Topic
Download
1 / 43

TOPIC - PowerPoint PPT Presentation


  • 153 Views
  • Uploaded on

TOPIC. LEPROSY AS AN ENVIRONMENTAL DISEASE. PRESENTER. Relindis K Fofung PUBH-8165-10 Environmental Health Service Learning Project Walden University

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' TOPIC' - kana


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Topic
TOPIC

LEPROSY AS AN ENVIRONMENTAL DISEASE


Presenter
PRESENTER

Relindis K Fofung

PUBH-8165-10

Environmental Health

Service Learning Project

Walden University

October, 2010

Professor: Dr. Raymond Thron


Outline
OUTLINE

  • Introduction

  • History of leprosy

  • A neglected Tropical Disease

  • Other Neglected Tropical Diseases

  • Etiology and Transmission

  • M. leprae close “cousins”

  • Types of Leprosy and symptoms

  • Diagnosis

  • Reasons for the late diagnosis

  • Contributing Factors

  • Enzootic Leprosy-Armadillos and Cats

  • Indigenous Cases of Non-human Etiology

  • Morbidities from Leprosy

  • Current Global Statistics

  • Leprosy in the Americas

  • Treatment

  • Elimination Strategies

  • Elimination in Progress

  • References


Introduction leprosy
INTRODUCTION - LEPROSY

  • Called Hansen’s Disease - Chronic and disfiguring

  • Caused by Mycobacterium leprae

  • Has high affinity for cooler body parts

  • Is a neglected Tropical infectious disease

  • Diagnosis in the US is always late

  • Treatment is very effective

  • The National Hansen's Disease treatment center is in Carville, Louisiana.


History of leprosy
HISTORY OF LEPROSY

  • Referred to in Biblical literature

  • Historically documented since 600 BC(WHO-LEPROSY)

  • Common in Chinese in 1518 (Luesink, 2010)

  • Was of curse or insect bite etiology beliefs

  • Imported to Europe 1860s to 1940s by Chinese immigrants (Luesink, 2010)

  • M. leprae discovered in 1873 by Hansen, Gerhard, A.

  • First pharmaceutical drug was dapsone in 1940’s


A neglected tropical disease
A Neglected Tropical Disease

  • Not common in Developed Countries

  • Neglect ed - Low incidence/mortality

  • Common in more than 70 countries

  • Not much attention is paid to it

  • Most often has efficient treatment

    (WHO NTD)


Some neglected tropical diseases
Some Neglected Tropical Diseases

  • Chagas disease ,

  • Schistosomiasis,

  • Filariasis,

  • Buruli ulcer,

  • Dengue Fever,

  • Dracunculiasis (guinea-worm disease)

  • Trypanosomiasis) (WHO NTD)


Leprosy etiology transmission
LEPROSY ETIOLOGY & TRANSMISSION

  • Caused by M. leprae (WHO NTD)

  • Respiratory droplets transmission

  • From person to person

  • From enzootic animal to human

  • Incubation period of 3 to 40 years


Mycobacterium leprae close cousins
Mycobacterium lepraeclose "cousins”

  • M. tuberculosis

  • M. ulcerans

  • M. intracellulare

  • M. avium

  • M. xenopi

  • M. simiae

  • M. kansasii


Types of leprosy and symptoms
TYPES OF LEPROSY AND SYMPTOMS

  • Tuberculoid or paucibacillary

    - Mild form of Leprosy

    - One or more light skin-blotches

  • Lepromatous

    - Multibacillary

    - Symmetrical rash

    - Widespread

    (WHO – Leprosy)














Vasculitic ulcerations lucio phenomenon
VASCULITIC ULCERATIONS-LUCIO PHENOMENON

  • See more at

    Fatal Lucio phenomenon

    This resemble buruli ulcer


Diagnosis methods
DIAGNOSIS METHODS

  • Symptoms and Physical Examination

  • Family and Travel History

  • Possible exposure to risk factors

  • Medications

  • Acid Fast stain of Biopsy

  • PCR and FITE Tests

    See WHO – Diagnosis of Leprosy.


Reasons for late diagnosis
REASONS FOR LATE DIAGNOSIS

  • Social stigma due to disfiguration

  • Inability to grow M. leprae in Laboratories

  • Symptoms Resemble other diseases

  • Many Doctors have little experiencein the disease (Nature Reviews)

  • Most US Physicians are untrained to diagnose leprosy

    References:

    1. Nature Reviews. Neurology. Nerve damage in leprosy and its management.


Contributing factors in the americas leprosy
CONTRIBUTING FACTORS IN THE AMERICAS’ LEPROSY

  • Genetics disposition

  • Environmental conditions.

