Hansen disease.

A 24-year -old man suffering from leprosy .

Hansen's disease or Morbus Hansen's disease formerly known as leprosy or leprosy is a chronic infectious disease that previously, only known to be caused by the bacterium Mycobacterium leprae, the bacterium Mycobacterium lepromatosis until discovered by the University of Texas in 2008, which led to a kind of leprosy endemic in Mexico and Caribbean, more specifically known as diffuse lepromatous leprosy. While the bacteria Mycobacterium leprae was discovered by a Norwegian scientist named Gerhard Henrik Hansen Armauer in 1873 as the pathogen that causes the disease has long been known as leprosy. Nowadays leprosy be referred to as Hansen's disease, not only to appreciate the hard work the inventor, but also because it has the word leprosy and leper so negative connotation, so the more neutral naming applied to reduce the social stigma that is not supposed to be suffered by leprosy patients.
This disease is a type of granulomatous disease in the peripheral nerves and mucosa of the upper respiratory tract, and skin lesions are a sign that can be observed from the outside. If left untreated, leprosy can be progressive, causing damage to the skin, nerves, limbs and eyes. Unlike the myths that circulate in society, leprosy does not cause the release of the body which is so easy, as the disease tzaraath.

History. 

That said, leprosy has been attacking humans since 300 BC, and was known to the ancient Chinese civilization, ancient Egypt, and India. In 1995, the World Health Organization (WHO) estimates that two to three million people were permanently disabled because of leprosy. Although the isolation or separation of patients with less perceived community needs and unethical, some groups of people can still be found in many parts of the world, such as India and Vietnam.
Effective treatment of leprosy found in fabric finishing 1940s with the introduction of dapsone and its derivatives. However, the bacteria that causes leprosy has gradually become resistant to dapsone and become increasingly diffuse. This occurs until the discovery of multidrug treatment in the early 1980s and the disease was able to be handled again.

Traits. 

Skin lesions on the thigh. 

Clinical manifestations of leprosy are very diverse, but mainly on the skin, nerves, and mucous membranes. Patients with this disease can be further grouped into 'tuberculoid leprosy (UK: paucibacillary), lepromatous leprosy (multibacillary Hansen's disease), or multibacillary leprosy (borderline leprosy).
Multibacillary leprosy, with intermediate severity, the type that is often found. There are skin lesions that resemble tuberculoid leprosy but more numerous and irregular; great part can disrupt the whole limb, and peripheral nerve disorders with weakness and loss of taste stimuli. This type is unstable and may be as leprosy lepromatous or tuberculoid leprosy.
Tuberculoid leprosy is characterized by one or more hypopigmented skin macules and parts that do not taste (anesthetic).
Leprosy lepormatosa associated with lesions, nodules, plaques symmetrical skin, the dermis skin thinning, and the development of the nasal mucosa that causes blockage of the nose (nasal congestion) and epistaxis (nose bleed), but the detection of nerve damage is often too late.
Not in line with the existing myths or beliefs, this disease does not cause the decay of the body. According to research long by Paul Brand, stated that the inability to feel stimulation in the limbs often cause sores or lesions. Today, leprosy can also cause problems in people with AIDS.

Cause. 

Mycobacterium leprae is the cause of leprosy. An acid-resistant bacteria M. leprae also an aerobic bacteria, gram-positive, rod-shaped, and dikelilimgi by candles cell membrane that is characteristic of Mycobacterium species.
M. leprae can not be cultured in the laboratory.

Pathophysiology. 

Exact mechanism of transmission is unknown. Several hypotheses have been put forward as the presence of close contact and transmission from the air.
In addition to humans, animals can be affected with leprosy is the armadillo, chimpanzees, and crab-eating monkeys. There is evidence that not everyone who is infected by the bacteria M. leprae suffering from leprosy, and genetic factors are also thought to play a role, after through research and observation in leprosy groups in a particular family. It is not known why it can also happen that different types of leprosy on each individual. Nutritional insufficiency factors are also believed to be the causative factor.
The disease is often believed that the transmission is caused by contact between infected persons and healthy persons. In incidence studies, infection rates for contacts of lepromatous leprosy varied from 6.2 per 1000 per year in Cebu, Philippines to 55.8 per 1000 per year in South India.
Two exit of M. leprae from the human body are the skin and the nasal mucosa. It has been proven that lepromatous cases show the presence of a number of organisms in the dermis of the skin. However still not been proven that these organisms may migrate to the surface of the skin. Although there are reports that ditemukanya acid-resistant bacteria in the skin epithelium deskuamosa, Weddel et al reported that they did not find bacteria resistant to acid in the epidermis. In a recent study, Job et al found that a large number of M. leprae in the superficial keratin layer of the skin in lepromatous leprosy patients. This forms a prediction that the organism could exit through the sweat glands.
The importance of the nasal mucosa has been proposed by Schaffer in 1898.
The number of bacteria from nasal mucosal lesions in lepromatous leprosy, according to Shepard, between 10,000 and 10,000,000 bacteria. Pedley reported that the majority of lepromatous patients showed the presence of bacteria in their nasal secretions.
Davey and Rees indicated that nasal secretions from lepromatous patients could produce 10 million organisms per day.
The entrance of M. leprae into the human body is still a question mark. It is currently estimated that the skin and upper respiratory tract into the gate of entry of bacteria. Rees and McDougall have successfully tried transmission of leprosy through aerosols in mice suppressed immune systems. The report also noted the successful trials on mice by exposure to bacteria in the nasal cavity.
Many scientists believe that the respiratory tract are the most possible entry of bacteria into the gate, however opinions on the skin can not be excluded.
The incubation period of leprosy surely can not be argued. Some researchers attempted to measure the incubation period. The minimum incubation period reported is a few weeks, based on a case of leprosy among young infants. The maximum incubation period reported for 30 years. It is based on observations are reported on war veterans who've exposed in endemic areas and then move to a non-endemic area. In general, it has been agreed that the average incubation period of leprosy is 3-5 years.

