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lecture 5

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L05 Leprosy - Hansens Disease - infectious disease that attacks the nervous system - Microbacterium Leprae - low infectious rate, 90% are immune - enters body -- immune cells seals off infection (destroys sweat glands, hair follicles, skins sensitivity) -- immune cells unable to destroy (bacteria multiplies freely within the skin) - attacks the cooler areas of the body (colour of skin changes, patchy red marks, progresses and degenerates, loses sensitivity of nervesarticulation) - destroys neurons in parts of the body - becomes numb and loses feeling - causes cartilage in areas to get absorbed back into the body, causing fingers, toes, ears, noses to disappear - lepromatous: damages respiration, eyes, and skin - tuberculoid: affects nerves in fingers, toes, and surrounding skin - borderline: effects of both types - long incubation period (2 weeks to 30 years) signs of leprosy - pale or slightly reddish patch - definite loss of sensation in the patch - signs of damage to nerves (loss of sensation, weakness of muscles, visible deformity, large bumps on the skin that do not feel paindo not heal) - irreversible effects how leprosy affects lives - eventually, people lose their fingers and toes and become disfigured - physicallyemotionally disabled - rejected from society and forced to live on their own * condemnation of society, minimal contact from family - later stages - lose sight & most of the feeling in their body cure - invented since 30s but bacterial became resistant - multidrug therapy (MDT) in 80s - 15 million lepers effectively cured in most affected areas * deny treatment as they dont want to be known to have leprosy * to prevent association between illness & stigma, people travel far distances for treatment epidemiology - discovered by Gerhard Hansen in 1873 - ancient disease - seen to be evil, criminal offense (1940s) - shipped off to islandssent to homes for quarantine for the rest of their life - diagnosis of leprosy was not very effective - diagnosed wrong - high in Central Africa, Madagascar, India, Indo-Malaya, Brazil - 17 countries = 94% of new leprosy cases worldwide - 620 638 (2002), 254 525 (2007) - prevalence is declining between 2006-2007, increased in 10 countries - India = 54% of total leprosy burden in 2007 * declined within the last 10 years, less infecteddiseased due to MDT - direct link between social stigma and epidemiology - few WHO approved treatment centres - underreported cases urban leprosy - leprosy elimination in urban areas is challenged by rapid increase in population, density migration
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