“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 diseases Photos from and

-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 and

Forms of Leprosy Tuberculoid (75%) –Partial T-cell immunity –Paucibacillary Lepromatous –Little to no T-cell immunity –Multibacillary April 6, 2010 Photo from

April 6, : Dr. Amauer Hansen of Norway Microphotograph from CDC, US Government public domain, 1979) Public Health Image Library (PHIL) #2123 and photo from

Mycobacterium leprae April 6, Identical in appearance to M. tuberculosis

April 6, 2010 Mycobacterium leprae

We can’t grow Mycobacteria leprae in the lab! We need living cells… April 6, 2010

The Solution? Armadillos, of course! April 6, 2010

Image from Cell Wall Features

Mycobacterium leprae has affinity for April 6, Schwann cells 2. Macrophages ile=images/histology/nervous_tissue/display/schwann3.jpg&image_id=1058

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 New York: Garland Science Publishing.

Genome Reductive evolution: pseudogenes Sequenced in 2001 Unique proteins PARK2/PACRG April 6, 2010 Image from

How infectious? April 6, 2010

Treatment Completely CURABLE! MDT (Multi-drug Treatment) –Dapsone –Rifampicin –Clofazimine April 6,

History of Leprosy April 6, 2010

Middle Ages April 6, 2010 Photo from

Leper Colonies April 6, s/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 Project World Health Organization

A disease of poverty April 6, 2010 Why? Photo from

April 6, 2010 “ The biggest disease of our time is not leprosy or tuberculosis, but the feeling of being unwanted ” - Mother Teresa Photo from Quote from

Sources Comment in: Am J Clin Pathol Dec;130(6): Brophy, Peter J. "Microbiology: Subversion of Schwann Cells and the Leper's Bell." Science (2002): Print. Abulafia, Jorge. “Leprosy: pathogenesis updated.” International Journal of Dermatology 38 (1999): Chacha, JJ. “Peripheral nervous system and grounds for the neural insult in leprosy.” An Bras Dermatol 84.5 (2009): Suzuki, Koichi. “Localization of CORO1A in the Macrophages Containing Mycobacterium leprae.” Acta Histochem Cytochem 39.4 (2006): Cole, S. T. “Massive gene decay in the leprosy bacillus.” Nature 409 (2001): Baillie, Rebecca A. “Biblical Leprosy as Compared to Present-Day Leprosy.” Southern Medical Journal 75.7 (1982): Vissa, Varalakshmi D. “The genome of Mycobacterium leprae: a minimal mycobacterial gene set.” Genoma Biology 2:reviews (2001). Rambukkana, Anura.“How does Mycobacterium leprae target the peripheral nervous system? “ Trends in Microbiology 8.1 (2000): Han, X. Y. “A new Mycobacterium species causing diffuse lepromatous leprosy.” Am J Clin Pathol Dec;130(6): Scollard, D. M. “The Continuing Challenges of Leprosy.” Clinical Microbiology Review ( 2006) Miller, Timothy S. “Medieval Leprosy Reconsidered.” International Social Sciene Review, Spring-Summer Nester, Eugene, W. Microbiology. Mcgraw Hill, 6 th edition (2009).

April 6, 2010 Sources new-insights-into-an-ancient-disease/ bones-from-medieval-times_ html WHO