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Saturday, 29 October 2011
Learning Objective 1: The learner will be able to identify the vulnerable populations affected by Hansen’s disease.
Learning Objective 2: The learner will be able to understand that even though Hansen’s disease is curable, the consequence of delayed diagnosis can lead to long-term disability.
Hansen’s disease is a curable infectious disease of biblical notoriety that continues to cause great disability and stigma globally, including the United States. Many clinicians believe that HD, or leprosy, is an ancient disease localized to underdeveloped countries, but the National Hansen’s Disease Programs reminds clinicians that HD still exists in the United States and should not be overlooked. As international travel becomes more common, clinicians are called to be familiar with populations that are susceptible to HD. It is caused by Mycobacterium leprae and is manifested by hypopigmented, hypoaesthetic lesions, enlarged peripheral nerves, and/or neuropathy. It is estimated that >95% of the general population have innate immunity to HD, and molecular genetic studies have identified some of the genes responsible. High risk groups include individuals from Brazil, Angola, India, the United Republic of Tanzania, and Pacific Island nations to name a few. The disease is also endemic in Louisiana & Texas. Therefore, clinicians should keep Hansen’s disease as a possible differential diagnosis in patients with history of travel or with chronic, non-healing lesions. The presence of acid fast bacilli within nerves in a skin biopsy is diagnostic. Where there is no access to a laboratory, diagnosis is made based on clinical presentation. With the introduction of multidrug therapy, this disease is highly curable and early treatment prevents disability and deformity. However, the long incubation period along with the ever-present stigma, inhibit patients from early diagnosis. Delayed diagnosis can lead to progressive and permanent damage to skin, nerves, limbs, and vision. There is no vaccine, and despite intensive leprosy control strategies, Hansen’s disease continues to evade eradication. The goal is for those affected by Hansen’s disease to lead normal lives with dignity.