Nadine Chase amp Priyanka Patel Taxonomy Genus Mycobacterium Family Mycobacteriaceae Mycobacterium Leprae Acidfast Bacillus Gram Positive Bacillus shape Single arrangement Aerobic ID: 330694
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Slide1
Leprosy
Nadine Chase &
Priyanka
PatelSlide2
Taxonomy
Genus: Mycobacterium
Family:
MycobacteriaceaeMycobacterium LepraeAcid-fast BacillusGram PositiveBacillus shapeSingle arrangementAerobicOptimum growth temperature is 30°Trivia Can not be grown in culture
http://asylumeclectica.com/asylum/malady/archives/leprosy/leprosy4.jpgSlide3
Sehgal, Alfica.
Leprosy, Deadly Diseases and Epidemics.
Philadelphia, PA, 2006.Slide4
Sehgal, Alfica.
Leprosy, Deadly Diseases and Epidemics.
Philadelphia, PA, 2006.Slide5
Types
Tuberculoid Leprosy
Pauci
-bacillary (PB) LeprosyWell defined skin lesions that are numb1-5 skin lesionsLepromatous LeprosyMulti-bacillary (MB) LeprosyChronically stuffy noseMany skin lesions and nodules>5 skin lesionsSlide6
Target Tissues
Skin tissue
Peripheral nerves
Mucus membranesBacteria prefers outer cooler parts of the body Sehgal, Alfica. Leprosy, Deadly Diseases and Epidemics. Philadelphia, PA, 2006.Slide7
Ecology
Widespread organism living in water and food sources
Obligate Parasites (cannot live independently)
FishInsectsSlide8
Infection Process
Not very contagious
Air born disease
Droplets discharged from the respiratory tractNasal secretionsProlonged contact with excretions from lesions Slow replication timeLong incubation periodSlide9
Infection process cont.
Affinity for macrophages and Schwann cells
In Schwann cell
Mycobacterium binds to the G domain of alpha chain of laminin 2 in the basal laminaStimulates cell mediated immune response which causes swelling, chronic inflammatory responseUltimately leads to axonal (nerve) deathhttp://www.med.nyu.edu/news_and_views/images/leprosy.jpgSlide10
Nerve cell
Normal Nerve Cell
Nerve Cell enlargement
Arnold, Harry.
Modern Concepts of Leprosy. Springfield, IL, 1953.Slide11
Preventative Measures
Avoid contact with infected persons
99% of the population have natural immunity
http://www.ruggedelegantliving.com/journal/images/2003/05/01/sars.mask.jpgSlide12
Symptoms
Long incubation period
Skin lesions with decreased sensitivity
NumbnessMuscle weaknessCosmetic Disfiguration Death is usually caused by a secondary opportunistic disease http://www.wrongdiagnosis.com/l/leprosy/deaths.htmSlide13
Diagnostic Test
Leprosy Skin Test
Inactive Leprosy-causing bacteria injected into skin
Body will react to the Leprosy antigens Check injection 3 days and 28 days later Positive skin reaction is seen in Tuberculoid Leprosy onlyNormal result: little to no skin irritation around injection sitehttp://www.nlm.nih.gov/medlineplus/ency/article/003383.htmSlide14
Diagnostic Test: Skin Biopsy
Shave Biopsy
Least invasive
Superficial layers of lesion scraped offNo stitches requiredBacteria can be identified on a slide http://www.nlm.nih.gov/medlineplus/ency/article/003383.htmSlide15
Diagnostic Test: Skin Biopsy
Punch Biopsy
Small cylinder of skin removed
Sizes vary depending on size of lesion May require stitches
http://www.nlm.nih.gov/medlineplus/ency/article/003383.htmSlide16
Diagnostic Test: Skin Biopsy
Excisional Biopsy
Local anesthetic applied
Entire lesion is removedStitches are usually neededhttp://www.nlm.nih.gov/medlineplus/ency/article/003383.htmSlide17
Diagnostic Test:
Methacholine sweat testing
An intradermal injection of methacholine demonstrates the absence of sweating in leprous lesions.
Helpful to identify diagnosis when lesions are not visible on dark skin individualsArnold, Harry. Modern Concepts of Leprosy. Springfield, IL, 1953.Slide18
Treatments
Multi-drug therapy
PB Leprosy
Two Drugs: Rifampicin and Dapsone for 6 monthsMB LeprosyThree Drugs: Rifampicin, Dapsone, Clofazimine for 12 months
http://www.nlm.nih.gov/medlineplus/ency/article/003383.htmSlide19
Sehgal, Alfica.
Leprosy, Deadly Diseases and Epidemics.
Philadelphia, PA, 2006.Slide20
Treatments cont.
Special Footwear to prevent foot ulcers
Grunberg, E., Babger, LF, et al.
Leprosy. New York, 1951.Slide21
Epidemiology
Age
Children are more susceptible
Bimodal age distribution with peaks at ages 10-14 and 35-44 with higher susceptibilities in younger yearsSexHigher infection rate in males compare to femalesRatio of infection is 2:1Slide22
Epidemiology cont.
Race
African blacks are highly susceptible to the tuberculoid form of leprosy
Caucasians and Chinese are more susceptible to the lepromatous type of LeprosyIts more rural than urban disease in Asia and Pacific BasinSlide23
http://tmcr.usuhs.mil/tmcr/chapter34/large34/34-01.jpgSlide24
Morbidity and Mortality
2002 Data
1,000 deaths in North and South America
96 cases in the U.S3,000 deaths in South East Asia1,000 death in Eastern Mediterranean 1,000 deaths Western Pacific 2005 Data166 new cases were reported in U.S.60% of these cases occurred in:California Louisiana Massachusetts New York Texas Slide25
HANSEN DISEASE (LEPROSY)
Number of reported cases, by year
United States, 1973-2003
www.cdc.gov/epo/dphsi/annsum/2003/slides/hansgraf.pptSlide26
Research
Attempt to identify new drugs that can stop the neural damage caused by the bacteria
Bacteria needs to recognize certain type glycoprotein on the cell surface to bind with and subsequently enter the cell
If these glycoprotein can be identified and a drug can interfere with the binding between the bacterium and the protein, this could potentially prevent entry of the bacteria and stop neural damageSlide27
A Twin Study
Leprosy has been found to NOT be hereditary
If twin siblings become infected, the disease is passed from one to the other solely because of the proximity in which they live
Twin A acquired the disease at age 15 Twin B at age 19The disease effects the twins differently Slide28
Twin Study
Twin A
Twin B
Chakravartti, M.R. and Vogel, F.
A Twin Study on Leprosy. Germany, 1973. Slide29
R
eferences
Arnold, Harry.
Modern Concepts of Leprosy. Springfield, IL, 1953.Chakravartti, M.R. and Vogel, F. A Twin Study on Leprosy. Germany, 1973. Grunberg, E., Babger, LF, et al. Leprosy. New York, 1951.http://www.cdc.gov/ncidod/dbmd/diseaseinfo/hansens_t.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003383.htm
http://tmcr.usuhs.mil/tmcr/chapter34/large34/34-01.jpghttp://www.wrongdiagnosis.com/l/leprosy/deaths.htm
“Leprosy.
“eMedicine from webmed
. http://www.sunysccc.edu/academic/mst/microbes/16mlepr.htm 21 July 2007.
“Leprosy, The Disease”
World Health Organization; Regional Office for Southeast
Asia.
www.searo.who.int/En/Section10/section20/section57_8963.htm. 22 December 2006.
Sehgal, Alfica.
Leprosy, Deadly Diseases and Epidemics.
Philadelphia, PA, 2006.