to recognize certain type
glycoprotein on the cell surface to bind
with and subsequently enter the cell
 If these glycoprotein can be identified
and a drug can interfere with the binding
between the bacterium and the protein,
this could potentially prevent entry of the
bacteria and stop neural damage
 Leprosy
has been found to NOT be
hereditary
 If twin siblings become infected, the
disease is passed from one to the other
solely because of the proximity in which
they live
 Twin A acquired the disease at age 15
 Twin B at age 19
 The disease effects the twins differently
Twin A
Twin B
Chakravartti, M.R. and Vogel, F. A Twin Study on Leprosy. Germany, 1973.
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Arnold, Harry. Modern Concepts of Leprosy. Springfield, IL, 1953.
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Chakravartti, M.R. and Vogel, F. A Twin Study on Leprosy. Germany, 1973.
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Grunberg, E., Babger, LF, et al. Leprosy. New York, 1951.
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http://www.cdc.gov/ncidod/dbmd/diseaseinfo/hansens_t.htm
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http://www.nlm.nih.gov/medlineplus/ency/article/003383.htm
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http://tmcr.usuhs.mil/tmcr/chapter34/large34/34-01.jpg
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http://www.wrongdiagnosis.com/l/leprosy/deaths.htm
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“Leprosy. “eMedicine from webmed.
http://www.sunysccc.edu/academic/mst/microbes/16mlepr.htm 21 July 2007.
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“Leprosy, The Disease” World Health Organization; Regional Office for Southeast
Asia.www.searo.who.int/En/Section10/section20/section57_8963.htm. 22 December
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Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.
2006.