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Leprosy (Hansen’s Disease)
1. Leprosy (Hansen’s Disease)
The topic of the lecture:Leprosy (Hansen’s Disease)
Professor Kutmanova A.Z.
2. What is Leprosy?
• It is a disease of Historical importamce• Worlds oldest recorded disease
• Stigmatized disease
3. Introduction
• Leprosy is a chronic infectious disease causedby Mycobacterium leprae, an acid-fast, rodshaped bacillus.
• The disease mainly affects the skin, the
peripheral nerves, mucosa of the upper
respiratory tract and the eyes.
• Leprosy is curable and treatment provided in
the early stages averts disability.
4. Introduction
• Multidrug therapy (MDT) treatment has been madeavailable by WHO free of charge to all patients
worldwide since 1995.
• It provides a simple yet highly effective cure for all
types of leprosy.
• Elimination of leprosy as public health problem (with
a prevalence less than 1 case per 10 000 persons) was
achieved globally in the year 2000.
• More than 16 million leprosy patients have been
treated with MDT over the past 20 years.
5.
6. Gerhard Armauer Hansen
1868 - Identifies Firstmicroorganism
Global Project on the History of Leprosy
http://www.leprosyhistory.org/graphics/gallery/hansen.jpg
7. Leprosy is caused by Mycobacterium leprae
• Bacilli maypresent in singles,
can be intracellular.
• Agglomerates.
• Bacilli bound by
lipid like substance
(Glia)
• Masses are Globi
• Appear cigar
bundles.
Scollard, DM et al. 2006. “The continuing challenges of leprosy.”
Clinical microbiology reviews 19, no. 2: 338-81.
8. Cultivation
Not possible
Can be propagated in Foot pads of Mice
Granulomas develop at the site of inoculation.
Nine banded armadillo highly susceptible.
Chimpanzees
Generation time 12 -13 days.
Average may be 8- 42 days
9. Important Experimental Animal
10. Most Important experimental Animal
11. Transmission
Nasal/oral DropletsDermal Inoculations
12. Classification (Madrid)
13. Symptoms
14. Types of Leprosy
Depending on clinical features, leprosy isclassified as:
• Indeterminate Leprosy (IL)
• Paucibacillary Leprosy (PB)
• Borderline Tuberculoid Leprosy (BT)
• Borderline borderline Leprosy (BB)
• Borderline lepromatous Leprosy (BL)
• Multibacillary Leprosy (MB)
15. WHO classification
• Two Groups:1 Paucibacillary
2 Multibacillary
• Paucibacillary (PB): the number of M. leprae in
the body is small (less than 1 million) and a
skin smear test is negative. The patient
presents five or fewer skin lesions. Most cases
of leprosy are PB.
16. WHO classification
• 2 Multibacillary• M. leprae can multiple in the body almost
without any check and is thus present in high
numbers. The bacillus has likely spread to
almost all areas of skin and peripheral nerves.
A skin smear test is positive and the patient
presents more than five skin lesions.
17. Bacteria Resides in Cooler Parts of the Body
SkinPeripheral Nerves
http://www.nlm.nih.gov
18. Symptoms & Diagnosis: (1) Skin Lesions
Symptoms & Diagnosis:(1) Skin Lesions
Worobec, Sophie M. 2009. “Treatment of leprosy/Hansen's disease in
the early 21st century.” Dermatologic therapy 22, no. 6: 518-37.
19. Immunocompromised individuals are more susceptible to disease
20. Mechanism of Nerve Damage
1.Entry ThroughBlood Vessels
2. Inflammatory
Response
3. Demyelination
Scollard, DM et al. 2006. “The continuing challenges of leprosy.”
Clinical microbiology reviews 19, no. 2: 338-81.
21.
Outcomes of Nerve DamageSensory Loss
Paralysis
Deformities
Leprosy: eMedicine Infectious Diseases
http://emedicine.medscape.com/article/220455-overview
22. Sensory Loss Can Lead to Secondary Infections and Severe Deformities
International Federation of Anti-Leprosy Associations (ILEP)http://www.ilep.org.uk/en/
23.
24.
25. 1941: Discovery of Dapsone
• Targets dihydropteroatesynthase (DHPS)
• Inhibits nucleic acid
synthesis
26. 1964: Dapsone Resistance from Missense Mutations in DHPS
DHPS - dihydropteroate synthasesMatsuoka, Masanori M. 2010. “Drug Resistance in Leprosy.” Japanese journal of infectious diseases 63, no. 1: 1-7.
27. 1960’s: Rifampicin and Clofazimine Discovered
• Rifampicin (Rifampin):Inhibit RNA synthesis
• Clofazimine:
Anti-inflammatory
28. 1981: WHO Proposes Multi-Drug Therapy (MDT)
• Combination of DAPSONE, RIFAMPICIN, andCLOFAZIMINE
+
+
29.
The Nippon Foundationhttp://www.nippon-foundation.or.jp/eng/
30. 1995: WHO Distributes MDT Drugs for Free to Worldwide Patients
31. 1999: Global Alliance to Eliminate Leprosy As a Public Health Problem
32. Obstacles to Eliminating Leprosy in Endemic Countries
STIGMAWorld Health Organization. 2001. “Leprosy: Learning from Success.”
WHO Publications on Leprosy.
33. Overcoming Stigma
Mass MediaIntegrated Primary Health Services
Education & Training
34.
Worobec, Sophie M. 2009. “Treatment of leprosy/Hansen's disease in the early 21st century.”Dermatologic therapy 22, no. 6: 518-37.
35.
In 2016 WHO has launched a newglobal strategy – “The Global Leprosy
Strategy 2016–2020: Accelerating
towards a leprosy-free world”
The targets of the new global strategy to be met by 2020 are:
• Zero disabilities among new paediatric patients.
• A grade-2 disability rate of less than 1 case per 1 million people.
• Zero countries with legislation allowing discrimination on basis of
leprosy.