  • Low literacy level

  • Malnutrition

  • Poverty, per Oxford Journal

  • Exposure to nine banded armadillo (Truman, NIH, 2005)

  • Globalization and Ease of Travel

    1. Kerr-Pontes, L. Barreto, M., Evangelista, C., Rodrigues, L., Heukelbach, J and Feldmeier, H. (2006) Oxford Journals. International Journal of Epidemiology. Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case–control study.

    2. Truman, R. (2005). Leprosy Review. Leprosy in wild armadillos. National Hansen's Disease Program, DHHS/HRSA/BPHC, LSU-SVM, Baton Rouge, Louisiana 70803, USA.


Indigenous cases of non human etiology leprosy
INDIGENOUS CASES OF NON-HUMAN ETIOLOGY LEPROSY

  • Texas armadillo hunter develops Leprosy (Becker, Kowalewski, & Martin IV,2009).

  • Brazil two fold increase leprosy incidence

    with armadillo exposure (Deps, Alves, Gripp, Aragao & Guedes, 2008)

  • Indigenous US lepers (Dr. Franco-Paredes and ABC News)

    References:

  • Becker, L., Kowalewski, C., & Martin IV, J. (2009). Nonpruriticerythematous plaques. Journal of Family Practice, vol. 58 pp. 657-659

  • Deps, P., Alves, B., Gripp, C., Aragao, R.,andGuedes, B. (2008). Contact with armadillos increases the risk of leprosy in Brazil: A case control study. Indian Journal of Dermatology, Venereology & Leprology, vol. 74, pp. 338-342.

    3. Dr. Franco-Paredes and ABC News. From Plague to Leprosy: 7 Diseases We'd Forgotten About


Enzootic leprosy armadillo
ENZOOTIC LEPROSY-ARMADILLO

  • 30 years study in 5000 armadillos

  • Confirmed armadillo leprosy

  • Common in Arkansas, Louisiana, Mississippi and Texas

  • M. leprae detected in Colombian Armadillos by PCR (Cardona-castro, Beltrán, Ortiz-Bernal and Vissa, 2009)

  • Common in people closely associated with armadillos (Truman, 2005 and Becker, Kowalewski & Martin IV, 2009)

    References:

    1. Truman, R. (2005). Leprosy Review. Leprosy in wild armadillos. National Hansen's Disease Program, DHHS/HRSA/BPHC, LSU-SVM, Baton Rouge, Louisiana 70803, USA.

    2. Cardona-castro, N., Beltrán, J., Ortiz-bernal, A., & Vissa, V. (2009). Detection of Mycobacterium leprae DNA in nine-banded armadillos (Dasypusnovemcinctus) from the And. Retrean region of Colombia. Leprosy Review, vol. 80,pp. 424-431

    2. Becker, L., Kowalewski, C., & Martin IV, J. (2009). Nonpruriticerythematous plaques. Journal of Family Practice, vol. 58 pp. 657-659


Enzootic leprosy armadillo cont
ENZOOTIC LEPROSY-ARMADILLO cont

  • Other M. leprae reservoirs are:

  • Chimpanzees and mangabey monkeys (NIH)

  • Monkey to monkey transmission observed

  • M. lepraemurium causes cat and mice leprosy

  • Mice develop nerve damage but not cats

  • Cat leprosy leproma look like humans

  • M. lepraemurium is a non-human pathogen


Armadillo
ARMADILLO

Oops, busted!

Oh, lovable Dinosaur-looking me!


Armadillo1
ARMADILLO

What about my beautiful toes?


Morbidties from leprosy
MORBIDTIES FROM LEPROSY

  • Irreversible peripheral nerve damage

  • Loss of sensation in affected areas

  • Ulcers and loss of digits

  • Blindness

  • Facial distortion

  • Stigmatization and social seclusion

  • Disabilities link:



Current global statistics
Current Global Statistics

  • 121 Countries reported new cases in 2008

  • Total global new cases in 2008 was 249, 007

  • Significant decline from 2002 of 620, 638

  • South east Asia reported most with 167, 505

  • Eastern Mediterranean with the least, 3, 938

  • By country, India lead with new cases, 134, 184

  • Brazil came in second with 38, 914 (WHO-WER, 2009)

    WHO. Weekly Epidemiological Report (WER). 14 august 2009, No. 33




Leprosy in the americas
LEPROSY IN THE AMERICAS

  • 1978 to 1985 Indochinese refugee to USA

  • US epidemic peaked in 1985

  • But declined in 1988 (Mastro, Redd & Breiman, 1992)

