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Notes for test 2

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Department
Health Studies
Course Code
HLTB21H3
Professor
Caroline Barakat

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Hansens disease / Leprosy:
HISTORY--------------------------------------------
-Egyptian Papyrus document (1550 BC) -Indian writings, approximately 600 BC -In 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 -Disease of the soul
-Earlier thought to be a hereditary illness, or caused by a curse or by punishment from God - Lepers were stigmatized -E.g. special clothing,
arrival notification, separate hospitals, and often had to live in colonies called leprosariums / lazaretto / leper colony / lazar house -First leper
house in England 936 AD - Mid-12th century - loss of civic status, removal from public office -13th century - 19,000 ‘leprosaria in use -
Mass of Separation -Decline around 1350 AD -Spread to North America
Dr. Armauer Hansen of Norway-1873.----------------------------------------
-Discovers the leprosy germ under a microscope -Mycobacterium leprae (M. leprae ) -Leprosy is now also called Hansen's Disease
Etiology-------------------------------------------------
-M. Leprae -Slow multiplying bacillus - average doubling time of 12 14 d -Incubation period of 3 5 yrs -Thought to be transmitted via
droplets, from the nose during close and frequent contact -Not highly infectious may be related to genetic susceptibility -Mainly affects the
skin, nerves, and mucous membranes
RISK-------------------------------------------------------
-Leprosy can affect people of all races all around the world -Most common in warm, wet areas in the tropics and subtropics -Most
common between the ages of 10 and 14 and in those aged 35-44 years old -Rarely seen in infants -Genetic susceptibility
Clinical Manifestations-------------------------------------------------
-Indeterminate Leprosy (IL): Earliest and mildest form, Usually few lesions, Loss of sensation is rare
-Tuberculoid Leprosy (TT): Development of large lesions, Loss of sensation, Affected nerves become thick, Progression can occur resulting in
borderline-type leprosy
- Borderline tuberculoid leprosy (BT): Lesions are smaller and more numerous
-Borderline Lepromatous Leprosy (BL): Lesions are numerous, but they may also consist of papules, plaques, and nodules, Punched-out-
appearing lesions that look like inverted saucers are common. The disease may remain in this stage
-Lepromatous Leprosy (LL): Never reverts to a less severe form, Early symptoms - nasal stuffiness, discharge and bleeding, and swelling of the
legs and ankles, Following problems may occur: Skin thickens, Eyebrows and eyelashes are lost, Nose deformation or collapses, Ear lobes thicken,
Photophobia (light sensitivity), blindness, Enlarged liver and lymph nodes, Hoarseness of voice, Fingers and toes become deformed
Diagnosis and Treatment------------------------------------------------------
Diagnosis on clinical symptoms, Laboratory studies, Treatment: chaulmoogra nut, Promin (1941), Dapsone (1950s), WHO recommends
multidrug therapy (MDT)
Nine-banded armadillo-----------------------------------------------------
Important animal for research -Armadillos do not develop human type leprosy; disease usually more severe and fatal - Low body
temperature (28-33 C) may promote the disease - Mid-1980s - concern of being infected from armadillos to humans
Multidrug Therapy------------------------------------------ Dapsone, Rifampicin and Clofazimine.
www.notesolution.com
Prevention-------------------------------------------------------
Hand washing, Disinfection of fomites, handkerchiefs, and nasal secretions, Household contacts, Young household contacts should be treated with
drugs, Vaccine
Possible Causal Factors for the Disappearance of Hansens disease---------------------------------------
Selective mortality of leprosy patients during plague pandemic, Cross-immunity with other, Mycobacteria, Loss of pathogenecity, Genetic
selection of the population, Improved quarantine, Improved socio-economic conditions, Better housing and sanitation, Climate
Hansens Disease in Canada-------------------------------------------
DArcy Island- Tracadie, NB, May have been introduced by sailors, Disease slowly spread from family to family to neighbour, First case detected
in 1815, Lepers were left unattended, living in a hut, In 1844, legislation passed to prevent the spread of the disease, Sheldrake Island was chosen
for the lazaretto
Where are we now?-------------------------------------------------------
212 000 at the beginning of 2008 (WHO), Three countries not reached the target of 1 in 10,000 set in 1991 by World Health Assembly: Brazil,
Nepal, Timor-Leste. , India - reported prevalence of 87 228 cases (2008) with 137 685 new cases detected during 2007. , Brazil (45 847) and
Indonesia (21 430) also cause for worry.
