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Lecture 3

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Health Studies
Caroline Barakat

Hansen’s disease / Leprosy History  The occurrence of leprosy has been recorded throughout history (old testament) - thought to be referred to in an Egyptian Papyrus document (1550 BC) - in Indian writings, approximately 600 BC - in the records of ancient Greece, after the army of Alexander the Great returned from India (320 BC) - in Rome (62 BC) with the return of Pompeii's troops from Asia Minor - Endemic/epidemic - Always been feared and misinterpreted - Earlier thought to be a hereditary illness, or one that was caused by a curse or by punishment by God - Lepers were stigmatized and shunned from society - E.g. In Europe - had to wear special clothing with a bell that would notify others of their impending arrival - Tied to posts and burned alive/buried alive - Patients treated in separate hospitals and often had to live in colonies called leprosariums / lazaretto / leper colony / lazar house (isolated from the rest of society) - First ‘leper house’ in England 936 AD th - Mid-12 century - loss of civic status, removal from public office (considered dead and spouses of lepers had no civic status) - 13 century - 19,000 ‘leprosaria’ in use - Mass of Separation - Disappearance 1350 AD - Louisiana & Hawaii - People of different ages found and diagnosed leprosy and was buried Dr. Armauer Hansen of Norway-1873.  Discovers the leprosy germ under a microscope  Mycobacterium leprae (M. leprae )  Not hereditary or caused by a curse, but there may be some genetic susceptibility. Leprosy is now also called Hansen's Disease.  Father Damien went to hawaii island to help them but contracted the disease itself and caused stigma Etiology  Chronic disease caused by Mycobacterium leprae (lives with person for a long time)  Slow multiplying bacillus with an average doubling time of 12 – 14 days (depends on host)  Incubation period of 3 – 5 years  Thought to be transmitted via droplets, from the nose during close and frequent contact (also shed through skin) But don’t know the contagion method reports of inhalation, open wounds, etc)  Not highly infectious – may be related to genetic susceptibility, related to level of immunity, maybe gender more male than female and having leprosy creates protection from Tuberculosis  frequent contact with an advance stage of leprosy may cause contraction  Mainly affects the skin, nerves, and mucous membranes Epidemiology - africa, south America, india Risk  Leprosy can affect people of all races all around the world of all ages  Most common in warm, wet areas in the tropics and subtropics (not limited)  Most common between the ages of 10 and 14 and in those aged 35-44 years old  Rarely seen in infants Clinical Manifestations 5 Stages:  Indeterminate (IL)  Tuberculoid (TT) (1-2 years)  Borderline tuberculoid (BT)  Borderline lepromatous (BL)  Lepromatous (LL) Indeterminate Leprosy (IL)  Earliest and mildest form of disease  Usually few numbers lesions (scars)  Loss of sensation is rare and only occurs when damage is done to nerves and has not developed at this stage  Majority of cases develop into a later form  Some patients with strong immunity may recover on their own or continue to have this form of leprosy without progressing Tuberculoid Leprosy (TT)  Development of large lesions with loss of sensation some nerve damage (anesthetic)  1-2 year exposure  Affected nerves become thick  Nerve functions become impaired  Progression can occur resulting in borderline-type leprosy and in rare instances, if the patient goes untreated for many years, the lepromatous form can occur afterwards Borderline tuberculoid leprosy (BT)  Similar to tuberculoid type except that lesions are smaller and more numerous (visible)look like inverted saucers  Disease may stay in this stage or revert back to tuberculoid form, or progress to a more advanced stage Borderline Lepromatous Leprosy (BL)  Lesions are numerous, but they may also consist of papules, plaques, and nodules (damaged skin)  Punched-out-appearing lesions that look like inverted saucers are common.  The dise
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