Leprosy (Hansen's Disease)

Harboe (Miller & Love, 1989, P. 318) reports that the disease leprosy, which is infrequently also known as Hansen's Disease, is caused by invasion of Mycobacterium leprae, an obligate intracellular parasite occurring in macrophages and other cells, with three resulting categories. These categories parallel the Ridley-Jopling classification of leprosy and, thus, are internationally accepted. The first category, indeterminate leprosy, typically heals spontaneously, while tuberculoid leprosy contains few lesions having bacilli and lepromatous leprosy has multiple lesions in which bacilli grow uninhibited due to " . . . defective cell-mediated immunity." In addition to the presentation of lesions in the second and third categories, sufferers of leprosy as well manifest nerve damage that results in the majority of deformities often associated with this disease. Lechat (Miller & Love, 1989, P. 324) notes that approximately 25% of all infected individuals who do not receive early intervention develop anesthesia and/or severe deformities of the hands and feet. Mansfield (1989) notes that trophic ulceration, which is succeeded by persistent erythema, occurs in denervated extremities due to a series of low-pressure traumas that are often initially tolerated, as is the case in diabetes mellitus. With the absence of feedback from pain and the existence of low-grade inflammation, autolysis of the skin occurs, resulting in secondary infection, enlargement of the ulceration with the p

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en that these countries are relatively un- or under-developed, it is notable that leprosy probably manifests in other such nations. There appears to be in force a declining trend of the presentation of leprosy in Norway, Venezuela, France, Hong Kong, the Philippines, China and India. Etiology Harboe (Miller & Love, 1989, p. 318) reports that the disease leprosy is caused by invasion of Mycobacterium leprae, an obligate intracellular parasite occurring in macrophages and other cells, which has entry to the new host via the nose. Cook (1990) reports that, in South India, a relatively high percentage of early cases involved pathology of the nasal mucosa, resulting in untreated disseminated, or multibacillary cases. Duncan (Cook, 1990) found, however, that Mycobacterium leprae infection is possible in utero, noting that the infants of untreated lepromatous leprosy mothers may well be infected at birth. The most empirically supported mode of transmission, however, appears to favor nose-to-nose, with a distance of 1.5 m constituting sufficient proximity for droplet size to impact the nose of the recipient. Reifsnyder (1980, p. 433) reports that Mycobacterium leprae in vivo appears to multiply with a generation time of approxim

Category: Medical - L