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Hansen's Disease

 

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Hansen's Disease is a chronic infectious disease caused by the leprosy bacillus. It affects mainly the peripheral nerves, the skin, muscles, eyes, bones, testes and internal organs. It is one of the oldest disease known to mankind. The word leper comes from a Greek word. In India it is knownas "KushtaRoga"and is attributed to a punishment from God.

South East Asia has the highest number of leprosy cases in the whole world. It is a major public health problem in India. The prevalence of leprosy in India is 6.7 per 10000 population. The numbers of infectious cases varies between 15-20 per cent. India has the highest recorded number of leprosy patients in the whole world. The treatment of choice is a multidrug therapy (MDT) using diaphenylsulfone (Dapsone), rifampicin (Rifadin), and clofazimine (Lamprene). Surgery can reconstruct damaged faces and limbs. Over millennia the leprosy bacterium has undergone "massive gene decay" -- the loss of many genes and therefore it has largely lost the ability to adapt. The term Hansen disease instead of leprosy is now preferred by some experts, because of it being less perjorative.

Spread of infectionis via nasal discharge either by blowing the nose or sneezing in public. Leprosy cases harbour millions of leprosy bacilli in their nasal mucosa. Leprosy is a social disease. It is common amongst the poor due to overcrowding, poor housing and lack of hygiene. It can spread by close contact as well as from person to person and skin to skin contact. Leprosy has an incubation period of 3-5 years. This disease can cause severe deformity of the feet, hands and face. The bacteria that cause leprosy thrive in cool areas of the body such as the skin, nerves near the skin surface and in oral and nasal mucus membranes. The bacterium responsible for leprosy is called Mycobacterium leprae or, for short, M. leprae. There it is able to withstand the onslaught of enzymes and other forces by virtue of possessing a peculiarly resistant waxy coat and thanks also to its association with lowered cellular immunity . The condition is marked initially by hyperesthesia (excess sensation) succeeded by anesthesia (lack of feeling) and by paralysis, ulceration, and various other problems, ending horribly in gangrene and self-mutilation.

Types of Leprosy

1. Indeterminate type: This denotes early cases with one or two vague hypo pigmented patches with definite sensory impairment. Common on knees and elbows.

2. Tuberculoid type: This type denotes those cases with one or two well defined lesions which may be flat or raised, hypo pigmented or reddish and with no sensations.

3. Borderline type: There are four or more lesions which may be flat or raised, well or ill defined, hypo pigmented or reddish with no sensations.

4. Lepromatus type: There is diffuse infiltration or numerous flat or raised, poorly defined, shiny, smooth, symmetrically distributed lesions. The lesions are bacteriologically positive.

5. Pure neurotic type: There is only nerve involvement. There are no skin lesions.

Leprosy, also known as Hansen disease, is a chronic infectious disease with a wide range of clinical manifestations. At that point, a multi-drug treatment was devised, combining dapsone with clofazimine and rifampin. This treatment has proven to be the most effective treatment for many years. In treating the tuberculoid leprosy, the multi-drug treatment must be followed for approximately six months, while in the case of lepromatous leprosy, the treatment can last as long as two years. Preventing the spread of Hansen's disease is, for the present, limited to treating individuals after they contract the disease. Hansen's discovery preceded Robert Koch's demonstration of the bacterial cause of anthrax by 3 years. Hansen's research helped to establish fundamental principles in microbiology, immunology , and public health .

It is a chronic granulomatous disease of the skin, mucous membranes, nerves, lymph nodes, eyes, and internal organs such as the liver, spleen, and testicles. Only about five percent of the people who are infected with the bacteria actually develop the disease. The immune system generally prevent the development of leprosy. As this type of leprosy advances, nodules may form on both sides of the body. For thousands of years, leprosy was one of the world's most feared communicable diseases, because the skin and nerve damage often led to terrible disfigurement and disability. Even after treatment and the infection is cured, there may still be disability and disfigurement. It is recommended that annual examinations be done for at least five years after the last contact with any person who is infectious.

Causes of Hansen's Disease

The common Causes of Hansen's Disease :

  • Leprosy is caused by Mycobacterium leprae, which is an aerobic (oxygen dependant) rod shaped acid-fast bacillus that spreads through droplet infection.
  • A large number of bacteria are shed in the nasal secretions and from the superficial lesions and nasal secretions of the multibacillary type of leprosy.
  • Both forms produce lesions on the skin , but the lepromatous form is most severe, producing large disfiguring nodules
  • All forms of the disease eventually cause peripheral neurological damage (nerve damage in the extremities) manifested by sensory loss in the skin and muscle weakness .
  • The emergence of drug-resistant Mycobacterium leprae , as well as increased numbers of cases worldwide, have led to global concern about this disease.

Symptoms of Hansen's Disease

Some are common Symptoms of Hansen's Disease :

  • Skin lesions that do not heal after several weeks to months
  • Muscle weakness resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)
  • The spot may lose feeling and hair.
  • In some people the only sign is numbness in a finger or toe.
  • Numbness or absent sensation in the hands and arms, or feet and legs
  • One or more hypopigmented (lighter than your normal skin color) skin lesions that have decreased sensation to touch, heat, or pain
  • Damage to the internal lining of the nose causes scarring and eventual collapse of the nose

Treatment of Hansen's Disease

Here is the list of the methods for treating Hansen's Disease :

  • Plasmoid (plastic) iridocyclitis with anterior uveitis should be treated aggressively to avoid synechia, iris bombé, and other complications (see Medication ).
  • Entropion or ectropion should be treated by appropriate surgical procedures.
  • With a painful blind eye due to glaucoma, enucleation may be the treatment of choice.
  • Surgery plays an important role in control programmes since it has not just the single aim to restore lost function but also to prevent further damage and to improve patient's self-confidence.
  • Ocular therapy depends on the manifestations aggressive treatment of iridocyclitis is probably one of the more important considerations as well as protecting anesthetic corneas from exposure, erosion, and ulceration in face of lagophthalmos
  • Iris bombé due to posterior synechia and glaucoma can be treated with sector iridectomies to help reduce intraocular pressure and improve vision in some patients with complicated cataracts or corneal opacities.