What effects does Hansen's disease have on the body?
Because the bacteria that cause Hansen's disease like the cooler parts of the body, the skin and its nerves are affected. This can cause dryness and stiffness of the skin. In some cases affected nerves can swell, causing pain. There can be loss of feeling and weakness in the muscles of the hands or feet.
Where is Hansen's disease found?
In the U.S., there are approximately 6,500 cases on the National Hansen's Disease Program Registry. This includes all cases reported since the registry began and who are still living. The number of cases with active disease and requiring drug treatment or management is approximately 3,300.
The NHDP compiles a statistical summary of new cases which present in the United States each year. Between 150 and 200 new U.S. cases are reported to the Registry annually. The largest number of U.S. cases are in California, Texas, Hawaii, Louisiana, Florida, New York and Puerto Rico. SeeNational Hansen's Disease Program Data..
In 2005, the World Health Organization, which compiles global Hansen's disease data, registered a total of 296,499 new cases worldwide. Global Leprosy Situation 2006 . These data indicate a rapid drastic reduction of the ~500 - 700 thousand cases seen each year for the previous 12 years and have raised questions. See the World Health Organization report, Global Leprosy Situation 2006 (not a U.S. Government Web site, pdf).
How is Hansen's disease treated?
Sulfone drugs were introduced at the National Hansen's Disease Program in 1941. These medications continue to be an important weapon against Hansen's disease.
An increasing incidence of sulfone-resistant disease, however, necessitates treating all patients with more than one drug. Antibiotics are a very effective treatment for Hansen's disease; the three most commonly used are Dapsone, Rifampin and Flofazimine. Other antibiotics, such as Clarithromycin, Ofloxacin, Levofloxacin and Minocycline also work well against M. leprae.
Treatment regimens differ depending upon the form of the disease and may last for 3 to 4 years
Treatment rapidly renders the disease non-communicable by killing nearly all the bacilli within a few days. These dead bacilli are then cleared from the body within a variable number of years.
The National Hansen's Disease Programs in Baton Rouge, Louisiana, is the only institution in the U.S. exclusively devoted to Hansen's disease. The center functions as a referral and consulting center with related research and training activities. Most patients in the U.S. are treated at National Hansen's Disease Program Ambulatory Care Clinics in major cities or by private physicians. See more on National Hansen's Disease Ambulatory Care Clinics.
Is Hansen's disease contagious?
Hansen's disease is far less contagious than other infectious diseases. More than 95 percent of the human population has a natural immunity to the disease. Healthcare workers rarely contract Hansen's disease. Most cases of Hansen's disease respond to treatment and become non-infectious within a short time.
How do I know if I might have Hansen's disease?
Hansen's disease in the U.S. is very rare, but between 150 and 200 new cases are reported each year.
The first signs of Hansen's disease are usually pale or slightly red areas or a rash on the trunk or extremities. Frequently, but not always, there is an associated decrease in light touch sensation in the area of the rash but not always. A loss of feeling in the hands or feet may also be the first signs of Hansen's disease. These changes in sensation are a valuable clue to diagnosis.
Nasal congestion may be a sign of infection, but infection is usually associated with changes of the skin on the face, such as thinning of the eyebrows or eyelashes.
Your doctor can make the diagnosis by doing a test called a skin biopsy, which reveals a particular pathologic pattern and demonstrates the specific "red" staining bacteria. By far the most important diagnostic tool is the biopsy of the rash.
How does Hansen's disease spread?
The most commonly accepted theory is that Hansen's disease is transmitted by way of the respiratory tract, since large numbers of bacteria can be found in the nose of some untreated patients. The degree of susceptibility of the person, the extent of exposure and environmental conditions are among factors probably of great importance in transmission.
Are there different forms of Hansen's disease?
There are two forms of Hansen’s disease. Tuberculoid or paucibacillary (few bacilli) is a limited form of the disease that is not thought to be contagious. Lepromatous or multibacillary (many bacilli) is a more generalized form.
Who is at greatest risk of contracting Hansen's disease?
Those at greatest risk are the family of a person who has the disease, but is not being treated. This could be because they are genetically susceptible and/or because they have prolonged contact with the infected individual. A spouse is the least at-risk family member. At greatest risk are children, brothers or sisters, or parents of an individual with untreated Hansen's disease.
Hansen's disease is not passed on from a mother to her unborn baby during pregnancy. Neither is it transmitted through sexual contact.
What should do if I think I have been exposed to Hansen's disease?If you think you have been exposed to Hansen's disease, you do not need to
take any action. Most people have a natural immunity and there is no need for
prophylaxis.
We do not yet have a vaccine or a blood or skin test that will tell if you have been exposed or if you have pre-clinical disease, although both of these are active areas of research at the National Hansen's Disease Program.
Household contacts of people with Hansen's disease should have a thorough physical examination annually for five years. If they develop a questionable skin rash, they should notify their health care providers and have the skin rash biopsied to determine whether or not Hansen's disease is present.
Why is the diagnosis of Hansen's disease difficult and often delayed?
Unfortunately, the rash caused by Hansen's disease often resembles other skin diseases. Hansen's disease is a slowly developing, chronic, infectious disease and 2 to 10 years may elapse before clinical signs and symptoms appear.
Moreover most private sector physicians in the U.S. lack experience with this disease, and do not consider a diagnosis of Hansen's disease, even in a patient who has lived in or migrated from a country where Hansen's disease is prevalent. Often a patient sees several physicians before the correct diagnosis is made, delaying the initiation of treatment even more.
Do all Hansen's disease patients develop deformities? Suffer damage to fingers and toes?
No. People with Hansen's disease who are diagnosed and treated early avoid many of the complications associated with the disease and experience no disfigurement or disability. Problems with insensitive fingers or toes can be prevented by avoiding injury and infections to these areas, and by taking the Hansen's disease medicines.
Many patients with the tuberculoid or paucibacillary form of Hansen's disease can even self-heal without benefit of treatment, but it is the standard of care to treat all patients identified with the disease.
Where can people be treated for Hansen's disease?
People with Hansen's disease in the U.S. can receive Hansen's disease medications at no cost through their own doctor or through the National Hansen's Disease Program Ambulatory Care Clinic closest to them.
Phone the National Hansen's Disease Program toll-free, weekdays 9 am to 5:30 pm ET at 1-800-642-2477.
Some Hansen's disease patients report that they get worse after treatment has begun. How can that happen?
Some patients experience what is called a reaction after treatment has begun. This is a response of the immune system to dead or dying bacteria and can cause worsening of the rash or a painful neuritis which can affect sensation and/or strength.
Reaction can be mild or severe. If mild, no treatment or only over the counter anti-inflammatory medication may be sufficient. More severe reactions can be harmful to nerves and should be promptly treated by a physician. If you think you are having a reaction of any type, it is best to notify your physician so that he can decide on appropriate treatment.
How is Hansen's disease related to tuberculosis?
Mycobacterium leprae, the bacillus that causes Hansen's disease is in the same bacterial family as M. tuberculosis, the bacillus that causes tuberculosis. Because of this relationship, the National Hansen's Disease Program conducts extramurally-funded research on tuberculosis. For more information, please see the National Hansen's Disease Program Research Web site.
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