Treatment. 

Until the development of dapsone, rifampin, and clofazimine in the 1940s, there is no effective treatment for leprosy. However, dapsone is only bactericidal drug (exterminator bacteria) are weak against M. leprae. Single use dapsone causing bacteria become resistant populations. In the 1960s, dapsone is not used anymore.
The search for anti-leprosy drugs better than dapsone, rifampicin and clofazimine eventually discovered in the 1960s and 1970s.

Drugs multidrug therapy of leprosy. 

Later on, Shantaram Yawalkar and colleagues formulated a combined therapy using rifampicin and dapsone, to outsmart bacterial resistance. Multidrug therapy and a combination of the above three drugs was first recommended by a WHO Expert Committee in 1981. This method became standard multidrug treatment. Three of these drugs not be used as a single agent to prevent bacterial immunity or resistance.
Therapy over quite expensive, and therefore quite difficult to get into the endemic countries. In 1985, leprosy remains a public health problem in 122 countries. At the World Health Assembly (WHA) in Geneva 44th, 1991, passed a resolution to remove leprosy as a public health problem in 2000, and sought to be pressed into 1 case per 100,000. WHO is mandated to develop strategies for the elimination of leprosy.
Working Group on Chemotherapy of Leprosy, WHO reported in 1993 and recommended two types of standard multidrug therapy. The first is the treatment for 24 months for lepromatous leprosy with rifampicin, clofazimine, and dapsone. The second is a 6-month treatment for tuberculoid leprosy with rifampicin and dapsone.
Since 1995, the World Health Organization gave drug package terapoi free of leprosy in endemic countries, through the Ministry of Health. This strategy will be walks up to the end of 2010.
Multidrug treatment is still effective and no longer infected patients in the first month of usage. This method is safe and easy. usage period has been listed on the drug packaging.

Epidemiology. 

Across the world, two to three million people are estimated to suffer from leprosy. India is the country with the largest number of patients, followed by Brazil and Myanmar.
In 1999, the incidence of leprosy in the world is estimated at 640,000, in 2000, 738 284 cases were identified. In 1999, 108 cases occurred in the United States. In 2000, WHO made a list of 91 leprosy endemic countries. 70% of cases in the world are India, Myanmar, and Nepal. In 2002, 763,917 cases found worldwide, and according to the WHO during the year, 90% of leprosy cases in the world are Brazil, Madagascar, Mozambique, Tanzania and Nepal.

Risk groups. 

Groups at high risk of leprosy were living in endemic areas with poor conditions such as inadequate bedding, unclean water, poor nutrition, and the presence of other diseases such as HIV investments that can suppress the immune system. Men have affected the level of leprosy two times higher than women.

Global situation. 

Table 1: Prevalence at beginning of 2006, and the trend of new case detection 2001-2005, excluding Europe
The prevalence areas listed
(Rate/10, 000 pop.)
The new cases were discovered in
Early 2006 2001 2002 2003 2004 2005
Africa 40,830 (0.56) 39,612 48,248 47,006 46,918 42,814
America 32,904 (0.39) 42,830 39,939 52,435 52,662 41,780
Southeast Asia 133,422 (0.81) 668,658 520,632 405,147 298,603 201,635
Eastern Mediterranean 4,024 (0.09) 4,758 4,665 3,940 3,392 3,133
Western Pacific 8,646 (0.05) 7,404 7,154 6,190 6,216 7,137
Total 219,826 763,262 620,638 514,718 407,791 296,499
Table 2: Prevalence and Discovery
The prevalence countries listed
(Rate/10, 000 pop.)
The discovery of new cases
(Rate/100, 000 pop.)
Early 2004 Early 2005 Early 2006 During 2003 During 2004 During 2005
 Brazil 79,908 (4.6) 30,693 (1.7) 27,313 (1.5) 49,206 (28.6) 49,384 (26.9) 38,410 (20.6)
 Democratic Republic of the Congo 6,891 (1.3) 10,530 (1.9) 9,785 (1.7) 7,165 (13.5) 11,781 (21.1) 10,737 (18.7)
 Madagascar 5,514 (3.4) 4,610 (2.5) 2,094 (1.1) 5,104 (31.1) 3,710 (20.5) 2,709 (14.6)
 Mozambique 6,810 (3.4) 4,692 (2.4) 4,889 (2.5) 5,907 (29.4) 4,266 (22.0) 5,371 (27.1)
 Nepal 7,549 (3.1) 4,699 (1.8) 4,921 (1.8) 8,046 (32.9) 6,958 (26.2) 6,150 (22.7)
 Tanzania 5,420 (1.6) 4,777 (1.3) 4,190 (1.1) 5,279 (15.4) 5,190 (13.8) 4,237 (11.1)
Total 112,092 60,001 53,192 80,707 81,289 67,614
As had been reported by WHO in 115 countries and territories in 2006 and published in the Weekly Epidemiological Record, the registered prevalence of leprosy at the beginning of 2006 was 219 826 cases. The discovery of new cases in the previous year tends to 296,499 cases. The reason the number is higher than the annual discovery late prevalence explained by the fact that the proportion of new cases that treatment was completed in the same year so it is no longer included registered prevalence. The invention is globalization of the new cases show a decline.
Thank you for reading this article. Written and posted by Bambang Sunarno. sunarnobambang86@gmail.com
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DatePublished: March 5, 2014 at 09:46
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