Midterm Notes.docx

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Health Studies
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Caroline Barakat

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HEALTH STUDIES SromainutorontocaOffice Hour Tuesday 1112pm MW343 th January 30 February 27 and March 19 activities worth 5 Best 3 activity 9 attendance 5 participation 2CH14 Leprosy the striking hands of godA Look BackIt probably arose in the East as there are Hindu writings of the Veda and descriptions in the Chinese literatureThe Nei Chang a textbook of medicine describe a disease where the patient has stiff joints facial hair falls off the flesh becomes nodular and ulcerates you become numb the bridge of the nose changes color and rotsIt came from India to Greece by soldiers of Alexander the Great or trade routes then went to France Hippocrates never saw it but Aractus a contemporary of Galen did in AD150The Hebrew word saraath describing skin conditions defiled accursed or scaly then became as lepros then John Wycliff translated as leprosy Sometimes disease was known as satyriasis an insatiable sexual appetite Hence it become known as divine punishment for the sins of the fleshConfusion btwn syphilis and leprosyLeprosy was contagious lepers were told not to mix with the crowds to use their own container in drawing water and not to touch anything unless he paid for it first wear a distinctive garment and announce his presence with a bell or clappers and there was a ritual burialThey were buried alive Many were called lazar houses or lazarets after Lazarus of Bethany who was believed to suffer from leprosy and who replaced job as patron saint of the helper th It disappeared in 13 century pulmonary tuberculosis had greater resistance than leprosy skin to skin contact with clothingIt came back in the 1860s and became epidemic in Hawaii islands and they were isolated and were killed on the way to the shore of Molokai In 1873 Father Damien a Roman Catholic priest from Beligum joined the colony as its resident priest He was supposed to be there for 3 months but stayed for 16 years helped them build homes hospital reservoir and a plumbing system and for the next decade and a half he buried many hundreds of leprosy victims He also provided comfort and compassion He became known as the Martyr of Molokai he died maybe infected with it and isolated continued until 1974 It was associated with the ChineseBy 1917 at the height of the US racial discrimination and xenophobia a leprosy bill was passd to establish a leprosariusBabies born to patients were given for adoption They werent allowed to marry until 1952 despite the fact tht durg to ctrl the diseasesuch as sulfone dapsone were introduced in the late 1940sUp until the 1960s strit public health laws forbade those with leprosy to use public transport to fly over certain states to use public restroom or to live freely in society The disease of LeprosyIn 1873 discovery of the leprosy bacillus Mycobacterium leprae by Gerhard Armauer Hansen hence Hansens disease todayLike M Tuberculosis its an acid fast bacillus but it differs in svrl significant ways it cant be grwn in tissue culture and it grows very slowly and only in humans mice and ninebanded armadilos taking abt 2 weeks to divide Tuberculosis bacilli divide every 12 hrs it was in 10 of armidillos in LousianaNo known vectors or reservoir hosts and no satisfaction way of detecting past infections or preventing inapparent ones What we know is tht it is a disease of low infectivity a spectral disease it shows diffrnt manifestations tuberculoid leprosy localized in skin nodules where the bacteria may be abundant and disseminated or lepromatous leprosy with in macrophages and the skin Most patients show the tuberculoid type which dvlps 12 yrs after exposure whereas leptomatous condtn requires longer periods Tuberculoid leprosy is assoctd with severe nerve damage it involves cell mediated immunity with T helper cells and interleukin2 secretion in tuberculoid leprosy but bacteria multiply within schwann cells tht insulate the nerve there is damage to the nerves and anesthesia results In lepromatous leprosy the Thelper cells dont respond to the bacilligamma interferon is not produced macrophages arent activated and as a consequence the bacteria multiply within the macrophages and the disease spreads with multiple organ involvement leading to facial deformity and blindnessDeath results most commonly from renal failure pneumonia and tuberculosis Lepromatous leprosy patients do have antibodies to M lepra antigens but arent protectiveBacteria enter the body through nose or through open wounds they somehow find their way to the Schwann cells that surround the nerve cellsThe schwann cells follow the lamini using bacterial surface protein called H1p they invade and once insdie the schwann cell theyre temporarily protected from the hosts immune system and overtime the immune system attacks the infected Schwann cells destroying nerves in the processWhere leprosy IsMostly in tropics endemic disease It is acquired in childhood but infection can occur even at age 70 Many new cases in the east Men are more frequently infected than females 21Leprosy TodayIts hard to assess the onset of the disease Microbiological analysis and studies on immunology and treatment can be done Examination of individuals with tuberculoid lesions stained for acid fast bacilli is the diagnostic method and was used by Hansen in 1873 Newer molecular methods such as polymerase chain reaction are being tested to detect the presence of M leprae nucleic acidsTreated through Dapsone developed in the 1940s which controls the growth of the bacilli It interferes with the synthesis of bacterial nucleic acids by blocking the conversion of paminobenzoic acid to folic acid since folic acid is obtained in the human diet dapsone does not affect the cells of the bodyIn 1991 WHO recommended multiple drug therapy using dapsone clofazimine and rifampin with treatment lasting 624 months before cure is complete It cured 8 million patients and 84 rcving MDT Mycobacterium bovis BCG vaccination for tuberculosis had had a pos effect on leprosy by reducing the incidence by 20 to 80India vaccine for leprosy called Leprovac It contain a heat killed fast growing nonpathogenic mycobacterium called mycobacterium w which shows the closest antigencity of all mycobacteria to M leprae The vaccine stimulates the immune system of leprosy patients by disrupting immune tolerance and provoking an immune response tht kills and clears M leprae from the bodyLeprosy patients must be given 8 doses of leprovac at 3 month intervals to effect clearance patients are also given MDTBCD and leprovac both stimulates clearance of leprosy bacilli
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