  • Today 80% of all cases is occur in Brazil

  • Brazil had 38, 914 new cases in 2008

  • Venzuela was second with 586(WHO, WER, 2009)

  • High incidence due to environmental and social behaviors (Kerr-Pontes, Barreto, Evangelista, Rodrigues, Heukelbach, & Feldmeier, 2006)


Treatment
TREATMENT

  • Multi antibiotic drug therapy

  • Anti inflammatory drug treatment

  • Treatment differ with form of the disease

  • Physical and supportive therapy

  • Reconstructive surgery (eye and orthopedic)

    (WHO NTD)


Prevention
PREVENTION

  • In the US, new cases are reportable to the CDC

  • National Hansen's Disease Programs in Baton Rouge, Louisiana clinics care for patients

  • Strict follow up treatment with Multidrug therapy

  • Free drugs from Hansen’s Disease Program

  • Vaccination with BCG argued as ineffective and unethical (Mangla. 1993)

    References:

    Mangla, B. (1993). Leprosy vaccine debate in India re-ignited. Lancet, vol. 342, p. 233.


Elimination strategies
ELIMINATION STRATEGIES

  • Surveillance and monitoring

  • Raise awareness of signs and symptom

  • Political commitment (WHO NTD)

  • Identification of Risk factors (WHO-leprosy)

  • Sustainable Multi drug therapy and health education

  • Encourage and gain public trust to seek help early

  • Ease accessibility to diagnosis (WHO NTD)

  • Enable easy national surveillance and monitoring

  • Discourage stigmatization through education (WHO NTD)

    References:

  • WHO Neglected Tropical Diseases (NTD).

  • WHO-Leprosy. Retrieved from


Elimination in progress
ELIMINATION IN PROGRESS

  • Worldwide Progressive drop in new case since 2002

  • 4% drop from 2007 to 2008

  • From 258, 133 in 2007 to 249,007 in 2008

  • Significant decline from 620, 638 in 2002 (WHO WER)

  • Excellent Case of Sri Lanka (WHO NTD)

  • Use of social marketing starting in 1990

  • By 1996 completely eliminated in the Nation

  • In all 20,000 cases diagnosed and treated effectively(WHO NTD)

    References:

  • WHO. Weekly Epidemiological Report (WER). 14 august 2009, No. 33 .

  • WHO Neglected Tropical Diseases (NTD).


References 1
REFERENCES 1

1. Becker, L., Kowalewski, C., & Martin IV, J. (2009). Nonpruriticerythematous plaques. Journal of Family Practice, vol. 58 pp. 657-659

2. Cardona-castro, N., Beltrán, J., Ortiz-bernal, A., & Vissa, V. (2009). Detection of Mycobacterium leprae DNA in nine-banded armadillos (Dasypusnovemcinctus) from the And. Retrean region of Colombia. Leprosy Review, vol. 80,pp. 424-431.

3. Deps, P., Alves, B., Gripp, C., Aragao, R.,andGuedes, B. (2008). Contact with armadillos increases the risk of leprosy in Brazil: A case control study. Indian Journal of Dermatology, Venereology & Leprology, vol. 74, pp. 338-342.

4. Dr. Franco-Paredes and ABC News. From Plague to Leprosy: 7 Diseases We'd Forgotten About

5. Kerr-Pontes, L. Barreto, M., Evangelista, C., Rodrigues, L., Heukelbach, J and Feldmeier, H. (2006) Oxford Journals. International Journal of Epidemiology. Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case–control study.

6. Kumari R, Thappa D. and Basu D. A fatal case of Lucio phenomenon from India Dermatology Online Journal. Vol. 14. Retrieved from


References 2
REFERENCES 2

7. Luesink, D. (2010). Leprosy in China: A History. Pacific Affairs, vol. 83, pp. 5-6.

8. Mangla, B. (1993). Leprosy vaccine debate in India re-ignited. Lancet, vol. 342, p. 233.  

9. Truman, R. (2005). Leprosy Review. Leprosy in wild armadillos.National Hansen's Disease Program, DHHS/HRSA/BPHC, LSU-SVM, Baton Rouge, Louisiana 70803, USA. Retreived from http://www.ncbi.nlm.nih.gov/pubmed/16248207

 10. WHO – Diagnosis of Leprosy.

11. WHO - Leprosy.

12. WHO. Neglected Tropical Diseases (NTD). Retrieved from   http://whqlibdoc.who.int/publications/2009/9789241598705_eng.pdf

13.. WHO. Weekly Epidemiological Report (WER). 14 august 2009, No. 33


ad