Tuberculosis The White Plague
History--------------------------------------------------------------------------------------------------
TB present since antiquity, Egyptian mummies (2400 BC), Phthisis’ or consumption Homer 800BC, 460 BC Hippocrates; disease was
due to evil air but did not consider it contagious, Aristotle (384 322BC) suggested that TB may be due to bad and heavy breath, TB
documented in Egypt, India, and China as early as 5,000, 3,300, and 2,300 years ago respectively (Daniel 2006), Typical skeletal
abnormalities, TB limited to animals in prehistoric times (8000 4000BC), TB epidemics likely from changes in the host population and the
environment, Claims of royal supernatural powers during the Middle Ages (AD 500 1500), In England, practice of Kings Evil or the
‘Royal Touching, (1546) Fracastorius describes Modern Theory of Contagion, (1629) Consumption - leading cause of death in London ,
(1679) Franciscus D Sylvius discovers the lung nodules - "tubercles, 1720 - Benjamin Marten - speculates that TB may be communicable
from one individual to another, 19th century TB spread to rest of Europe and by 1900 reached N America, (1839) term "tuberculosis"
first used, Mid 19th century TB was romanticized, Opera productions La Traviata (1853), La Boheme (1895), Classical movie Camille
(1936) based on Alexandre DumasnovelThe Woman of the Camellias, (1854) Dr. Brehmer - Doctoral Dissertation- Tuberculosis is a
Curable Disease, 1854 - Jean-Antoine Villemin -specific microorganism as cause, 1882 Dr. Robert Koch discovered Mycobacterium
tuberculosis. Developed tuberculin test, 1895 - Wilhelm Konrad von Rontgen use of radiation
Etiology------------------------------------------------------------------------------------------
Agent - tubercle bacillus germ Mycobacterium tuberculosis, an acid-fast bacillus, 3 main types of the human bacillus, Type 1 found in
India; least virulent, Type A Africa, China, Japan, Europe, N America, Type B Exclusively in Europe and North America
Forms of Tuberculosis----------------------------------------------------------------------------------------------------------------
Several animal forms of the bacillus, Bovine type may lead to pulmonary TB (most common form) or Miliary tuberculosis, Commonly
affects infants and young children, Fatal within few weeks or days, Spread through the air by coughs or sneezes, Each droplet nuclei
(airborne particles) can contain between one and three bacilli, Each sneeze contains 100,000 nuclei droplets
What happens when TB enters the body?-------------------------------------------------------
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Description
Hansens disease Leprosy: HISTORY-------------------------------------------- -Egyptian Papyrus document (1550 BC) -Indian writings, approximately 600 BC -In records of ancient Greece, after the army of Alexander the Great returned from India (320 BC) -In Rome (62 BC) with the return of Pompeiis troops from Asia Minor -Disease of the soul -Earlier thought to be a hereditary illness, or caused by a curse or by punishment from God - Lepers were stigmatized -E.g. special clothing, arrival notification, separate hospitals, and often had to live in colonies called leprosariums lazaretto leper colony lazar house -First leper house in England 936 AD - Mid-12th century - loss of civic status, removal from public office -13th century - 19,000 leprosaria in use - Mass of Separation -Decline around 1350 AD -Spread to North America Dr. Armauer Hansen of Norway-1873.---------------------------------------- -Discovers the leprosy germ under a microscope -Mycobacterium leprae (M. leprae ) -Leprosy is now also called Hansens Disease Etiology------------------------------------------------- -M. Leprae -Slow multiplying bacillus - average doubling time of 12 14 d -Incubation period of 3 5 yrs -Thought to be transmitted via droplets, from the nose during close and frequent contact -Not highly infectious may be related to genetic susceptibility -Mainly affects the skin, nerves, and mucous membranes RISK------------------------------------------------------- -Leprosy can affect people of all races all around the world -Most common in warm, wet areas in the tropics and subtropics -Most common between the ages of 10 and 14 and in those aged 35-44 years old -Rarely seen in infants -Genetic susceptibility Clinical Manifestations------------------------------------------------- -Indeterminate Leprosy (IL): Earliest and mildest form, Usually few lesions, Loss of sensation is rare -Tuberculoid Leprosy (TT): Development of large lesions, Loss of sensation, Affected nerves become thick, Progression can occur resulting in borderline-type leprosy - Borderline tuberculoid leprosy (BT): Lesions are smaller and more numerous -Borderline Lepromatous Leprosy (BL): Lesions are numerous, but they may also consist of papules, plaques, and nodules, Punched-out- appearing lesions that look like inverted saucers are common. The disease may remain in this stage -Lepromatous Leprosy (LL): Never reverts to a less severe form, Early symptoms - nasal stuffiness, discharge and bleeding, and swelling of the legs and ankles, Following problems may occur: Skin thickens, Eyebrows and eyelashes are lost, Nose deformation or collapses, Ear lobes thicken, Photophobia (light sensitivity), blindness, Enlarged liver and lymph nodes, Hoarseness of voice, Fingers and toes become deformed Diagnosis and Treatment------------------------------------------------------ Diagnosis on clinical symptoms, Laboratory studies, Treatment: chaulmoogra nut, Promin (1941), Dapsone (1950s), WHO recommends multidrug therapy (MDT) Nine-banded armadillo----------------------------------------------------- Important animal for research -Armadillos do not develop human type leprosy; disease usually more severe and fatal - Low body temperature (28-33 C) may promote the disease - Mid-1980s - concern of being infected from armadillos to humans Multidrug Therapy------------------------------------------ Dapsone, Rifampicin and Clofazimine. www.notesolution.com
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