scholarly journals Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Kristoffer E. Leon ◽  
Jesse T. Jacob ◽  
Carlos Franco-Paredes ◽  
Phyllis E. Kozarsky ◽  
Henry M. Wu ◽  
...  
Keyword(s):  
United States ◽  
Delayed Diagnosis ◽  
Retrospective Chart Review ◽  
The United States ◽  
Nerve Damage ◽  
Hansen's Disease ◽  
Delay In Diagnosis ◽  
Hansen’S Disease ◽  
Time Period ◽  
Delays In Diagnosis

Abstract Background.  Hansen's disease (HD), or leprosy, is uncommon in the United States. We sought to describe the characteristics of patients with HD in a US clinic, including an assessment of delays in diagnosis and HD reactions, which have both been associated with nerve damage. Methods.  A retrospective chart review was conducted on patients seen at an HD clinic in the southern United States between January 1, 2002 and January 31, 2014. Demographic and clinical characteristics were summarized, including delays in diagnosis, frequency of reactions, and other complications including peripheral neuropathy. Results.  Thirty patients were seen during the study time period. The majority of patients were male (73%) and had multibacillary disease (70%). Brazil, Mexico, and the United States were the most frequent of the 14 countries of origin. Hansen's disease “reactions”, severe inflammatory complications, were identified among 75% of patients, and nerve damage was present at diagnosis in 36% of patients. The median length of time between symptom onset and diagnosis was long at 12 months (range, 1–96), but no single factor was associated with a delay in diagnosis. Conclusions.  The diagnosis of HD was frequently delayed among patients referred to our US clinic. The high frequency of reactions and neuropathy at diagnosis suggests that further efforts at timely diagnosis and management of this often unrecognized disease is needed to prevent the long-term sequelae associated with irreversible nerve damage.

scholarly journals Mycobacterium lepromatosis as a Second Agent of Hansen’s Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Patrícia Deps ◽  
Simon M. Collin
Keyword(s):  
United States ◽  
Case Reports ◽  
The United States ◽  
Lepromatous Leprosy ◽  
Clinical Aspects ◽  
Red Squirrels ◽  
Hansen's Disease ◽  
Hansen’S Disease ◽  
Mycobacterium Lepromatosis

Mycobacterium lepromatosis was identified as a new species and second causal agent of Hansen’s disease (HD, or leprosy) in 2008, 150years after the disease was first attributed to Mycobacterium leprae. M. lepromatosis has been implicated in a small number of HD cases, and clinical aspects of HD caused by M. lepromatosis are poorly characterized. HD is a recognized zoonosis through transmission of M. leprae from armadillos, but the role of M. lepromatosis as a zoonotic agent of HD is unknown. M. lepromatosis was initially associated with diffuse lepromatous leprosy, but subsequent case reports and surveys have linked it to other forms of HD. HD caused by M. lepromatosis has been reported from three endemic countries: Brazil, Myanmar, and Philippines, and three non-endemic countries: Mexico, Malaysia, and United States. Contact with armadillos in Mexico was mentioned in 2/21 M. lepromatosis HD case reports since 2008. M. lepromatosis in animals has been investigated only in non-endemic countries, in squirrels and chipmunks in Europe, white-throated woodrats in Mexico, and armadillos in the United States. To date, there have only been a small number of positive findings in Eurasian red squirrels in Britain and Ireland. A single study of environmental samples found no M. lepromatosis in soil from a Scottish red squirrel habitat. Future studies must focus on endemic countries to determine the true proportion of HD cases caused by M. lepromatosis, and whether viable M. lepromatosis occurs in non-human sources.

scholarly journals Pure neuritic leprosy presenting as ulnar nerve neuropathy: a case report of electrodiagnostic, radiographic, and histopathological findings

2015 ◽  
Vol 123 (5) ◽  
pp. 1238-1243 ◽  
Author(s):  
Russell Payne ◽  
Jennifer Baccon ◽  
John Dossett ◽  
David Scollard ◽  
Debra Byler ◽  
...  
Keyword(s):  
United States ◽  
Differential Diagnosis ◽  
Peripheral Neuropathy ◽  
Ulnar Nerve ◽  
The United States ◽  
Health Concern ◽  
Radiographic Evaluation ◽  
Causative Organism ◽  
Hansen's Disease ◽  
Hansen’S Disease

Hansen’s disease, or leprosy, is a chronic infectious disease with many manifestations. Though still a major health concern and leading cause of peripheral neuropathy in the developing world, it is rare in the United States, with only about 150 cases reported each year. Nevertheless, it is imperative that neurosurgeons consider it in the differential diagnosis of neuropathy. The causative organism is Mycobacterium leprae, which infects and damages Schwann cells in the peripheral nervous system, leading first to sensory and then to motor deficits. A rare presentation of Hansen’s disease is pure neuritic leprosy. It is characterized by nerve involvement without the characteristic cutaneous stigmata. The authors of this report describe a case of pure neuritic leprosy presenting as ulnar nerve neuropathy with corresponding radiographic, electrodiagnostic, and histopathological data. This 11-year-old, otherwise healthy male presented with progressive right-hand weakness and numbness with no cutaneous abnormalities. Physical examination and electrodiagnostic testing revealed findings consistent with a severe ulnar neuropathy at the elbow. Magnetic resonance imaging revealed diffuse thickening and enhancement of the ulnar nerve and narrowing at the cubital tunnel. The patient underwent ulnar nerve decompression with biopsy. Pathology revealed acid-fast organisms within the nerve, which was pathognomonic for Hansen’s disease. He was started on antibiotic therapy, and on follow-up he had improved strength and sensation in the ulnar nerve distribution. Pure neuritic leprosy, though rare in the United States, should be considered in the differential diagnosis of those presenting with peripheral neuropathy and a history of travel to leprosy-endemic areas. The long incubation period of M. leprae, the ability of leprosy to mimic other conditions, and the low sensitivity of serological tests make clinical, electrodiagnostic, and radiographic evaluation necessary for diagnosis. Prompt diagnosis and treatment is imperative to prevent permanent neurological injury.

