Nadine Chase & Priyanka Patel

 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

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

Normal Nerve CellNerve Cell enlargement Arnold, Harry. Modern Concepts of Leprosy. Springfield, IL, 1953.

 Avoid contact with infected persons  99% of the population have natural immunity

 Long incubation period  Skin lesions with decreased sensitivity  Numbness  Muscle weakness  Cosmetic Disfiguration  Death is usually caused by a secondary opportunistic disease

 Leprosy Skin Test  Inactive Leprosy- causing 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

 Shave Biopsy  Least invasive  Superficial layers of lesion scraped off  No stitches required  Bacteria can be identified on a slide

 Punch Biopsy  Small cylinder of skin removed  Sizes vary depending on size of lesion  May require stitches

 Excisional Biopsy  Local anesthetic applied  Entire lesion is removed  Stitches are usually needed

 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

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 and 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

 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,

 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.

 Arnold, Harry. Modern Concepts of Leprosy. Springfield, IL,  Chakravartti, M.R. and Vogel, F. A Twin Study on Leprosy. Germany,  Grunberg, E., Babger, LF, et al. Leprosy. New York,      “Leprosy. “eMedicine from webmed July  “Leprosy, The Disease” World Health Organization; Regional Office for Southeast Asia. 22 December  Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.