Transcript Resurgence of Leprosy in Florida

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Terri Bianchi, DNP, ARNP
Ormond Beach Dermatology, Ormond Beach, FL
2009
2014
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Power Point
assistance
*Participant will:
-Increase awareness leprosy
-Expand differential or Ddx
-Identify national resource
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* http://abcnews.go.com/Health/leprosy-caseshit-florida-counties/story?id=29258128
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* A century ago,
Pioneering German
psychiatrist 1st
suggested the
differential
approach to
diagnosis
* Ddx
* Important consideration when encountering & treating
any chronic skin or rheumatological disorder
* 95% humans naturally immune
* Pathogen incubation 9 mo – 20 years
* SSx appearance may follow this time frame
* Reportable federally & in most states, including FL
* Armadillo host, not villain
* Transmission can be fomite, such as soil
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Lack of awareness! CDC reported most cases in US delay dx by 3 years (onset SSx
to accurate dx)
* Gulf coast region reported
100-150 cases each year
past few years
for 70% cases (2010):
* Previously FL typically
reported 8-10 cases/year
* 68% cases male (ages 11-92)
* Human:human transmission,
droplets nose & mouth
(household contact 25% risk)
* Fortuitously, humans
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become non-infectious
w/ 1st few doses
appropriate
oral abx tx
* These states account
* TX 36
* HI 35
* NY 34
* CA 32
* FL 30
* LA 21 and MA 15
* Morally suspect, quarantine
*Mycobacterium Leprae 1873
bacterial bacillus
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Cure 1940 (sulfone drug)
Out pt treatment 1982
Hansens Disease 1931
Latin ‘lepra’ or scaly
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location: Carville, Louisiana (LA)
LA Leper Home est. 1894 in an abandoned
plantation home built 1859, 350-400 acres
- Nat’l Leprosarium 1894-1999
- voluntary admission 1970
- home to 4,500 victims of dz
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Simultaneously sponsored research & lead to
successful tx
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Now called, Gillis W. Long Hansens Disease
Center (1982 USDHHS)
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1992 Carville Historic District > Nat’l Register
Historic Places
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1993 several aged elect to remain > ALF
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Most suffered inflamed sores, ulcers, lesions
eyes, throat & numbness peripherally
Pen name, Betty
Miller, NY Times
Best Seller, 1950
memoir
Miracle@Carville
& No One Must
Ever Know , 1959
Pen name, Stanley Stein
Prints newsletter, STAR,
mission, spread light
& truth of HD (advocate
1994 founded Nat’l Hansens Disease Museum >
@HRSA , Virtual Tour
Leprosy > HD)
(ear lobes, toes/fingers) > disfigured
1899-1967
1928 “pale rose spots on thighs”, debutante, engaged to medical student
* Carville/National Hansens Disease Center
simultaneous research
* 2011 Whole genome resequencing from 1 wild
armadillo & 3 humans w/ dz revealed identical
strain M. lepare
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Autochthonous cases
Native born (SE USA), no foreign travel
No h/o foreign exposure
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Important in research
& current vaccine development effort
4/28/11 N Engl J Med; 364: 1626, accessed 7/25/15 www.nejm.org/doi/full/10.1056
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9 Banded (Dasypus novemcinctus), decendents prehistoric,
South America 50 million years ago
Cannot hear or see well, great sense smell. No bite.
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- Armadillos related to sloths & anteaters
- Cannot thrive in very cold, very dry environments
- FL is much like the Mother Land: humid, rain, & bugs galore!
* Texas – state mammal
* Armadillo racing
* People hunt & eat
them
* “Hoover hogs” during
Depression
* Moved w/ cattle, TX to
other states, train
cattle cars
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* Florida
* Pets, easy to catch
* 1936 escaped traveling
circus
* 1924 released small
zoo & escaped Cocoa,
FL
* FL Crackers “possum
on the half shell”
* FL Dept Health,
leprosy reported since
1921
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The Clinical Advisor April 2015, case 2 = leprosy!
- 27 yod male
- Extensor forearm
- Scattered ill-defined erythematous
nodules & papules
- Pain left leg prevented ambulation
- Exam evidenced skin colored nodules
on earlobes
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* Journal of Drugs in
Dermatology
* May 2015
* NY Hansen’s Disease
Program, Dept Derm,
Bellevue Hospital, NY
* During RA tx for 2 years,
cutaneous lesions
erupted > referral derm
>punch bx w/ fite stain
* dx leprosy
* “leprosy often presents
as rheumatology d/o”:
- Lupus erythematous
- RA
- Anticardiolipin syndrome
(aka antiphospholipid/APS)
* Caution, age of biologics
(immune suppressive) tx
in RA, Ps
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* 55 yod Caucasian male
* Landscaper, Florida
- Sores hands off/on x 2
years, claw like hand
- Sores > ulcerations
- Pain on ambulation
* Admit to hospital,
systemic vasculitis
Ddx: granulomatis w/
polyanglitis, SLE, APS
Accurate Dx, Leprosy
AEB skin bx!
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* Cutaneously & commonly, early
on: pale, reddish skin patch w/
or w/o diminished sensation
* 1 or more chronic or recalcitrant
maculopapular lesions
* Slight, if any prodromal
* 90% have numbness (maybe years)
before skin lesion
- temp goes 1st
- light touch 2nd
- pain last to go
(hence injuries hands & feet)
• 4mm punch, full thickness, +/- suture
• Fite stain
• Dermatopathologist!
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Rare, but tragic to miss it
Cool areas of body affected
- Superficial peripheral nerves
- Anterior chamber eyes
- Testes
- Chin
- Malar (cheeks)
- Ear lobes
- Knees, elbows
- Distal BULEs
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Thickened superficial peripheral
nerve
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- Provides all HCPs w/ knowledge to dx & tx the disease
- Introduces methods used to prevent disabilities caused by disease
- Aids in dx & management, including complications
Add thank you & skin ca ad
- An American’s life
time risk melanoma is
1 in 36
- Melanoma #1 cancer
adults ages 25-29
- 1 blistering sun burn
in youth doubles
lifetime risk
US incidence melanoma increased each year x last 30