Lepromin Skin Testing in the Classification of Hansen's Disease in the United States

1993 ◽  
Vol 305 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Wojciech A. Krotoski ◽  
Tomasz F. Mroczkowski ◽  
Thomas H. Rea ◽  
Pablo I. Almodovar ◽  
Bruce C. Clements ◽  
...  
Keyword(s):  
United States ◽  
Skin Testing ◽  
The United States ◽  
Hansen's Disease ◽  
Hansen’S Disease

scholarly journals Carville and Curupaiti: experiences of confinement and community

2003 ◽  
Vol 10 (suppl 1) ◽  
pp. 123-141 ◽  
Author(s):  
Cassandra White
Keyword(s):  
United States ◽  
Twentieth Century ◽  
The United States ◽  
Significant Problem ◽  
Outpatient Basis ◽  
Multidrug Therapy ◽  
Hansen's Disease ◽  
Hansen’S Disease ◽  
The World ◽  
History Of

Although Hansen's disease (leprosy) is still a significant problem in many parts of the world, the effectiveness of multidrug therapy has allowed people affected by this disease to be treated on an outpatient basis. However, throughout much of the twentieth century, people diagnosed with Hansen's disease were isolated from their families in facilities known as 'leprosaria'. This article presents a brief history of isolation policies and the development of community structures at two such facilities, Carville and Curupaiti, in the United States and Brazil, respectively. The modern dilemmas faced by the administration, staff, and residents of these institutions will also be discussed.

scholarly journals 970. Transmitted Antiretroviral Drug Resistance Over a Period of 11 years at a Single Center in Southeast, USA

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S514-S514
Author(s):  
Olga M Klibanov ◽  
Chris Gillette ◽  
Tagbo Ekwonu
Keyword(s):  
United States ◽  
Drug Resistance ◽  
Relative Risk ◽  
Cumulative Incidence ◽  
Retrospective Chart Review ◽  
The United States ◽  
Cd4 Count ◽  
Steady Increase ◽  
Single Center ◽  
Time Period

Abstract Background In the United States, the prevalence of TDRMs is approximately 20%. As newer agents have become available, INSTI-based therapies have become the standard first-line treatment. The objectives of this study were to: (1) examine the incidence of TDRMs during 2008-2019 at a single institution and, (2) examine the association between TDRM and year as well as type of therapy. Methods A retrospective chart review was conducted at a single center in the Southeast United States. Resistance was defined on the basis of the International AIDS Society 2019 definition and Stanford University’s HIV Drug Resistance Database. Relative risk and multivariable logistic regression were used to analyze data. Results Among 456 treatment-naïve patients who entered care 2008-2019 (80% male, 86% African American, mean CD4 count 359 cells/mm3), the cumulative incidence rate of >1 TDRM was 19.3% (n=88). There has been a steady increase in annual cumulative incidence in TDRMs since 2008, with the highest incidences in 2018 (46,667/100,000) and 2019 (36,585/100,000). Over the 11-year study period NNRTI resistance was most common (67/88; 76%), followed by NRTI (9/88; 10%), PI (4/88; 5%), and INSTI (2/88; 2%). Dual class resistance was noted in 6 (7%) patients, one of whom had TDRMs in the INSTI and NNRTI classes. The relative risk (RR) for TDRMs was 1.76 (95% CI=1.42-2.17). According to the regression model, compared to patients whose initial treatment was NNRTI-based, patients who started treatment on PI-based therapies (OR=5.34, 95% CI=2.17-13.11) or INSTI-based therapies (OR=4.00, 95% CI=1.43-11.20) had significantly greater odds of TDRMs, controlling for age, gender, race, baseline CD4+ count, HIV RNA, hepatitis B status, hepatitis C status, and time period of testing. The time period was not significantly related to TDRM incidence in this model. TDRM Incidence 2008-2019 Conclusion The overall incidence of TDRMs in our clinic mirrors national surveillance data, with notably higher incidences in the last 2 years. Prescribing of the newly available INSTI-based regimens reflects the continued increase in the incidence of NNRTI TDRMs. Disclosures All Authors: No reported disclosures

Hansen's disease in the United States

1982 ◽  
Vol 16 (9) ◽  
pp. 997-1004 ◽  
Author(s):  
Tim Hudson ◽  
Jim Genesse
Keyword(s):  
United States ◽  
The United States ◽  
Hansen's Disease ◽  
Hansen’S Disease

scholarly journals A Challenging Case of Domestically Acquired Leprosy in the Southern United States

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Shruthi Mohan ◽  
Jessica K Fairley
Keyword(s):  
United States ◽  
Erythema Nodosum ◽  
The United States ◽  
Southern United States ◽  
Hansen's Disease ◽  
Hansen’S Disease ◽  
Erythema Nodosum Leprosum ◽  
Multibacillary Leprosy

Abstract Hansen’s disease (HD) is rare in the United States, but a steady number of cases are diagnosed annually, especially in southern areas where armadillos are present. Challenges associated with erythema nodosum leprosum (ENL), a complication of multibacillary leprosy, call for novel regimens. We present a case of a man with recalcitrant ENL from HD likely acquired in the United States. He required a combination of 4 drugs to control chronic ENL.

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